FINAL ORDER/JUDGMENT
SMT. SUKLA SENGUPTA, PRESIDENT
The instant case is filed by the complainant U/S 35 of the C.P. Act, 2019.
Facts of the case in brief is that her husband namely Rabindranath Ghosh since deceased purchased two Life Insurance Policies from the OPs Bajaj Allianz Life Insurance Co. under Long Life Goal Plan being Policy No. 0419320487 on 06.10.2020 and 0422009367 on 28.10.2020 respectively on payment of required premium on Rs.1,00,000/- each and the sum assured was of Rs.10,00,000/- each. The photocopies of policy certificate are marked as annexure P-1 and P-2 respectively.
It is the further case of the complainant that the proposer of the subject policies / policy holder namely Rabindranath Ghosh (since deceased) breath his last on 03.11.2020 at his own residence at Chakananta, Haripal, Hooghly-712403. The Photocopy of death certificate of Rabindranath Ghosh (since deceased) has been brought into evidence as annexure P-3.
The complainant further stated that the premium of Rs.1,00,000/- was received by the OPs in respect of the policy No. 0419320487 was received on 08.10.2020 and the premium of Rs.1,00,000/- for another policy being No. 0422009367 was received by the OPs on 03.11.2020 and both the receipts have been brought into evidence as annexure P-4 and P-5.
It is further stated by the complainant that after demise of her husband the complainant claimed the death benefit from the OPs. The OP-2 vide letter dated 19.05.2021 asked for a clarification from the OP-3. The photocopy of the letter dated 19.05.2021 has been brought into evidence as annexure P-6. The complainant alleged that the OP-4 repudiated the death benefit claim in both the subject policy as mentioned above vide letter dated 23.04.2021. The photocopy of letter dated 23.04.2021 has brought into evidence as annexure P-7 and P-8 collectively.
It is alleged by the complainant that the OPs issued the policy certificates on proper verification and investigation and also receipt the premium of Rs.1,00,000/- each. But after demise of the policy holder namely Rabindranath Ghosh being the husband of the complainant, the complainant being the nominee claimed the death benefit from the OPs but the OPs without lent their ears to the request of the complainant repudiated the claim on 23.04.2021. Hence, cause of action raised in this case on the date of death of the policy holder Rabindranath Ghosh (since deceased) and on the date of repudiation of the case. Hence, having no other alternative, the complainant has filed this case against the OPs with a prayer to give direction to the OPs to reimburse the death claim of Rs.10,00,000/- in Policy No. 0419320487 and Rs.10,00,000/- more for 0422009367 in total of Rs.20,00,000/- only as death claim along with compensation of Rs.5,00,000/- and litigation of Rs.1,00,0000/-.
In view of the above stated facts and circumstances it has to be considered by this Commission:
- Is the complainant is a consumer?
- Whether there is any deficiency of service on the part of the OPs?
- Is the complainant entitled to get reliefs as prayed for?
The OPs did not contest the case even on receipt the notice, so, the case do run ex parte against OPs-1 to 4 vide order No. 9 dated 24.01.2023.
Decision with reasons
All the points are taken up together for convenience of discussion and to avoid unnecessary repetition.
On a close scrutiny of the materials on record it appears that the husband of the complainant namely Rabindranath Ghosh (since deceased) initiated the subject insurance policies from the OPs Bajaj Allianz Life Insurance Co. under the Bajaj Allianz Life Long Life Goal Plan being Policy No. 0419320487 and 0422009367 respectively. The Policy No. 0419320487 was commenced on 06.10.2020 on payment of first premium of Rs.1,00,000/- and the other policy being No. 0422009367 was commenced on 28.10.2020 on payment of required premium of Rs.1,00,000/-. The complainant was the nominee in both the policies in question. From the unchallenged evidence on record as adduced by the complainant it is revealed that both the policies in question were initiated on 06.10.2020 and 28.10.2020 and the policy holder Rabindranath Ghosh (since deceased) was demised on 03.11.2020 from which it is crystal clear that the deceased husband of the complainant only paid the first premium of Rs.1,00,000/- each and he died due to Cardiac Arrest as it is revealed from the prescription issued by one Dr. K.L. Das dated 03.11.2020 at 01.30 p.m.
The complainant being the wife deceased claimed the death benefit from the OP Insurance Co. and it is admitted fact that the policy holder since deceased Rabindra Nath Gosh initiated the policies on 06.10.2020 and 28.10.2020 respectively on payment of required premium of Rs. 1,00,000/- each and died on 03.11.2020 due to cardiac arrest at his residence which is just after few days of the initiation of the subject policies.
It is fact that the complainant is the nominee of both the policy in question and she produced all the required documents as asked by the OP insurance Co. along with her application for death claim due to sudden demise of her husband ie policy holder Rabindra Nath Ghosh since deceased. From the ex parte evidence on record as adduced by the complainant we have got the policy holder deceased Rabindranath ghosh suddenly demise due to cardiac arrest at his residence. It is fact that just before few days of his death he initiated the policy on 06.10.2020 and 28.10.2020 on payment of Rs. 1,00,000/- each towards the premium but no body can say when he will fallen ill and sometimes it happened without any prior notice like the instant case. The wife of the diseased Rabindra nath Ghosh being the nominee of both the policy in question rightly prayed for death claim and he made application before the OP insurance co. with all the required documents along with Dr. certificate but the OP without making any investigation arbiterally and legally repudiated the claim of the complainant which they cannot even the OPs insurance co. did not feel any urge to come before the commission and to contest the matter by submitting supporting documents.
As and when the OP Insurance Co. raised the question of suppression of material facts in respect of existing disease of the policy holder then onus lies upon the insurance Co. to prove the same but the OP insurance Co. failed to submit the cogent document in support of the cause of repudiation vide letter dated 23.04.2021 sent by them to the complainant.
Under such circumstance, this commission is of view that the OPs caused deficiency in service by repudiating the claim of the complainant and by their conduct they also caused harassment, mental pain and agony to the complainant.
In both the subject policies the sum assured of Rs. 10,00,000/- each. Hence, in view of the discussion made above, this commission is of view that the complainant could be able to prove her case on the basis of her ex parte evidence beyond all reasonable doubts against the OPs and she is entitled to get the relief as prayed for.
All the points of consideration are thus considered and decided in favour of the complainant.
The case is properly stamped.
Hence,
Order
that the case and be same is decreed exparte against all the OPs with cost of Rs 2,000/- .
The complainant do get the decree as prayed for.
The OPs are directed to reimburse the death claim of Rs. 10,00,000/- each in respect of both policy No. No. 0419320487 and 0422009367 in total amounting of Rs. 20,00,000/- only to the complainant either jointly or severally within 45 days from the date of this order.
The repudiation letter dated 23.04.2021 issued by the OP-4 has no force at all.
The OPs are further directed to pay compensation of Rs. 30,000/- to the complainant either jointly or severally for harassment, mental pain and agony along with litigation cost of Rs. 10,000/- to the complainant within 45 days from the date of this order id the complainant is at liberty to execute the decree as per law.
The Judgment be uploaded forthwith on the website of the Commission for perusal of the party.
