ORDER

BY SRI D.SURESH, MEMBER

1.     This Complaint is filed by the Complainant U/S Section 12 of Consumer Protection Act 1986, against the Opposite Parties  (herein referred in short as O.Ps)alleging the deficiency in service in denying the payment of the Death Benefit of insurer. SalankuNagendra in respect of  Life Insurance Policy obtained by him along with interest at the rate of 18% per annum from the date of denying  and further for a sum of Rs.1,00,000/- for causing mental agony hardship and to pay Rs.5,000/- towards  cost and for such other reliefs as this Hon’ble Forum deems fit. 

2.     Brief facts of the complaint are that the Complainant is the  son of uncle of deceased  SalankuNagendra i.e., cousin brother.  He was residing with the complainant and his family member since 16 to 18 years. Said SalankuNagendrapurchased a life insurance policy during his life time from Max Life Guaranteed Income Plan on 08.09.2017 by paying first premium of Rs.52,250-00 for a guaranteed maturity sum assured Rs.7,47,600/- and guaranteed death benefit is Rs.9,25,000.56. He died on 08.08.2018. While purchasing the policy, said SalankuNagendra  nominated the Complainant as his Nominee to the said policy. After the death of SalankuNagendra, the policy holder made complainant claim petition along withrequired documents to get death benefit.  After receiving documents and claim petition representative of OP obtained signatures of the complainant. OP’s representative also enquired with the neighbors and collected the details about complainant as well as deceasedSalankuNagendra.  Thereafter OP did not  any reply regarding  his claim petition and have failed to process the claim. Thereafter, OP wrote letter dated 28.12 2018 insurer directing the complainant to produce succession certificate from the competent court.  Later complainant visited personally to the OP’s office  and tried to convince the officer of OP company as it is not possible to obtain Succession certificate as he is not a full blood relative of deceased SalankuNagendra  and he convinced OP that he is only a nominee to the deceased policy holder and same was mentioned in nominee column in the proposal form by the deceased himself and in the policy.  OP is giving vogue reason for not honouringthe  claim.  This act of OP amounts to deficiency of service .Hence this complaint.

3.     Upon the service issue of notice, Ops remained absent  and placed exparte. On 21.06.2019 one Sri Kapil Dixit advocate files power on behalf of Ops files application to set aside the exparte order passed on 16.03.2019. On perusing the application and affidavit OP has no reasons to allow the said application . Hence application filed by the OP is hereby dismissed.

4.      In order to substantiate their case, complainant  has filed his affidavit evidence and documents. Heard the arguments.  On the basis of the pleadings of the complainant, the following points have arisen for our consideration:-

                        (1)   Whether the complainant has proved

deficiency in service on the part of the O.Ps?

(2)  Whether the complainant is entitled to

the relief prayed for in the complaint?

5.     Our answers to the above points are:-

POINT 1: In the Affirmative.

POINT 2: Partly in the Affirmative

                For the following:

REASONS

POINT No. (1):-

6.     On perusing  Pleading , evidence and documents it is the case of complainant that is the cousin brother of deceased SalankuNagendra.The said deceased  purchased a life insurance policy during his life time from the Max Life Insurance Companyby paying  premium amount of Rs.52,250/- on  08.09.2017 in his name and is referring the name of the complainant as his nominee and the  same is not denied by the OP in its letter dated:28.12.2018. While filling Proposal form,  saidSalankuNagendrra has nominated the Complainant as nominee to the said policy, he is the son of uncle of deceased i.e., his cousin brother and this can be seen in the Ex.P4 filed by the complainant. Deceased was residing with complainant  and his family members during his life time. But all of a sudden SalankuNagendra died due to CEREBRAL  STROKE  and same has been confirmed by the Medical Officer Government General Hospital Yelahanka, Bangalore as per Ex.P2.  After the death of SalankuNagendra, complainant moved claim petition along with  documents to get the death benefit of SalankuNagendra to the OP insurance company on 11.09.2018. Complainant alleges that  since  he  is the nominee,  signature has been taken by   the representative of OP on the required documents annexed to the claim petition and also they made enquiry  with neighbor regarding status of complainant and collected the detail of the cause of death of the deceased, thereafter,  OP has not taken any action in  that  regard and also has not given any reply and hence complainant personally visited OP office and made enquiry about his claim petition then it came his notice that OP did not proceed the claim as per the  policy procedure.

