SRI JIBAN KRUSHNA BEHERA, MEMBER (I/C)

            The Complainant has filed this complaint petition, U/s-35 of C.P.A.-2019, (here-in- after called as the “Act”) alleging a “deficiency-in-service” against the Opp. Parties, who are the Life Insurance Corporation of India located at different places.

2.         The factual matrix of this case is that the deceased father of the complainant namely Suresh Shah had purchased one policy from the LIC of India, Balasore Branch on 15.2.2005 vide policy No.585987342 for a assured sum of Rs.50,000/- with a quarterly premium of Rs.757/- wherein the minor complainant was the nominee. His deceased father had appointed his sister namely Sannu Shah to receive policy amount during the minority of the complainant. His father died on 20.9.2015 when the complainant was aged about 14 years. Said Sannu Shah did not take any step to claim the policy amount as because she was then married and living with her family somewhere. As the copy of the proposal form of his deceased father and the address details of the OP No.1 so also the contact details of grievance redressal mechanism are not available with the complainant, he approached OP No.2 on 2.2.2019 alleging for non-cooperation by OP No.1 for death claim of his deceased father. When the matter could not be settled, the complainant moved the Grievance Redressal Officer, LIC of India, ED(CRM), Mumbai on 30.4.2019 so also the OP No.1 on 17.7.2019 along with all relevant documents through registered post. On receipt of the grievance, OP No.1 informed the complainant to submit the documents as required for release of the policy claim vide letter dated 18.7.2019. The complainant further made representation on 27.7.2019 stating that the death of birth as mentioned in the Birth Certificate of the complainant supported by his PAN Card may be considered instead of sticking to two years of his age. But the OP No.1 did not pay any heed to it. In response to his representation, OP No.1 vide his letter dated 30.7.2019 informed the complainant for submission of required documents, which have been submitted by the complainant on 6.9.2019  followed by another representation dated 6.8.2019 and 13.8.2019. The OP No.1, in response to the representation dated 6.8.2019, informed the complainant to submit an affidavit duly executed before Magistrate of Class-I for mismatch of the name of claimant and father’s name of his deceased father and a copy of self- attested I.D. proof as because in the policy the name of the complainant (nominee) was mentioned as Asish Shah instead of Ashish Kumar Shah as reflected in the PAN card and further the father’s name of his deceased father was mentioned as Late Chatelal Shah instead of Chhotelal Shah, as reflected in the death certificate.

            In the above premises, Ops played a dilatory tactics in settling the claim of the complainant. Thereafter, the complainant made application before the OP No.2 under the RTI Act to which OP No.2 informed the complainant that the PAN card furnished by the complainant in proof of his date of birth and the claim forms with identity proof submitted by him as Asish Kumar Shah is received by OP No.1 and the claim in respect of policy in question was pending for some requirements. For the above intentional delay, the complainant complained before the Grievance Redressal Office of LIC, Mumbai regarding early settlement of the claim in respect of his deceased father. When all these attempts undertaken by the complainant became futile, he was constrained to file this case.

            The cause of action for filing the case arose on 6.8.2019, when the complainant came to know from his brother about the letter dated 5.2.2019 and 10.10.2015 which were sent to Sri Sudhir Shah, brother of his deceased father and on 25.11.2019, when the OP No.1 informed him that his claim is pending for some requirement and finally on 4.3.2020, when the CPIO, IRDAI, Hyderabad informed him about registration of his complainant. Hence, this case.

            To substantiate her case, the complainant has relied on the following documents, which are placed in the record, as mentioned hereunder-

1. Photocopy of policy bond.
2. Photocopy of death certificate of the father of complainant.
3. Photocopy of birth certificate of the complainant.
4.  Photocopy of representation dated 2.2.2019.
5. Photocopy of representation dated 30.4.2019.
6. Photocopy of representation dated 17.7.2019.
7. Photocopy of letter dated 18.7.2019 of OP No.1.
8. Photocopy of representation dated 27.7.2019.
9. Photocopy of letter dated 30.7.2019 of OP No.1.
10. Photocopy of representations dated 6.8.2019 & 13.8.2019.
11. Photocopy of letter dated 5.2.2019 & 10.10.2015 of OP No.1.
12. Photocopy of letter dated 12.8.2019 of OP No.1.
13. Photocopy of representation dated 16.8.2019.
14. Photocopy of representation dated 20.9.2019.
15. Photocopy of letter dt.25.11.19 of OP No.1 & dt.4.3.20 of CPIO, IRDAI, Hyderabad.
16. Photocopy of representation dated 31.1.2020.

