1.                     The brief history of the case of the complainant is that his brother, Jitendra Kumar Satapathy during his life time had opened SB A/c. No.0924048939 with OP.1 and as per facility under the scheme, the account holder had insured himself under Pradhan Mantri Jeevan Jyoti Bima Yojana vide Policy No.SBY20160011000615958 covered under Master Policy No.900100940 with LIC of India.  Accordingly a premium amount of Rs.330/- was deducted from the SB accounts on 13.6.2016 for a sum assured of Rs.2.00 lacs.  It is submitted that the insured died on 25.7.2016 of Cancer and the present complainant being his brother and nominee under the policy filed claim application before the OP.1 but till date the Ops have not settled the claim.  Thus alleging deficiency in service on the part of the Ops he filed this case praying the Forum to direct the Ops to settle the death claim of Rs.2.00 lacs and to pay Rs.10, 000/- towards compensation and costs to the complainant.

2.                     The Ops 1 & 2 filed counter denying the allegations of the complainant but admitted about PO SB account opened by Mr. Jatindra Kumar Satapathy.  It is submitted that after death of the insured, the nominee of the deceased policy holder has filed claim application with them which was duly forwarded to the LIC authorities for processing of claim as per standard operating procedure  laid down for the purpose.  Thus denying any deficiency in service on their part, the OPs prayed to dismiss the case of the complainant.

3.                     The OP No.3 filed counter denying the allegations of the complainant and contended that the life assured was a patient suffering from the last stages of cancer but suppressing the material facts, the complainant in connivance with the deceased LA had obtained this policy.  It is further contended that as per amendment to the PMJJBY rules, if the LA under the scheme died within 45 days from the date of enrollment, the claim shall be repudiated.  Further declaration of good health was necessary w.e.f. 01.06.2016 and the present policy commenced from 13.06.2016.  It is also contended that as the policy holder died within 45 days of the lien period, they have rightly repudiated the claim.  Thus denying any deficiency in service on its part, the OP prayed to dismiss the case of the complainant.

4.                     Parties have filed certain documents in support of their cases.  Heard from complainant as well as A/R for the OP.3 and perused the materials available on record.

5.                     In this case opening of SB accounts with OP.1 by Jitendra Kumar Satapathy on 13.6.2016 and death of life assured on 25.7.2016 due to cancer are all admitted facts.  The present complainant being the brother and nominee under the policy has submitted claim form to get the benefit from the Ops but the OP.3 repudiated the claim inter alia citing the reason that the death of the LA occurred within the lien period of 45 days.  The Ld. A/R for the OP.3 vehemently argued on the above issue and furnished a document to that respect.  In view of above facts, we are inclined to decide the issue before going into the other merits of this case.

6.                     The OP.3 in support of its allegation has furnished letter dt.02.05.2016 of Govt. of India, Ministry of Finance, Department of Finance Services addressed to Chairman, LIC of India in which it has been stated at Para-2 (ii) that “ A 45 days lien clause may be imposed in the PMJJBY Scheme whereby the claim cases during the first 45 days from the date of enrollment will not be paid.  However, deaths due to accident would be exempted from the lien cause”.  It is seen that the LA has obtained the policy on 13.6.2016 and died on 25.7.2016.  The LA was covered under the policy for a total period of 43 days whereas the lien period as per clause is 45 days.  It is also revealed from that letter that the lien clause as applied, suggested above will weed out the very early claims that adversely affect the claims ratio.

7.                     In view of above facts, it was clearly ascertained that the death of the LA occurred within the lien period and as per the above clause of the concerned department, the complainant is not entitled to get the death claim as applied for.  Further it is seen that the member has not enrolled based on submission of a declaration of good health.

8.                     With above discussions, it can be concluded that the complainant is not entitled for any relief as his case deserves no merit.  In the result, we dismiss the case of the complainant but without costs in the peculiar circumstances of the case.

(to dict.)