1.                     The brief facts of the case of the complainant are that her late husband during his life time had obtained a policy from Reliance Life Insurance Co. vide Policy No.14240259 dt.31.3.2009 Cash Flow Plan with yearly premium of Rs.11, 271/- for a sum assured of Rs.1, 30,000/- and had deposited the premium from the year 2009 to 2014 regularly.  It is submitted that her husband died on 26.6.2015 and the fact of death was intimated to the Ops but the OP.1 gave impression to the complainant that the nominee will get the deposited premiums only.  It is further submitted that in spite of repeated requests the Ops have not settled the claim.  Thus alleging deficiency in service on the part of the Ops, she has filed this case praying the Forum to direct the Ops to settle death claim with interest @ 18% p.a. and to pay Rs.1.00 lac towards compensation to the complainant.

2.                     The Ops filed counter in joint denying the allegations of the complainant but admitted about the Cash Flow Plan issued by them in favour of Santanu Kumar Patro on 31.3.2009 for a sum assured Rs.1, 30,000/- with annual premium of Rs.11, 271/- vide Policy No.14240259.  The Ops with some preliminary objections contended that the complainant has neither communicated the death intimation of the Life Assured (LA) nor approached the Ops regarding death claim before filing of this present case.  The Ops contended that they have paid survival benefit to the LA on 20.3.2013.  Thus denying any deficiency in service on their part, the Ops prayed to dismiss the case of the complainant.

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

4.                     In this case Reliance Life Insurance Policy vide No.14240259 dt.31.3.2009 under cash flow plan for a sum assured Rs.1, 30,000/- with yearly premium of Rs.11, 271/- issued in favour of Santanu Kumar Patro under which the present complainant is the nominee are all admitted facts.  It is a fact that the LA did on 26.6.2015 which is supported by the certificate of Registrar, Birth and Death, Jeypore Municipality.  The case of the complainant is that she met OP.1 in his office for settlement of death claim but the complainant was given impression by the said OP that the nominee will get the deposited premium amount only.  The Ops stated in their counter that they have neither received any death intimation of LA nor received any claim application from the complainant as nominee.

5.                     It is seen from the record that the complainant has intimated the OP.1 about the death of her husband to OP.1 through her application dt.15.7.2015 and also requested the said authority to supply necessary claim forms for settlement of death claim of her late husband.  The copy of application dt.15.7.2015 is available on record with endorsement of OP.1.  It is also seen that the LA had deposited premiums regularly from the year 2009 to 2014 and the copy of receipts are available on record.  The Ops have also given one survival benefit of Rs.26, 000/- to the LA during the year 2013.

6.                     From the above facts it was ascertained that the complainant had approached the OP.1 on 15.7.2015 with an application to issue necessary claim forms in her favour but the OP.1 has not issued the same.  Rather she was told that the nominee is to get the deposited amount only under the policy.  After filing of this case and as per suggestion of the Ops through their A/R, the complainant has filed claim application with relevant documents on 27.12.2016 with the Ops and the OPs have settled the claim at Rs.41, 860/- on 13.1.2017.   The complainant on receipt of above amount has filed a dissatisfaction note with the OPs on 23.1.2017 stating that the claim has not been settled in full.  The complainant has filed copy of all the documents related to settlement of claim on 13.1.2017 and her objection submitted with the Ops.

7.                     The crucial point in this case is that the Ops have not stated anywhere as to how they evaluate the claim and come to the conclusion that the death claim was to be settled at Rs.41, 860/- when the policy was not in a lapsed condition or the LA had violated any of the conditions of the policy during his life time.   It is found that the LA died when the policy was in force that to in a proper order.  No objection is filed regarding the ailment of the LA in the counter of the Ops.  In the claim settlement letter dt.30.12.16 the Ops have not mentioned the reason as to why the claim could not be settled in full as it is a death claim.  It is seen from the Reliance Cash Flow Plan Agreement at Sl. No.2 of terms and conditions that “The Company will pay the full Sum Assured shown in the policy Schedule Plus vested bonuses (if any) on the death of the LA before the maturity date”.  In this case the sum assured is Rs.1, 30,000/- and the LA also died before the maturity.  Hence as per terms and conditions of the policy, the complainant being the nominee under the policy is entitled to get Rs.1, 30,000/- plus vested bonus.  This being the terms of the policy, we failed to understand as to how the Ops settled the death claim at Rs.41, 860/- instead of sum assured and bonus.  This inaction of the Ops in our opinion amounts to deficiency in service on their part.  Therefore, the complainant is entitled to get Rs.1, 30,000/- plus vested bonus as the policy matured on the death of the LA.  Due to such inaction of the Ops, the complainant must have suffered some mental agony and has filed this case incurring some expenditure for which she is entitled for some compensation and costs.  Considering the sufferings of the complainant we feel a sum of Rs.5000/- towards compensation and cost in her favour will be just and proper.  Further the settled amount certainly bears interest @ 9% p.a. from the date of filing of this case.

8.                     Hence ordered that the complaint petition is allowed in part and the Ops being jointly and severally liable are directed to pay Rs.1, 30,000/- plus vested bonus with interest @ 9% p.a. from 06.11.2015 minus Rs.41, 860/- (already paid) along with Rs.5000/- towards compensation and costs to the complainant within 30 days from the date of communication of this order.

(to dict.)