BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KAITHAL.
Complaint no.176/13.
Date of instt.: 30.08.2013.
Date of Decision: .2015.
Rakesh Kumar son of Sh. Nanha Ram, resident of Village Sega, P.O.Narar, Tehsil & Distt. Kaithal.
……….Complainant.
Versus
1. Birla Sun Life Insurance Company Ltd., Amartara Marbles, Khurania Shopping Complex, Kurukshetra Road, Kaithl-136027 (Haryana).
2. Birla Sun Life Insurance Company Ltd., G.Corp. Tech. Park, 5th & 6th Floor, Kasar Wadavali, Ghodbunder Road, Thane-400601.
Regd. Office: One India Bulls Centre, Tower-1, 15th & 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013.
3. Insurance Ombudsman, SCO No.101-102 & 103, 2nd Floor, Batra Building, Sector 17-D, Chandigarh-160017.
..……..Opposite Parties.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Sh. Rajbir Singh, Presiding Member.
Smt. Harisha Mehta, Member.
Present : Sh. Manoj Ahuja, Advocate for complainant.
Sh. Manoj Ichhpilani, Advocate for the opposite parties.No. 1 & 2.
Op No.3 already given-up.
ORDER
(RAJBIR SINGH, PRESIDING MEMBER).
The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that the father of complainant namely Nanha Ram purchased a policy bearing No.004817526 on 31.03.2011 for sum of Rs.4,40,000/- under BSLI Vision Plan from the Ops. It is alleged that the father of complainant died on 24.06.2011. It is further alleged that the complainant lodged the claim with the Ops and submitted all the necessary documents but the Ops repudiated the claim of complainant. The said repudiation of claim is wrong and illegal. This way, the Ops are deficient in service. Hence, this complaint is filed.
2. Upon notice, the opposite parties No.1 & 2 appeared before this forum, whereas Op No.3 was given-up vide order dt. 23.10.2013. Ops No.1 & 2 filed written statement raising preliminary objections with regard to maintainability; cause of action; locus-standi; that the life assured Sh. Nanha Ram approached BSLI for purchase of policy by misrepresenting, providing the false and incorrect information qua his health. The policy was obtained under fraud and misrepresentation in collusion with one Rakesh, who happened to be agency manager and one Salim; that the life insured was explained and made to understand with the terms and conditions of the policy and declaration to get the policy. The life insured was given a detailed description about the features of the said Policy Plan including all the charges that shall be levied on the same and was also apprised with its terms and conditions before signing of the application/proposal form; that the Kaithal Branch received a death claim against the policy No.004817526, wherein the insured died within three months from the date of application. The death claim was accordingly scrutinized and investigated by the Claims Deptt. through outsourced Investigator. The Investigator raised apprehensions with respect to the medical history and health conditions of the Insured, however, initially the Investigator could not procure any medical records due to non-availability of any reference/ticket number and non-cooperation from the family members of deceased, the death claim was thus approved and a cheque of Rs.4,40,000/- was processed and sent to the Nominee Mr. Rakesh as per the process. The answering Ops prepared the claim cheque in the name and account provided by the nominee at the time of submission of death claim and which was maintained with AXIS Bank Limited, Panipat having account No.240010100117333 and this account was in the name of Rakesh Kumar, Agency Manager of answering Ops, whereas the nominee under the policy was Rakesh Kumar son of Nanha Ram. Then, the nominee requested for issuance of the fresh cheque in lieu of earlier cheque as explained above due to some family/personal reasons and he did not want claim amount to be credited in the bank account maintained with Axis Bank, Panipat for which the above-stated cheque was made. The nominee visited at BSLI Kaithal Branch for the said purpose with verbal request and finally submitted a written request dated Nil for the same to be issued in his account maintained with Allahabad Bank. During all this, it was apprehended that Agency Manager Rakesh Kumar had some illegal and unethical involvement in this matter and the Bank account details provided at the time of death claim belonged to Rakesh Kumar Agency Manager and not the complainant Mr. Rakesh under the policy. There is no deficiency in service on the part of answering Ops. On merits, the contents of complaint are denied and so, prayed for dismissal of complaint.
3. In support of their case, both the parties submitted their affidavits and documents.
4. We have heard ld. counsel for both the parties and perused the case file carefully and minutely.
5. We have perused the complaint & reply thereto and also have gone through the evidence led by the parties.
A copy of this order be sent to both the parties free of cost. File be consigned to the record room after due compliance.
Announced.
Dt. .2015.
(Harisha Mehta), (Rajbir Singh),
Member. Presiding Member.
