{ Per S.B.Lohia, President } Briefly stated, the complainant had obtained an insurance policy no. 333120451 from the opposite parties on 22.4.2010 for a value of Rs. three lacs and he has been depositing the premium instlaments regularly with late fees and the policy is continuing. That the complainant sustained serious injuries in a motor vehicle accident and he has become 100% disabled person. Accordingly, he submitted the claim alongwith all the documents but the claim was not paid to him despite repeated requests; hence, this complaint.
2) In the reply, it is pleaded that the complainant is defaulter in paying the premium amount and no due premium of 22.10.2012 was paid and thus the policy was lapsed and the complainant is not legally entitled for any benefit as per the terms of the policy.
3) We have heard the counsel for the parties and gone through the record of the case available on the file thoroughly.
4) The claim was repudiated vide letter dt. 15.10.2015 Ex. C-13 on the ground that the policy was in lapsed condition a the half yearly premium due for 22.10.2012 was not paid by the life assured at the time of accident and the premium due was paid on 16.1.2013 i.e. after the accident which occurred on 2.1.2013.
5) Accident took place on 2.1.2013. Admittedly, the premium due for 22.10.2012 was paid by the complainant on 16.1.2013 i.e. after the accident. The next premium due date was April, 2014. No doubt, at the time of accident, the due premium of Oct. 2012 was not paid. Yet, the complainant has paid the due premium on 16.1.2013 alongwith penalty, if any, and the policy is continuing. Nothing is on the file to show that any intimation was ever given by the opposite parties to the complainant regarding lapse of the policy at the relevant time or later. Be that as it may, the learned counsel for the complainant stressed on condition no.2 of the policy Ex. C-1 alleging that even before the payment of premiums due, the policy will still be valid. The condition no.2 reads as under :- Payment of premiums: a grace period of one month but not less than 30 days will be allowed for payment of yearly, half yearly or quarterly premiums and 15 days, for monthly premiums. If death occurs within this period and before the payment of premiums then due , then policy will still be valid and the sum assured paid after deduction of the said premium as also the unpaid premiums falling due before the next anniversary of the policy. No doubt, the premium was paid after the accident but the accident occurred before the premium paid by the complainant then due. Thus, in view of aforesaid clause 2 of the policy, the complainant is entitled to the benefit of the policy. No doubt, it is established on the file that the complainant suffered 100% permanent disability vide certificate dated 29.10.2014 Ex. C-8 and thus he is entitled to the full assured amount of the policy. Thus ,after considering all the facts and circumstances, of the case, the present complaint is allowed directing the opposite parties to pay the sum assured of Rs. three lac to the complainant within 45 days from the date of receipt of the copy of this order failing which the amount shall fetch interest @ 9% p.a. from the date of filing of the present complaint till payment. In the peculiar circumstances of the case, parties are left to bear their own cost. Announced 16.3.2018. President Distt. Consumer Disputes Redressal Forum, Rewari. Member, DCDRF,Rewari.