The fact regarding hospitalisation of the insured person was not disputed by the second respondent-Insurance Company. The affidavit filed in support of the present writ petition would reveal that the insured was hospitalised for more than two months and died in the hospital itself. The petitioner, who is the wife of the insured, cannot be expected to pay the February and March 2020 premium due amounts. Under those circumstances, this Court is of an opinion that the non-payment of premium dues by the husband of the writ petitioner respectively on 09.02.2020 and 09.03.2020, cannot be construed as willful or intentional one. The nonpayment of premium dues by the husband of the writ petitioner respectively on 09.02.2020 and 09.03.2020 were on account of extraordinary circumstances, wherein the insured fell ill and admitted in the hospital and died after taking treatment in the hospital for more than two months.
{Para 6}
7. Considering the facts and circumstances and the mitigating factors placed before this Court, the petitioner is entitled for the relief on the ground of equity and more-so, there was no wilful or intentional default in non-payment of premium dues for the months of February and March 2020 by the deceased insured person.
Policy holder regularly paid monthly premium on his life insurance policy of Rs.18.40 lakhs taken from SBI Life Insurance Co. from October 2017 to January 2020. But thereafter fell ill and was hospitalised for over 2 months. He died in hospital only on 15.3.2020 without paying 2 instalments due on Feb. and March 2020. Company refused to pay claim due to overdue instalments. On filing writ petition, Madras High Court exercised its discretion and instructed insurance company to pay insurance claim to the wife of the policy holder:
IN THE HIGH COURT OF JUDICATURE AT MADRAS
WP No.17604 of 2020
R.Sasikala Devi Vs The AAO/Assistant Secretary,
CORAM
MR.JUSTICE S.M. SUBRAMANIAM
DATED : 08-01-2024
The order passed by the first respondent-Insurance
OMBUDSMAN, Chennai dated 18.09.2020, is sought to be quashed in the present writ proceedings.
2. The husband of the writ petitioner late Mr.S.Ramesh insured
in the second respondent-SBI Life Insurance in Policy No.1W466306604.
The deceased Mr.S.Ramesh was regularly paying the premium amount to
the tune of Rs.19,882/- per month from the month of October 2017 till
January 2020. In February 2020, the deceased Mr.S.Ramesh suffered illhealth
and immobilised. Thereafter, the husband of the writ petitioner could
not perform his day-to-day works and died on 15.03.2020.
3. The Insurance Policy for Life Insurance was made to the
tune of Rs.18,40,000/-. The deceased Mr.S.Ramesh was paying the
premium amount punctually without committing any default from the month
of October 2017 till January 2020.
4. The learned counsel appearing on behalf of the respondents
2 and 3-Insurance Company has submitted that the insured committed
default in payment of premium amount due on 09.02.2020 and the
subsequent premium amount was also not paid on 09.03.2020. The
petitioner is not entitled for the insured amount. As per the terms and
conditions of the contract, the policy lapses and thus there is no infirmity in
respect of the order passed by the first respondent-Insurance
OMBUDSMAN, Chennai.
5. Admittedly, the insured husband of the writ petitioner has
not paid the premium amount due respectively on 09.02.2020 and
09.03.2020. However, the affidavit filed by the writ petitioner in support of
the present writ petition would show that the husband of the writ petitioner
fell ill and was hospitalised for more than two months and died in the
hospital itself on 15.03.2020. When the family itself was in distressed
condition and the insured was hospitalised and was taking treatment for
more than two months and subsequently died in the hospital on 15.03.2020,
one cannot expect that the husband of the writ petitioner will be promptly
paying the February and March 2020 premium due amounts. Though the
Insurance Company has strictly comply with the terms and conditions of the
contract, this Court has to exercise its powers of discretion in such
circumstances to mitigate the circumstances aroused on account of death of
the insured person.
6. The fact regarding hospitalisation of the insured person was not disputed by the second respondent-Insurance Company. The affidavit filed in support of the present writ petition would reveal that the insured was hospitalised for more than two months and died in the hospital itself. The petitioner, who is the wife of the insured, cannot be expected to pay the February and March 2020 premium due amounts. Under those circumstances, this Court is of an opinion that the non-payment of premium dues by the husband of the writ petitioner respectively on 09.02.2020 and 09.03.2020, cannot be construed as willful or intentional one. The nonpayment of premium dues by the husband of the writ petitioner respectively on 09.02.2020 and 09.03.2020 were on account of extraordinary circumstances, wherein the insured fell ill and admitted in the hospital and died after taking treatment in the hospital for more than two months.
7. Considering the facts and circumstances and the mitigating factors placed before this Court, the petitioner is entitled for the relief on the ground of equity and more-so, there was no wilful or intentional default in non-payment of premium dues for the months of February and March 2020 by the deceased insured person.
8. In view of the facts and circumstances, the impugned order
passed by the first respondent in proceedings Ref:CHN-L-041-2021-0139,
dated 18.09.2020, is quashed and the respondents 2 and 3 are directed to
settle the insured sum as per the policy in favour of the writ petitioner,
within a period of four weeks from the date of receipt of a copy of this
order.
9. With the above directions, the present writ petition stands
allowed. However, there shall be no order as to costs.
08-01-2024
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