This case has arisen out of an application U/s 35 of the Consumer Protection Act, 2019.
The case of the complainant is that Sachchidananda Biswas was a policy holder of HDFC Life Ins. Co. Ltd vide Policy No:20182444 who paid his 1st premium on 30.10.2018 and he had assigned his minor daughter Somoshree Biswas/Complainant No:3 as a nominee and appointed his mother Smt. Maya Biswas Chatterjee/Complainant No:2 as appointee in the policy. He died on 10.09.2018 & the policy is in force at the time of his death.
That after his demise his wife Smt. Smriti Biswas/Complainant No:1 submitted death certificate along with all necessary documents before Insurance Company through Agent Sandip Paul for her husband’s death benefit & O.P.No:1 assured her that they would receive it immediately. After some days Sandip Paul came to her house and ask for signature on a form for getting death benefit of her husband & accordingly she put her signature, thereafter she & complainant No:2/ her mother-in-law met with Sandip Paul & O.P.No:1 who informed that a new policy was issued in the name of complainant No:1 being Policy No:20841698, dated 30.10.2018, but they took time on several pretext. So she lodged a complaint against O.P before AD, CA & FBP, U/D Region on 06.07.2021, then complainant No:2 on dated 07.09.2021 fill up the death claim form and submitted it. After submission thereof complainant No:1 & 2 met several time with O.P but O.P making unnecessary delay to provide death benefit, thereby complainants have been suffering from poverty. The complainant thus prays for an order directing O.P/Insurance Company to pay the policy amount Rs.3,00,000/-, compensation for harassment and mental pain Rs.10,00,000/- etc.
O.P.No:1&2 contested the case by fling W.V stating that policy bearing No:20182444 (HDFC Life Young Star Udaan) was issued to Sachchidananda Biswas on 14.03.2018 for a sum assured Rs.2,50,000/- with risk commencement date 14.03.2018, half yearly premium Rs.12,782/-for 10 years, upon the information provided in the proposal form. That the initial/1st premium was paid on 08.03.2018 through cheque and next premium was due on 07.09.2018 which was not paid by LA, who died on 10.09.2018, for which the policy became lapsed. So no claim is entertainable. That Insurer has not received any death claim in Policy No:20182444.
That complainant No:1 has visited HDFC Life’s Office and applied for a new policy, submitted all required document and give her consent, accordingly Policy No:20841698 has been issued to her and she has paid several premiums. They pray for dismissal of the case.
Point for consideration is:-
- Whether there was any deficiency in service on the part of the O.Ps which gives rise cause of action to file the complaint and the complainants are entitled to get the claim?
D e c i s i o n w i t h r e a s o n s
Admittedly, the life assured (LA) i.e (Late) Sachchidananda Biswas, S/o: Late Sadananda Biswas submitted application (Proposal) before the HDFC Standard LIC Ltd for a policy for HDFC Life Young Star Udaan (hereinafter referred to as the Policy), through online & initial/1st premium was paid through cheque and on the basis of declaration and documents submitted by him O.P/Insurance Company issued a policy bearing No:20182444 on 14.03.2018 for sum assured Rs.2,50,000/- with risk commencement date 07.03.2018 & the half yearly premium of said policy was Rs.12,500/- & the mode of premium paid was half yearly for 10 years and next premium was due on 07.09.2018.
The Death Certificate shows that LA Sachchidananda Biswas had died on 10.09.2018.
O.P/Insurance Company stated that premium notices were sent through email to Policy holder on 18.08.2018 & 15.02.2019 and also sent lapse letter through email on 08.04.2019.
Admittedly, LA died without paying subsequent (2nd ) premium due on 07.09.2018. Though insurer stated that the policy was lapsed prior to death of the LA due to non-payment of premium but 30 days grace period was available to the LA for payment of premium & during this grace period LA had died, so we find that the policy was not lapsed prior to death of the LA, rather on the date of his death dated 10.09.2018 the policy remain in force.
The case and evidence of the complainant No:1/P.W.1 is that after demise of her husband Sachchidananda Biswas (LA) she submitted death certificate along with all necessary documents before the Insurer through agent Sandip Paul and O.P.No:1 assured that they would receive death benefit immediately, but O.P.No:1 took considerable time on several pretexts, as a result she lodged a complaint before AD, CA & FBP, U/D Region on dated 06.07.2021, but of no result.
In cross-examination she stated that she has submitted claim intimation to the Insurance Company but she cannot recollect the date of intimation. Later she admits that her husband had died on 10.09.2018 and she gave written intimation to the O.P/Insurance company on 07.09.2021.
In Para 8 (a) of W.V it is mentioned that as per complainant the death claim was submitted on 07.09.2021 by Mrs. Maya Biswas (mother of the deceased life assured), whereas no death claim has received by Insurer.
List of document depicts xerox copy of individual Death Claim form of O.P/Insurance company signed by Maya Biswas (Banerjee) dated 07.09.2021 and list of documents were ticked bearing signature of third party, namely, Sadananda Biswas (father of the deceased), found no receiving seal and signature from the end of Insurer. Reply email of the Insurer dated 12.01.2022 in response to Complainant No:1’s email dated 29.07.2021 on the subject: HDFCSL=009-214-703 claim intimation-A110 & reply of complainant No:1’s email dated 10.08.2021 on same subject. It depicts attention: This mail was sent from someone outside of HDFC Life. Always use caution when opening attachments or clicking links from unknown senders or when receiving unexpected emails. From reply emails it has clearly been proved that at least claim intimation through email was sent by complainant No:1 & received by insurer on 29.07.2021, thereafter on 10.08.2021 & on 07.09.2021 it was submitted in physical form i.e within 03 years of death of LA.
We are not concerned with policy No:20841698 stands in name of complainant No:1 Smt. Smriti Biswas so we find needless to ascertain whether on her request said policy was issued or agent of Insurer Sandip Paul managed to get it done on the plea of receiving her husband’s death claim quickly.
Under above facts and discussion, we are of the opinion that though LA had died after payment of initial/1st premium, which requires investigation U/s 45 of Insurance Act, but as LA had died within 30 days grace period & death claim has been submitted within statutory period of 03 years from the date of death of the LA, the Insurer is bound to settle the death claim & pay the same to the complainants, heirs of deceased LA without any delay. We find deficiency in service on the part of the Insurer in not settling the death claim in reasonable time which gives rise cause of action to file written complaint to AD, CA & FBP, Raiganj Region, finally this complaint. We are not inclined to grant any amount as compensation for too late submission of claim, but the complainants may get some cost for litigation.
In the result the case succeeds.
Hence, it is
O R D E R E D
that the C.C-09/2022 be and the same is allowed on contest against the O.Ps.
We do direct O.P.No:1&2 to severally & jointly pay Rs.2,50,000/- (sum assured on death) and litigation cost of Rs.5,000/-, within 01 month from the date of order, failing which it will carry interest @6% p.a till final realization and the complainants will be at liberty to recover the same through execution.
Let a copy of this order be given to the parties free of cost.
