Date of Filing: 12.12.2017. Date of Disposal: 23.06.2022.
Complainant :Debnath Bauri, S/O Late Rabi Bauri, resident of Village: Napara, P.O. Birudiha P.S. Kanksa, District. Purba Bardhaman, Pin-713148.
-VERSUS -
Opposite Party : 1.Bharati AXA Life Insurance Company Ltd., having its Branch Office at R.G. Bhavan, Parbirhata, P.O. Sripally, District. Purba Bardhaman. Pin 713103, represented by its Branch Manager.
2. The Chairman, Bharati AXA Life Insurance Company Ltd., having its registered office at Unit 601 & 602, 6th Floor, Raheja Titanium , Off Western Express Highway, Goregaon ( E ) , Mumbai, India, Pin -400063.
Present : Mohammad Muizzuddeen -Hon’ble President.
: Mrs. Lipika Ghosh - Hon’ble Member.
Appeared for the Complainant : Sri Sumit Roy Ld. Advocate.
Appeared for the Opposite Party Nos.1 & 2. : Sri Anirban Mukherjee Ld. Advocate.
FINAL ORDER
On 12.12.2017 the complainant, Debnath Bauri, being the nominee of his deceased father Rabi Bauri, lodged this complaint u/S 12 of the Consumer Protection Act, 1986 against the OPs.
The case of the complainant, in brief, is that his father Rabi Bauri purchased Bharati AXA Life Elite Advantage Plan bearing Policy No. 501-4821291 ( UNI 130N060V01) which was commenced on 21.09.2016 and the date of maturity was 21.09.2028 and during the lifetime father of the complainant paid the first installment of Rs. 20,999.89/- only including service tax . But his father expired on 27.12.2016 at 7.25 P.M. at his residence at Vill. Napara, P.S. Kanksa, Dist. Purba Bardhaman, due to cardiac respiratory failure. Xerox copy of death certificate was issued by Dr. Shamsundar Manna. The complainant intimated the said fact to the OP Nos. 1 and as per its advice he submitted the claim form duly filled up along with all required documents on 28.04.2017 for settling the death claim as per policy in favour of the complainant. OP No.1 investigated the matter but no response was received by the complainant regarding the claim. The OPs neither repudiated the claim nor settled the same. As a result, the complainant went to the office of the OP No.1 and requested to look into the matter for settling the claim but the OP did not settle the claim. Finding no other alternative, the complainant has filed this case, as the OPs committed deficiency in service and unfair trade practice and for that the complainant suffered great mental pain, agony and harassment.
The cause of action of this case arose on and from 27.12.2016 and finally on 28.04.2017 and the case is not barred by Law of Limitation.
Upon this background, the complainant prayed for direction upon the OPs to give the maturity value of Rs. 4,84,295/- against the said policy and Rs.1,50,000/- as compensation towards mental pain, agony and harassment along with cost of Rs.22,000/-.
The OPs have contested the case by filing written version denying all the material allegations contending inter alia that the Consumer Forum has no jurisdiction to entertain the matter and the complainant has no locus-standi to file the complaint and that the complainant has no cause of action to file the case.
The specific case of the OPs is that the complainant has, with mala-fide and di-honest intentions not only concealed the materials facts but also twisted, distorted the same to suit his own convenience and to mis-lead the Hon’ble Forum. The OPs admitted that father of the complainant purchased the policy in question including the amount of premium and the sum assured was Rs. 4,84,295/- and the policy term was for 12 years. It is also admitted fact that the father of the complaint paid Rs.20,999.89/- as premium.
The further case of the OPs is that the present complaint is devoid of any substance as complainant has concealed and suppressed the material and relevant facts of the case. During investigation by the company, evidence was collected which established that the father of the complainant had already expired on 05.07.2016 but the policy was taken on 24.09.2016 against the name of a dead person and subsequently, the said policy has been claimed by the complainant with wrong information that the insured was expired on 27.12.2016. If at the time of issuing policy in the name of dead person, the OPs were aware of the actual fact, then the said policy was not issued in the name of a dead person. Accordingly, the claim of the policy was repudiated by them which was informed to the complainant through their letter dt. 30.09.2017.
Upon this background, the OPs claim the disposal of the case.
Decision with Reasons.
