SRI G.K. RATH, PRESIDENT.…….. The gist of case is that, the late husband of complainant had taken an insurance policy under plan/table-814 vides policy no.573354840 on dt.28.12.2014 for Rs.2,00,000/- having its maturity on dt.28.12.2029 and nominee is the present complainant. The counsel for complainant contends that, while the policy was in force the complainant died in heart attack at his residence. Later the complainant intimated the fact to the OP.1 and lodged claim forms along all relevant documents but on dt.15.02.2017, the OP.2 repudiated the claim of complainant with a plea of suppression of age of the deceased life assured DLA at the time of proposal. They further noted that at the time of commencement the life assured has mentioned his date of birth to be on 01.01.1965, but it is pertinent that as he has no authenticated age proof, he had submitted a declaration declaring his date of birth is to be 01.01.1965 vide form no.3260/5096 and due to non availability of standard age proof the OP.s charged more amount of premium adding his annual premiums. So she further contends that the OP.s repudiate the claim of complainant despite charging more amounts towards non standard age proof as per legal parameter from the life insured, hence is illegal and unfair. She further stated that the DLA had never studied in any school, hence had no authenticated age proof and on guidance of concerned agent of OP.s he preferred to procure the said policy paying extra charges and signed the proposal where the agent says, but the OPs repudiated the same with a vogue plea which is illegal and high handed which amounts to deficiency in service, hence she contends that due to the inaction and arbitrary manner of OP.s she sustained mental, physical and financial losses, so prayed before the forum for the assured amount of the policy along with interest and a sum of Rs.10,000/- as compensation.
2. The counsel for OP.s filed his counter and averred that, the policy no.573354840 was issued in favour of Krushna Mohan Mandal under Plan 814-15 for sum assured of Rs.2,00,000/- with yearly premium of Rs.15,262/- maturing on 28.12.2019 and the present complainant is the nominee. As per the death certificate filed by the complainant the date of death mentioned as 28.03.2015 but as per prescribed form no 3260/5096, the age admitted was 01.01.1965. As per the manual provision in case of nonstandard age proof maximum entry age is restricted to 50 and maturity age 65 but in the voter Id card his age is proved to 55 and at the time of proposal the DLA suppressed the material fact and declared his age as 50 to gain extraneous gain, hence the OP.s legally repudiated the claim of complainant for the above grounds. He further contends that there is no deficiency in service on the part of OP.s and prayed to dismiss the case in the interest of justice.
3. The counsel for complainant has filed copy of certain relevant documents along with an affidavit in support of his claim. On the other hand the counsel for OP.s also filed copy of some documents in support of his claim. Case heard from both sides at length and perused the record.
4. From the above submissions, it reveals that, the deceased policy holder had procured an insurance policy vides policy no.573354840 under plan 814-15 date of commencement was 28.12.2014, dt.of maturity is 28.12.2029, premium paid Rs.15,262/- yearly mode, sum assured of Rs.2,00,000/- and the present complainant is the nominee respectively.
5. The main issue of dispute is that though the DLA had preferred to procure the said policy but he had no authenticate standard age proof at the time of proposal and under guidance of agent he procured the said policy and declared his date of birth is 01.01.1965 approximately aggregating his age to 50 years. But from the voter identity card of her husband, the OP.s found the age of DLA was 55 years at the time of commencement of the policy. The OP.s contends that the complainant deliberately suppressed his correct age and declared his age as 50 years at the time of proposal to gain extraneous benefits. The OP.s further contends that the DLA has signed his signature in English, hence he was a literate person and deliberately suppressed fact of his age, and for this reason the OP.s repudiated the claim of complainant.
6. The counsel for complainant has filed copy of Non-Standard Age Proof (NSAP) guidelines of LIC wherein clearly held that “the LIC accepts categorically as NSAP-I, II, III only if the proposer does not have any of the NSAPs under Form No.3260/5096. Wherein further mentioned Special conditions applicable to NSAP-II & III a) Age proof extra equivalent to Class I extra, subject to a minimum of Rs.1.50/- per Rs.1000/- will be charged, b) Plans involving term assurance element, whole life (Table- 2) Term Rider & critical illness Rider will not be allowed. c) maximum age at entry will not exceed 50 years of age (nearest birthday) & maximum maturity age/premium ceasing age will be restricted to 65 years.
