- This complaint is about arbitrary under payment of Life Insurance Policy No.591133248 relating to Sanjay Kumar Agrawal died in a road accident on 24.11.2011. The complainant is the nominee. The sum assured was Rs.1.00 Lakh. The complainant alleged that the O.P only paid Rs.16,480/- vide letter dated 16.3.2012. The complainant made a protest letter dated 28.1.2013 through registered post. During the death period of insured the Bima Kiran Policy had covered 16 years out of 30 years term commencing from 28.9.1995. Half yearly basis premium of Rs.515/- has been paid in 32 times. The O.P paid all other policies discriminating to pay the policy No.59113328. The discrimination amount to deficiency in service. The Opp. Party failed to apply its mind to the policy conditions and their implications without following the guidelines.
- The O.P after appearance in this case filed show cause, admitted that the complainant is the nominee of the assured deceased Sanjay Kumar Agrawal in respect of “Bima Kiran” policy No.591133248. The Opp. Party has not acted arbitrarily. Each policy has been dealt as per its own merit. After receipt of claim papers the Opp. Party noticed that the assured died on 24.11.20112 and the first unpaid premium (FUP) of policy No.591133248 was due on 28.9.2011. The policy was on lapse condition at the time of death of the life assured. The grace period was for 30 days. After the grace period the assured died. The Bima Kiran policy (T-111/30) covered the paid up value i,e, total premium paid (less extra Premium) as death claim. The 32 half yearly premium @ Rs.515/- comes to Rs.16,480/- as death claim paid to the complainant vide cheque No.0803284 dated 19.3.2012 . Claim concession/extended claim concession is not applicable to table 111. The Opp.Party rightly paid the calculated death claim.
- After the perusal of the complaint, Show cause of the Opp. Party and documents filed by the parties the following issues are framed:
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1) Whether the Opp. Party calculated the death claim in a right manner?
(2)What relief the complainant is entitled to get?
ISSUE NO.1. Whether the Opp. Party calculated the death claim in a right manner?
It is the admitted case of both the parties that the life assured died on 24.11.2011 and the premium was due on 28.9.2011 against policy No.591133248. The assured has paid 32 times half yearly premium. As per table 111 policy terms and conditions the death of the assured occurred after days of grace and as the policy was in force for more than five years only notional paid up value was paid. Paid up value is equal to total premiums paid less extra premium paid as death claim. Further extended claim concession and Chairman’s Rules, 1987 are not applicable to Table 111 policy. In a general policy concessions are available to a lapsed policy.
In the present case the Opp. Party has clearly mentioned the detail calculation and death claim paid at Para-5 of the Show Cause. Accordingly, as the calculation is based on policy terms and conditions the issue is answered in favour of the Opp. Party.
ISSUE NO.2.What relief the complainant is entitled to get?
As discussion supra, the complainant has received the payment amounting to Rs.16,480/- vide cheque No.0803284 dtd.19.,3.2012 as death claim of deceased. Accordingly it is ordered:
O R D E R.
The complaint is dismissed on contest. Parties are to bear their own cost.
Order pronounced in open court on this 26th day of April,2022.
Supply a copy of this judgment to the parties free of cost.
