SRI NILAKANTHA PANDA, PRESIDENT

            The Complainant has filed this complaint petition, U/s – 12 & 13 of erstwhile Consumer Protection Act, 1986, read as U/s-35 of C.P.A.-2019 of the New Act (here-in-after called as the “C.P. Act - 2019”), on dated 17/08/2015, alleging a “deficiency-in-service” by the Ops, where OP No.1 is The Chief Manager Life Insurance of India, Zila School Road, Balasore, OP No. 2 is Divisional Manager, Sri Prafulla Kumar Sethi, Life Insurance of India, At Divisional Office Nuapatana, Cuttack, Odisha.

            The factual matrix of this case is that deceased Narayan Dash (life assured), the deceased husband of the complainant, had purchased two policies from the above Ops vide policy No.588038424 dated 28/06/2006 and No.583739950 dated 28/06/010. In both the policies, the complainant was the nominee. It is further stated that in both the polices, it was clearly mentioned in Serial No.3 of Column-5 of the proposer Form that “accidental benefit is required”, VIZ “Is Accidental Benefit Required – YES”.

            That Deceased Narayan Dash has died on 29/06/2012. After the death of life assured, the instant complainant claimed all benefits covered under both the policies before the OPs. The Ops have paid “death claim” and “accidental benefit” in respect of policy No.583739950. But in respect of Policy No.588038424, the Ops paid only “death claim” without paying the accidental benefit which is unjust and illegal. The complainant submitted all the relevant documents before the Ops. After several reminders, Ops intimated the instant complainant to apply death claim in writing and accordingly, the complainant submitted all the documents. But the Ops did not pay the accidental benefit to her. Finding no other way out, the complainant sent legal notice on 14/07/2015, but the Ops did not pay any heed to it. Therefore, after 15 days, the complainant filed the present case with the reliefs stated in the complaint petition.

            To substantiate her case, the complainant has relied on the following documents, which are placed in the record, as mentioned hereunder-

1. Photocopy of information supplied by the LIC authority dated 10/04/2015.
2. Photocopy of proposal form.
3. Photocopy of status report in respect of policy No.588038424.
4.  Photocopy of policy bond bearing No.588038424.
5. Photocopy of information supplied by the LIC authority dated 02/06/2015.
6. Photocopy of proposal form.
7. Photocopy of status report in respect of policy No.583739950.
8. Photocopy of policy bond bearing No.583739950.
9. Photocopy of voter identity card of complainant.
10. Photocopy of death certificate of Narayan Dash.
11. Photocopy of legal notice.

             In the present case, OP No.1 made his appearance and filed written version whereas Op No.2 neither appeared nor filed written version for which he was set ex parte vide order dated 11/07/2023.

            The OP No.1, in his written version, has not only challenged the cause of action to file the present case but also emphatically stated that the case is not maintainable. The OP No.1 has denied the allegations made in the complaint petition. Admitting the fact of purchasing two policies by the life assured i.e. the deceased husband of the complainant, OP No.1 has stated, inter alia, that after the death of life assured, the complainant claimed for payment of the policy dues. Out of two policies, the Ops had settled the death claim in favour of the complainant in respect of policy No.583739950 for an amount of Rs 78,597/- and DAB of Rs.75,000/- by NEFT as DAB premium was paid by the life assured at the time of proposal. But in respect of policy No.588038424, the Ops had settled the death claim in favour of the complainant on the basic sum assured of Rs.01,00,000/- and assured bonus amount of Rs.01,24,332/- by NEFT except DAB claim on 27/07/2013 after deducting the anniversary premium of Rs.7,068/-. It is further stated that the life assured although opted for DAB in the proposal form and mentioned the premium amount as Rs.03,584/-, but has deposited only Rs.03,534/- as the 1^st premium amount. So, for non-payment of DAB premium, the policy was accepted only ordinary rate except DAB and accordingly, the bond was issued to the life assured in the year 2006. The life assured has not intimated them (The Ops) for correction of the bond. The Ops as well as the life assured are bound by the terms and conditions of the bond. Therefore, it is claimed that, the question of illegality and deficiency of service on their part does not arise at all. Thus, the OP 1 have prayed to dismiss the case with cost.    

             To substantiate its case, the OP 1 has relied on the following documents, which are placed in the record, as mentioned hereunder-

1. Photocopy of proposal form.
2. Photocopy of policy bond in respect of policy No.588038424.
3. Photocopy of premium calculation sheet.
4.  Photocopy of status report in respect of policy No.588038424.
5. Photocopy of premium history sheet of policy No.588038424.
6. Photocopy of premium calculation sheet in respect of policy No.588038424.

