Rajeshwar Nath Gupta filed an appeal against the decision of ABC Life Insurance Company relating to non-settlement of death claim of his sister's pension policy. The claimant stated that his sister had purchased a Deferr

CS Professional · Insurance - Law & Practice · PYQS · December 2019
Rajeshwar Nath Gupta filed an appeal against the decision of ABC Life Insurance Company relating to non-settlement of death claim of his sister's pension policy. The claimant stated that his sister had purchased a Deferred Annuity policy from the insurance company on 24-2-2005 which matured on 24-2-2011 and he was the nominee in her policy. His claim was rejected by Divisional Office Agra on the ground that his sister had not given the name of her "spouse" at the time of annuity. The complainant stated that since his sister was unmarried, hence, the question of spouse as nominee does not arise. It is possible that the time of maturity, wrong annuity option was ticked by his sister. His claim was genuine and should be paid by the Insurance Company in the shape of annuity or sum assured. The Insurance Company submitted that the policy matured on 24-2-2011 and annuity started @ ₹5949 on yearly basis. The total Notional cash option under the policy was ₹66023. After receipt of five annuity installments, the assured died on 10-6-2016. Since it was an annuity plan, the deceased had opted for option "I" which means Annuity for life with provision of 100% annuity to Spouse for life on death of Annuitant. Since the annuitant did not provide the name of her spouse, the claim was rejected by the insurance company. However, later on it was observed that the annuitant was unmarried and had nominated her brother in her policy. The matter of fact is that the deceased had wrongly ticked option 'I' (Annuity for life with a provision for 100% of annuity to the spouse of the annuitant for life on death of annuitant) instead of option 'F' (annuity for life with return of purchase price). Based on above facts, answer the following: Is the insurance company justified in denial of the claim in the given case.

Answer & Explanation:

In the given case, Rajeshwar Nath Gupta is entitled to the death claim of his sister's pension policy. Based on the facts of the case, the insurance company is not justified in denial of the claim in the given case. The matter of fact is that the deceased had wrongly ticked option T (Annuity for life with a provision for 100% of annuity to the spouse of the annuitant for life on death of annuitant) instead of option "F" (annuity for life with return of purchase price). And they simply denied the claim stating that the assured had ticked the option T Hence, considering it an unintentional human error, the Insurance Company should not have denied the claim on such a flimsy ground. The claim thus stands payable.

Topics: Life Insurance

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