Whereas partially upholding an order handed by the state fee, the nationwide shopper disputes redressal fee (NCDRC) directed Birla Solar Life Insurance coverage Co Ltd (Aditya Birla Solar Life Insurance coverage Co Ltd) to pay a Rs35.10 lakh loss of life declare and Rs30,000 value of litigation to the nominee of the deceased life assured (DLA). On this case, the insurer had accepted cost for renewal of the coverage however rejected the declare, stating that the coverage was not in pressure on the time of the DLA’s loss of life.

The case is expounded to a loss of life insurance coverage declare filed by Sonipat-based Suman Devi, the spouse and nominee of Manoj Kumar, the DLA. Mr Kumar had purchased a 30-year insurance coverage coverage from Birla Solar Life Insurance coverage for a sum assured of Rs35.10 lakh for an annual premium of Rs10,501. He paid 4 instalments until 15 July 2012. On 8 August 2013, he paid Rs21,010 for the revival of the coverage and handed over the certificates of insurability (COI) to Kamlesh Kaur, the agent of Birla Solar Life Insurance coverage. 

Nonetheless, on 12 August 2013, Mr Kumar was fatally shot. A primary info report (FIR) was registered within the case. Nonetheless, because of the severity of the damage sustained, on 16 August 2013, he died. 

Suman Devi submitted a loss of life declare with Birla Solar Life Insurance coverage. Nonetheless, the insurance coverage firm rejected the declare, stating that the coverage was not in pressure on the time of Mr Kumar’s loss of life. Consequently, the insurer refunded the premium of Rs 21,010. 

In response to Birla Solar Life Insurance coverage, the LA (Mr Kumar) was already lifeless by the point the coverage was reinstated, and the insurer was saved at the hours of darkness about him being critically injured. It was resulting from such concealment that the renewal was finished, and due to this fact, the repudiation of the declare is so as, it added.

Additional, the insurer says, “Kamlesh Kaur was not particularly authorised to gather premium (from Mr Kumar), and he or she deposited the premium solely on 13 August 2013 after he was injured and earlier than he died on 16 August 2013, with out disclosing the very fact. Subsequently, the coverage reinstated on 21 August 2013 just isn’t tenable.”

Being aggrieved by the repudiation of the declare and deficiency in service on the a part of the insurer, Suman Devi filed a shopper grievance earlier than the Haryana state shopper disputes redressal fee in search of the insured quantity of Rs35.10 lakh together with curiosity at 18percentpa (each year), Rs2 lakh as compensation for psychological agony and harassment, Rs50,000 for bills and Rs22,000 in the direction of litigation value.

Throughout the listening to, the insurance coverage firm acknowledged that the coverage was reinstated on 21 August 2013 because of the concealment of true info by the DLA. It says, “Though the DLA signed and crammed the certificates of insurability on 8 August 2013, the premium was paid on 13 August 2013 by way of Kamlesh Kaur. Furthermore, the DLA had already sustained a gunshot damage on 12 August 2013, which was not disclosed. The basic precept governing insurance coverage contracts, ‘uberrima fides,’ which interprets to utmost good religion.”

In her submission, Kamlesh Kaur admitted to receiving the premium and the COI on 8 August 2013 from Mr Kumar. Nonetheless, she claimed she couldn’t deposit the cost till 13 August 2013. On 8 August 2013, when she visited the workplace of Birla Solar Life Insurance coverage, the involved official requested her to return later resulting from a rush on the workplace. Subsequently, she deposited the cost on 13 August 2013. 

She additionally clarified that she used to gather premiums on behalf of Birla Solar Life Insurance coverage based mostly on an understanding with them. She asserted that Suman Devi by no means knowledgeable her to settle the declare. As well as, she objected to the maintainability of the grievance, together with considerations in regards to the accruing reason behind motion. 

Whereas partly permitting the grievance, the state fee directed Birla Solar Life Insurance coverage to pay the sum assured with 9% curiosity, Rs21,000 as compensation for psychological and bodily harassment and Rs11,000 as litigation value. 

Aggrieved by the order of the state fee, Birla Solar Life Insurance coverage filed a revision petition earlier than NCDRC. The counsel for Birla Solar Life Insurance coverage reiterated the grounds acknowledged within the attraction and vehemently contended that the coverage was reinstated after the loss of life of the DLA, and this important reality was hid when the renewal premium was paid, together with the COI by Suman Devi.

He emphasised that the coverage lapsed on 19 March 2013 and was revived on 21 August 2013. Because the DLA died on 16 August 2013, the coverage was not in pressure on the time of his loss of life, justifying the repudiation of the declare. He argued that Kamlesh Kaur, the insurance coverage agent, was not particularly authorised by the insurer to gather the premium on its behalf. Furthermore, the premium quantity was deposited with Birla Solar Life Insurance coverage solely after the accident, making Suman Devi ineligible for any declare profit.

