SMT. RAVI SUSHA: PRESIDENT
This complaint has been filed by the Complainant U/s 35 of Consumer Protection Act 2019 for getting an order directing opposite parties to pay an amount of Rs.5,88,212/- as death benefit to the complainant together with Rs.25,000/- towards compensation and cost of the proceedings of the complaint.
Brief facts of the complainant are that complainant’s husband late Sri.Narayanan parayil was a policy holder of a pension policy from Canara HSBC OBC Life Insurance Co. Ltd. purchased as per the compulsion of the Manger, Canara Bank Kannapuram Branch. Narayanan Nair was issued a policy with plan name “Canara HSB Oriental bank of Commerce Life Insurance Pension for Life plan” on 24/07/2020 with policy No.0110518917 with a purchase price of Rs.5,88,812 plus goods and service tax amounting to Rs.11,187.43, totaling Rs.6,00,000/-. The branch Manager and sales Executive in the bank had informed and convinced while selling the policy to Narayanan Nair, that the policy is a pension policy wherein he will be receiving about Rs.6,000 as pension monthly till his life span and after that his nominee will be given the purchase price in lump sum. Narayanan Nair started receiving the pension of Rs.5,717/- from 25/08/2020 every month. He passed away on 18/05/2021 just 9 months after taking the policy. Complainant informed the company about the death of Narayanan Nair and surrendered the original policy document to the company. She was also asked to submit some other documents also which she readily submitted and requested for the lump sum amount which is to be paid by the company to the nominee. It was informed by the company that the capital amount will not be paid back because the company is only liable to pay pension amount till the death of policy holder. Perusing the policy document it is seen printed that the Death Benefit is Rs.5,88,812/- and as such the OPs are liable to pay the same to the complainant. This is a clear case of unfair trade practice on the part of OPs. Hence the complaint.
After receiving notices, OPs 1 and 2 filed separate written version. OP No.1 denies entire allegation and averment made in the complaint against this OP. It is incorrect that the complainant’s husband Late Sri Narayanan Parayil purchased the policy from the OP No.2 as per the compulsion of OP No.2. The OP No.1 submitted that complainant’s husband approached the officials of the OP No.2 for the pension policy on his own volition and he had availed the policy duly understanding the terms and condition of the policy. OP No.1 submitted that there was no occasion to advice him to take the policy, which is purely a contract between himself and OP No.2. He had done according to the directions of OP 1 are incorrect and hereby denied. Sri. Narayanan had not paid any amount to this OP, therefore OP 1 is not liable to repay any amount to the complainant as alleged in the complaint. It is submitted that there is no unfair practice on the part of this OP as alleged in the complaint, hence this OP is not liable to pay any compensation to the complainant. So, prayed for dismissed the complaint with costs.
OP No.2 insurance company filed version stating that the complainant is seeking Death Benefit under the policy for which she is not at all entitled as per the terms and conditions of the policy. In the present case, the Deceased policy holder/annuitant obtained the policy plan namely “Canara HSBC Oriental Bank of Commerce Life Insurance Pension 4 Life Plan” dated 24/07/2020 by paying purchase price of Rs.5,88,812/- in lieu of which LA was to be given pension of Rs.5,717/- per month. Further it is submitted that the Plan which Deceased policy holder/annuitant opted is a pension plan with “immediate Life Annuity” and in such plan annuity is payable throughout the life of the annuitant and after the death of annuitant, all further annuity pay-outs cease immediately by the company. The proposal form was duly filled and signed by the Deceased policy holder/annuitant. He was duly informed that the subject policy is pension plan with “immediate Life Annuity” and in such plan annuity is payable throughout the life of the annuitant and after the death of annuitant, all further annuity pay-outs cease immediately by the company and the policy is terminated. It is further submitted that policy was issued on 24/07/2020 and the DLA started receiving the pension of Rs.5,717/- after one month till the life span of the LA ie. for 9 months. As per the terms of the Annuity option I (immediate LIFE Annuity (single life)) opted by the deceased policy holder/annuitant under the subject policy no death benefit is payable. Further on the death of the annuitant, all future periodic annuity payouts ceases immediately and the policy terminates. Further, submitted that the deceased policy holder was duly informed that in case he is not satisfied with the feature or the terms and conditions of the policy he can withdraw/cancel the policy under the “Free Look Period” provision that is within 15 days from the date of receipt of policy document. The deceased policy holder//annuitant herein retained the documents and never approached the company for any rectification/clarification. Hence, no death benefit is payable to the complainant in accordance with policy terms and conditions. OP submits that there is no deficiency in service on the part of OP and prayed for the dismissal of complaint.