In order to prove the case, the complainant has filed evidence-on-affidavit of himself along with copies of policy documents , first premium receipt and the Xerox copies of proposal form , acknowledgment slip etc. The questionnaires to that evidence were filed by the OP Nos. 1 & 2 and the complainant gave answer to those questionnaires.
In order to disprove the case and to prove their own case, the OP Nos. 1 & 2 filed evidence-on-affidavit and the complainant also filed questionnaire against their evidence. But the OPs did not file reply against the said questionnaire and categorically stated that they would not file any reply.
The complainant has filed Written Notes of Argument (W.N.A) and the OP Nos. 1 & 2 also filed Written Notes of Argument (W.N.A).
From the complaint, W/V, Xerox copies of Insurance papers and Written Notes of Arguments, it appears that the father of the complainant was the consumer under the OPs and it is also admitted that during his lifetime, the father of the complainant paid the first installment of Rs.20,999.89/- to the OP but it is alleged by the OPs that the complainant by practicing fraud and forgery , obtained the Insurance Policy against the dead person who was the father of the complainant, by showing that Rabi Bauri died on 05.07.2016, though actually he died on 27.12.2016. But the complainant has adduced evidence both oral and documentary that he did not commit any fraud or forgery upon the OP at all and he claimed that his father Rabi Bauri died on 05.07.2016 actually. The OPs only relied on the report of investigation submitted by their Asha workers which is not supported by any documents i.e. death certificate of the father of the complainant or any paper of criminal case regarding fraud and forgery. On the other hand, the complainant has produced Xerox copy of death certificate given by Dr. Shamsundar Manna, who examined the father of the complainant, which disclosed that Rabi Bauri died on 27.12.2016 at 7.25 p.m. at his residence and the Xerox copy of the death certificate issued by the Pradhan, Amlajora Gram Panchayet, Dist. Burdwan that Rabi Bauri died on 27.12.2016 but the OPs could not produce any document to show that Rabi Bauri died on 05.07.2016. Therefore, we have no hesitation to hold that Rabi Bauri , father of the complainant, died on 27.12.2016 and there is no dispute regarding the date and time of death of the insured. In such situation, it can be said that during the life time of Rabi Bauri, he has paid the first installment of premium of Rs.20,999.89/- on 21.09.2016. The complainant claimed that his father died at his residence at Vill. Napara, P.S. Kanksa, Dist. Burdwan due to Cardiac Respiratory Failure and he has already proved the same by death certificate given by the doctor concerned and as no document regarding the death of the father of the complainant is forthcoming on behalf of the OPs, the contradictory version of the OPs cannot be accepted according to law. It is also admitted fact that the total assured value was Rs.4, 84,295/- after the maturity of the Insurance policy. But before the date of maturity, the insured person died and accordingly the insured person is entitled to get total maturity value of the policy. The complainant, being the nominee and son of the insured person Rabi Bauri, has claimed the said amount. But the OPs repudiated the said claim on the above ground as alleged by them which has been discarded in the findings of this case.
Under the above facts and circumstances, we are of opinion that the complainant has been able to prove his case to the fact that the OPs committed the deficiency in service by repudiating the death claim insurance and the complainant is entitled to get the death benefit for pre-matured death of his father.
As a result, the case succeeds.
Hence, it is
ORDERED
That the Consumer Complaint No. 246/2017 be and the same is allowed on contest against the OPs but without any cost.
The OPs are hereby directed to pay the sum assured of Rs. 4, 84,295/-(Rupees Four Lakh Eighty Four Thousand Two hundred Ninety Five Only) against the Policy being No. 501-4821291 (UNI 130N060V01) to the complainant by account payee cheque within 45 days from the date of receipt of this order, failing which the said amount shall carry interest @8% p.a. till realization.
OPs are also directed to pay Rs.10,000/- (Rupees Ten Thousand only) towards mental pain, agony and harassment and Rs.3,000/- (Rupees Three Thousand only) as litigation cost to the complainant within 45 days from the date of passing of this award , failing which the said amount shall also carry interest @ 8% p.a. till realization.
Let a copy of this order be given to the parties on free of cost.
Dictated & corrected by me.
President
D.C.D.R.C , Purba Bardhaman.
Member President
D.C.D.R.C , Purba Bardhaman. D.C.D.R.C , Purba Bardhaman.
