( Passed on dated 29th September, 2015 )
Per Shri Atul D. Alsi – Hon’ble President.
The complainant had took life insurance policy namely RELIANCE LIFE INSURANCE GUARANTEED MONEY BACK PLAN towards life insurance of his wife namely Smt. Rachna w/o. Vinodkumar Modi. The authorized agent of opposite party No. 1 & 2 had collected dully filled proposal form from complainant on dated 21/02/2013 along with first premium cheque No. 383387, dated 21/02/2013 drawn on PNB Bank, Branch Gondia for worth Rs. 50,000/-. The above mentioned first premium cheque was duly encashed in account of opposite party on dated 23/03/2013. Thus, if the insurance policy protection cover was not available from date of collection of proposal form i.e. date 21/08/2013, it must be available from date of encashment of premium cheque i.e. 23/02/2013, as mentioned in premium receipt of opposite party.
2. Unfortunately on dated 25/02/2013, complainant’s wife namely Smt. Rachna was suddenly died and left this world. Complainant had received letter of opposite party on dated 31/03/2013 informing complainant regarding issuance of policy No. 50778593 and further that policy commenced from 31/03/2013. The above act of opposite party to make delay in issuance of policy cover from dated 31/03/2013, in spite of receipt of proposal form on dated 21/02/2013 and encashment of premium cheque on dated 23/02/2013, amounts to deficiency in service and unfair trade practice. The complainant is legally entitled for benefit of life insurance policy as per money back plan.
3. The complainant had submitted the death claim intimation and claim form with opposite party No. 2 on dated 24/04/2013. But opposite party No. 1 & 2 had failed to settle the claim of complainant till today.
4. The complainant had issued legal notice dated 12/08/2013 to opposite party, thereby call upon opposite party No. 1 & 2 to make the payment of sum insured Rs. 2,16,000/- along with all death benefits to complainant.
5. The complainant praying to direct the opposite party to pay sum insured Rs.2,16,000/- along with all death benefits to complainant, with 12% interest from the date of death of insured i.e. dated 25/02/2013. The complainant is also prayed to direct the opposite party to pay compensation of Rs.25,000/- towards mental harassment and Rs.25,000/- towards litigation charges.
6. The complaint admitted and notices were issued.
7. After receiving the notice issued by the Forum, the O.P. appeared through their counsel but failed to submit their written statement before the forum. Hence, this Forum had passed No W.S. order against O. P. 1 & 2 on Exh.1 on 26/06/2015.
8. The complainant has filed copy of policy schedule at page no. 13, Copy of statement at page no. 16, Copy of death certificate at page no. 17, Legal notice dated 12/08/2013 at page no. 18, postal receipts and acknowledgements at page no. 21 on record.
9. The learned counsel for complainant Mr. S. B. Rajankar filed pursis that he did not want to adduce evidence and submitted that the complaint may treated as written notes of argument.
10. As per petition and arguments and documents filed on record following points came for consideration:-
Sr. No. | Points | Findings |
1. | Whether the O.P. has committed deficiency in service by not allowing the insurance claim of complainant? | YES |
2. | What Order? | As per final order. |
REASONING & FINDINGS
11. The complainant has filed policy schedule on page No.13. It has mentioned that the date of issue of policy is 31st March, 2013. The date of maturity of policy is 31st March, 2028. The policy terms is 15 years and in case of death before 31st March, 2028 Rs. 2,16,000/- will be payable plus maturity and money back benefits as specified in policy. The complainant had submitted proposal form of deceased Rachana Modi the wife of complainant with O. P.. The proposal form was filed and submitted along with money of first installment of Rs.50,000/- vide cheque No. 383387, dated 21/02/2013 drawn on PNB Bank, Branch Gondia. The proposal form was accepted by opposite party on 21st February, 2013 as per stamp impression along with date is mentioned on receipt filed on page no. 13. The client code identification number was also given to the deceased at the time of acceptance of payment & proposal form.
12. It is unfortunate that the wife of complainant died on 25/02/2013. The opposite party ought to have refunded the premium amount of Rs.50,000/- to the complainant as the date mentioned in issue of policy i.e. 31st March, 2013 because the wife of complainant was not alive. In spite of knowledge of death of wife of complainant before inception of policy or after knowing the fact by intimation of legal notice the opposite party ought to have cancel the policy & ought to have refund the money. Hence the circumstances so presume that the opposite party might have with intention to avoid liability issued the insurance policy for extended date. It is accepted from circumstances that the O.P. has accepted the liability of policy holder from the date of receipt of proposal and amount of premium when policy holder was alive because no policy of dead person is issued. At the time of issue of policy the wife of complainant was not alive and the policy is not accepted by the O. P. Hence from the date of acceptance of proposal and amount the liability of O. P. begins. Hence, opposite party is liable to pay the sum assured of Rs.2,16,000/- along with all benefits to the complainant as per following order :-
-: ORDER :-
1. The complaint is partly allowed.
2. The O. P. 1 & 2 are directed to pay Rs.2,16,000/- (in wards Rupees Two Lacs Sixteen Thousand only) along with all benefits under the policy bearing No. 50778593 to the complainant with interest @ 9% p.a. from the date of admission of complaint i.e. 23/04/2014 till its realization..
3. The O. P. 1 & 2 are directed to pay Rs.15,000/- towards mental torture and Rs.10,000/- towards cost of litigation.
4. The O. P. 1 & 2 are directed to pay the aforesaid amount jointly & severally to the complainant.
5. The above amount shall be paid within 30 days from the date of receipt of this order.