3.         In the present case, Ops were made their appearance and filed their joint written version. In their written version, the Ops have not only challenged the cause of action to file the present case but also emphatically stated that the case is not maintainable. They have denied the allegations made in the complaint petition. The Ops have stated, inter alia, that the policy in question is a premature one and the matter is pending with OP No.1 as the complainant is not submitting the required documents. The deceased father of the complainant namely Suresh Shah purchased one policy bearing No.585987342 for a sum of Rs.50,000/- with yearly mode and the complainant at the age of 2 years was the nominee. On 9.10.2015, the brother of deceased namely Sudhir Shah submitted an application with death certificate of said Suresh Shah before OP No.1. On the next day, OP No.1 issued a letter along with claim forms to said Sudhir Shah for settlement of death claim, but neither said Sudhir Shah nor the appointee Sanu Shah nor even any legal guardian submitted the claim form and required documents. On 5.2.2019, again OP No.1 sent a letter with claim forms to said Sudhir Shah for the same purpose. But on 17.7.2019, the complainant for the first time submitted application to OP No.1 for death claim and on the next day OP No.1 issued a letter along with claim form duly executed, signed, witness, counter signed by the appointee Sanu Shah under the policy along with guardianship certificate, I.D. proof of both Suresh Shah and Sanu Shah, death certificate, NEFT mandate, copy of pass book duly attested and original policy bond for consideration of death claim. On 27.7.2019, the complainant sent a letter claiming that he has attained his majority on 29.4.2019. Thus, OP No.1 sent a letter to him for submission of claim forms duly executed by him along with copies of ID proof, birth certificate, school certificate, bank pass book duly attested and ID proof of his deceased father and also clarification for mismatch in the father’s name of his deceased father Suresh Shah. When the complainant did not comply, OP No.1 again sent a letter to him on 12.8.2019 requesting to submit the duly executed the claim form-CR and Annexure-II and declaration duly executed before the Magistrate of First Class. But the complainant without submitting the required documents, used to write letters after letters to various authorities making false allegation against the Ops. The case is still a premature one and the claim settlement is delayed due to non-cooperation of the complainant. In the above premises, Ops have prayed to dismiss the case with cost.

4.         In view of the above averments of parties, the points for determination in this case are as follows:-

(i)         Whether the complainant is a consumer or not?

(ii)         Whether the complainant has cause of action to file this case?

(iii)        Whether this consumer case is maintainable?

(iv)        Whether there is any deficiency in service on the part of the OPs?

(v)        Whether the complainant is entitled to get the relief, as sought for?

(vi)        To what other relief(s), the Complainant is entitled to? 

F  I  N  D  I  N  G  S

5.         First of all it is to be determined as to whether the complainant is a consumer or not. From the averments made in the pleadings of both the parties and document produced on behalf of the complainant vide Annexure-1, it is clear that the complainant is the nominee of his deceased father Suresh Shah, who purchased one bond from the Ops bearing No.585987342. The deceased father of the complainant died on 20.9.2015, as reflected vide Annexure-2. From the above, it is clear that the complainant is covered under the definition of a consumer as defined under the provisions of the Consumer Protection Act, 2019.   

6.         Before delve into the merits of the case, it is required to be decided how far the complainant is able to prove his case with regard to the cause of action and maintainability of the case. Learned counsel for the complainant urged that the deceased father of the complainant had appointed his sister namely Sannu Shah to receive policy amount during the minority of the complainant. His father died on 20.9.2015 when the complainant  was aged about 14 years. Said appointee Sannu Shah did not take any step to claim the policy amount as because she was then married and living with her family somewhere. As the copy of the proposal form of his deceased father and the address details of the OP No.1 so also the contact details of grievance redressal mechanism are not available with the complainant, he approached OP No.2 on 2.2.2019 alleging for non-cooperation by OP No.1 for settlement of the death claim of his deceased father. It is further urged that OP No.1 informed the complainant to submit the documents as required for settlement of the policy claim vide letter dated 18.7.2019. The complainant further made representation on 27.7.2019 stating that the death of birth as mentioned in the Birth Certificate of the complainant supported by his PAN Card may be considered instead of sticking to two years of his age. But the OP No.1 did not pay any heed to it. In response to his representation, OP No.1 vide his letter dated 30.7.2019 informed the complainant for submission of required documents, which have been submitted by the complainant on 6.9.2019 followed by another representation dated 6.8.2019 and 13.8.2019. The OP No.1, in response to the representation dated 6.8.2019, informed the complainant to submit an affidavit duly executed before Magistrate of First Class for mismatch of the name of claimant and father’s name of his deceased father and a copy of self- attested I.D. proof as because in the policy the name of the complainant (nominee) was mentioned as Asish Shah instead of Ashish Kumar Shah as reflected in the PAN card and further the father’s name of his deceased father was mentioned as Late Chatelal Shah instead of Chhotelal Shah, as reflected in the death certificate.

