Dear sir,
I tried my level best to search case no. of following case but i could not get that, please help to use this case in a case for reference, link for following case is given below :
https://www.consumercourt.in/insurance/9296-metlife.html
Mr. Srinivas,
S/o. Late Guruvappa,
Aged about 50 years,
R/A. KGP 9/425,
@@@@hinagar, Mogral Post,
Kasaragod District. …….. COMPLAINANT
(Advocate: Sri.K.B. Arasa)
VERSUS
1. The Divisional Manager,
Met Life Insurance Co. Ltd.,
Brigade Sesh Mall,
No.5, Vani Vilas Road,
Bangalore – 560 004.
(Advocate: Sri.K.S.N. Rajesh).
2. The Registrar,
Manipal University,
Madhava Nagar,
Manipal – 576 104. ……. OPPOSITE PARTIES
The Complainant’s brother Sundara M was joined as a security guard under 2nd Opposite Party’s college at Mangalore and he died on 21.4.2006.
It is submitted that, the 2nd Opposite Party as per its circular dated 20.10.2005 informed the group life insurance policy is active from 1.10.2005 for all the regular employees of the institutions. The brother of the Complainant Sundara was the regular employee of the 2nd Opposite Party as on 1.10.2005. The 2nd Opposite Party as per the above said circular recovered insurance premium from the salary of Sunadra and remitted the same to the 1st Opposite Party.
It is submitted that the Complainant’s brother M.Sundara died during the course of his employment under the 2nd Opposite Party on 21.4.2006. It is submitted that the circular dated 20.10.2005 the Group Life Insurance Policy is obtained for a sum of Rs.10,00,000/- for each employee for the financial assistance to the family members of the employee in case of the death of the employee during the tenure of his service with the 2nd Opposite Party. It is submitted that Sundara M was unmarried and his parents are pre-deceased, the Complainant alone is the surviving family member of the deceased Sundara and also the nominee.
After the death of his brother Sundara M filed a claim form before the Opposite Parties but the Opposite Parties failed to honour the claim. Thereafter the Complainant issued a legal notice on 25.10.2007 to the Opposite Parties but the Opposite Parties issued a frivolous reply and not honoured the claim of the Complainant which amounts to deficiency in service and hence the above complaint is filed by the Complainant before this Hon'ble Forum under Section 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Hon'ble Forum to the Opposite Parties to pay Rs.10,00,000/- with 12% interest from 21.4.2006 to the Complainant and also claimed for compensation and cost of the proceedings.
2. Version notice served to the Opposite Parties by RPAD. Opposite Party appeared through their counsel filed separate version.
Opposite Party No.1 contended that they had issued a group policy bearing No.3200500000266 in favour of the Manipal Education and Medical Group International Private Limited which was effective from September 30th 2005. It is submitted that all members are actively at work on the day the coverage commences. All employees who are either performing in the usual way all their regular duties of their work or are absent from work for reasons other than sickness, injury or medical leave will be considered as actively at work. For employees who are not actively at work on the commencement date of coverage, their coverage will commence on the day they join full time active duty and have given a good health certificate from their physician.
The terms and conditions of the Group Life Insurance Policy also provides that only those persons who met the eligibility criteria as stated in the policy schedule were eligible to be covered. It is contended that the deceased was not actively at work within the definition of the policy as on the commencement date of the policy i.e., 30.9.2005, since he was absent on account of sickness. He resumed work only on 17.11.2005 and he also failed to produce good health certificate from a doctor in order to be covered under the policy as per the eligibility criteria and further contended that deceased did not attend work at all after 1.12.2005 and was on continuous leave thereafter. He expired on 21.4.2006 and it is prayed that the Complainant is not entitled for any claim and prayed for dismissal of the complaint.
Opposite Party No.2 submitted that Opposite Party No.2 introduced the Group Life Term Insurance Policy of Opposite Party No.1 for the benefit of its over 8,000 employees as a staff welfare measure. The insurance premium payable was Rs.1,200/- per annum for each employee for sum insured of Rs.10.00 lakhs. The management decided to collect only the partial premium from the employees by way of deduction from salary as shown in the circular dated 20.10.2005. The said circular was based on the representations of Opposite Party No.1 as to the premium payable and the benefits of the policy. It is submitted that the terms of the policy were not given to Opposite Party No.2 to Opposite Party No.1 at the time when the circular was issued. A total sum of Rs.93,72,300/- was paid as premium to Opposite Party No.1 for the said policy which was valid for the period from 30.9.2005 to 29.9.2006.
