SRI NILAKANTHA PANDA, PRESIDENT

              The Complainant has filed this complaint petition, U/s-35 of C.P.A.-2019 (here-in-after called as the “C.P. Act - 2019”), on dated 11/08/2021, alleging a “deficiency-in-service” by the Ops, where, OP No.1 is the ICICI Prudential Life Insurance Company Ltd, being represented through its Branch Manager, Bolangir Branch, At. 1^st floor Tapaswini Plaza, Patanagarh Road, Near Civil Court, Balangir Town - 767001 and OP No.2 is Pragati Praharaj, at 20, Rajiv Nagar, AT/Po/Dist Balangir - 767001.

              The factual matrix of this case is that, the complainants are the successors of life assured Late Bhagabat Behera, who was serving under the Forest Department at Balangir, under Government of Odisha and used to stay there temporarily. During his service period, life assured Late Bhagahat Behera had purchased one policy  from OP No.1 through the agent OP No.2 with sum assured Rs.06,00,000/- (Rupees Six Lakhs Only) vide policy No.45741461 for 10 years with monthly premium of Rs.05,000/-. It is stated that said life assured paid the monthly premium in respect of the above policy till 20/9/2020 i.e. for the month of October, 2020 and he suddenly died due to heart attack at FM MCH, Balasore on 04/10/2020. Thereafter, the instant complainants to have their claim approached the OP No.1 for release of the benefits of said policy and presented all relevant documents, as required. But the OP No.1 did not pay any heed to their repeated request. Thus, the complainants sent legal notice against OP No. 1. But till today, OP No.1 has not taken any step for release of policy benefits to the instant complainants.

              Further, the case of the complainants is that OP No.2 is an agent appointed by OP No.1, who illegally reflected one stranger namely “Mrs. Santosini Meher” as the nominee of the policy in question, mentioning the status of such un-known person as “wife” of the life assured. She has no relationship with the family of the deceased life assured. During his life time, deceased life assured has requested OP No.2 for correction of the name of nominee in his policy bond, but he did not take any step for the purpose. OP No.2 has fraudulently shown Mrs. Santosini Meher as the spouse of deceased life assured. In fact, the complainant No.1 is the legally married wife of the deceased life assured, which is also reflected in the policy bond.

              It is further stated that the complainants are passing their days with mental agony as because they have not yet got their legitimate claims from the OP No.1 irrespective of repeated approach. Therefore, the Ops are liable for deficiency in service towards them.

              The cause of action for filing of this case arose on 09/04/2021, when the OP No.1 has received the served legal notice and did not take any step for disbursement of the policy benefits. Hence, finding no other way out, they have constrained to file this case.

              Hence, this case.   

              To substantiate their case, the complainants have relied on the following documents, which are placed in the record, as mentioned hereunder-

1. Photocopy of Policy bond with policy manual.
2. Photocopy of premium receipt.
3. Photocopy of proposal form.
4. Photocopy of benefit illustration for life time classic.
5. Photocopy of Death Certificate of Life Assured.
6. Photocopy of Legal Heir Certificate of life assured in the name of Complainants.

              In the present case, OP No.1 made his appearance and filed written version, whereas OP No.2 did not appear in this case, for which he was set ex parte vide order dated 12.04.2022.

              That in its written version, OP No.1 has not only challenged the cause of action to file the present case but also emphatically stated that the case is not maintainable. It has denied the allegations made out in the complaint petition. The OP No.1 has stated, inter alia, that insurance is a contract between the life assured and the insurance company. On submission of appropriate proposal form, the OP No.1 has issued the said policy. As per the proposal form, the life assured had disclosed his relationship with the nominee as the daughter (by virtue of Correction letter issued by life assured dated 20/08/2019) and on that basis OP No.1 had issued the policy in question. Further, life assured has taken no further step during its rest of his life time for any modification of name and / or relation with his nominee. That it is further stated that as per the terms and conditions of the policy contract, the “nominee” is entitled to receive the claim benefits. It is also further stated that till date, OP No.1 has not received any “death claim intimation” from the complainants and / or from the nominee for which death claim has not yet been processed to disburse. The claim of the complainants is in complete contravention to the terms & conditions procedural of the contract of insurance between the parties and here in this case the complainants are not the parties to the contract of insurance with the OP No.1. Therefore, the very question of deficiency in service on the part of OP No.1 does not arise at all. Hence, it is prayed to dismiss the case with cost.

