Adv. for the complainant- Sri B.C.Pradhana & Associates.
Adv. for the Opp.Parties – Sri N.R.Babu & S.Joshi.
Date of filing of the case-15.07.2016
Date of order - 13.10.2016
JUDGMENT.
Sri A.K.Purohit, President.
The complainant being the nominee of the policyholder late Pandaba Ghadei, has preferred; this case after the death of the policy holder alleging deficiency in insurance service. The case of the complainant is that, her husband late Pandab Ghadei ;is a policy holder of the O.Ps vide policy No.0119534820, which is valid from 18.02.2009 to 18.02.2019 and paid one time premium amounting to Rs 6,820/- .The assured amount for the said policy known as Bajaj Allianz Protector is Rs 5,00,000/- which covers death benefit as well as loan protector benefit .The policy holder died on dt.24.10.2014 due to GI bleed and decompensated Alcoholic Liver disease. To this the complainant being the nominee has lodged a claim before the O.Ps and after consideration of the claim the O.Ps have settled the claim at Rs 2,89,770/- .The complainant alleges that, when the assured amount is Rs 5,00,000/- settlement of the claim for a lesser amount by the O.Ps amounts to deficiency in service. Hence the complaint.
2. Although notice was served on O.Ps 1 & 2 neither they appeared nor proceeded with the hearing of the case and hence they are set exparte vide order dated 17.07.2017. O.P. 3 files written version. In his version the O.P.3 simply denied the complainant’s allegations and submitted that, the minimum death benefit payable will be equal to the outstanding loan amount and accordingly an amount of Rs 2,89,770/- has already been paid to the complainant. The O.P.3 claims dismissal of the case.
3. Heard the complainant. The O.Ps have not participated with the hearing of the case. Perused the written version filed by O.P.3. The O.P.3 has not produced any documentary evidence.
4. Perused the policy document filed by the complainant. The policy is a life insurance policy which covers death benefit and also loan protector benefit and the sum assured is Rs 5,00,000/- and the policy is valid for a period of ten years i.e from 18.02.2009 to 18.02.2019. The medical certificate issued by the ordinance factory hospital, Badmal shows that, Pandaba Ghadei died on dt.24.10.2014 at the age of 39 years, due to GI bleed and Decompensated Alcoholic Liver disease. This evidence disclosed that during the subsistence of the policy, the policy holder died and the policy is covered with death benefit. There is no evidence available on record to show that the death benefit is limited to the loan amount of the policy holder. The policy is covered with loan benefit ;but the death benefit is not limited to the loan amount. Terms and conditions of a insurance policy is binding on the party and it cannot be interpreted which is not the true intention of the parties. Once the insurance company issued a insurance policy, he is bound to indemnify the loss and damages caused to the policy holder. An interpretation which is acceptable to the insurance company cannot be accepted and the complainant is entitled to sum assured of the policy.
5. Under the aforesaid facts and material available on record, the settlement of claim of the complainant for a lesser amount by the O.Ps amounts deficiency in service on the part of the O.Ps. Hence ordered.
ORDER.
The O.Ps are directed to pay the balance assured amount of Rs 2,10,230/- (Rupees Two Lakhs ten thousand two hundred thirty) only to the complainant with interest @ 8% per annum from the date of death i.e 24.10.2014 till payment within 30 days from the date of receipt of this order. The O.Ps are further directed to pay Rs 1,000/- towards cost and Rs 5,000/- towards compensation to the complainant within the aforesaid period.
Accordingly the case of the complainant is allowed.
Order pronounced in open forum this the 13th day of October 2017.
(S.Rath) (A.K.Purohit)
MEMBER. PRESIDENT.