It is submitted that late Mr. Sundara M was a regular employee of Kasturba Medical College, Mangalore i.e., Opposite Party No.2 and he was working as a Security Guard. His name was covered in the group policy No.3200500000266 had with Opposite Party No.1. The Company has accepted the premium paid by the management on behalf of late Mr.Sundara M. It is submitted that the proportionate amount of premium have been refunded by Opposite Party No.1 to Opposite Party No.2 in respect of employees who had left from the institution. The name of late Sundara M., was not included in the bill of proportionate premium refunded in respect of employees left/died.
It is submitted that the Opposite Party No.1 has covered the name of late Mr.Sundara and accepted the full premium and it had released the list of members covered by allotting Company’s identification number i.e., man/BHU/150680 to Mr. Sundara M. The date of the commencement of the policy is 30.9.2005. At that time all the members are actively at work on the day the coverage commences. It is submitted that the condition came to the knowledge of the Opposite Party No.2 only on 10.10.2005 and his last date of working was 10.8.2005 and he had availed leave from 11.8.2005 to 20.4.2006 and died on 21.4.2006 and the production of good health certificate did not arise. Opposite Party No.2 had submitted that partial premium of Rs.80/- from his salary had collected from his salary in the month of November 2005 and submitted the claim of the Complainant is maintainable only against the Opposite Party No.1 and not against the Opposite Party No.2 and contended that there is no deficiency whatsoever on the part of the Opposite Party No.2 and prayed for dismissal of the complaint.
3. In view of the above said facts, the points now that arise for our consideration in this case are as under:
(i) Whether the Complainant proves that the Opposite Parties committed deficiency in service?
(ii) If so, whether the Complainant is entitled for the reliefs claimed?
(iii) What order?
4. In support of the complaint, Sri.Srinivas (CW1) filed affidavit reiterating what has been stated in the complaint and answered the interrogatories served on him. Ex C1 to C9 were marked for the Complainant as listed in the annexure. One Sri.Anil P.M. (RW1), Associate-Legal and Duly Constituted Attorney of Opposite Party No.1 and one Sri.H.S. Bhat (RW2) – working as Management Executive of the Opposite Party No.2 filed counter affidavits and answered the interrogatories served on them. Ex R1 to R4 were marked for the Opposite Parties as listed in the annexure. The Complainant produced notes of arguments.
We have considered the notes/oral arguments submitted by the learned counsels and we have also considered the materials that was placed before the Hon'ble Forum and answer the points are as follows: Point No.(i): Affirmative.
Point No.(ii) & (iii): As per the final order.
Reasons
5. Point No. (i) to (iii):
The facts which are not in dispute that the Opposite Party No.1 had issued a group policy bearing No. 3200500000266 in favour of the Manipal Education and Medical Group International Private Limited which was effective from September 30th 2005 (i.e., Ex R1). It is also admitted that the Opposite Party No.2 introduced the Group Life Term Insurance Policy of Opposite Party No.1 for the benefit of its over 8,000 employees as a staff welfare measure. The insurance premium payable of Rs.1,200/- per annum for each employee for sum insured of Rs.10,00,000/-. It is also admitted that the management i.e., Opposite Party No.2 collected partial premium from the employees by way of deduction from salary as shown in the circular dated 20.10.2005 (i.e., Ex C1). And it is also admitted that a total sum of Rs.93,72,300/- was paid as premium to Opposite Party No.1 for the said policy which was valid for the period from 30.9.2005 to 29.9.2006 and it covered 8,926 employees of Opposite Party No.2.
It is further admitted that the premium was collected by the Opposite Party No.2 from the salary of the Sundara M and paid premium. And further it is not in dispute that late Mr.Sundara M was a regular employee of Kasturba Medical College, he was working as a Security Guard - II, his name was covered in the group policy No.3200500000266 had with the Opposite Party No.1 and the company accepted the premium paid by the management on behalf of Mr.Sundara M.
It is also not in dispute that the proportionate amount of premium has been refunded by Opposite Party No.1 to the Opposite Party No.2 in respect of employees who had left from the institution and the name of late Sundara was not included in the bill of proportionate premium refunded in respect of employees left/died. The Opposite Party No.1 has covered the name of late Mr.Sundara M and accepted the full premium and the company i.e., Opposite Party No.1 released the list of members covered by allotting Companies identification number for every employee. Accordingly the Company has allotted No.Man/BHU/150680 to Mr. Sundara M at the time of commencement of the policy all the members are actively at work on the day the coverage commences.