              To substantiate its case, the OP No.1 has relied on the following documents, which are placed in the record, as mentioned hereunder-

1. Photocopy of proposal form, customer declaration form.  
2. Photocopy of letter dated 20/08/2019.
3. Photocopy of letter dated 06/02/2021  
4. Photocopy of authorization letter.
5. Photocopy of Nominee Status correction letter submitted by Life Assured

              In view of the above averments of parties, the points for determination in this case are as follows:-

(i)         Whether the complainant is a consumer or not?

(ii)         Whether the complainant has cause of action to file this case?

(iii)        Whether this consumer case is maintainable?

(iv)        Whether there is any deficiency in service on the part of the OPs?

(v)        Whether the complainant is entitled to get the relief, as sought for?

(vi)        To what other relief(s), the Complainant is entitled to? 

F  I  N  D  I  N  G  S

              That first of all it is to be ascertained as to whether the complainants are “Consumers” or not. From the averments of the pleadings of the complainants & document produced on behalf of the complainants vide above mentioned Annexures vis-à-vis the documents as submitted by the Ops, it is undisputedly admitted that the complainant number 1 is the legally married  wife of the life assured who is now dead. There is also no dispute regarding the status of complainant No 1 to this case matter & that of the policy / premium itself. Therefore, the complainant is, along with its surviving dependent children (Complainant 2 to 5) are well covered under the previews of definition of “Consumer” as defined under the provisions of the Consumer Protection Act, 2019.

              That to arrive at conclusion, weather, there is any “Cause of Action” arose  upon the part of the O.Ps, “Maintainability” of the case matter, “Deficiency” attributed to Ops, last but not the least, that whether the complainant is entitled to have any “Relief” thereof, the aspects following points, as stated by both complainants & respondent, are hereunder addressed collectively. 

              They are as under: -,

              That upon perusal of Annexure-1 of complainants as well as Annexure-A of OPs, it is reflected that the life assured although has supplied the information with regard to spouse as “Ranjulata Behera”, the complainant No.1, but supplied the name of nominee as one “Santosini Meher”. The relationship between the said nominee and life assured was shown as “wife”, but later on dated 20/08/2019, the life assured has changed the relationship from “wife” to “daughter” vide Annexure-B of OP No 1. It is the admitted fact that, life assured Bhagabat Behera was dead.

              Thus, it is held that a mere nomination made out under Section 39 of the Insurance Act does not have the effect of conferring on the nominee any beneficial interest in the amount payable under the insurance policy on the death of the life assured. The nomination only indicated the hand which was authorized to receive the amount on the payment of which the insurer got a valid discharge of its liability under the policy. The policy holder continued to have interest in the policy during his lifetime and the nominee acquired no sort of interest in the policy during the lifetime of the policy holder. Further, on the death of the policy holder, the amount payable under the policy became part of his (Policy Holder) estate which was governed by the Law of Succession applicable to him. Such succession may be testamentary or intestate. Section 39 of the Insurance Act did not operate as a third kind of succession which could be styled as a statutory testament. Therefore, a nominee could not be treated as being equivalent to that of an heir or legatee. The amount of interest under the policy could, therefore, be claimed by the heirs of the life assured in accordance with law of succession governing them. In the present case, the complainants have sworn affidavit stating that they are the legal heirs of deceased life assured Bhagabat Behera and also submitted Legal Heir Certificate issued by competent authority. Further, the Ops have miserably failed to prove by way of any documentary evidence that Mrs. Santosini Meher is the legal heir or successor in interest of deceased life assured Bhagabat Behera. Therefore, it is held that Mrs. Santosini Meher is not the legal heir / successor of deceased life assured Bhagabat Behera, hence not entitled to get the benefit under the insurance policy in question.

              That to ascertain the etymological meaning this commission followed the Law Lexicon, which says,

That the Law Lexicon speaks “Nominee under Policy of Insurance”: - A nominee under a policy of Insurance in the Official or Public Branch of the Government Life Assurance Department is not the beneficial owner under the rules governing the Insurance unless the wording of the nomination has that effect. Where the nomination merely authorises the Insurance Company to pay the amount to the "nominee", it does not amount to a bequest in favour of the nominee; nor does it create any right in the nominee except the right to collect it. The "nominee" is not in the position of a cesti que trust, but, is merely authorised to receive payment. 20 Mys LJ 63.

