The complainant has filed this complaint U/S 12 of consumer protection Act 1986 against the o.p. Insurer/Reliance Life Insurance Company Ltd. praying for direction upon the O.P.s 1) to pay sum assured of Rs 75000/- (Rupees Seventy five thousand only ) along with interest at the rate of 10% per annum from the date of filing claim petition before the O.P.s on account of the said policy, 2) O.Ps be directed to pay the compensation of Rs 15000/- for unnecessary harassment, mental pain and agony of the complainant, 3) litigation cost of Rs 5000/- to be awarded to the complainant and 4) any other relief be granted as the court thinks fit and proper.
The fact of the case is that the husband of the complainant late Aswani Barman was holder of Insurance policy under Reliance Traditional Super Invest Assurance Plan under policy No 18061838 and policy holder ID No 77691383 with O.P No 2. The period of cover of the said policy was from 16/10/10 to 16/10/25, sum assured was Rs 75000/- with yearly premium of Rs 10000/- only. The complainant was the nominee of the said policy. The husband of the complainant died on 15/12/12.
After the death of her husband who was the holder of the said insurance policy, the complainant reported the matter and filed claim with O.P No 2 in appropriate form within 30 days from the death of her husbands death .Though at the time of death of her husband the policy in his name was in force and accordingly to the terms and condition of the policy, the O.Ps were liable to make payment of entitled amount to the claimant, the legitimate claim of the complainant was not entertained, which according to the complainant amounts to negligence and deficiency in service on the part of the O.P. Insurance Company and for this Act of the O.Ps ,the complainant suffered irreparable loss due to non-payment of the sum assured. So the present case has been filed.
The O.Ps/Insurance Company has contested the case by submitting a written version where in they have submitted that all the material allegations made in the complainants application filed by the complainant are false and not maintainable either in facts or in law against O.P. Insurance Company. The O.Ps have further submitted that instant petition of complaint is Barred by law of limitation, is wholly misconceived , groundless and filed under mistaken understanding and accordingly this complaint is liable to be dismissed with exemplary cost in favour of the opposite parties. The complainant has filed one affidavit-in-chief along with some documents in support of a claim. She was also examined and cross examined as PW1 by Lawyer of both sides.
Decisions with reasons
Giving due consideration to the contents of the petition of complaint, W.V., documentary evidence of record and hearing advanced by the Ld. Lawyers of both parties; the Ld. Forum has come to the findings as follows: -
The complainant in support of her claim has submitted 1) Xerox copy of booklet explaining terms and conditions of the policy 2) copy of customer identity proof bearing No DMG1109503 issued by O.P insurer 3) copy of Insurance proposal form filed up by complainants husband in application No K7349680 with first premium amount of RS 10000/-, filed with the O.P Insurance Company 4) copy of first premium receipt dated 18/10/10 issued by O.P Insurance Company of RS 10000/ 5) Premium collection receipt against lapsed policy bearing No WC0018307517 of RS 10000/- dated 12/12/12, next renewal date being 16/10/13 and 6) copy of death certificate of the policy holder and husband of the complainant late Aswani Barman bearing registration No 114/A dated 26/12/12, stating that the date of death of the insured was 15/12/12. From these documents it is proved that husband of the complainant died during the validity period of the instant Insurance policy. From the booklet issued by the O.P Insurance Company, describing terms and conditions and benefit of the instant policy, it is found at Para 4.1.3 under heading commencement of risk cover that if the age of life assured on commencement of the policy was equal to or greater than 12years, commencement of the risk cover on the life assured will be Immediately. Here the basic sum assured in the policy of the complainants deceased husband was Rs 75000/- and age at entry of the policy holder was 47 years. Therefore, according to terms and condition of the instant policy, the nominee of the deceased policy holder was entitled to get assured sum of Rs 75000/- immediately. The complainant has come before this Forum as this claim of the complainant was not entertained by the O.P. Insurance Company.
Main points raised by the O.P. Insurance Company for not entertaining complainants claims, as it appears from the W.V submitted by the O.Ps is concealment of material fact by the policy holder before issuance of the policy that life assured had undergone treatment for Gangrene before the issuance of the policy.
It is found from complainants petition at Para No 7 that the claimant is an illiterate housewife of backward classes. Due to premature and tragic demise of her husband, the claimant was very much shocked and could not come before the others for considerable periods. The complainant in her complaint application has also stated that the petitioner reported the matter of her husbands death to the office of O.P. No 2. As the legitimate claim of the complainant was not entertained by the O.Ps she has come to this Forum for justice. Here the O.Ps did not repudiate her claim in writing. So considering the complainant being from backward class and illiterate, she was not familiar with of official procedures of filing claim .In the circumstances we take up the instant case for consideration of her complain as she is entitled to get her claim.
The Insured died more than 2 (two) years from the date of purchase of the policy on 16/10/10. There is no evidence from the Insurer side that the Insurer had a pre existing disease. In this case burden of proof lies upon the Insurer to prove that there was pre-existing disease on the date of purchase of a policy. Without further enquiry the Insurer had also renewed the policy. So it cannot be an accepted ground for repudiation of claim of the policy holder and the nominee of the late policy holder is entitled to get the insured amount i.e. Rs 75000/- from the opposite parties/Insurance Company. Therefore we hold that the complainant is entitled to get the Insured amount from the opposite parties /Insurer without any cost and compensation as because she failed to inform the O.P/Insurer about her husband’s death in time.
Fees paid are correct.
Hence it is ordered,-
That the case bearing No CC- 26/2013 is allowed on contest against the opposite parties /Insurer without any cost and compensation.
That the complainant do get an order of award of Rs 75000/-(Rupees seventy five thousand only) against the opposite party M/S Reliance Life Insurance Company Limited .The Opposite party/Insurer is directed to pay the money as stated above within one month from passing of this order failing which the order may be put into execution.
Furnish the photocopies of the final order to the parties free of cost.
