MR RAMSANKAR NAYAK, MEMBER …         The factual matrix of complaint in brief is that, the complainant being the nominee and husband of his deceased wife Late Sanjukta Kumari Nayak who had availed Life Insurance Policy under the OP.s vide Policy no.573343887 for a sum assured of Rs.47,615/-, Rs.62,500/- for death cover benefit & another Rs.62,500/- towards accidental benefit under the scheme and Rs.3096/- as premium yearly mode. Unfortunately Smt Sanjukta Kumari Nayak died on dt.03.03.2016. The widower complainant being uneducated villager had approached the OP.s for several times requesting for the benefits under the policy but for no use. The counsel for complainant contends that the policy was made on 25.03.2013 and the policy holder died on 03.03.16 and the forum has jurisdiction to try the case. Due to the overt act and deficiency in service of OP.s the complainant inflicted severe mental agony and financial losses. Hence he prayed before the forum to allow the entire benefits coming under the policy along with 12 % interest p.a., and allow Rs.30,000/- as compensation and Rs.5000/- as the cost of litigation.

            The counsel for complainant has filed LIC policy bond, 03 receipts & affidavit of complainant.

2.         The counsel for OP.s entered his appearance and filed his counter to contend that, the deceased Sanjukta Kumari Nayak the concerned policy holder had nominated the present complainant as her husband and had taken policy under table 165-15-15 for sum assured Rs.62500/- on dt.15.01.2013 by paying yearly installment Rs.3096/- vide policy no.573343887. He further contends that, the complainant never approached the OP.s with death certificate (attested) of the deceased policy holder. The alleged policy plan shows that if 03 years premiums are paid subsequent premium are not paid, then full death cover shall continue for 01 years from first unpaid premium. But in the instant case premium have been paid only for two years and the date of first unpaid premium is 15.01.2015. Hence auto cover period expired after 01 years from 15.01.15, i.e. on 14.01.16, and the death of deceased was on 03.03.16 after expiry of auto cover period. So the policy is lapsed as on the date of death. Here in the instant case premium payments are not upto date. Hence nothing is payable to the complainant. So there is no deficiency in service on the part of OP.s, hence the present case is liable for dismissal.

            The counsel for OP.s filed nothing except his counter and affidavit.

3.         The counsel for both parties has been heard the case at length and the evidences considered.

4.         It reveals from the record that, the wife of complainant had procured a Life Insurance Policy on dt.15.01.2013 and the date of risk was covered on dt.25.03.2013 paid premium of Rs.3096/- as yearly mode. The policy holder nominated her husband, the present complainant as nominee. That the policy holder died on dt.03.03.2016 i.e. within the valid period of life coverage. The counsel for complainant said to have that the complainant facing financial crunches had been approached the OP.s again and again with claim form along with required documents but the OP.s did not yet settled his claim on one plea or the other. Hence under compulsion he craves the leave of this forum claiming assured sum along with other benefits and appropriate compensation.

5.         The counsel for OP.s vehemently urged upon the contentions and to contend that, the complainant never approached the OP.s in any time, rather he has not yet produced the death certificate of the deceased policy holder. He approached the dist. forum for undue gain and hence the claim of compensation is illegal and baseless. He further contends that the provisions of the alleged policy says that if 03 years premiums are paid subsequent premium are not paid, then full death cover shall continue for 01 years from first unpaid premium. But in the instant case premium have been paid only for two years and the date of first unpaid premium is 15.01.2015. Hence auto cover period expired after 01 years from 15.01.15, i.e. on 14.01.16, and the death of deceased was on 03.03.16 after expiry of auto cover period. So the policy is lapsed as on the date of death.  So there is no deficiency on the part of OP.s, hence prayed for dismiss the case.

6.         From the foregoing transactions it is seen that, the complainant belongs to a tribal category being an uneducated lady, hardly put her signature in Odia on the face of complaint petition. After sudden demise of his wife he was not aware of the insurance policy availed by his late wife. But on advise of some well wishers he hopefully approached the OP.s again and again for the assured sum but the OP.s denied his claim in one pretext or the other. The counsel for complainant have also filed relevant receipts of the policy, which shows that the policy holder was a regular depositor of premium and have deposited premium for two years. No doubt the policy holder discontinued to deposit the premium for onward period, but the OP.s neither intimated her to deposit the unpaid premiums nor cooperate the policy holder in any manner. According to the IRDA of India there is statutory provisions in every policy that, if a policy holder or nominee could not continue his/her policy premiums then the insurance corporation shall allow him/her to deposit premiums with late fine charges to avoid the policy lapsed.

7.         In the instant case the OP.s fails to file any supportive evidences that they took initiations by way of intimation, letters to the policy holder or the nominee to continue the policy during lapse periods, and despite approaches made by the complainant they denied to settle the claim in dilly dallying tactics. Hence we came to a conclusion that there is serious deficiency in service on the part of OP.s and to which action the complainant inflicted severe mental agony and financial losses. Hence in our view the complainant is entitled for his claim.

            As thus we allow the complaint against the OP.1 & 2 with costs.

                                                                        ORDER

i.          The opposite parties are hereby directed to pay the assured sum of Rs.1,10,115/- (One lakh Ten thousand one hundred & fifteen) i.e. (Rs.47,615/- + 62,500/-) as specified in the policy in question to the complainant along with 8% interest p.a. from the date of filing of this case to the period of such realization. Inter alia to pay Rs.2,000/- (Two Thousand) as cost of litigation. 

ii.         The complainant shall handover the death certificate of his late wife late Sanjukta Kumari Nayak along with attestation to the OP.No.1. Besides the OP.s shall reserves liberty to minus the unpaid premiums for the lapse period from the above awarded sum.

iii.       All the above directions shall be complied with in 30 days of receipt of this order, failing which, the total sum will bear 12% interest per annum till its realization. Pronounced on this the 20th day of April' 2017.

                            Sd/-                                                          Sd/-

                      MEMBER                                           MEMBER, DCDRF,

                                                                                     NABARANGPUR