1        The complainant Maya Devi has filed the present complaint under Section 12 and 13 of the Consumer Protection Act (herein after called   as 'the Act') against HDFC Egro General Insurance Company Ltd. and another (Opposite parties) on the allegations of deficiency in service and negligence in service on the part of the opposite parties with further prayer to direct the opposite party No. 1 to release the insurance claim of Rs. 10,00,000/- to the complainants  besides this Rs. 50,000/- as compensation and Rs. 10,000/- as litigation expenses.

2        The case of the complainant in brief is that the complainants are legal heirs of deceased Pradeep Kumar son of Harbans Lal, who was shop-Keeper and the complainants No. 3 to 5 are minors and are filling this complaint through their mother being guardian Pradeep Kumar (deceased) opened a current account with the opposite party No. 2 having account NO.50100042640416 and while opening that account of the opposite party No.2 got insured with Life Insurance Policy of the opposite party No. 1 by crediting Rs. 1098/- in the account of the deceased being the payment of premium to the opposite party No. 1 with the insurance cover of Rs. 10 Lacs. The Pradeep Kumar (deceased) regularly operated the above mentioned account and various transactions were done by him during his life time up-till he met with road accident on 09.02.2018, in which he died and necessary legal formalities and paper work was done by the police of P.S Sarhali, by which it is proved that the death of the deceased was due to injuries in a road side accident. The post mortem report of the deceased on the same day also proves that deceased has suffered injuries on his person in that road side accident that resulted in his death. After the death of Pradeep Kumar, the complainants lodged claim with the opposite party No. 1 to get released the insurance claim of Rs. 10 Lacs and all the required documents for the same were supplied to the opposite party No.1 and also other required formalities were fulfilled by the complainants. The opposite party No.1 informed and told the complainants that their insurance claim will be released in a few days. The complainants waited for the insurance claim for a couple of months but the same was not released to them, so the complainants approached the opposite party No.1 through their Local office at Amritsar and required documents were also supplied. The opposite party No.1 was approached through Telephone and E-Mail but the opposite party No.1 delayed the release of the same on one pretext of the other0 The complainants had even maled the soft copies of the documents to the opposite party No..1 at the E-Mail address of the opposite party No. 1, as opposite party No.1 had posted vague letters to them vide which it had again and again demanded the same documents from them.    The complainants have requested the opposite party No. 1 to give the genuine claim of the complainants but the opposite party No. 1 refused to release the genuine claim of the complainant and it amounts to deficiency in services on the part of the opposite parties. Hence the present complaint is filed.  

3        After formal admission of the complaint, notice was issued to Opposite Parties. Opposite Party No. 1 appeared through counsel and filed written version contesting the complaint on the preliminary objections that the complainants have concealed the material facts from this Forum, therefore, they are not entitled for any relief as claimed, as the opposite party No. 1 in order to ensure the legitimacy of the case, have to depend upon the various documents, which are mandatory to be filed by the claimants, and in pursuance of the same the opposite party No. 1 issued various letters date 25.04.2015, 08.05.2015, 08.06.2015, 01.09.2015, 11.09.2015, 24.09.2015, 09.10.2015, and 24.10.2015, therefore, the complainants were given various opportunity to file the required documents, so that the claim as alleged be looked upon to, but on the contrary, in spite of the constant requests on the part of the opposite party No. 1, the complainants completely ignored the said letter and never submitted the requisite documents, therefore, the claim was closed, therefore, the complainants are not entitled for any claim. The complainants are estopped by their own act and conduct from filing the present complaint. The complainants have filed the present complaint without any cause of action against the opposite party No. 1, therefore, liable to be dismissed. The complainants have no locus standi to file the present complaint, as they themselves have waived their right, by not supplying the required documents, as mentioned in terms and condition of the policy, through which an inference can be drawn that the alleged claim of the complainants is not authentic, because had it been a genuine claim of the complainants, then they would have taken all the steps to establish their claim before the respondents, by submitting all the documents on the repeated request by the opposite party No. 1. The complainants have not approached this Hon’ble Forum with the clean hands and have presented a distorted and incorrect version of facts before this Forum, as they in their entire complaint have nowhere mentioned about the efforts made by the opposite parties, in order to bring out the documents, which were compulsory, according to the terms and condition mentioned in the policy, which is also agreed by the complainants. Further the complainant in order to mislead the Forum had deliberately concealed the true facts of closing of their claim in the record of the opposite party No. 1.  On merits, it is pleaded that in order to ascertain the authenticity of the case and as per the terms and conditions mentioned under the policy itself, which states that the maximum compensation in respect of an insured person under the policy shall not exceed 7 times the annual income. Income proof for availing the compensation at the time of claim is mandatory. Income proof shall mean the previous year’s returns filed with the Income Tax Department and in furtherance of the said terms and conditions, which is also agreed by the complainant, the document related to income proof IT Returns, salary slip, last six months bank statements were required. Further, to rule out the fact of intoxication, the complainant was required to file the chemical visera report which is prepared after post mortem. But insite of repeated reminders from the side of the opposite party No. 1, requisite documents never came on record of the opposite party No.1, therefore the claim as closed and the complainants are not entitled for any claim.  The opposite party No. 1 has denied all other allegations leveled in the complaint and prayed for dismissal of the complaint.

