Counsel for:

The Complainant:  Sri Soumendra Chand, Advocate ,Bhawanipatna .

For the O.P 1 & 2 :  Sri R.Panigrahi .Advocate .

                                                                                         JUDGMENT

Sri Aswini Kumar Patra,President,

1. The captioned consumer complaint is filed by the complainant named above inter alia alleging willful negligence & deficiency in  service on the part of the Ops for  non release of death  benefit under insurance policy vide No.0159121380 claimed on account of the premature death of insured son of the complainant which caused financial loss & mental agony to the complainant.
2. The complainant seeks for the following relief:-

1.  The Ops may be directed to pay the death benefit amount of Rs.1,50,000/-i.e sum assured and final maturity amount.  
2. The Ops may be directed to pay cost of  Rs.50,000/- to the petitioner for mental  agony and suffering,
3. The Ops may be directed to pay cost of Rs.5,000/- towards filing of this   case,
4. Any other order of reliefs passed by the Hon’ble Commission feel deem fit and proper.

1. The factual matrix leading to the case of the complainant as emerged from the case record is that, the deceased son of the complainant namely Khirasindhu Bag died unmarried on 02.06.2019. During his life time he had purchased one life insurance policy on 13.03.2010  vide policy No.0159121380 from  Bajaj Allianz Life Insurance Company  Ltd, Bhawanipatna Branch(OP 1) for a term of 10 (ten) years & for sum assured of Rs. 1,50,000/-wherein risk commence from 13.03.2013.Insurance premium was paid annually @ Rs. 30,000/- .The father of the complainant was  featured as  the nominee there in the said insurance policy to receive the benefit under the said policy in case of premature death of the insured and that , policy holder had deposited the required premium in due time till premium payment term against this said policy .Unfortunately the father of the insured died and there after the insured himself died on 02.06.2019 living behind  his mother /here the complainant as the sole legal heir. The insurance policy was in force as on the date of the death of the insured. It is further contended that, after death of insured Khirasindhu Bag and being the sole legal heir/mother of deceased insured, the complainant made a claim before the  Branch  Manager, Bajaj Allianz Life Insurance Company  Ltd/ OP 1 at Bhawanipatna on 20.03.2020 to release the  insurance benefit accrued there under the said policy where upon the Ops assured to process the same but  the Ops have not yet released the insurance benefit to the complainant even after several approaches which caused financial loss and mental agony to the complainant. Hence, his complaint.

