DATE OF DISPOSAL: 15.04.2019

Sri Karuna Kar Nayak, President.   

               The complainant   Smt. K.Adilaxmi has filed this consumer complaint  Under Section 12 of the Consumer Protection Act, 1986, alleging deficiency in service against the Opposite Parties    ( in short the O.Ps) and for redressal of his   grievance before this Forum.

               2. Briefly stated the case of the complainant is that Late Maniyal Buli Ama the deceased mother of the complainant during her life time had insured her life before the O.P.No.1 &2 through O.P.No.3 their agent for Ganjam District at Golabandha village in cash flow plan on dated 30.09.2011 in client I.D. No. 80956003 by depositing the policy premium installment amount sum of Rs.24,954.68 paisa through the O.P.No.3.  The O.P.No.1 and 2 on receiving the said policy premium installment amount had issued in Reliance cash flow plan policy number 19313013 in the name of said insured for assureds sum of Rs.2,50,000/- only.  The O.P.No.1 is the registered office of Reliance Life Insurance Co. ltd. functioning its office at Mumbai and carrying on business at Odisha Region through O.P.No.2 its Regional Office at Bhubaneswar-1, Khurda district of Odisha state and responsible for compliance of terms and conditions of said policy. The date of benefit expiry of said Life Insurance Policy was scheduled by the O.Ps to the date on 30.09.2027. In the said reliance cash flow plan policy, the complainant above named Smt. K.Adilaxmi, the daughter of said policy holder was cited as the nominee. The terms and conditions of the said Reliance cash flow plan policy was that in case of premature death of the policy holder Manyal Buliama at any time prior to expiry of date of benefit of said Reliance cash flow plan policy, the O.P.No.1  and 2 shall jointly and severally are liable to make payment of the policy assured sum Rs.2,50,000/- plus vested Bonus and additional benefits attaching to the said policy to the said nominee of the said Reliance cash flow plan policy under to the complainant Smt. K. Adilaxmi.  Unfortunately said Reliance cash flow plan life insurance policy holder Mrs. Manyal Buliama died on dated 30.10.2011. After the death of said policy holder the complainant had submitted the death certificate of the policy holder, original policy bond and lodged her claim application before the O.P.No.2 claiming assured policy benefits and for settlement and disbursement of death claim of deceased policy holder. But the O.P.No.1 & 2 have not taken any action to settle the death claim of the complainant inspite of repeated approaches to the O.P.No.2 & 3 and running from her village to the office of the O.P.No.2 till this date. The genuine death claim of the complainant was to be settled by the O.Ps within 40 days of lodging claim by the complainant but they remained silent without taking any action to that effect. Therefore on dated 29.07.2016 the complainant had issued legal claim notice through her advocate for the O.P.No.1 and 2 by Regt. Post with AD. The O.P.No.2 had received the said claim notice with proper acknowledgement but maintained silence. Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.Ps to pay death claim of the Reliance Cash Flow plan policy No.19313013 sum assured Rs.2,50,000/- with 12% interest per annum from the date 30.10.2011 till disbursement and compensation & cost of Rs.25,000/- in the best interest of justice.

               3. Upon notice the O.P.No.1 & 2 filed version through his advocate. The O.Ps deny all the allegations contained in the complaint, except those, which are specifically admitted hereinafter in this written statement, and nothing stated in the complaint should be deemed to be admitted merely because the same is not specifically traversed. On the information and declaration contained in the application forms and believing the same to be true and also upon receipt of the duly filled forms along, the O.Ps issued policy bearing No. 19313013 on 30.09.2011 in the name of the Maniyal Buli Ama, details of which are given below:

The answering Opposite Parties submit that believing and relying upon the information given by the Life Assured in the proposal forms to be true and correct in all aspects and as per the underwriting norms of the company, the said proposals was accepted by the O.Ps and the Life Assured was issued the policy bearing No.19313013. The policy terms and conditions of the product, IRDAI regulations and insurance Act, 1938, provides that in the event of any information, declaration or statement if found to be false and incorrect or any material information is found to be withheld or misrepresented, the policy can be Null & void, ab initio by the Company. The O.Ps received claim intimation for which investigation of the claim of the Life Assured took place and as in response to the same, the complainant was asked to submit necessary documents to assess the authenticity of the claim vide letter dated 05.12.2012.  On receipt of relevant documents, investigation was done by the O.Ps in order to assess the legitimacy of the claim. During investigation it was revealed that the Life Assured at the time of submission of the proposal had been grossly understand, in view of the fact that Life assured was aged 74 years, thereby life assured had misled the insurer to offer life insurance cover even though the permissible age at entry for the plan of insurance opted was 65. Afore-mentioned facts establish misrepresentation about Age, of the life assured and the same was material to the issuance of the policy and ought to have been disclosed in the proposal form. By not doing so, the Life Assured has misled the O.Ps to grant him insurance cover on the terms as stated in the policy schedule, thereby denying the company the right to do fair risk assessment. Had the proposer disclosed the correct information with regard to age, and the fact that he has proposed insurance from other companies as well; the above policy would not have been issued to him. Owing to above mentioned reasons, the O.Ps were misled to offer the said policy and this has thus, rendered the policy void ab-initio, illegal, invalid and unenforceable. In view of the above facts and irrefutable evidence, the contract stands void ab initio and the claim under the said policy bearing No.19313013 was repudiated and the same was communicated to the complainant vide its letter dated 29.03.2013. It is stated that the repudiation of the claim is legal, bonafide and justified. The O.Ps earnestly follows the rules and regulations passed by the IRDAI and further functions of the business are carried in accordance with the settled principles of law. The alleged benefit of the complainant is contrary to the settled principles of law and therefore is liable to be rejected.

