Order No. 25 Dt. 08.11.2017
One Salaha Bibi filed the instant case against Tata AIG Life Insurance Co. Ltd. having its Head Office situated at Mumbai also under P.S. English Bazar P.O. & Dist. Malda. The trux of the case is that the husband of the complainant Late Mustafa purchased a policy from Tata AIG Life Insurance Co. Ltd. vide policy No. U016459810. The policy was issued on 23/07/2008 and the policy was for a period of 15 years. The complainant’s husband and it was to mature on 23/07/2023. The complainant’s husband paid a total premium of Rs. 299799/-. The sum assured was Rs. 749250/-. Husband of the deceased died on 06/12/2011 leaving behind his wife the complainant herein as the nominee. The complainant after death of her husband filed a claim before the O.Ps. The O.P. issued a cheque of Rs. 203901/- to the complainant but the complainant states that her husband Late Mustafa was told that the officials of the O.P. in case of the death of her husband the legal heirs Mustafa would get Rs. 1549250/-. After receiving a sum of Rs. 203901/- the complainant herein made further demand of Rs. 1500000/- and sent a letter which was received by the O.P. and replied on 13/06/2013. Hence, this case.
The O.P. entered appearance and filed their written version and enumerated in Para 13 (II) that the statement declared by the deceased Mustafa in the proposal form under Step 10 being health declaration of life insurer being negative. The O.P. refused and repudiated the claim.
POINTS FOR DISCUSSION
- Is the complainant entitled to any relief as prayed for ?
- Are the O.Ps liable for any deficiency in service or unfair trade practice ?
DECISION WITH REASONS
We take up both the points together for continuance.
It is admitted fact that the husband of the complainant had taken a Life Insurance Policy from the O.P. Companies and have also paid premium of Rs. 99900/- on 28/06/2010, 06/10/2009, and 22/07/2008.
The O.P. has admitted that the husband of the complainant had purchased the life insurance policy and alleged that he did not disclose his health condition at the time of taking the policy.
The O.P. by a letter dt. 07/07/2013 had stated that the husband of the petitioner i.e. the life insured was under treatment for cancer of Larynx prior to the issuance of the said policy and such an information was not disclosed on application dt.22/07/2008 for the above policy. The O.P. has failed to substantiate the claim either by way of documents in support of their contention. Neither they have proved their point by adducing evidence nor placed their submission by way of argument before this Forum.
As such we can very well come to the conclusion that to avoid payment and death claim made by the complainant the O.P. has come up with a cock and bull story. The O.P. has also alleged that the case is barred by limitation. The complainant filed the case on 06/01/2015 after receiving a registered mail with A.D. from the O.P. on 07/06/2013 which brings the cause of action of this case very much within the period of limitation. There is no doubt that after the death of the husband of the complainant on 06/12/2011 the complainant had been running from pillar to post to get the death claim of the insurance from the insurer. As such we are of the view that the complainant is entitled to the benefits of the sum assured to the tune of Rs. 749250/- . According to the basic definition of the invest assured the definition of sum is the guaranteed amount of the benefit i.e. payable on the death of the insured under the basic policy. As such the complainant being a nominee / legal heir of the deceased Mustafa is entitled to a sum assured i.e. Rs. 749250/-
All the points are discussed in favour of the petitioner as well as not in favour of the O.P.
In the result, the case succeeds.
Court fee, paid on the petition, is correct.
Hence, ordered
that Malda D.F.C. Case No. 01/2015 be and the same is hereby allowed on contest in full with cost.
The O.P. is directed to make payment of a sum of Rs. 545349/- i.e. basic benefit of the sum assured by the deceased Mustafa after deducting the amount already paid to the wife of deceased Mustafa together with a sum of Rs. 10000/- as compensation and Rs. 5000/- as litigation cost.
The total amount shall be paid by the O.P. to the complainant within 30 days of receiving of this order in to to failing which the O.P. have to pay interest to the tune of Rs. 7% of the total sum of Rs. 560349/- from the day of filing of this case and the complainant is also be at liberty to put this order into execution after expiry of the period of 30 days.
Let a copy of this order be given to each of the parties free of cost
