MR. PRABODHA KUMAR DASH, PRESIDENT:-             

                      Complainant filed the present C.C.Case No. 12/2022 being aggrieved by the delay in claim settlement by Tata AIA Insurance Company Ltd. On death of his wife policy holder (insured).

Brief Fact:-

                        Complainant’s wife (deceased) was insured under the Ops bearing Policy No. C222199948, date of commencement of Policy was 21.02.2019, date of risk also in same date. The deceased insured under the insurer in Tata AIA Insurance Samporna Raksha, sum assured Rs. 50,00,000/-(Fifty Lakhs). Premium amount Rs. 45,249/- yearly. Duration of policy 11years11 months 7 days the insured died at the age of 56 years in care hospital on dt. 29.01.20221 while undergoing treatment in breathlessness & chest discomfort the husband being nominee in said policy claimed the death benefit under the policy the ops took more than 6 months only given sum assured without interest of delay. Being aggrieved by such deficiency the nominee/complainant filed present C.C.Case for deficiency & unfair trade practice of Ops and the same should be redressed by this Honbl’e Commission.

                        Heard for complainant appeared in person & Ld. Counsel for Ops. Perused the materials available on record. Gone through the complainant averments and written version on behalf of Ops.     

                        The Complainant being a nominee of his deceased wife is a consumer within subsection2(5)(vi) being the husband also nominee as the Complainant & Ops are service provider to complainant under Sec-2(7)(ii) the Complainant in consumer.

                         The insured died on dt. 29/01/2021 & the Ops settled only sum assured after 6 months of claims therefore the C.C.Case was filed on 21/04/2022 which is well within the prescribed period of limitation.

                      Non-payment of claimed amount within 15 days of death of insured & the Ops made payment after more than 6 months in the deficiency as per the meaning prescribed by sub section 2(ii)(i) the act of negligence or omission by the Ops which causes loss or injury to the consumer & deliberate withholding the death claim for long period is deficiency of service. As per Regulation 14(2)(i) of IRDAI (Protection of Policy holders interest) Regulation, 2017, a death claim under a Life Insurance Policy shall be paid or be rejected or repudiated giving all the relevant reasons within 30 days from the date of receipt of all relevant papers & required clarification. It was held in Rajesh Kumar Hiralal Bajaj Vs Oriental Insurance Company Ltd. Honbl’e Bombay High Court on dt. 07/10/1994 said delay in settlement of justifiable insurance claim is a deficiency in the service of Insurance Company. Delays in settlement of Insurance claims are common in India. Worse, the insured may have to face lot of hassles and may be made to run from pillar to post by the Insurance Company to get the claim settled. If the Insurance fails to make the payment of claim the stipulated time limit the Company will have to pay a penal interest that is @2% more than the Bank rate specified by the IRDAI as on April 1 to 2017.Further in Samiran Bhadra vs ICICI Prudential 2018(2) CPR 584(NC) IRDA guidelines allows processing time of 10 days for any request received from policy holder for surrender of policy.

                       The insured died on 29.01.2021 Complainant nominee deposited relevant paper on dt. 08/03/2021 but the actual payment made on dt. 14/09/2021. As we found the evidence produced by Complainant he submitted claim form with documents on dt. 08.03.2021 but the Ops sent letter that the Complainant submitted on 22.05.2021 which is wrong and not admissible because of sufficient documentary evidence exhibited confirmed the date of claim intimation was on 08.03.2021. The delay in settlement of Claim was 6 months & 6 days. Complainant intimated the Ops on dt. 08.03.21 & Ops could not made payment within 30 days as per mandate of IRDA guideline, regulation but Ops failed to performed statutory duties & delay in settlement of death claim by insured cannot be justified which was upheld by National Commission  LIC vs Dharmendra Choudhary 2018(2)CPR66(NC). Complainant approached the insurer in time & submitted documents to the Ops for releasing claimed benefit, but the same were not attended to within prescribed period of 30 days, as prescribed by IRDA on account of unusual delay of 6 months 6days caused in claim settlement prejudiced the complainant forced to approach this commission against the Op for deficient of service of Insurance for interest for such delay of 6 months 6 days with @ 18% P.A is just & proper for non a positive interest on Ops for non-settlement on a contractual obligation which cast a duty on the insurer to perform his duties as per terms & condition therein and there under. The Ops intentions was evil they constrained the Complainant to file case before Honbl’e High Court then they released the amount without interest the same was received by Complainant on protest which was not voluntarily acceptances. The Complainant again constrained to file C.C.Case for payment of interest before DCDRC, whereby mental agony suffered by Complainant with litigation cost incurred for the settlement of claims. Non-payment of interest with sum assured is a inseparable part of dispute which can be well address by us. In ordinate delay remained unexplained showing carelessness on part of Ops. The Ops are liable for interest which is pre requisite for an inordinate delay of more than 6 months. The Ops failed to substantiate with sufficient cause for such delay when the Insurance Act, IRDA guidelines prescribed for strict principle for settlement of claims. The claimant can’t wait indefinitely for payment of claim benefit. Once the Court accepts the Ops are deficient in service or unfair trade practice then it is the discretion to uphold the interest part by recording justifiable findings. In a decided case LIC was directed to pay interest for delay of 4 months for settlement of claims in Sarajabi Priajichinchore’s case by Honbl’e Pune Consumer Commission.

                                                                   O R D E R

                     Taking into consideration of facts & laws discussed above it is directed the Ops are liable to pay the complainant interest @18% P.A. on sum assured Rs. 50,00,000/- already received for delay of 6months 6 days and Rs. 50,000/- for mental agony suffered & Rs. 5,000/- as litigation cost failing which the Ops are liable as Judgement debtor under execution proceeding as per C.P.Act,2019.

On the above observation the C.C.Case is disposed off.

                      Issue extract of the order to the parties for compliance.           

       Pronounced in the open Court, on this the 18th day of October,2022.             

                              I, agree

                                Sd/-                                       Sd/-     

                           MEMBER                             PRESIDENT