This case has been brought by complainant namely Ajay Kumar S/o Late Abhiram Singh, R/o House no.1 Ramjaipal Nagar, Near Sonu Market, Gola Road, Danapur Market, Gola Road, Danapur Patna-801503 against O.P’s Reliance Nippon Life Insurance company ltd, Railway centre, 5th floor off western expressway highway, Santacruz East Mumbai-400055, Maharashtra,(O.P.no.1) 2. Vaiva Vidya, Head-claims Relaince Nippon Life Insurance Company Ltd Reliance centre, 5th floor off western expressway highway, Santacruz east Mumbai-400055, Maharashtra (O.P no.2) 3 and Reliance Nippon Life Insurance Company ltd, 4th floor, Shahi Bhawan, Exhibition Road, Patna-800001 (O.P no.3) for the following reliefs,
- Opposite Party be directed to pay Rs.9,45,900.88/- remaining claim amount plus Rs.4lacs for mental agony and Rs.50,000/- for litigation cost.
The above reliefs have been claimed on account of the fact that Complainant had taken a policy bearing no.52600862, in the name of his wife Krishnamani Devi on 21.03.2016. Unfortunately she died due to natural reason on 10.02.2018 and he had applied claim for her death on 14.03.2018 for payment of sum assured amount of Rs.14,00,000/- against which Rs.454099.88/- was credited only on 31.03.2018 but rest of the amount has not been paid for which he has requested on several times but O.P refused to pay the balance amount stating that the D.L.A was a house wife and her husband does not have any insurance policy. Further stated that actually Rs.9,45,900.88/- is still due along with interest.
It appears that in this case Opposite Parties have appeared and filed W.S in detail but after going through the entire facts as stated therein. It is stated that the Complainant has alleged that in the name of his wife Mrs. Krishnamani Devi a insurance policy bearing policy no.52600862 was opened on 21.03.2016 but D.L.A (deceased life assured) died on 10.02.2018 and on account of her death claim intimation Opposite Party paid only Rs.4,54,099/- but Complainant has still claiming for rest of the payment and also cost for mental agony and litigation cost but it has been stated by O.P that there is no deficiency of service on the part of Opposite Parties and the Complainant is not entitled for any reliefs what so ever. Because after duly filled form dated 21.03.2016 in the name of Mrs. Krishnamani Devi wherein the proposal under the policy was for the Complainant Ajay Kumar who is the husband of D.L.A wherein the sum assured has been shown 14lacs and proposal has been signed on 22.03.2016. Installment premium amount Rs.2 lacs total premium were paid twice in number. It has also been stated therein that there is free look period to amend the policy within 15 days. The deceased life assured expired on 10.02.2018 and thereafter death claim intimation dated 14.03.2018 was received. DLA died on 10.02.2018. The policy duration was only of 1 year 10 months 9 days on behalf of O.P no.1, 2 and 3. It has also been stated that during claim investigation it came to the knowledge of Opposite Party that the deceased life assured had given false declaration in the proposal form regarding the existing insurance policy on the life of Complainant/proposal who is the husband of DLA upon the basis of the policy as stated above for the sum Rs.14lacs. DLA did not have any independent income of her own. Complainant had stated in question no.27 of the proposal form that he had an existing Insurance cover of Rs.18 lacs which was found to be absolutely false and misleading. It was revealed during investigation that the Complainant did not have any existing Insurance cover on his life and as per the terms total premium amount paid had to be refunded to Complainant. Accordingly, the amount has been paid. Further, it appears that though in detail about committing fraud and also about frivolous and vexatious approach has been shown against Complainant and same is moving around only against the fact that while the proposal was made the true picture about the existing policy has not been brought. Therefore, this case is not maintainable and is in violation of the provision of IRDAI rules. There is no deficiency of service or negligence on the part of O.P. The principal of uberrima fides is the rocky foundation of the contract of Insurance. It has been emphasized in W.S. that proposer has himself admitted in copy of complaint that the proposal was signed by the Complainant and D.L.A which would amount that the proposer was having well aware of the policy terms and consequences, therefore, submitted that this complaint is fit to be dismissed.
