Page 53 - Life Insurance Today January-June 2020

for cash after the premiums have been paid for at least 3 of Rs. 5000/- paid on28.07.2016 & Hospital Cash Benefits
years. The guaranteed surrender value allowable under this of Rs. 2000/- paid on 02.01.2017.
policy is equal to 30% of the total premium paid excluding
1st premium and all extra premium paid therein. The poli- FINDINGS & DECISION:- During hearing, the complainant
cies were commenced on 06/2011 and the First unpaid pre- contended that he was admitted from 09.03.2016 to
mium in both the policy was 12/2013. Thus the premium 25.03.2016 and claim should be paid accordingly. There-
were paid for 2 years and 9 months. fore, I direct the Insurance Company to settle the claim of
the complainant for hospitalization period from 09.03.2016
The complainant is ready to pay all renewal premiums due to 25.03.2016. Accordingly an Award is passed with the
along with interest but the insurer is not accepting the direction to the Insurance Company to settle the claim of
payment and allowing the renewal of policy. The request the complainant for hospitalization period from 09.03.2016
of renewal has been made within 5 years from the date of to 25.03.2016.
first unpaid premium. In such a case the insurer does not
have any right to forfeit the premium. Forfeiture of pre- Mr. Jagdish Wadhwani
mium is possible only if the condition laid down in condi-
tion No 5 are satisfied. None of the conditions as laid down V/S
in condition No 5 is satisfied. Hence all the premiums paid Bajaj Allianz Life Insurance Co. Ltd.
by the insured is refundable.
Complaint No. BHP-L-006-1617-0540
Taking into account the facts & circumstances of the case
and the submissions made by both the parties during the Brief Facts:- The Complainant had taken above policy
course of hearing the Respondent is hereby directed to while he had taken loan from Bajaj Finance Ltd.. It is al-
make refund of all premium paid total Rs.74448/- to the leged that at the time of proposal wrong information were
complainant being full and final settlement of the claim. given about SA and terms & conditions of the policy and
further added that he has also not received the policy bond
Hospitalization Claim so far. He made request for cancellation of policy but no
satisfactory reply was given by the respondent. As per SCN
Mr Anoop Tiwari the company first time comes to know of the grievance of
V/S the complainant upon the receipt of his mail dated 04-Oct-
2016 i.e. after the lapse of nearly 31 months from the date
Life Insurance Corporation of India of commencement of the policy. So, his request was re-
jected being beyond free look period.
Complaint No. BHP-L-029-1617-0530
FINDINGS & DECISION:- During hearing, the represen-
Brief Facts:- Complainant’s right leg was fractured due tative of the respondent company could not submit any
to an accident on 09.03.16 and got treatment in Hospital. proof of delivery of the policy. Hence, it emerged that the
Then medical expenses claim was lodged to the respondent, complainant had not received the policy and therefore In-
but hishospitalization claim was not paid by the respondent surance Company is advised to provide a duplicate policy
as per the condition and requirement mentioned in the to the complainant.
policy. As per SCN the policyholder had been admitted in
the City Hospital, Bhopal on 09.03.2016 at 4.20 pm due to Mr. Kaushal Wadhwani
road accident. He was diagnosed as RTA c Fracture Tibia
Shaft Rt side. His surgery was done on 09.03.2016 under V/S
spinal anesthia. Closed interlocking nailing was done. On Bajaj Allianz Life Insurance Co. Ltd.
10.03.2016 he was shifted to Shivam Hospital for further
treatment and was admitted there up to 25.03.2016 at Complaint No. BHP-L-006-1617-0541
7.00 pm, hence, as per the policy condition following pay-
ments are made to the policyholder. Hospital Cash Benefits Brief Facts:- The Complainant stated that the above policy

Sometimes the questions are complicated and the answers are simple.

Life Insurance Today January - June 2020 53