Miscellaneous Policy (General) - Gbic.co.in

ii) Income Tax benefit under Sec. 88 CCC since he could not produce the premiumdeduction receipt (28.03.04);iii) Interest on Rs. 2630/- from 24.03.04 to 10.06.04 and relief for the mental torture thatthe he suffered on account of the attitude of OMKMLICL.The Insurer (OMKMLICL) stated that due to punching error the premium of Rs. 2630/- (due28.03.04) was credited against the Pol. No. 55338 instead of the complainant’s Pol. No.58338 and so the lapsed letter was generated and issued to Shri Saha on 18.05.04.However, When the error came to the light of the Insurer, rectified the same afterdiscussing the matter with Shri Saha over phone and vide letter dt. 03.09.2004. The Policywas continued to be in force.But later on due to non payment of the Qly. Premium due 28.06.04 the policy was lapsed.So it was clear that the policy was lapsed due to non-payment of Qty premium 28.06.04and not for premium due 28.03.04. They also admitted the deficiency in service on theirpart but it was more a fault in the “System” rather than any deliberate human negligence.In course of hearing arranged on 18.03.05, Shri Shah expressed his total lack ofconfidence and faith in the Insurer and rejected the proposal of the Insurer or continue withthe policy. On the other hand the Insurer expressed the circumstances under which thethings happened. The Insurer admitted their deficiency in rendering service to the P.H. butat the same time explained that it was more a fault in the system rather than any deliberatehuman negligence.Held The Facts stated by the complainant and the clarifications cited by the Insurerwere considered carefully. The explanation give by the insurer was not convincing enough.It was a clear of a deficiency in rendering service on the part of the insurer for which thecomplaint must be compensated.The Insurer (OMKMLICL) was directed to make the following payments within 15 days fromthe receipt of consent letter from the complainant.i) Refund of 5 premium amount amounting to Rs. 13, 146.75.ii) Interest for the delay in giving credit to the premium of Rs.2630/- for the period from24.03.04 to 10.06.04. Interest is to be calculated at a rate 2% above the bank rateduring the period of default;iii) Loss of benefit on account of rebate under Section 88 and 80 CCC of the IT Act, 1961subject to actual calculations;iv) For mental torture and harassment, a token relief of Rs. 2,500/-.Kochi Ombudsman CentreCase No. IO / KCH / GI / 11 - 002 - 018 / 2004 - 05Shri A. P. SreejithVs.New India Assurance Co. Ltd.Award Dated 03.11.2004The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998 arose fromrepudiation of Death claim under Pravasi Suraksha Social Welfare Scheme - Certificate No.47 / 760901 / 80041 issued by the respondent. The complainant’s brother, the policyholder,had an accidental fall and he succumbed to his injuries while he was in Lebanon. Thecomplainant was the nominee under this policy. The respondent despite Lawyer Noticedeclined his claim for death benefit. His appeal to consider his claim in full to theGrievance Cell of the Insurer was of no use. Aggrieved by the decision of the respondenthe had approached this Authority to reopen the case and award the amount in full.The Insurer contested that the actual cause of death could not be ascertained from thedocuments submitted by the claimant. It can be due to an accidental fall or an intentionalsuicide. The father of the deceased gave contradictory versions to the insurer. Thecomplainant did not co-operate with the insurer by submitting the required documents toprove that death was due to an accident. As such they were unable to settle the claim.