MR RAMSANKAR NAYAK, MEMBER …         The factual matrix of complaint in brief is that, the complainant being the nominee and wife of her deceased husband Late Mohan Harijan who availed Life Insurance Policy under the OP.s vide Policy no.573612161 for a sum assured of Rs.50,000/-, Rs.25,000/- as extended cover benefit under the scheme and Rs.50,000/- for accidental benefit with half yearly premium mode. Unfortunately Mohan Harijan died on dt.01.02.2016 at his house at Papadahandi. The complainant being uneducated tribal women but with the instructions from others had approached the OP.s for several times requested for the death benefits but for no use. The counsel for complainant contends that the policy was made on 30.07.2011 and the policy holder died on 01.02.16. 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 Mohan Harijan the concerned policy holder had nominated the present complainant as wife and had taken policy under table 179-20-20 for sum assured Rs.50,000/- on dt.28.07.2011 by paying half yearly installment Rs.1147/- vide policy no.573612161. 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 02 years premiums are paid subsequent premium are not paid, then full death cover shall continue for 02 years from first unpaid premium. But in the instant case premium have been paid only for one year and six months, the date of first unpaid premium is 28.01.2013. Hence auto cover period expired after 02 years from 28.01.13, i.e. on 27.01.15, and the death of deceased was on 01.02.16 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 husband of complainant had procured a Life Insurance Policy on dt.28.07.2011 and the date of risk was covered on dt.30.07.2011 paid premium of Rs.1147/- as half yearly mode. The policy holder nominated his wife, the present complainant as nominee. That the policy holder died on dt.01.02.2016 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 for several occasions with claim form along with other required documents but the OP.s did not yet settled her claim on one plea or the other. Hence under compulsion she 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 she has not yet produced the death certificate of the deceased policy holder. She 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 02 years premiums are paid subsequent premium are not paid, then full death cover shall continue for 02 years from first unpaid premium. But in the instant case premium have been paid only for one year and six months, the date of first unpaid premium is 28.01.2013. Hence auto cover period expired after 02 years from 28.01.13, i.e. on 27.01.15, and the deceased died on 01.02.16 i.e. 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 her husband she was not aware of the insurance policy availed by her late husband. But on advice of some well wishers she hopefully approached the OP.s again and again for the assured sum but the OP.s did not even turn to her request. The counsel for complainant have also filed relevant receipts of the OP.s, which shows that the policy holder was a regular depositor of premium and have deposited premium for One year and six months. No doubt the policy holder discontinued to deposit the premium for onward period, but the OP.s neither intimated him 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 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 her 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.75,000/- (Rupees Seventy five thousand) 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 her late husband Mahon Harijan 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.