Complainant has filed her affidavit and has been examined as Pw1. Ext.A1 to A2 were marked. OP2 has submitted 3 documents and have been marked as Ext.B1 to B3. After that the learned counsel of parties, complainant and OP2 filed their written argument notes.
We have perused the policy terms and conditions and also considered the submission of learned counsels.
As per complainant, the payment of death benefit as Rs.5,88,812/-, as per policy should have been paid but instead the claim application of the complainant has been repudiated and hence insurance company (OP2) were deficiency and negligent.
Here, the undisputed facts are that the complainant’s deceased husband Mr. Narayanan Nair was a policy holder of “Canara HSBC Oriental Bank of Commerce Life Insurance pension for life plan” taken on 24/07/2020 with policy No.0110518917 with a purchase price of Rs.5,88,812 plus goods and service tax amounting to Rs.11,187.45, totally Rs.6,00,000/-. It is submitted by the complainant that, while selling the policy to the Deceased Life Assured Narayanan Nair, the Brach Manager and the Sales Executive in the OP No.1 bank had informed and convinced the policy is a pension policy wherein he will be receiving about Rs.6,000/- as pension monthly till his life span and after that his nominee will be given the purchase price in lump sum. It is an admitted fact that the Life Assured got Rs.5717 as pension from 25/08/2020 every month till his death on 18/05/2021 and after his death, the complainant has submitted request to OP No.2 for the death benefit, but insurance company repudiated her claim, informing that the capital amount will not be paid back because the company is only liable to pay pension amount till the death of policy holder. The only point with which we are concerned here is, whether the complaint is eligible to get the death benefit as claimed by the complainant.
From the materials on record and papers it is evident from the policy (Ext.A1) itself that in the heading “Benefit converge Details” Death benefit as Rs.5,88,812/- and nominee’s name as Mrs. Nani N, spouse of the Life assured, complainant here in and so the complainant is entitled to get the benefit.
In the circumstances, we are of the view that the repudiation of eligible claim of the complainant is unjustifiable. The contention raised by OP No.2, that no death claim benefit is payable to the complainant according to the policy terms and conditions and after the death of Life Assured, all further annuity pay-outs cease immediately by the complainant, is not sustained. Since OP No.1 has no role in the payment of policy benefit and more over, there is no delay alleged on the side of OP No.1 in sending documents to OP No.2, OP1 bank is exempted from the liability.
In the result, complaint is allowed opposite party No.2 is directed to pay Rs.5,88,812/- to the complainant together with Rs.10,000/- towards compensation and Rs.5,000/- towards cost of the proceedings of this case. Opposite party No.2 shall comply the order within one month after receipt of the certified copy of this order, failing which, Rs.5,98,812/- (Rs.5,88,812 + Rs.10,000) carries interest at @ 12% per annum from the date of order till realization. Complainant is at liberty to execute the order as per the provision in Consumer Protection Act 2019.
Exts
A1-Copy of policy
A2-Death certificate
Pw1-Complainant
B1-Copy of policy
B2-Copy of claim intimation
B3-Copy of claim intimation rejection
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
(mnp)
/Forward by order/
Assistant Registrar