3. On being notice, the Ops appeared through their Learned Counsel Sri R.Panigrahi and filed their written version denying the petition allegation on all its material particulars. It is submitted that, this complaint is not maintainable as the complainant has suppressed the material facts and hence, committed fraud upon the Ops while obtaining the alleged policy and that it is filed beyond the statutory limitation period as such liable to be dismissed with cost .It is further submitted that, the deceased had issued a Cheque vide No.233079 dt. 10.03.2010 drawn on Allahabad Bank for an amount of Rs.30,000/-towards the premium amount which was deposited by the Ops  on 11.03.2010 but the said cheque was returned unpaid by the banker of the complainant. It is further submitted that, since the premium has not been paid by the deceased /insured the policy was not in existence and complainant cannot have any claim and that, on this ground alone this present complaint is liable to be dismissed.
4. Peruse the material on record. We have our thoughtful consideration on the contention of the both parties.
5. After perusal of the complaint petition, written version and all the documents relied on by both the parties placed in the record, the points for consideration before this Commission is whether the complainant is entitled for insurance benefits there in the  alleged insurance policy  vide policy No.0159121380 of   Bajaj Allianz Life Insurance Company  Ltd, on account of premature death of her insured son Khira Sindhu Bag   and whether the Ops have deficient in service to settled the insurance claim of the complainant?
6. As per Sec.38(6) of C.P.Act,2019 every complaint shall be heard by the District Commission on the basis of affidavit & documentary evidence placed on record ; as such it casts an obligation on the District Commission to decide the complaint on the basis of evidence brought to its notice by the complainant and the service provider/seller, irrespective of whether the service provider/seller adduced evidence or not. The decision of the District Commission has to be based on evidence relied upon by the complainant. The onus thus is on the complainant making allegation.
7. To substantiate her claim, the complainant has filed the true photo copy of the following documents: -(i) Photo Copy of death certificate of insured Khirasindhu Bag,(ii) Photo copy of insurance Policy Bond  vide Policy No.0159121380,(iii) Photo copy of pass book of SB Account of complainant Shanti Bag vide A/c No.35832258671 of S.B.I, Junagarh Road, Bhawaniptna, (iv)Photo  copy of Aadhar Card of Shanti Bag vide No.2463 3744 4189 and these documents are not disputing by the Ops accordingly taken in to consideration.
8. The complainant has also filed her evidence on affidavit as prescribed under C.P Act 2019 ,the facts of which stated there in the affidavit evidence   are corroborating with the complainant averments is taken in to the record for consideration and it remain un-rebutted .
9. The Ops have not come forward to lead their evidence as prescribed under Sec.38(6) of C.P.Act,2019 to proved their pleading rather the evidence adduced by the complainant by way of her affidavit evidence remain unchallenged/un-rebutted.
10. The Ops have relied on the extract of the policy status and premium payment details as stated to be annexed with their written version vide Annexure –R 1. But we found no such document vide annexure R 1 is filed/annexed here with the written version to consider the version of the Ops.
11. Law is well settled that, mere pleading shall not construe evidence and it may not be taken as evidence to decide the matter in dispute.. Here in this case , the Ops have  failed to adduce any cogent evidence to substantiate their pleadings  .No iota of evidence is place on the record to hold that, “the insured (deceased) had issued any cheque vide No. 233079 dt.10.03.2010 drawn on Allahabad Bank for an amount of Rs.30,000/- towards the premium amount which was deposited by the Ops  on 11.03.2010 and that , said cheque was returned unpaid by the banker of the complainant and that, since the premium has not been paid by the deceased /insured the alleged policy was not in existence and that, the complainant cannot have any claim” .The Ops have failed to proved the contention of their written version .
12. Learned counsel for the complainant draw our attention on Para 8 (6) & (7) of Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests) Regulations, 2017 as follows :-“ 8. PROPOSAL FOR INSURANCE: (6). Insurer shall process the proposals with speed and efficiency and the decision on the proposal thereof, shall be communicated in writing to the proposer within a reasonable period but not exceeding 15 days from the date of receipt of proposals or any requirements called for by the insurer. (7). Where a proposal deposit is refundable to a prospect under any circumstances, the same shall be refunded within 15 days from the date of underwriting decision on the proposal.” We found nothing cogent evidence placed on record to hold that ,the proposal for  the alleged insurance policy has ever rejected or the alleged  policy, which is claimed to be issued to the deceased insured son of the claimant  has ever rejected or recalled at any point of time, under which complainant is  claiming  insurance benefit from the Ops in this case .
13. Here in this case, issued of insurance policy vide No. 0159121380 as per Sl. No-2 of the list of documents relied by complainant is not specifically denied by the Ops. So also death of the insured while said insurance policy was in force i.e on dt. 02.06.2019   leaving behind the complainant/mother as the sole legal heir to received the accrued benefit their under the said insurance policy is not specifically denied by the Ops. Law is well settled that every allegation or facts in the complaint if not denied specifically or by necessary implication, or stated to be admitted in the pleading of the O.P shall be taken to be admitted accept as against a person disability.