The counsel for Suman Devi emphasised that acceptance of the premium by the insurance coverage firm on 13 August 2013 and reinstatement of the coverage on 21 August 2013 show that Kamlesh Kaur was certainly their authorised agent. “There was no scope for coverage to be reinstated in any other case. An insurance coverage agent is an worker of the insurer, operates underneath a license or authorisation and sells its merchandise, and earns a fee. Subsequently, the argument that she was not an worker of the insurer is baseless.” 

He additionally highlighted the precept of fine religion and acknowledged that the insured had paid the premium quantity in good religion on 8 August 2013. “Any failure by the agent or the insurance coverage firm to deal with the transaction mustn’t penalise the harmless widow who acted sincerely in good religion.”

After listening to the arguments and browsing paperwork obtainable on document, NCDRC noticed that the first difficulty, on this case, revolves across the validity of the life insurance coverage coverage, which was reinstated after Mr Kumar’s loss of life. 

It’s an uncontested place that the deceased insured by no means hid any reality in anyway. The bench says, “It is usually admitted place that he paid the premium to the agent, who commonly collected these premiums dues on behalf of Birla Solar Life Insurance coverage. As on the date when he (Mr Kumar) paid the premium and handed over the certificates of insurability, there was no objection in anyway as regards reinstatement of insurance coverage coverage already issued to him.” 

“It is just after just a few days that he sustained a gunshot damage on 12 August 2013, critically injured and died on 16 August 2013. Within the interim, the agent had deposited the premium paid by the DLA on 8 August 2013 with Birla Solar Life Insurance coverage. In any case, the DLA, having finished his due had no additional mandate on this regard. Kamlesh Kaur had expressly acknowledged that she went to Birla Solar Life Insurance coverage to deposit the premium paid by the insured on 8 August 2013. Nonetheless, resulting from rush within the workplace of Birla Solar Life Insurance coverage, it couldn’t be deposited,” the bench famous.

Contemplating the info and circumstances of the case, NCDRC says it sees no purpose to intrude with the order issued by the state fee on 25 November 2016. Whereas directing Birla Solar Life Insurance coverage to pay the complete sum assured with 9% curiosity and Rs30,000 as the price of litigation, the bench put aside the order to pay Rs21,000 in the direction of compensation for psychological and bodily harassment.

(First Attraction No576 of 2017  Date: 12 January 2024)Whereas partially upholding an order handed by the state fee, the nationwide shopper disputes redressal fee (NCDRC) directed Birla Solar Life Insurance coverage Co Ltd (Aditya Birla Solar Life Insurance coverage Co Ltd) to pay a Rs35.10 lakh loss of life declare and Rs30,000 value of litigation to the nominee of the deceased life assured (DLA). On this case, the insurer had accepted cost for renewal of the coverage however rejected the declare, stating that the coverage was not in pressure on the time of the DLA’s loss of life.

In an order final week (https://cms.nic.in/ncdrcusersWeb/GetJudgement.do?methodology=GetJudgement&caseidin=0percent2F0percent2FFApercent2F576percent2F2017&dtofhearing=2024-01-12), the NCDRC bench of Subhash Chandra (presiding member) and air vice-marshal (AVM) J Rajendra (retd) says, “…it was bona fide transaction whereby the life assured (LA) had paid the dues as required and handed over the certificates of insurability in addition to required and the info are uncontested and undisputed. There was additionally no scope for the LA to tell Birla Solar Life Insurance coverage or the department supervisor of the insurance coverage firm about any accidents sustained by him as he suffered essential gunshot accidents. Even when there was some ambiguity within the matter, as per settled rules, the advantage of the doubt ought to go to the LA who fulfilled all his obligations.”

The case is expounded to a loss of life insurance coverage declare filed by Sonipat-based Suman Devi, the spouse and nominee of Manoj Kumar, the DLA. Mr Kumar had purchased a 30-year insurance coverage coverage from Birla Solar Life Insurance coverage for a sum assured of Rs35.10 lakh for an annual premium of Rs10,501. He paid 4 instalments until 15 July 2012. On 8 August 2013, he paid Rs21,010 for the revival of the coverage and handed over the certificates of insurability (COI) to Kamlesh Kaur, the agent of Birla Solar Life Insurance coverage. 

Nonetheless, on 12 August 2013, Mr Kumar was fatally shot. A primary info report (FIR) was registered within the case. Nonetheless, because of the severity of the damage sustained, on 16 August 2013, he died. 

Suman Devi submitted a loss of life declare with Birla Solar Life Insurance coverage. Nonetheless, the insurance coverage firm rejected the declare, stating that the coverage was not in pressure on the time of Mr Kumar’s loss of life. Consequently, the insurer refunded the premium of Rs 21,010. 

In response to Birla Solar Life Insurance coverage, the LA (Mr Kumar) was already lifeless by the point the coverage was reinstated, and the insurer was saved at the hours of darkness about him being critically injured. It was resulting from such concealment that the renewal was finished, and due to this fact, the repudiation of the declare is so as, it added.

Additional, the insurer says, “Kamlesh Kaur was not particularly authorised to gather premium (from Mr Kumar), and he or she deposited the premium solely on 13 August 2013 after he was injured and earlier than he died on 16 August 2013, with out disclosing the very fact. Subsequently, the coverage reinstated on 21 August 2013 just isn’t tenable.”

