Order No. 11 dt. 28/06/2018
The case of the complainant in brief is that one Sanjay Bindra was a life insurance policy holder under the Max New York Life insurance Company Ltd vide policy no.101837888 having a semiannual premium of Rs.3497/- and it was a whole life plan. The insurance commenced from 30.09.2001. The policy holder Sanjoy Bindra appointed a nominee as his nominee and the policy holder died on 09.05.2017 at the age of 55 years. As per the schedule of the said policy in case of death the amount to be paid to the beneficiary mentioning therein at the age of the death of the policy holder. The complainant accordingly after the demise of the policy holder claimed the amount of Rs.5,53,548/- Plus annual bonus as death benefit. The o.ps paid an amount of Rs.2,70,519.58. Since the balance amount was not paid the complainant filed this case praying for the balance amount of Rs.2,83,039/- plus compensation of Rs.2,00,000/- and litigation cost of Rs.50,000/-.
O.ps. contested the case by filing w/v and denied all the material allegations of the complaint. It was stated that the life assured had given a request to withdraw the paid up additions on 03.09.2010 and accordingly cheque of Rs.23,769.02 was paid to the life assured on 08.09.2010 further on receipt of the claim on 29.05.2017 the o.ps paid a sum of Rs.2,70,519.58 which included the sum assured Rs.2,00,000/- plus bonus accrued Rs.70,519.53 on 06.06.2017 as per the terms and conditions of the policy. Thus in total an amount of Rs.2,94,288.06 disbursed under the said policy. Therefore the claim made by the complainant has got no basis. The o.ps also in the w/v in a tabulated form mentioned in details the said policy. The complainant is under obligation and legally duty bound to abide by the terms and considerations of the insurance policy. The o.ps after the claim made by the nominee disbursed the amount in the bank a/c of the claimant. The amount paid by the o.ps as per the terms and conditions of the policy thereby the amount claimed by the complainant cannot be entertained and there is no deficiency in service on the part of the o.ps as such the o.ps prayed for dismissal of the case.
On the basis of the pleadings of parties the following points are to be decided:
- Whether the complainant being the nominee of the death claim of the policy holder was denied to provide the amount claimed by her?
- Whether there was any deficiency in service on the part of o.ps.?
- Whether the complainant will be entitled to get the relief as prayed for?
Decision with reasons:
All the points are taken up together for the sake of brevity and avoidance of repetition of facts.
Ld. lawyer for the complainant argued that one Sanjay Bindra was a life insurance policy holder under the Max New York Life insurance Company Ltd vide policy no.101837888 having a semi annual premium of Rs.3497/- and it was a whole life plan. The insurance commenced from 30.09.2001. The policy holder Sanjoy Bindra appointed a nominee as his nominee and the policy holder died on 09.05.2017 at the age of 55 years. As per the schedule of the said policy in case of death the amount to be paid to the beneficiary mentioning therein at the age of the death of the policy holder. The complainant accordingly after the demise of the policy holder claimed the amount of Rs.5,53,548/- Plus annual bonus as death benefit. The o.ps paid an amount of Rs.2,70,519.58. Since the balance amount was not paid the complainant filed this case praying for the balance amount of Rs.2,83,039/- plus compensation of Rs.2,00,000/- and litigation cost of Rs.50,000/-.
Ld. lawyer for the o.ps. argued that the life assured had given a request to withdraw the paid up additions on 03.09.2010 and accordingly cheque of Rs.23,769.02 was paid to the life assured on 08.09.2010 further on receipt of the claim on 29.05.2017 the o.ps paid a sum of Rs.2,70,519.58 which included the sum assured Rs.2,00,000/- plus bonus accrued Rs.70,519.53 on 06.06.2017 as per the terms and conditions of the policy. Thus in total an amount of Rs.2,94,288.06 disbursed under the said policy. Therefore the claim made by the complainant has got no basis. The o.ps also in the w/v in a tabulated form mentioned in details the said policy. The complainant is under obligation and legally duty bound to abide by the terms and considerations of the insurance policy. The o.ps after the claim made by the nominee disbursed the amount in the bank a/c of the claimant. The amount paid by the o.ps as per the terms and conditions of the policy thereby the amount claimed by the complainant cannot be entertained and there is no deficiency in service on the part of the o.ps as such the o.ps prayed for dismissal of the case.
Considering the submissions of the respective parties it is an admitted fact that one Sanjoy Bindra was a life insurance policy holder under the Max New York Life insurance Company Ltd vide policy no.101837888 having a semi annual premium of Rs.3497/- and it was a whole life plan. The insurance commenced from 30.09.2001. In the proposal form the name of the nominee mentioned as Ritika Bindra but subsequently the name of the nominee was changed and Jyoti Bindra was included. On the basis of the said change of the name of the nominee the complainant submitted the claim of the death benefit of the policy holder. The o.ps after considering the claim disbursed an amount of Rs.2,70,519.58 and it is also found from the materials on record that during the life time of the policy holder and on the basis of his claim the o.ps paid an amount of Rs.23,769.02 i.e. in total the o.ps paid a sum of Rs.2,94,288.06. On perusal of the policy document whereby whole life participating insurance policy illustration has been explained in the death benefit column it was specifically stated that the amount will pay to the beneficiary, on the happening of the insured event, provided the policy in force and a details illustrative figures has been provided with the policy. Since the police holder died at the age of 55 years therefore the beneficiary will get the death benefit of Rs.5,53,548/-. Since the policy was in force therefore the denial of the said amount and by paying the lesser amount undoubtedly caused deficiency in service on the part of the o.ps. Having regard to the facts and circumstances of the case we hold that out of the total amount of Rs.5,53,548/- and the o.ps paid an amount of Rs.2,94,288/- including the amount paid to the policy holder during his life time therefore the o.ps are liable to pay the rest amount i.e. Rs.2,59,260/-. Since the complainant has suffered due to not receiving the balance amount therefore we hold that the complainant will be entitled to get compensation of Rs.20,000/- plus litigation cost.
Thus all the points are disposed of accordingly.
Hence, ordered.
that the CC No.291/2017 is allowed on contest with cost against the o.ps. The o.ps are jointly and/or severally directed to pay the sum of Rs.2,59,260/- along with compensation of Rs.20,000/- and litigation cost of Rs.5,000/- within 30 days from the date of communication of this order, i.d. an interest @ 8% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.