14. We found nothing contended there in the said insurance policy bond paper placed in the record vide Sl  No 2 series (of  13 pages) of the list of documents relied by complainant that, premium of the policy is paid by way of  Cheque. As such, in absence of cogent evidence placed on the record, we are unable to accept the contention of the Ops that, premium paid by way of cheque was returned unpaid by the banker of the complainant and that, since the premium has not been paid by the deceased /insured the alleged policy was not in existence rather, these contention has got no force hence,  rejected .
15. During hearing of this case, the Learned Counsel for the complainant submitted that, all the required documents along with  Claim Form  has been submitted  to the insurer/Ops for settlement of the claim on dt. 20.03.2020 which is corroborated with the facts stated there in para 7(seven) of the affidavit evidence of the complainant and that, the Ops have not yet released the insurance benefit to the complainant payable under the above said policy is proved as such, we are of the opinion that, there is sufficient cause of action continue to present this complainant. This complaint is filed on 23.09.2020 before  this Honourable Commission  where the complainant is residing  &  the Ops have their branch office and it is  within two years from the death of the insured as such this complainant  is well maintainable under C.P Act 2019
16. There is nothing  proved that, the complainant or the deceased insured  have ever  misrepresented any fact or have played fraud to obtained insurance under said policy  and there is nothing fault  proved against the deceased insured or against the complainant , as such we are of the opinion that, the complainant is entitled for insurance benefit as claimed   in this complaint but not yet released by the insurer /Ops is an act of unfair trade practice & deficient in providing service on the part of Ops/insurance company towards  the complainant for which  there is sufficient cause to brought this complainant .
17. We found nothing material to hold that, the ops /insurer has ever come forward to settled the insurance claim of the complainant & have taken any step earliest either to reject the clam or  to release the entitlement of the complainant rather the OP are sitting over the claim of the complainant under the said insurance policy by contesting the case taking the plea of nonpayment of insurance premium without having /adducing any cogent evidence in this respect is certainly an act of unfair trade practice & deficient service on the part of the Ops.
18. The complainant has proved her case by affidavit remain un-rebutted.  It may not be disputed that, Insurance is taken to get support at the peril and delayed in settlement of the insurance claim certainly frustrated the very purpose of insurance causing financial loss & mental agony to the complainant. It is reported in Gurumel Singh Vrs. Natural Insurance Company Ltd. in Civil Appeal No.4021 of 2022 disposed of on 20.05.2022.the Hon’ble Supreme Court held that: - “once there was a valid insurance on payment of huge sum by way of premium the insurance company should not be too technical while settling the claims.” With due regard to the aforesaid decision of the Hon’ble Supreme Court of India when the genuine  claim of the complainant is not yet settle , the complainant is entitle to heavy compensation with punitive damages, so that in future they/insurance company  would not dare to repudiate genuine claim of the beneficiary under the policy . Reliance may also be placed on the judgment recently passed on dt. 08.07.2022 by the Honorable State Commission, Odisha, Cuttack in C.C No. 19 of 2018, Ranjan Mahapatra Vs. Star Health & Allied Insurance Co.Ltd reported in 2020(II) OLR (CSR) Page 326.
19. Based on the above discussion and  settled principles of law  we are of our opinion that, the complainant is entitled to get release of the insurance benefit under  insurance policy vide No. 0159121380 as per the terms & condition and that , the Op are found negligent & deficient in settlement of claim of the complainant as such there is sufficient cause of action continue to present the complainant and it is found in time well within the jurisdiction of this Commission maintainable under the C.P.Act .Hence it is ordered .

ORDER

   This consumer complaint is allowed in part against the Ops on contest with the following direction:- (i)The Ops are directed to release the sum assured amount of Rs.1,50,000/- along with accrued insurance benefit under  insurance policy vide No. 0159121380 with interest @ 9% p.a  only from the date of filling of this complainant i.e 23.09.2020  and further directed to pay Rs.50,000/- as punitive damages to the complainant which include cost of this litigation (ii) It is further directed to comply the aforesaid order within four weeks from the date of receipt of a copy of this order falling which the Ops will be liable to pay Rs.1,000/-(one thousand) per day as compensation to the complainant till compliance of this order and the C.E.O of the Ops  shall be liable to be prosecuted under penal provision of Section 72 of C.P Act 2019 on his own cost. The pending application if any is also stands disposed off accordingly.

Dictated and corrected by me.

President

I   agree.

                 Member   

     Pronounced, in open Commission today on this 22^nd  day of June  2023 under the seal and signature of this Commission.

    The judgment be uploaded forthwith in the website of the Commission and free copy of this order be supplied to the respective parties or they may download the same from the Confonet  to treat the same as copy of the order received from this Commission .Ordered accordingly.