Sri Sudhakar Senapothi    - Member.

Complainant Sunena Naidu has filed this case u/s 35 of CP Act-2019 alleging deficiency of service on the part of the Opposite Parties for non-payment of the insurance claim to her praying therein for direction to the Opposite Parties to pay a sum of Rs. 10,00,000/- under insurance policy No.

23722972 with interest @ 18% per annum from 07.10.2021 till its realization and a sum of Rs. 2,00,000/- towards deficiency and harassment and a sum of Rs. 1,00000/- towards cost of litigation.

1.           Brief fact leading to the case is that the complainant is the nominee and adopted daughter of Late Arakhita Barik who had an Life Insurance Policy in HDFC Life bearing Policy No. 23722972. The policy was in force from 20.04.2021 and the annual premium was Rs. 1,00000/- and the sum assured was Rs. 9,51,656/-. During the course of the policy, Arakhit Barik died in accident and the complainant being the nominee of the policy claimed the amount. But, the Opposite Parties repudiated the claim of the complainant on the ground of suppression of the material facts by the insured at the time of obtaining of policy. It is submitted that the insured has never produced any forged documents and never made any false statement to defraud the company and no questions have been asked to the insured and therefore the repudiation of the claim is illegal and arbitrary for which she approached this Commission for the reliefs as discussed in the preceding paragraph.

2.           After receipt of the notice, the OPs appeared through their Advocates and filed their joint written statements. In their written statements, the Ops stated that deceased late Arakhita Barik was covered under the insurance policy for a term of 17 years with an annual premium of Rs. 1,20,250/- for a premium payment of Rs. 1,20,250/- with premium payment mode 12 years and the sum assured of Rs. 9,51,656/-. In the proposal form, the complainant had declared that he had read and understood the terms and conditions of the insurance plan/policy obtained. After being convinced and satisfied with terms and conditions explained in the relevant literature and illustration, the complainant had filled and duly signed the proposal for issuance of the said policy. The Opposite Parties after taking due consideration of the afore said proposal of the deceased and had accepted the same and issued the insurance policy. It was mentioned in death claim form that late Arakhit Barik had died on 06.12.2021 due to cardiac arrest. After receipt of the proposal form, one investigator was appointed and it was reported  by the investigator that the deceased was 43 years old, male, unemployed and the local residents could not state anything regarding the whereabouts of his wife and the nominee Sunena Naidu is in no way bloodly related with the deceased. The insured in his proposal form has specifically mentioned that he was a salaried employee in District Welfare Department, Nuapada working as Junior Clerk with annually income of Rs. 5,80, 000/-, 3 months’ salary slips as income proof and bank statement showing salary for the period from 01.04.2020 to 19.03.2021. It was revealed after investigation that all these information are false and his previous proposal has been declined by several insurance companies. As the insured had furnished false information for obtaining the policy, the claim was repudiated and there is no question of deficiency in service on their part and pray for dismissal of the case with costs.

3.           The only question relating to this case is whether the deceased has filed false documents and made false statements in his proposal form?

We have perused the entire case record along with the order sheet. The Opposite Parties have not filed a single scrap of paper like the proposal form, the documents which they claimed to be fake, the report of the investigators and other relevant documents to support their pleadings. In the absence of any documents, the pleading of the Opposite Parties are unacceptable in the eyes of law. It creates very big doubt in our mind as to why the Opposite Parties suppressed the documents which are essential for just decision of the case. The prime documents on which the case of the Opposite Parties involve is the proposal form and the documents filed by the deceased at the time of the obtaining the policy. In the absence of any documents, we are unable to accept the pleadings forwarded by the Opposite Parties.

4.           As the Opposite Parties failed to prove their case, we are of the considered view that the Opposite Parties have caused deficiency in service to the complainant by not paying her insurance claim and are made liable to compensate the complainant for the loss and harassment sustained by her due to the illegal act of the Opposite Parties and hence the order.

O R D E R

The complaint petition is allowed on contest against the Opposite Parties. The Opposite Parties are directed to pay a sum of Rs. 9,51,656/- (Rupees Nine Lakh, Fifty-one Thousand and six hundred fifty-six) only with interest @ 12% per annum from the date of repudiation. The Opposite Parties are directed to pay a sum of Rs. 1,00,000/- (Rupees One Lakh) only towards compensation for causing deficiency in service and harassment and a sum of Rs. 25, 000/- (Rupees Twenty-Five Thousand) only towards cost of litigation. The order is to be complied with within a period of 30 days from the date of order failing which the order as to cost and compensation shall carry interest @ 12% per annum from the date of order till its compliance.