7. It reveals from record that the DLA educational qualification is class 5th, hence was illiterate and the agent of OP.s filled the proposal form of DLA at the time of commencement wherein he also filled a declaration form 3260/5096 wherein he certified that the age of DLA is 50 years as on 19th day of Jan’2015. So it is crystal clear that the agent of OP.s has charged extra premiums towards Non standard age proof from the DLA. It is also seen that the counsel for OP.s also filed the copy of form no.3260/5096 but failed to file the exact extra premiums they have taken from DLA. Hence in our view repudiation of claim by the OP.s seems unlawful and unjust enrichment privity of contract despite receipt of extra premiums from the life insured through declaration form no.3260/5096. Before we embark upon determination of the relevant points involved in the complaint we found that the DLA has paid extra charges of premium of Rs.1.50/- per Rs.1000/- to the sum assured of Rs.2,00,000/- which cannot be denied by the OP.s.
8. We have carefully considered the pleadings, evidence & the documents produced on behalf of two parties and came to a conclusion that the OP.s in the whole transaction did not challenged on any other issues except age proof and in our view the DLA has commenced the policy on 28.12.2014, dt.of maturity is 28.12.2029 and unfortunately he died in heart attack within the valid maturity period and it is also seen that the OP.s nowhere challenged on payment of premiums or any other pleas on the part of DLA. Hence without going to the unwarranted abbreviation we considered the evidences and submissions made by both the parties.
9. We are inclined to rely the self declaration form no.3260/5096 filed by both the counsel for parties, wherein proved that the agent of OP.s has filled the form wherein he/she certified on
REASONS: that I further certify that according to my estimation his/her apparent age is 50 years. ……Signed by agent.
I have discussed the question of standard proof of age with the proposer and I am satisfied that he/she cannot submit a standard proof of age for the following REASONS: I further certify that according to my estimation his/her apparent age is 50 years. ……Signed by agent.
10. It seems that the concerned agent being following the guidelines of NSAP-I, II, III as acceptance of OP.s had preferred for the declaration form no.3260/5096 and approximately filled the date of birth of the DLA 01.01.1965 at the time of proposal which per se rejected by the OP.s relying the voter Id card of DLA calculating the age of 55 years of the DLA at the time of commencement.
11. It is further observed that the OP.s though filed a copy of declaration form no.3260/5096 and vehemently contended around every point but never discussed on the declaration form no.3260/5096 and about the extra charges of premium for non availability of standard age proof on the part of DLA. However it is crystal clear that the DLA had paid extra Rs.1.50 paise per Rs.1000/- per se deposited Rs.300/- extra for sum assured of Rs.2,00,000/- towards non availability of any standard age proof. Hence in our view as the DLA had deposited the extra charges, the complainant being nominee is liable to get the said assured sum, but the OP.s repudiated the claim of complainant arbitrarily without going through the authenticity of I.R.D.A guidelines.
12. It is further seen that, according to I.R.D.A. guidelines the basic concept of life insurance is to provide protection to the continuous livelihood of the dependents of the life insured. It shall not be treated as investment or savings. It is a means of providing an instant estate for the survivors on the death of an insured person or head of the family or the earner of the family. Ordinarily when the earning member of a family dies, the cash flow which was the basic of livelihood of non earning dependent collapses, and the basic needs and dignity of the dependents is shattered for day to day survival. Life insurance is thus opted, for protection of the family members from financial disasters, on the death of the bread earner insured.
13. Finally the OP.s repudiated the claim with an ulterior motive to harass the present complainant, which the complainant is lawful beneficiary and entitled for the assured sum. Hence we feel that the action of OP.s in the entire transaction is highhanded, unscrupulous and unfair which amounts to deficiency in service and for which illegal action the complainant inflicted financial crunches and restrained to get her legitimate monetary benefits, hence the OP.s found guilty as provisions envisaged in the Act.
ORDER
i. The opposite parties 1 & 2 supra are jointly, severally & collaterally hereby directed to pay the sum assured as agreed in policy no.573354840 i.e. Rs.2,00,000/- (Rupees two lakhs) along with 9% simple interest per annum from the date of receipt of claim i.e. dt.27.06.2016 to till the date of filing of this case i.e. dt.12.09.2017, inter alia, to pay Rs.5,000/-(Five thousand) as cost of litigation to the complainant. As we have allowed interest, hence are not inclined to allow any compensation.
ii. All the above directions shall be complied with in 30 days of receipt of this order, failing which, the total declared sum will carry 12% interest per annum till its realization. Pronounced on this the 14th day of May' 2018.
MEMBER PRESIDENT,DCDRF,
Memo No_______________DF Dt………………………
Copy to the parties concerned.
PRESIDENT, DCDRF,
NABARANGPUR