7.         On the other hand, learned counsel for the Ops submitted that on 9.10.2015, the brother of deceased namely Sudhir Shah submitted an application before OP No.1 with death certificate of said Suresh Shah. On the next  day, OP No.1 issued a letter along with claim forms to said Sudhir Shah for settlement of death claim, but neither said Sudhir Shah nor the appointee Sanu Shah nor even any legal guardian submitted the claim form and required documents. On 5.2.2019, again OP No.1 sent a letter with claim forms to said Sudhir Shah for the same purpose. But on 17.7.2019, the complainant for the first time submitted application to OP No.1 for death claim and on the next day OP No.1 issued a letter along with claim form duly executed, signed, witness, counter signed by the appointee Sanu Shah under the policy along with guardianship certificate, I.D. proof of both Suresh Shah and Sanu Shah, death certificate, NEFT mandate, copy of pass book duly attested and original policy bond for consideration of death claim. On 27.7.2019, the complainant sent a letter claiming that he has attained his majority on 29.4.2019. Thus, OP No.1 sent a letter to him for submission of claim forms duly executed by him along with copies of ID proof, birth certificate, school certificate, bank pass book duly attested and ID proof of his deceased father and also clarification for mismatch in the father’s name of his deceased father Suresh Shah. When the complainant did not comply, OP No.1 again sent a letter to him on 12.8.2019 requesting to submit the duly executed the claim form-CR and Annexure-II and declaration duly executed before the Magistrate of First Class. But the complainant without submitting the required documents, used to write letters after letters to various authorities making false allegation against the Ops. The case is still a premature one and the claim settlement is delayed due to non-cooperation of the complainant.

8.         From the above rival submissions of the parties,it is clear that the deceased father of the complainant had purchased a policy bond from Ops and the minor complainant was the nominee to the said policy. The deceased father of the complainant appointed Sanu Shah to receive the premature amount on behalf of the minor complainant, if required, but as reflected said Sanu Shah was married and living else where with her family for which the matter was not placed before the Ops in time. However, after the death of the deceased father of the complainant, his brother Sudhir Shah made application for settlement of the claim amount with death certificate of deceased. Soon after, OP No.1 issued letter to said Sudhir Shah to place the required documents for settlement of the claim. As it appears, on 17.7.2019 the complainant for the first time submitted an application before OP No.1 for settlement of death claim. On 18.7.2019, OP No.1 issued a letter along with claim form duly executed, signed, witness, counter signed by the appointee Sanu Shah under the policy along with guardianship certificate, I.D. proof of both Suresh Shah and Sanu Shah, death certificate, NEFT mandate, copy of pass book duly attested and original policy bond for consideration of death claim. On 27.7.2019, the complainant sent a letter claiming that he has attained his majority on 29.4.2019. Thus, OP No.1 sent a letter to him for submission of claim forms duly executed by him along with copies of ID proof, birth certificate, school certificate, bank pass book duly attested and ID proof of his deceased father and also clarification for mismatch in the father’s name of his deceased father Suresh Shah. When the complainant did not comply, OP No.1 again sent a letter to him on 12.8.2019 requesting to submit the duly executed the claim form-CR and Annexure-II and declaration duly executed before the Magistrate of First Class. But the complainant without submitting the required documents, used to write letters after letters to various authorities making false allegation against the Ops. The case is still a premature one and the claim settlement is delayed due to non-cooperation of the complainant.