Being aggrieved by the repudiation of the declare and deficiency in service on the a part of the insurer, Suman Devi filed a shopper grievance earlier than the Haryana state shopper disputes redressal fee in search of the insured quantity of Rs35.10 lakh together with curiosity at 18percentpa (each year), Rs2 lakh as compensation for psychological agony and harassment, Rs50,000 for bills and Rs22,000 in the direction of litigation value.

Throughout the listening to, the insurance coverage firm acknowledged that the coverage was reinstated on 21 August 2013 because of the concealment of true info by the DLA. It says, “Though the DLA signed and crammed the certificates of insurability on 8 August 2013, the premium was paid on 13 August 2013 by way of Kamlesh Kaur. Furthermore, the DLA had already sustained a gunshot damage on 12 August 2013, which was not disclosed. The basic precept governing insurance coverage contracts, ‘uberrima fides,’ which interprets to utmost good religion.”

In her submission, Kamlesh Kaur admitted to receiving the premium and the COI on 8 August 2013 from Mr Kumar. Nonetheless, she claimed she couldn’t deposit the cost till 13 August 2013. On 8 August 2013, when she visited the workplace of Birla Solar Life Insurance coverage, the involved official requested her to return later resulting from a rush on the workplace. Subsequently, she deposited the cost on 13 August 2013. 

She additionally clarified that she used to gather premiums on behalf of Birla Solar Life Insurance coverage based mostly on an understanding with them. She asserted that Suman Devi by no means knowledgeable her to settle the declare. As well as, she objected to the maintainability of the grievance, together with considerations in regards to the accruing reason behind motion. 

Whereas partly permitting the grievance, the state fee directed Birla Solar Life Insurance coverage to pay the sum assured with 9% curiosity, Rs21,000 as compensation for psychological and bodily harassment and Rs11,000 as litigation value. 

Aggrieved by the order of the state fee, Birla Solar Life Insurance coverage filed a revision petition earlier than NCDRC. The counsel for Birla Solar Life Insurance coverage reiterated the grounds acknowledged within the attraction and vehemently contended that the coverage was reinstated after the loss of life of the DLA, and this important reality was hid when the renewal premium was paid, together with the COI by Suman Devi.

He emphasised that the coverage lapsed on 19 March 2013 and was revived on 21 August 2013. Because the DLA died on 16 August 2013, the coverage was not in pressure on the time of his loss of life, justifying the repudiation of the declare. He argued that Kamlesh Kaur, the insurance coverage agent, was not particularly authorised by the insurer to gather the premium on its behalf. Furthermore, the premium quantity was deposited with Birla Solar Life Insurance coverage solely after the accident, making Suman Devi ineligible for any declare profit.

The counsel for Suman Devi emphasised that acceptance of the premium by the insurance coverage firm on 13 August 2013 and reinstatement of the coverage on 21 August 2013 show that Kamlesh Kaur was certainly their authorised agent. “There was no scope for coverage to be reinstated in any other case. An insurance coverage agent is an worker of the insurer, operates underneath a license or authorisation and sells its merchandise, and earns a fee. Subsequently, the argument that she was not an worker of the insurer is baseless.” 

He additionally highlighted the precept of fine religion and acknowledged that the insured had paid the premium quantity in good religion on 8 August 2013. “Any failure by the agent or the insurance coverage firm to deal with the transaction mustn’t penalise the harmless widow who acted sincerely in good religion.”

After listening to the arguments and browsing paperwork obtainable on document, NCDRC noticed that the first difficulty, on this case, revolves across the validity of the life insurance coverage coverage, which was reinstated after Mr Kumar’s loss of life. 

It’s an uncontested place that the deceased insured by no means hid any reality in anyway. The bench says, “It is usually admitted place that he paid the premium to the agent, who commonly collected these premiums dues on behalf of Birla Solar Life Insurance coverage. As on the date when he (Mr Kumar) paid the premium and handed over the certificates of insurability, there was no objection in anyway as regards reinstatement of insurance coverage coverage already issued to him.” 

“It is just after just a few days that he sustained a gunshot damage on 12 August 2013, critically injured and died on 16 August 2013. Within the interim, the agent had deposited the premium paid by the DLA on 8 August 2013 with Birla Solar Life Insurance coverage. In any case, the DLA, having finished his due had no additional mandate on this regard. Kamlesh Kaur had expressly acknowledged that she went to Birla Solar Life Insurance coverage to deposit the premium paid by the insured on 8 August 2013. Nonetheless, resulting from rush within the workplace of Birla Solar Life Insurance coverage, it couldn’t be deposited,” the bench famous.

Contemplating the info and circumstances of the case, NCDRC says it sees no purpose to intrude with the order issued by the state fee on 25 November 2016. Whereas directing Birla Solar Life Insurance coverage to pay the complete sum assured with 9% curiosity and Rs30,000 as the price of litigation, the bench put aside the order to pay Rs21,000 in the direction of compensation for psychological and bodily harassment.

(First Attraction No576 of 2017  Date: 12 January 2024)

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