ORDER

Complaint under  Sec.12 of the CPA 1986 as amended upto date

Ms. Nipur Chandna, Member

          The complainant is the father of the deceased Munna Prasad Gupta, who had purchased four life insurance policies from the OP the details of which is given as under : -

1. Policy No. 11052899, Policy term 15 years, policy commencement dated 24.1.2009, due dated of last premium 24.7.2023, termination dated 24.1.2024, ICIC Pru Protect-Classic accident and disability Ben, Rider, waiver of Premium rider, sum assured Rs.15,00,000/- periodicity of payment shall be half yearly.

2. Policy No. 11550952, policy term 15 years, policy commencement dated 17.3.2009, due dated of last premium 17.9.2023, cover cessation dated 17.3.2024, death benefit Rs.4,22,700/- critical illness/TPD Rs.4,22,700/-.

3. Policy No. 11556588, policy term 25 years, policy commencement dated 19.3.2009, due dated of last premium 19.9.2023, cover cessation dated 19.3.2034, benefit life stage pension, premium Rs.13,500/- half yearly.

4. Policy no. 12873694, policy term life stage Assure Pension, Receipt No. 83855565, date of receipt 11.11.2009, last premium 12.10.2033, premium paying term 24, premium Rs.2100/- from address.

      It is alleged by the complainant that the deceased died on 30.11.2010  leaving behind Smt. Munako Devi and the complainant as his only legal heirs.  It is further alleged by the complainant that he and his wife are the nominees/beneficiaries under the aforesaid policies.  The complainant approached the OP for the settlement of his claim but no remedial action was taken by the OP and as such the complainant sent a legal notice to the OP who again failed to settle the claim of the complainant and therefore the complainant approached this Forum for rederessal of his grievance.

                 OP has contested the complaint and has filed a written statement. It has denied any deficiency on its part.  Para Nos 6 & 7 of the brief facts of written statement contains the defence of OP.  It is reproduced as under:-

6.That In reply to letter dated 2.8.2011 the complainant presented claim forms alongwith desired documents before Respondent Insurance Company.  The Respondent Insurance Company after receiving the said claim forms found that two policies having No. 11052899 & 11550952 lapsed before the death of LA so benefit under the said two polices could not be given. Other two polices having No. 11556588 & 12873694 was in force at the time of the death of LA but under the said policies no death benefit was available to the LA as the said two policies were taken by the LA under the pension plan.

7. That the Respondent Insurance Company as per the Policy Contract and its Terms and Conditions found the two claims genuine under the Policy Nos. 11556588 & 12873694 against which the payment could be made not as death claim but as per the terms of the policy and accordingly without any demur the payment was made to the complainant.  The full details regarding the lapsed polices and the polices under which the claim payment was made are as under:-

POLICY NO. 11052899

1. Policy was in a Lapsed status since 24.1.2010 due to non payment of premiums
2. Accordingly the rejection of claim was communicated to the complainant vide letter dated 17.08.2011 wherein it was clearly communicated to the complainant the reason for rejection of claim.

POLICY NO. 11550952

1. Policy was in a Lapsed status since 17.09.10 due to non payment of premiums
2. Accordingly the rejection of claim was communicated to the complainant vide letter dated 25.10.2011 wherein it was clearly communicated to the complainant the reason for rejection of claim.
3. The policy is governed by its terms and conditions.
4. That the claim was rejected in accordance with the clause 9(b) of the terms and conditions of the policy.

POLICY NO. 11556588

1. The policy is Zero Death Benefit policy.  In case of death of the LA, Fund Value is payable to the nominee/beneficiary.
2. The claim towards the policy was accepted to the tune of Rs.53372.85/-
3. Payment of Rs.53372.85/- was processed on 6.9.2011 through NEFT to the account no. 206010100056708 of UTI Bank.  The said amount has been transferred to the beneficiary account on 7.9.2011.

POLICY NO. 12876394

1. The Policy is Zero Death Benefit policy.  In case of death of the LA, Fund Value is payable to the nominee/beneficiary.
2. The claim towards the policy was accepted to the tune of Rs.28990.17/-
3. Payment of Rs.28990.17/- was processed on 21.10.2011 through NEFT to the account No. 206010100056708 of UTI Bank.  The said amount has been transferred to the beneficiary account on 22.10.2011.

     Both the parties have filed their evidence by way of affidavits. 

     We have heard arguments advanced at the bar and have perused the record.

     The counsel for the OP has contended that under policies Nos. 11052899 and 1550952 the life assured had to pay the second premium on 24.1.2010 and 17.09.2010 respectively, but he had not paid the same and as such he said  policies had lapsed.  He has further contended that since the above said policies had lapsed before the death of the LA and the same were not restored, no payment was due against the said policies.  In respect of the other two policies having No. 11556588 & 12873694, it is contended that no death benefit was available under these policies  & as such  payment of Rs.53,372.85 and Rs.28,990.17 was made to the complainant as per policy term and conditions.

       The OP has placed on record the policies documents, its terms and conditions the copies of letter dated 2.8.2011, 17.8.2011 and 25.10.2011 sent by the OP to the complainant.

     The counsel for the OP had further contended that as the full and final payment has already been made to the complaint, OP is not under any obligation to pay any further amount to the complainant. He has therefore prayed for the dismissal of Complaint.

     We are in agreement with the contention of the counsel for the OP .  The life assured had opted for half yearly mode of premium for its policy  No 11550952.  The same was due on 17.9.2010, and its grace period was of 30 days which was over on 16.10.2010.  The life assured had expired on 30.11.2010 hence at the time of his death the policy was in a lapsed state.  Thus as the policy lapsed before the death of the LA, no claim was payable under the  policy and the OP had rightly rejected the claim of the complainant in respect of the said policy.  A similar situation existed in respect of the Policy no. 11052899.

       While pursuing the record available in the file,  it has been  revealed that the OP had acted in accordance with the policy terms and conditions while making payment due in respect of the other two policies.  The complainant was  guilty of suppression of material facts, as he had failed to disclose receipt of payments which had already been credited to his account.

        In view of the above discussion and the documents placed on record,  we are unable to hold that there was any deficiency in service on the part of the OP.  We see no merits in the complaint, which is accordingly dismissed.

          Copy of the order be made available to the parties as per rule.

 File be consigned to record room.

          Announced in open sitting of the Forum on.....................