9.         From the above discussions, it is held that the complainant has sent letters one after another to the Ops and simultaneously the Ops used to send replies one after another to the complainant. But, in fact, the complainant has not yet fulfilled the required documents as required by the Ops for settlement of the policy claim. From the documents produced on behalf of the complainant nor even from the averments made in the complaint petition, this Commission is not satisfied that the complainant has ever produced the claim form supported with copies of ID proof, birth certificate, School certificate, attested bank pass book, ID proof of his deceased father for clarification regarding mismatch of the father’s name of his deceased father supported with an affidavit from a Magistrate of First Class as because the father’s name of his deceased father was mentioned as Late Chatelal Shah in the policy bond whereas in the death certificate it is mentioned as Chhotelal Shah and original death certificate of his deceased father, for settlement of the death claim, as required under Section 8 of the IRDA (PPI) Regulations, 2002.Not a single document is produced on behalf of the complainant to show that he has produced the aforesaid documents before the Ops for settlement of the policy claim. That apart, during course of hearing, on being asked, the complainant has not satisfied that he had/has visited the office of OP No.1 personally at any point of time for settlement of the death claim. Further, the complainant is silent with regard to the fact as to whether the OP No.1 had been to the residence of his deceased father for obtaining the LIC policy bond or his deceased father had been to the office of OP No.1 for purchasing of LIC policy bond or it was purchased by his deceased father through any authorized agent or insurance intermediary of the Ops. In case the proposal for purchase of LIC policy bond was executed on the advice of an agent or an insurance intermediary, such person must have advised the prospect dispassionately, who shall act according to the code of conduct prescribed by the Authority or the Councils that have been established under Section 64-C of the Act or the recognized professional body or association of which the agent or intermediary or insurance intermediary is a member. As per Section 14(2)(i) of IRDA (PPI) Regulations, 2017, a death claim under a life insurance policy shall be paid or be rejected or repudiated giving all the relevant reasons, within 30 days from the date of receipt of all relevant papers and required clarifications. But in the present case, as it appears that the complainant has neither produced all relevant papers nor complied the required clarifications before the Ops. Therefore, it cannot be said that deficiency of service, as alleged by the complainant, is attributed against the Ops.

10.        So far as the cause of action for filing of the case is concerned, it is stated by the complainant that on 6.8.2019 he came to know from his brother Manish Kumar Shah that one letter dated 5.2.2019 addressed to Sri Sudhir Shah, brother of his deceased father, was lying on his veranda which was sent from OP No.1. It is interesting to say that one letter is lying on the veranda of the house of the complainant since the month of February, 2019 and it was traced out in the month of August, 2019. In this context, the complainant is silent with regard to the fact as to whether said veranda of the house belongs to him or belongs to said Sudhir Shah, who has been separated from them or they have no access to the veranda in question. Secondly, it is stated by the complainant that on 25.11.2019, the Manager (CRM)/CPIO of OP No.1 informed him that his claim is pending for some requirement without spelling out for what requirements the claim is pending. In all the events, the complainant used to send letters to the Ops, but in the present scenario what prevented him to seek clarification about the pendency of death claim for some requirements, is not stated specifically. Thirdly, complainant has stated that on 4.3.2020 the CPIO of the IRDAI, Hyderabad informed him that his complaint was registered in IGMS.In this connection, it has already been held that the complainant has neither approached the Ops personally nor any authorized agent through whom his deceased father had purchased the LIC bond or insurance intermediary of the Ops for settlement of the death claim nor has produced all the relevant documents as sought for by the Ops and complied with the clarifications vide Annexure-7, 9 & 12 with a view to insist and compel the Ops to settle the death claim. But as it is seen that the complainant has not complied with the requirements of the Ops. On the other hand, the Ops have not taken any step to repudiate the claim of the complainant, rather, they have emphatically admitted that the that the policy in question is a premature one and the matter is pending with OP No.1 as the complainant is not submitting the required documents. Taking into consideration the discussions made in the foregoing paragraphs, the dates, as referred to above herein this case by the complainant, do not construe as cause of action for filing the case.

11.        Considering the facts and circumstances of the case and the observations made earlier, the complainant has no cause of action to file the case and the case is not maintainable. Consequently, the complainant is not entitled to any reliefs, as sought for, in this case.

             Hence, it is ordered -

O   R   D   E   R

             The case of the complainant be and the same is dismissed on contest against the Ops. In the facts and circumstances of the case, there shall be no order as to costs.

             Pronounced in the open Court of this Commission on this day i.e. the 12^th day of December, 2023 given under my Signature & Seal of the commission.