               4. Upon notice the O.P.No.3 filed version. Mr. Judhistira Sethi is the authorized agent of the O.P.No.2. The Area Manager Reliance Life Insurance Company Ltd., Bhubaneswar zone approved by the O.P.No.1 vide his code Number: 20868635 and collecting premiums from the subscribers of different places of Ganjam District and collecting proposal forms from the local subscribers and depositing the premium value of the policies as per the name and nature of policy and assured value of different categories of Reliance Life Insurance policy.  On dated 30.09.2011 the O.P.No.3 contacted with the mother of the complainant late Maniyal Buli ama at her village when she was alive and collected proposal forms with her identity proof, date of birth proof and collected premium amount sum of Rs.24,954.68 paisa towards cash flow plan of Reliance Life Insurance policy for assured amount of Rs.2,50,000/- and paid said amount to the O.P.No.2 by depositing in the account number of the O.P.No.2 in the bank at Berhampur.  After receiving the said premium amount the O.Ps 1 and 2 have issued cash flow plan policy No. 19313013 and the complainant K.Adilaxmi remained as nominee in the said policy. The term and conditions of said Reliance Life Insurance cash flow plan were that in the event of premature death of policy holder, the O.P. 1 & 2 shall make payment to the said nominee of the policy holder before the expiry of the date of disbursing benefit of the policy. The O.P.No.1 and 2 shall liable to disburse the assured sum of the said life Insurance policy Rs.2,50,000/- plus vested Bonus and additional benefit attaching to the said policy to the complainant  the nominee of the said policy. On dated 30.10.2011 the policy holder Maniyal Buli ama expired. Her nominee in the said Reliance Life Insurance Policy surrendered the insurance policy bond, death certificate of the policy holder and her identity proof to the O.P. No.2 and lodged death claim of the said deceased policy holder against the said cash flow plan of Reliance Life Insurance Policy, but till this date the O.P.No.1 and 2 have not settle the death claim of the deceased policy holder in favour of the nominee. The O.P.No.3 is not responsible and liable for non-settlement of death claim of the complainant. The O.P.No.1 & 2 are liable to disburse the claim of the complainant which will be ordered by the Hon’ble court.

               5. On the date of hearing of the consumer complaint learned counsel for the complainant is present.  We heard argument from the advocate for complainant at length and perused the complaint petition, written version and written argument and materials placed on the case record. It reveals from the policy bond that at the time of commencement of the policy, the age of the insured was 49 years and the age of the nominee (complainant) is 29 years. It reveals from the copy of electoral photo identity card submitted by the complainant’s mother to Reliance Life Insurance Company Limited that the age of D.L.A. Manyal Buliama is 32 years as on 01.01.1994 but the copy of the electoral photo identity card which has been filed by the O.Ps therein the   age of the Deceased Life Assured is 58 years as on 01.01.1994. It is pertinent to mention here that the complainant daughter of late Manyal Buliama (D.L.A.) at the time of filing the complaint has mentioned her age as 47 years as reflected from her affidavit filed on 01.01.2016 with complaint petition.  It clearly proves that the complainant was 42 years old at the time of commencement of the policy i.e. on 30.09.2011 of her deceased mother late Manyal Buliama. But her mother Manyal Buliama’s  age is 49 years at the time of commencement of the policy  can not be accepted as the age gap between the DLA (mother)  and complainant (Daughter) is 7 years which is unbelievable.  As such the copy of the electoral photo identity card and voter list of deceased life assured filed by the O.Ps seems to be true. The O.Ps have rightly repudiated the claim of the complainant due to concealment and mis-presentation of the material facts regarding the age of the life assured. It is observed that the complainant has not come to the Learned Forum in clean hand.

               6. On foregoing discussion, it is crystal clear that the O.Ps are not negligent in rendering proper service to the complainant. Hence, in our considered view there is no deficiency in service on the part of the O.Ps.

               In the result, the complainant’s case is dismissed against the O.Ps.

               The order is pronounced on this day of 15^th April 2019 under the signature and seal of this Forum. The office is directed to supply copy of order to the parties free of cost and a copy of same be sent to the server of www.confonet.nic.in for posting in internet and thereafter the file be consigned to record room.