Now the point in dispute is that the Opposite Party No.1 specifically contended that the deceased Sundara M did not fulfill the eligibility criteria as laid down in clause No.2 of the policy and therefore he was not eligible to be covered under the policy at the time of his demise. However, we have perused the clause No.2 of the policy, the policy schedule contained interalia the following provision with regard to eligibility criteria which reads thus:
Eligibility criteria:-
1) Coverage is provided to all full time and permanent employees of Manipal Group Companies comprising of Manipal Education and Medical Group International India Private Limited.
2) All members are actively work on the day the coverage commences. All employees who are either performing in the usual way or regular duties of their work or are absent from work for reasons other than sickness, injury or medical leave will be considered as actively at work. For employees who are not actively at work on the commencement date of coverage, their coverage will commence on the day they join full time active duty and have given a good health certificate from their physician.
3) All members are within the age band of 18 to 59 years age last birthday at the time of entry to the scheme.
From the above clause it has stated that all employees who are either performing in the usual way or regular duties of their work or are absent from work for reasons other than sickness, injury or medical leave will be considered as actively at work.
Now the point for consideration is that the Opposite Party No.2 in their version Para No.4 it is stated that the Opposite Party No.1 has covered the name of late Mr.Sundara M and accepted the full premium. The company had released the list of members covered by allotting company’s identification number for every employee. Accordingly the company has allotted identification number to Mr.Sundara M. The date of commencement of the policy was 30.9.2005. At that time the clause No.2 of the policy condition was not made known to the Opposite Party No.2 and the name of late Mr.Sundara M was already covered under the policy. The condition came to the knowledge of the Opposite Party No.2 only on 10.10.2005. The above said evidence of the Opposite Party No.2 was not contradicted by the Opposite Party No.1.
From the above evidence of the Opposite Party No.2 it clearly shows that the Opposite Party No.1 ought to have furnished the condition before commencement of the policy or the Opposite Party No.1 should not have collected the premium paid by the Opposite Party No.2. And further it is pertinent to note that the Opposite Party No.1 ought to have cross verified the employees who are benefited under the above policy before acceptance of the premium. In the present case, the Opposite Party No.2 had collected the premium from the salary of Mr.Sundara M and paid to Opposite Party No.1 and the policy is commenced from 30.9.2005 now Opposite Party No.1 cannot contend that the Complainant is not actively at work on the day the coverage commences.
It is clearly shows that the conditions of the policy issued by the Opposite Party No.1 only after the commencement of the policy not before. And it is significant to note that it is an internal arrangement between the Opposite Party No.1 and the Opposite Party No.2 for the welfare of the staffs of the Opposite Party No.2. The deceased Mr.Sundara M is innocent as far as the condition of the policy is concerned. The premium of the policy was recovered from the salary of the beneficiary i.e., Mr.Sundara M and the policy was issued and the identification number was also issued. And further we have noted that the proportionate amount of the premium has been refunded by Opposite Party No.1 to Opposite Party No.2 in respect of employees who have left from the institution. If at all the Mr.Sundara M is not covered under the policy the Opposite Party No.1 could have refunded the premium paid by the Opposite Party No.2. The same was not done by the Opposite Party No.1.
From the above discussion as well as the admitted facts on record before the FORA it is proved beyond doubt that the policy was in force at the time of death of the Mr.Sundara M and the sum assured under the policy was of Rs.10,00,000/- and the entire premium was paid by the deceased Mr.Sundara M till his death and hence the repudiation of the claim is not justifiable which amounts to deficiency in service.
In view of the above discussions, we are of the considered opinion that the Complainant is only legal heir of the deceased Sundara M and the Complainant produced legal heir certificate issued by the concerned department as per Ex C3 before the FORA. Therefore, by considering the above we hereby direct the Opposite Party No.1 i.e., Met Life Insurance Co. Limited to pay Rs.10,00,000/- to the Complainant along with interest at 10% p.a. from the date of death i.e., 21.04.2006 till the date of payment. And further Rs.1,000/- awarded as cost of the litigation expenses. Payment shall be made within 30 days from the date of this order.
Since there is no deficiency on the part of the Opposite Party No.2 the complaint against Opposite Party No.2 is hereby dismissed.
6. In the result, we pass the following:
ORDER
The complaint is allowed. Opposite Party No.1 i.e., Met Life Insurance Co. Limited is hereby directed to pay Rs.10,00,000/- (Rupees ten lakhs only) to the Complainant along with interest at 10% p.a. from the date of death i.e., 21.04.2006 till the date of payment. And further Rs.1,000/- awarded as cost of the litigation expenses. Payment shall be made within 30 days from the date of this order.