            That 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

            First of all, it is to be ascertained as to whether the complainant is “Consumers” or not. From the averments of the pleadings of the complainants and document produced on behalf of the complainant vide above mentioned Annexures, it is clearly admitted and established that the complainant, it is clear that the complainant is the nominee of her deceased assured husband Late Narayan Dash, who purchased the policy bonds in question from the Ops. The deceased husband of the complainant died on dated 29/06/2012, as reflected vide Annexure-10.  Therefore, the complainant is well covered under the previews of definition of “Consumer” as defined under the provisions of the Consumer Protection Act, 2019.

            Before delve into the merits of the case matter, it is required to be decided how far the complainant is able to prove her case with regard to the cause of action and maintainability of the case.

            Learned counsel for the complainant urged that deceased Narayan Dash (life assured), the deceased husband of the complainant, had purchased two policies from the Ops vide policy No.588038424 dated 28/06/2006 and No.583739950 dated 28/06/2010 and in both the policies, the complainant was the nominee. It is further submitted that in both the polices, it was clearly mentioned by the policy holder in Column-5 of Serial No.3 of the proposer Form that “accidental benefit is required”. Deceased Narayan Dash died on 29/06/2012 and after his death, the present complainant claimed benefits in both the policies. Although the Ops have paid death claim and accidental benefit in respect of policy No.583739950, but in respect of Policy No.588038424, the Ops have illegally paid only death claim without paying the accidental benefit. After several reminders, Ops intimated the complainant to apply for death claim in writing and accordingly, she submitted all the documents, but the Ops did not pay the accidental benefit to her. Hence this commission is of opinion that there is sufficient cause of action to file this case before this commission, which is under the provision of AP Act-19.

            On the other hand, learned counsel for the OP No.1 submitted that after the death of life assured, the complainant claimed for payment of the policy dues. Out of two policies, the Ops  had settled the death claim in favour of the complainant in respect of policy No.583739950 for an amount of Rs 78,597/- and DAB of Rs.75,000/- by NEFT as DAB premium was paid by the life assured at the time of proposal. It is further submitted that in respect of policy No.588038424, the Ops had settled the death claim in favour of the complainant on the basic sum assured of Rs.01,00,000/- and assured bonus amount of Rs.01,24,332/- by NEFT except “DAB claim” on 27/07/2013 after deducting the anniversary premium of Rs.07,068/-. It is further submitted that the life assured although opted for DAB in the proposal form and mentioned the premium amount as Rs.03,584/-, but has deposited only Rs.03,534/- only as the 1^st premium amount. So, for non-payment of DAB premium, the policy was accepted only towards ordinary rate except DAB and accordingly, the bond was issued to the life assured in the year 2006. The life assured has not intimated them for correction of the bond at any time thereafter. The Ops as well as the life assured are bound by the terms and conditions of the bond. That in this context the complainant has served a Legal Notice to the Ops on dated 14/07/2015, which was received by the Ops on dated 15/07/2015. Hence it is determined that the present case filled is within the permitted scope of the CP Act, hence it is maintainable under this Act.

            That from the above rival submissions, it is found that the deceased husband of the complainant had purchased two Insurance policies from the Ops and the complainant was the nominee in both the policies. It is also an admitted fact that the life assured died on 29/06/2012. It is claimed by the complainant that the Ops have settled the claim in respect of policy No.583739950, but failed to settle the claim in respect of policy No.588038424 in spite of all efforts taken by the complainant. On the other hand, Ops have claimed that life assured opted DAB in the proposal form and mentioned the premium amount as Rs.03,584/-, but used to deposit premium amount as Rs.03,534/-, so, for non-payment of DAB premium the policy was accepted only in ordinary rate except DAB. To substantiate the claim of the Ops, on perusal of proposal form in respect of policy No.588038424 vide Annexure-2 as well as Annexure-A, it is found that the life assured had opted DAB in the proposal form and mentioned the premium amount of deposit as Rs.03,584/-. In Col-7 of Serial No.3 of the said form, it is also found that the life assured had deposited only Rs.03,584/-. But surprisingly, the premium history vide Annexure-E shows that a sum of Rs.03,534/- only has deposited. In this connection, it is to be decided as to whether the information mentioned in Annexure-2 is true or the information supplied by the Ops in Annexure-E. On a bare scrutiny, it is found in Annexure-2 that the information supplied and written therein is not the handwriting of life assured, rather, it has been filled up by one Dibakar Mishra, who is the agent of Ops vide licence no.489031. It is also seen from the said proposal form that the life assured had only signed in the place where tick mark has been supplied. Similarly, in Col-5 of Serial No.3 of said proposal form, the information supplied as “YES” to the question “Is Accident Benefit required?” At this juncture, it is seen from Annexure-E that it has been prepared by the Ops. The Ops have not assigned any endorsement that it has been prepared to their best knowledge. Furthermore, in Annexure-2 when it has been mentioned that the life assured deposited a sum of Rs.03,584/-, how and under what circumstances the Ops received the aforesaid amount instead of Rs.03,586/-. Although, the Ops have received the said amount, no document has been produced to show that they have intimated the life assured about the deposit of less amount in stead of agreed amount. The Ops have claimed that it is mentioned in the lower part of the bond that if any mistake be found therein, return it for correction immediately and the bond was issued in August, 2006, but the life assured had not intimated them for correction of the bond. It is the prevailing practice that one cannot directly purchased a LIC bond, rather, through an approved & appointed LIC agent. The life assured has no direct communication with the LIC. The agent played a vital role between the LIC and the life assured, upon getting remuneration out of the premium so paid. Further, it is the plea of the Ops that the life assured and the Ops are bound by the terms of the bond and the Ops have taken decision as per the terms of the bond and rules and regulation. In this regard, on perusal of Annexure-2 & 4 as well as Annexure-E & B, nowhere it is found that the terms and condition of the proposal form were read over and explained to the life assured and understanding the terms and conditions of the policy bond so also the rules and regulations, the life assured put his signatures. That apart, the agent who is a mediator between the life assured and Ops has also not supplied any endorsement that the terms and conditions of the policy bond so also the rules and regulations are explained to the life assured, who understanding the same to be true has put his signatures in his presence. Not a single document is filed by the Ops to satisfy the Commission that all those were in the knowledge of the life assured. From the above discussion, it is clear that the Ops have committed mischief by taking / accepting lesser amount from the life assured not intimating the life assured. From the above discussion, this Commission is of the considered view that the Ops have committed gross error in accepting the policy in question in ordinary rate, which should have been accepted in accordance with the proposal form. Therefore, withholding of death claim in favour of the complainant is illegal. Hence this amounts to deficiency on the part of the Ops.