The main point for consideration in this case is that whether the Complainant is entitled to a claim as prayed?
Learned Counsel on behalf of Complainant submitted at the first that Complainant is the husband and also the nominee of the policy holder. The Insurance Company however on account of claim after the death of the policy holder namely Krishnamani Devi on 10.02.2018 altogether rest Rs.454099.88/- had deposited into account but rejected about the rest payment which was infact based as per policy. The main objection raised by the insurer that husband of D.L.A was having no policy which is quite wrong and claimant has not concealed anything rather existing policy for Rs.18 lacs was disclosed. Therefore, the claim of the Complainant for Rs.454099.88/- rupees out of Rs.14 lacs only has been decided which is quite wrong and against the policy as the D.L.A was policy holder and policy was for Rs.14 lacs. On life of husband / parent (all policies) have been shown as Rs 18 lacs in column of question no.27 which would falsify the case of the Insurance Company O.P and nothing has been concealed or fraud has been committed on behalf of Complainant. Hence, submitted that the case of Complainant be allowed.
It has been submitted in contrary to the submission as above on behalf of O.P no.1, 2 and 3 that during claim investigation it came to the knowledge of the O.P’s that the deceased life assured had given false declaration in the proposal form regarding the existing Insurance cover about life of the Complainant proposer who is the husband of DLA and upon the basis the policy bearing no.52600862 for sum assured DLA did not have any independent income of her own. Further submitted that in question no.27 of the proposal form it has been mentioned that he has an existing insurance cover of Rs.18 lacs which was found to be absolutely false and misleading. It was revealed during investigation that the Complainant did not have any existing Insurance cover on his life. Hence, the O.P on account of misleading whatever found sent letter dated 31.03.2018 to the complainant/ proposer intimating about the aforesaid misrepresentation and to show the goodwill O.P’s had refunded the amount of Rs.4,54,099/- as a full and final settlement of the claim amount. It has also been submitted that this claim application is not maintainable under the IRDAI regulation and section 45 of the Insurance Act and further submitted that rest facts have mentioned in W.S elaborately. Therefore, submitted that there is no deficiency of service on the part of O.P.
Considering the submissions as raised on behalf of both sides as well as on perusal of the pleading and the documents as placed we find that the Complainant has brought this case for Rs.9,45,900.88/- after payment shown as above and also for the cost. On account of policy no.52600862 in the name of Krishnamani Devi w/o Complainant premium installments has been shown for Rs.2lacs and sum assured for such policy Rs.14 lacs. Policy term to 10 years. The deceased (W/c) died on 10.02.2018 of natural death. The Complainant made claim of Rs. 14 lacs as per the policy but only Rs.4,54,099.12/- has been paid and Opposite Party has refused to pay any remaining amount by assigning reason that faulty and misleading statement was furnished that her husband has any insurance policy but the plea taken by the O.P does not appear to be convincing Annexure 1 shows about the policy held by the Complainant for Rs.18lacs and same has been disclosed in column no.27 but not concealed. It is only a matter of consideration that whether after death of policy holder namely Krishnamani Devi of policy no.52600862 Complainant being husband is entitled to entire claim amount or not. Whereon before her death two installments were paid and the policy holder died within the valid tenure. We therefore, in this case find that the plea taken by the O.P as discussed above has got no leg to stand.
Hence, under the aforesaid facts and circumstances as discussed above and also after perusal of pleadings and documents available on record we constrained to allow this complaint case and O.P’s 1 to 3 are directed to pay Rs.9,45,900.88/-(Nine lacs forty five thousand nine hundred rupees and eighty eight paise only) along with 6% p.a accrued thereon since 31 March 2018 to which the part payment has been made. There shall be no other cost. The above payment shall have to be made by the O.P’s above within two months of the order. In case of non-payment claimant shall be entitled to recover the amount in due course of law.
