1.                     The brief facts of the case of the complainant are that her late husband, Ranganath Mohapatra during his life time had subscribed 2 Nos. of policies under Invest Gain – Economy product under the Ops in the name of their sons.  One policy was taken in the name of their son, Udit Narayan Mohapatra vides Policy No.0035172972 dt.05.1.2007 and another in the name of their son Aditya Narayan Mohapatra vides Policy No.0035170775 for a Sum Assured of Rs.3.00 lacs and Rs.2.80 lacs respectively with quarterly payment of premium dues.  Under both the policies, the present complainant being their mother was nominee.  It is submitted that the policy holder – Ranganath Mohapatra died on 02.08.2009 and the complainant approached OP.1 for settlement of claims personally and sent reminders on 24.3.2010 and 28.4.2014 but the Ops did not settle the claim.  The complainant has also sent registered letter on 24.2.2016 to OP.1 requesting settlement of claim but in vain.  It is further submitted that to the Advocate Notice dt.21.6.2016 of the complainant, the OP.1 replied on 14.7.2016 that no claim has been made by the complainant so far.  Thus alleging deficiency in service on the part of the Ops, she filed this case praying the Forum to direct the Ops to pay Rs.5, 80,000/- towards maturity benefits under two policies and to pay Rs.1.00 lac towards compensation and costs to the complainant.

2.                     The Ops filed counter in joint denying the allegations of the complainant but admitted about the policies taken by the policy holder – Mr. Ranganath Mohapatra in the name of their sons Aditya and Udaya vide Policy No.0035170775 and No.35172972 respectively on 05.01.2007.  It is contended that the complainant has misunderstood the policy terms and conditions wherein death benefit is payable upon death of LA only but not the policy holder and hence the claim of the complainant for death benefit under the policies where the life assured is alive, is untenable.  It is also contended that in case of death of policy holder, the nominee can become the policy holder and since the policies are discontinued, the surrendered value of the policy will be converted to a reduced paid up policy but the complainant is not entitled for any death benefit.  Thus denying any deficiency in service on their part, the Ops prayed to dismiss the case of the complainant.

3.                     Both the parties have filed certain documents along with affidavits in support of their cases.  Heard from the parties through their respective A/Rs and perused the materials available on record.

4.                     In this case it is an admitted fact that the late husband of the complainant during his life time had subscribed for 2 Nos. of policies under InvestGain-Economy of Ops commenced from 05.01.2007 for their sons Uday vide Policy No.0035172972 and for another son Aditya vide Policy No.0035170775 for sum assured of Rs.3.00 lacs and Rs.2.80 lacs respectively with quarterly payment mode.  It is also a fact that the policy holder – R.N. Mohapatra died on 02.08.2009.  The case of the complainant is that on her repeated requests as the Ops did not settle the death claim under the policies, she sent registered notice through his advocate on 21.6.2016 to the Ops and the OP.1 only replied on 14.7.2016 that the complainant has not advanced death claim under the policies so far.  The complainant in support of her above contentions has filed copy of her applications from which it is found that her application dt.23.3.2010 has been duly acknowledged by OP.1 on 24.3.2010 with seal and signature.  Hence the contention of OP.1 in his reply to the advocate’s notice that no death claim is advanced so far is not acceptable by us.

5.                     In their counter the Ops stated that the claim of the complainant for death benefit is against the conditions of the policy wherein the life assured are still alive and Mr. R. N. Mohapatra is only the policy holder/premium payer who died on 02.08.2009.  It is stated that both the policies are on lapsed condition and as per rule, if the premium payments are discontinued for the policy as acquired paid up policy, the basic sum assured would be reduced by a factor equal to the proportion of the number of premiums paid corresponding to the total number of premiums payable.

6.                     The learned Counsel for the complainant vehemently objected to the contention of the Ops that the present status of the policies is lapsed.  He relied upon Section.50 of the Insurance Act which reveals as follows:

                        “50. Notice of options available to the assured on the lapsing of a policy.—An insurer shall, (before the expiry of three months from the date on which the premiums in respect of a policy of life insurance were payable but not paid,) give notice to the policy-holder informing him of the options available to him.”  In the present case of the complainant, the statutory obligations u/s.50 of Insurance Act has not been followed by the Ops.  In view of the above facts and circumstances, it cannot be said that the policies are in lapsed conditions.

7.                     Further the learned Counsel for the complainant submitted that the waiver of premium benefit under Bajaj AllianzGain is available.  He has referred the policy terms and conditions the copy of which is available on record.  It has been laid down in the said policy documents as follows: “We very well understand that a dreaded disease or accidental disability or even death can rob us of regular earnings for ourselves or our family.  Such dreadful situations can take a toll on our long term financial goals due to want of funds.  An insurance plan in place would definitely take care of the immediate crisis.  But, how do we provide for our long term goals?  We at Bajaj Allianz understand the need – come what may! Bajaj Allianz Waiver of Premium (WOP) benefit Rider provides you the benefit of waiver of all future premiums payable under the base policy and applicable riders on the earlier occurrence of untimely death, accidental permanent total disability or critical illness.”  From the above facts it became very much clear that there exists waiver of premium benefits under the policies and it waives off of future premiums in case of death while keeping the available life insurance cover alive. 

8.                     Now coming to the point of death claim under both the policies, it is seen that, as we already hold supra, the policies acquired waiver of premium benefits and the Ops have not followed the conditions U/s.50 of Insurance Act..  Date of last premium under both the policies was 05.01.2016 that means premium paying period is over.  It is seen that the LAs have become major and for their higher studies money is required.  On the other hand the complainant is a helpless lady after a sorrowful demise of her husband and sole earning member of her family.  Hence money is a matter of concern for the complainant now.

9.                     Further Insurance Act and the Consumer Forums under C. P. Act are welfare legislations constituted by the statute.  The insurance policy is being taken and its aim for helping the insured persons at the time of need.  In the above circumstances, we feel that it would be just and proper to direct the OPs to settle the death claim in favour of the complainant and pay the maturity value in case of both the policies in the interest of justice.  However, non settlement of death claims under the above circumstances in a fair manner amounts to deficiency in service on the part of the Ops and for such inaction of the Ops, the complainant must have suffered some mental agony and also has come up with this case incurring some expenditure.  Hence she is entitled for some compensation and costs.  Considering the sufferings of the complainant, we feel a sum of Rs.5, 000/- towards compensation and costs in favour of the complainant will meet the ends of justice.

10.                   Hence ordered that the complaint petition is allowed in part and the Ops being jointly and severally liable are directed to pay Rs.5, 80,000/- towards sum assured under both the policies with other death benefits besides Rs.5, 000/- towards compensation and costs to the complainant within 30 days from the date of communication of this order failing which the awarded sum shall carry interest @ 12% p.a. from the date of this order till payment.

(to dict.)