            Learned counsel for the Ops urged that the complaint is barred by limitation as the complainant has filed the present beyond the statutory period. It is further urged that by serving the legal notice or by making representation, the period of limitation cannot be extended by the complainant. In this connection, it is seen that the proposal form was submitted on 30/06/2006, but in the policy bond the date of commencement of policy has mentioned as 28/06/006, that means the policy already commenced before two days of proposal. Further, the policy bond was issued on 9/08/2006. Admittedly, the life assured died on 29/06/2012. Thereafter, the complainant filed documents before the Ops for settlement of her claim in respect of both the policies. As it is seen that the Ops have settled the claim in respect of Policy No.583739950 on 07/07/2014 and issued cheque in favour of the complainant by NEFT on 18/07/2014 and did not settle the her claim in respect of policy No.588038424. The complainant has sent legal notice to the Ops by registered post with AD on 14/07/2015. The present complaint is seen to have been presented on 1/08/2015. In this regard, Section 24-A of the Act deals with this situation which is reproduced as under:

“24-A, Limitation period-(1) The District Forum, the State Commission or the National Commission shall not admit a complaint unless it is filed within two years from the date on which the cause of action has arisen.”

            In the complaint petition, nowhere the complainant has stated that the cause of action for filing the case arose from the date of issuance of legal notice. Rather, it is stated that the Ops have settled her claim in respect of policy No.583739950 on 18/07/2014 and not settled her claim in respect of another policy No.588038424. Thus, it is clear that the actual cause of action for filing the present case arose on the day following of 18/07/2014 and the case is filed on 17/08/2015. Therefore, the case is not barred by limitation, as per the statute as mentioned supra.

            From the discussions made in the foregoing paragraphs, this Commission is of the unanimous opinion that the complainant has cause of action to file the case and the case is maintainable. The Ops are found to have committed gross deficiency in service in not settling the claim of the complainant in respect of the policy No.588038424. Therefore, the complainant is entitled to get the reliefs, as claimed for in her complaint petition.

            Hence, it is ordered –

O   R   D   E   R

            The case of the complainant be and the same is allowed on contest against OP No.1 and on ex parte against OP No.2. Both the Ops are hereby directed to settle the accidental benefit claim in respect of policy No.588038424 and to release the same, Rs 01, 31, 400/-, in favour of the complainant with interest @ 9% per annum from 30.07.2015 till its actual realization along with compensation of Rs.25,000/- towards harassment, mental agony and litigation cost.

            All the aforesaid amounts shall be paid by the O.Ps to the complainants within 45 days from the date of receipt of this order.

            That deferment in any manner / mode / reason / step for compliance of this order, both the O.Ps, shall carry an additional fine of Rs.150/- (Rupees One hundred fifty) only, per day, upon above Order, payable by the defaulter O.Ps to the complainant.

            In case of failure by any of the O.Ps to comply any of the orders as above mentioned, within the aforesaid stipulated time frame, the Complainant shall be at liberty to realize the same as afore mentioned, from the O.Ps as per the prevailing law.

            Pronounced in the open court of this Commission, this the 23^rd day of September, 2024 under my signature & seal of the Commission.