              In the case of Vishin N. Khanchandani and another v. VIdya Lachmandas Khanchandani and another reported in AIR-2000-SC-2747, Hon’ble Apex Court have been pleased to observe that –

           “Though the nominee of the national savings certificates has a right to be paid the sum due on such savings certificates after the death of the holder, yet be retains the said amount for the benefit of the person who are entitled to it under the law of succession applicable in the case, however, subject to the exception of deductions mentioned in the sub-section. Any amount paid to the nominee after valid deductions becomes the estate of the deceased. Such an estate devolves upon all persons who are entitled to succession under law, custom or testament of the deceased-holder. The nominee becoming entitled to the payment of the amount on account of national savings certificates received by him under S.6 read with S.7 of the Act is in turn liable to return the amount to those, in whose favour law creates beneficial interest, subject to the provisions of sub-section (2) of S.8 of the Act.”  

              In the present case, admittedly the life assured is dead leaving behind the Insurance policy bond vide Annexure-1 and the complainants as his legal heirs. Ops have not filed any documents evidence to show that the nominee in respect of the policy bond in question has made her claim under the policy left by the life assured. That it is seen that the Op No-1, has placed a copy of a letter issued to Sarojini Mehar, on dated 06/02/2021, to place her claim through “Claim State Form”. But has squirely failed to present any evidence of action taken by that S. Mehar, till date. The Ops have only claimed that they have not received any death claim intimation from the complainants or from the nominee for which death claim has not yet been disbursed. In the above facts and circumstances, when it is held that the complainants are the “Legal Heirs” of deceased life assured Bhagaban Behera, and on the contrary, the so-called nominee has not come forward with to claim the impugned insurance benefits, the complainants are rightfully entitled to receive the sum due on the aforesaid Insurance policy upon furnishing of proper certificate to that effect.

              Further, the deficiency in service can be alleged with attributing fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance which is required to be performed by a person in pursuance of a contract or otherwise in relation to any service. Here in this present case matter it is seen that on dated 05/09/2023, the OP No-1, has filled an adjournment petition stating that the OP No-1, is in an intention to settle the matter in an amicable out of court settlement, but to the dismay of this Commission that till date of disposal of this case matter the OP No 1, has not yet able to come out with any such solution as declared therein. Even though in the present case the OP No.1 has not received any death claim intimation from the complainants / nominee sum for which sum assured has not yet been disbursed. Still then, deficiency in service as alleged by the complainants against the Ops does is attributed for the reason stated above (Declaration Dated 05/09/2023). Hence, the complainants are entitled to the compensation, as claimed for.

              So, now upon careful consideration of all the materials available in the case record vis-a-vis submission made by complainants & O.P No.1, this Commission is of the unanimous opinion that the OP No 1 has not adjudicated their dispute properly before the Commission. There is no solution arrived by the O.P No 1 for the loss sustained / suffered by the Complainants incurring out of aforesaid deficiency on the part of OP No 1, which legally termed as deficiency-in-service by the O.P No 1. Therefore, the complainants are entitled to get  relief as sought for.

              Hence, it is ordered –

O   R   D   E   R

              That having regard to the judgement reflected above, the complaint petition of the instant complainants bears merit and hence allowed on contest against O.P No.1 & dismissed on exparte against O.P No.2. That, this Commission is of the unanimous opinion that there is a gross deficiency of service on the part of the O.P No.1

              That before assigning any award to present complainants, this Commission directs the complainants and / or their nominated representative out of the legal heirs to appear before the competent authority of the O.P No.1 and submit documents as required by them to resolve the matter and release the sum insured, with in a period of 30 days from date of receipt of this order, and, the O.P No.1, is also simultaneously directed to give a list of documents required in the case matter and receive those document and issue the acknowledgement receipt of those documents and to resolve the matter with in a time frame as directed below.

              The O.P No.1 is hereby directed to: -

1. pay the complainants the maturity value of the Policy, i.e. a sum of Rs 06,00,000/- with its other benefits as enumerated in the policy bond, along with 09% interest P.A., from the date of cause of action i.e. 09/04/2021 till actual date of payment.
2. pay the complainants a sum of Rs 30, 000/-, as compensation for mental agony & harassment.
3. pay the complainants a sum of Rs 20, 000/-, as litigation cost as incurred by the complainants.

              All the aforesaid ordered amounts / compliances will be paid / abided by the O.P No.1 to the complainants within 45 days from the date of receipt of all documents from complainants, as aforementioned in this order.

              That deferment in any manner / mode / reason / step for compliance of this order, the O.P No.1, shall carry an additional fine of Rs 750/-, per day of delay.

              In case of failure by the O.P No.1 to comply any of the orders as abovementioned, within the aforesaid stipulated time frame, the complainants is at liberty to realize the same from the O.P No.1 as per the prevailing law.

              Pronounced in the open Court of this Commission on this day i.e. the 19^th day of November, 2024 given under my signature & seal of the commission.