4        The Opposite Party No. 2 appeared through counsel and filed written version contesting the complaint on the preliminary objections that the present complaint against the opposite party No. 2 is not maintainable in the eyes of law. The complainants have got no cause of action against the opposite party No. 2.  On merits it is pleaded that the deceased Pardeep Kumar opened his bank account with the opposite party No. 2. The opposite party No. 2 has denied all other allegations leveled in the complaint and prayer was made for dismissal of the complaint with costs. 

5        Sufficient opportunities were granted to the parties to lead evidence in order to prove their respective case. Ld. counsel for complainant tendered in to evidence affidavit of complainant Ex. C-1 alongwith documents Ex. C-2 to Ex. C-20 and closed the evidence. Ld. counsel for the opposite party No. 1 tendered in evidence documents Ex. OP1/1 to Ex. OP1/10, affidavit of Pankaj Kumar Ex. OP1/11, document Ex. OP1/12 and closed the evidence. Ld. counsel for opposite party No. 2 tendered in evidence affidavit of Ashish Arora Branch Manager Ex, OP2/1 and closed the evidence.

6        We have carefully examined the documents/ evidence produced on record (along with the scope of ‘adverse inference’ for that ignored to be produced) to support/ prove their respective ‘claims’ as pleaded by the present litigants in the light of the arguments as put forth by their learned counsels, while adjudicating the present complaint.

7        We find that the present complainants have been the nominee/ legal heirs of the DLA (Deceased Life Assured) who had been somehow made to purchase the related policy from the OP1 insurers upon opening-up of his Business A/c with the OP2 Bank by getting the policy premium paid/ deducted from this very account. However, the DLA died in a road-side accident on 09.02.2015 when the related insurance death-claim was allegedly not being settled (initially) but repudiated finally as closed and thus prompted the current dispute turning into the present complaint. We further find that the complainant has duly proved the contents of his complaint vide his affidavit Ex.C1 along with the duly produced evidentiary documents exhibited here as: Ex.C2 to Ex.C20.

8        We further find that the OP insurers have vehemently rebutted (affidavit Ex.OP1/11) the impugned death-claim for the lone reason that the insurance-benefits claimants have failed to produce the requisitioned copy of the Chemical Viscera Report (along with the Post Mortem Report) to rule out the fact of intoxication. Sic!. Somehow, we are unable to comprehend as to how such a stark situation gets determined measured against the total abstinence of even a faint-idea of the same. And, all the OP1 produced documents (Ex.OP1 to Ex.OP12) have even jointly justify the arbitrariness elemental to their impugned repudiation. Moreover, it has been the responsibility/ liability of the OP insurers to have justifiably proved the statutory necessity of the impugned repudiation caused to the instant death claim (in hand) but somehow they have failed to well-discharge their responsibility, in its true letter and spirit.

9        Thus, we find that the impugned repudiation of the instant insurance claim (treating it as closed) at the hands of the OP1 insurers certainly infringes the consumer rights of present complainants and all the more so at the face of non-requisite/ non-existent ambiguity of the requisitioned item chemical report of viscera examination of the DLA. Presently, we find that the OP insurers have not been able to justify the impugned ‘claim-repudiation’ and did not even attempt to settle the ‘claim’ as of ‘now’ during the ‘pendency’ of the present complaint to show/ exhibit its bona fide intentions but it chose otherwise and thus we hold it guilty of ‘deficiency in service’ and ‘unfair trade practices’ etc.

10      In the light of the all above, we partly accept the present complaint and thus ORDER the OP Insurers to pay the full benefits in terms of the related Insurance Policy to the complainant within 30 days of the receipt of the copy of these orders besides to pay him Rs 10,000/- as compensation and Rs 5,000/- as cost of litigation, otherwise the aggregate awarded amount shall attract interest @ 9% PA from the date of orders till actually paid.  

11      Copy of the orders be communicated to the parties free of charges. After compliance, file be consigned to record.