The complainant Sri Chandan Sah has filed this complaint petition against Chief Managing Director, Sri Ram Life Insurance Company Ltd. Hyderabad-500029 and two others (o.ps) for realization of Rs. 5 lacs/- as sum assured, Rs. 55,000/- for compensation of physical and mental harassment and Rs. 21,000/- as litigation cost. with 18 % p.a. interest on the total sought amount since the date of death of life assured person till the date of final payment of awarded amount.

The brief, facts of the case is that the father of complainant namely Chandan Sah  (here - in after  called as L.A. Chandan Sah) purchased a Life Insurance Policy bearing No. N.P.141300106191 for sum assured Rs. 5 lacs/- by paying  Rs. 26016 as premium by demand draft on 28-11-2013 in which the complainant is nominee. The further case is that on 16-01-2014 L.A. Rama Sah complained chest pain, breath lessness and restlessness  to his family members, who in turn consulted Dr. J.Yadav  (M.B.B.S), (BRABU)  and he treated Rama Sah but could not save his life and L.A expired on 16-01-2014 due to cardio respiratory failure. The further case is that after death of L.A the complainant filed death claim against policy No. NP141300106191 to the insurance company with all the relevant documents but the insurance company declined the death claim filed by the complainant on the concocted, baseless, headless and legless ground that the L.A. person Rama Sah had died 2-3 months ago before applying the policy i.e on 21-12-2013.

The complainant has filed the following documents with the complaint petition- Photocopy of Policy Schedule –annexure-1, photocopy of Death Certificate -annexure-2, photocopy of  prescription of Dr. J.Yadav – Annexure-3, photocopy of  certificate of Dr. J.Yadav about the death of Rama Sah annexure-4, photocopy  First Premium receipt annexure-5, photocopy of repudiation letter annexure-6.

On issuance of notices, o.p. no. 1 & 2 appeared and filed their w.s. on 18-01-2019.  Issuance of Policy bearing No. NP141300106191 in the name of D.L.A Rama Sah for sum assured money Rs. 5 lacs/- is an admitted fact. O.ps have annexed photocopy of proposal form as annexure-A, and photocopy of policy schedule as annexure-B. it is also an admitted fact that the complainant filed intimation of death before the o.p company. It has been further mentioned in the w.s. that in view of early death claim arising within 19 days  from the date of commencement of subject policy, the Respondents conducted the investigation in respect of the same to know the veracity of the claim and after investigation the investigator submitted his report to the respondents of the effect that L.A. died in November 2013 due to heart attack, but family members denied his actual date of death and said that LA died on 16-01-2014. It has been further mentioned that at the time of making of proposal for insurance LA was not alive and someone impersonated his signatures and identity.  It has been further mentioned that the nominee and the other family members had fraudulently and dishonestly taken the instant insurance policy. It has been further mentioned that in view of the evidence collected during investigation, investigator went to native place of LA where it came to light that LA died before taking policy. Hence, on the ground of fraud, the said policy was declared null and void and the company/respondents repudiated the claim vide its letter dated 21-01-2015. The o.ps have also annexed photocopy of repudiation letter and photocopy of study analysis and report regarding the  insurance claim as annexure 3 & 4. Which are read as annexure – C & D.

The complainant  Chandan Sah has examined himself as AW-1. He has exhibited annexures filed with the complaint petition as exhibited 1 to 6.

On behalf of o.ps op w-1, E.Shridhar, working General Manager, in M/S Sri Ram Insurance Company Ltd. has been examined who has exhibited the documents submitted  with w.s. as A to D.

Annexure-6 produced on behalf of complainant and exhibit –C. produced on behalf of o.ps are same document i.e repudiation letter dated 21-01-2015. The o.ps have repudiated the claim of the complainant on the ground that L.A Rama Sha died  2-3 months before applying the policy that is 11-12-2013. The complainant has stated in his complaint petition that L.A. Rama Sha died on 16-01-2014, due to cardio respiratory failure.   He has filed photocopy of death certificate as annexure-2. The death certificate has been issued by appropriate authority  of Government of Bihar . On the perusal of the same it transpires that Rama Sah died on 16-01-2014. The complainant has also filed the prescription of Rama Sah furnished on by J.Yadav as annexure-3 and certificate furnished by Dr. J.Yadav regarding the death of Rama Sha as annexure-4. On perusal of the same it transpires that L.A. Rama Sah was treated by Dr. J.Yadav on 16-01-2014, but he died on the same day due to cardio respiratory failure. The complainant has also supported this fact in his examination-in-chief on affidavit. On the other hand on behalf of o.ps photocopy of study analysis report against the insurance claim has been filed as AW-D4. No proper document has been annexed with annexure-4-D to show that Late L.A. Rama Sha had died before 2 to 3 months before issuance of policy. In his conclusion the investigator has mentioned that during   secret investigation , he came to know that L.A. was healthy and died in November due to heart attack. Family member denied his actual date of death and said L.A. died on 16-01-2014. The o.ps have not examined the investigator, nor disclose the secret investigation information on the basis of which one   reach on conclusion that L.A. died before 2 to 3 months of issuance of said policy.  No reason has been as assigned on behalf of o.ps for not examining the investigator or not producing any relevant documents regarding the death of L.A. On behalf of o.ps, o.p w.-1 E.Shridhar has been examined who has not adduced any evidence regarding the death of L.A. He only exhibited the annexures as A to D.

 The o.ps have raised the above facts regarding the death of L.A in their w.s. so burden of proof lies on them to prove the above fact  so they failed to prove the same.

Learned Lawyer for the complainant relied on decisions of Hon’ble N.C.D.R.C New Delhi, observed him first appeal No.1696/2016  Aegone Religare Life Insurance Company V/s Rejendra Rai on31-05-2018.  In the aforesaid case, the matter was the same and death certificate was challenged.  In the above case Hon’ble N.C.D.R.C observed that the “Panchayat Sewak is the competent authority who had issued death certificate in proper proforma under the Panchat Raj Act. The o.p has not produce any other death certificate in proper proforma of the L.A. Randhir Kr his elder brother Sudhir Kr., hence the allegation of o.p that the insurance policy was obtained  of dead person Sri Randhir Kr. is not proved and its becomes a baseless allegation.”

On the basis above discussion, we find that o.ps have wrongly repudiated the claim of the complainant and as such there is deficiency on their part.

In the circumstances the complaint petition is allowed with direction to o.ps  to pay  Rs. 5,00,000/- as sum assured with 8 % interest p.a  from the date of filing of complaint petition that is on 04-04-2016,  Rs. 20,000/- as physical and mental harassment and Rs. 10,000/-  as litigation cost within two months from the date of  order, /, on failure they shall be responsible  to pay the above amount   with 9 %  p.a. interest till realization. Let a copy of this order be furnished to both the parties as per rule.