7.     Further, it is contended that, OP had issued a letter directing the complainant to produce the succession certificate from the competent court. Complainant tried to convince the Ops thatas he is nominee to the policy of deceased SalankuNagendrathere is no need to produce succession certificate to obtain claim amount as per the policy clause and Section 39 of Insurance Act makes clear that a nominee is in the nature of a trustee who receives the money due under a policy and keeps it for the benefit of the legal heirs of deceased.If  thelegal  heirs of deceased  Policy holder do  not dispute payment of claim amount to the nominee, the insurance company should not cause any disruption to the nominee in receiving the claim of deceased policy holder and they do not have any right to with hold the claim amount by giving unholy reasons and insisting for Succession Certificate.

8.     In view  of the above discussion,  Ex. P5  makes it clear  that  no legal successors of deceased have made objection to the nominee to receive the claim amount and also Ops have not mentioned said fact  in the afore said letter.  Hence OP cannot withhold policy amountof  deceased and they cannot direct the nominee to produce succession certificate from the court.   Even after knowing fully well, Ops have  with hold the claim amount and made the complaint to suffer lot is against to the principle of Insurance Act. The act of the OPs have caused to the complainant harassment and mental agony which amounts to deficiency of service.  Hence we answerPOINT NO.1 IN  AFFIRMATIVE.

POINT No.(2):-

9.     In view of above discussion,OP is bound to pay the death benefits of SalankuNagendrato his nominee the complainantRevindra Reddy. OP has no right to refuse to pay the death benefits to the nominee when there is no dispute regarding the acceptance of the policy and the acceptance of the premium.  OP has not at all disputed the nomination nor receipt of the premium nor the existence of the insurance policy.

10.   On perusing the insurance document it becomes clear that the guaranteed maturity sum assured is Rs.7,47,600/- and as per the key features documents for guaranteed income plan, the guaranteed death benefit is Rs.9,25,000.56. The terminal benefits after maturity is Rs.1,00,000/- plus monthly income payable in the last five years of the payout period is Rs.10,202.50 per month.  The policy terms and policy payment period was for 12 years and payout period is 10 years.

11.   When this is taken into consideration, since the policy holder i.eSalankuNagendradied 08.08.2018 OP is bound to pay the amount to the complainant i.e. the nominee herein the complainant within a reasonable time after the claim, the same has not been done by the OP on the other hand much against to the rules and procedure and the law of the land OP insisted the complainant to produce a succession certificate for which it has no right to insist and demand. Hence OP is directed to pay a sumof  Rs.9,25,000.56 being the death benefits in respect of the said policy to the complainant along with interest at 12% per annum from 08.08.2018 till the payment of the entire amount.

12.   Further the act of the OP made thecomplainant to make repeated requests to OP and to correspondence in its direction and further made him to file complaint before this forum by engaging service of the advocate, for which he has to pay professional pay and also incur incidental charges in attending the hearing before the forum. We deem it proper to direct the OP to pay a sum of Rs.10,000/- towards the same. 

13.   Further the direction of the OP insisting for succession certificate without paying the death benefits to the nominee put the nominee into mental stress , strain for which OP are bound to compensate and we deem it proper to direct OP to pay a sumof Rs.25,000/- towards damages for causing mental  agony, strain and physical stress. Hence we answer POINT NO.2 PARTLY IN THE AFFIRMATIVE and pass the following:

ORDER

1. The complaint is hereby partly allowed with cost.

2. OP No.1 to 3 are jointly and severally directed to pay a sum of Rs.9,25,000.56 along with interest at 12% per annum from 08.08.2018 the day on which the policy holder the SalankuNagendra died till payment of the entire amount.

 3. Further OPs are directed to pay Rs.25,000/- towards   mental agony physical hardship caused and Rs10,000/- towards litigation expenses.

4.  The O.Psaredirected to comply the above order within 30 days from the date of receipt of this order and submit the compliance report to this forum within 15 days thereafter.

5. Send a copy of this order to both parties free of cost.

Note: You are hereby directed to take back the extra copies of the Complaints/version, documents and records filed by you within one month from the date of receipt of this order failing which the same will be destroyed as per the C.P. Act and Rules thereon.

(Dictated to the Stenographer over the computer, typed corrected and then pronounced by us in the Open Forum on this 29^th FEBRURY 2020).

MEMBER PRESIDENT

ANNEXURES

1. Witness examined on behalf of the Complainant/s by way of affidavit:

Copies of Documents produced on behalf of Complainant/s:

Ex.P1: Copy of the address proof of the deceased SalankuNagendra.

Ex.P2: Copy of the Medical Certificate of cause of death of SalankuNagendra.

Ex.P3: Copy of the death certificate.

Ex.P4: Copy of the Life Insurance Policy.

Ex.P5: Copy of the letter dated 28.12.2018 issued by OP.

2. Witness examined on behalf of the Opposite party/s by way of affidavit:

RW-1: - Nil –

Copies of Documents produced on behalf of Opposite Party/s

- Nil -

.

MEMBER                        PRESIDENT