JUDGEMENT
Complainant by filing this complaint has submitted that husband of the complainant Rajendra Kumar Chaudhury (since deceased) during his lifetime purchased an insurance multi benefit insurance policy from op named ICICI Pru Pinnacle Super – LP being Policy No.15948741 from the op on 15.09.2011 on payment of early premium of Rs. 50,000/- having sum insured being Rs. 3,50,000/- and accordingly op handed over a complete policy document containing all the terms and conditions of the said policy.
The said Rajendra Kumar Choudhury (since deceased) was a Chartered Accountant by profession and for the purpose of keeping himself fit and active, he used to exercise every early morning at the roof of his residential apartment and as per his regular practice on the early morning on 30.06.2012 he went alone to the roof top to perform his regular exercise. But after sometime, the local residents heard a loud sound of falling of a heavy object and went outside to see the incident when they found Rajendra Kumar Choudhury was lying on the ground floor passage of his apartment in a pool of blood. Thereafter he was admitted in Apollo Hospital where he was declared dead at about 6:40 in the morning. Pertaining to the said fact, Phoolbagan P.S. GDE No. 2344 dated 30.06.2012 was entered and inquest No. 52 dated 30.06.2012 was registered.
That on 16.08.2012 on the death of said Rajendra Kumar Choudhury, complainant submitted her claim in connection with the aforesaid insurance policy at the office of the op along with all documents including FIR, Death Certificate and other materials and op on receipt of the same issued acknowledgement sheet dated 16.08.2012.
In the meantime the Phoolbagan P.S. authority after investigation submitted their Final Report on 30.06.2012 in respect of the incident of death of Rajendra Kumar Choudhury and thereafter complainant submitted copy of FIR and Post Mortem Report, Police Final Report and Hospital document to the op and op duly received it by putting their signature in the acknowledgement receipt. On the self same day of 04.02.2012 op/insurance company handed over the Rs. 43,539.33 paisa as fund value of the policy along with a letter dated 04.02.2012 demanding from the complainant, a Final Police Investigation Report, ignoring the fact that the same has been submitted by the complainant after collecting it from the Police. On receiving the said letter dated 04.02.2013, complainant duly authorized through her Advocate issued a letter on 24.07.2013 stating that the said incident of death of Rajendra Kumar Choudhury was a mere accident and not a suicide and further claimed the balance amount of Rs. 3,06,461/- out of the total sum assured of Rs. 3,50,000/- after deducting Rs. 43,539.33 paisa already paid within 15 days from receiving the instant letter.
Thereafter complainant and her Ld. Advocate received a letter from the op on 16.08.2013 wherefrom it is learnt that op claimed Final Police Report from the complainant ignoring that the same was already received by them and fact remains in the GDE or FIR or Police Report or Post Mortem Report or nursing home’s death certificate cause of death is not mentioned as suicide or no such case was started by the Police also and in the above circumstances, complainant has relalised that op only for the purpose of deceiving the complainant, apprehended that it was a case of suicide for which again and again they are provoking the complainant to file Final Police Report to know whether it is suicidial or accidental or not but such an act is nothing but harassing one for which complainant for negligent manner of service filed this complaint.
On the contrary the op by filing written version submitted that the entire complaint is false and fabricated and no doubt there was a policy of deceased Rajendra Kumar Choudhury and said policy was for a term of 10 years with an annual premium of Rs. 50,000/- and policy document was received by the complainant’s husband on 20.09.2011. But on 16.08.2012 op received the death certificate from the complainant wherefrom op came to learn that life assured died on 30.06.2012 in an accident and fact remains life assured died within 6 months from the date of issuance of both the policies respectively but exact cause of death was not reported. But during settlement of the claim of the complainant after considering the Police Investigation Report, they found that there is note to that effect “life assured was depressed and same was caused as life assured was professionally not doing well and so he was depressed” and those two lines of the Police Investigation Report caused much suspicion about the death of Rajendra Kumar Choudhury. But in the Post Mortem report or Final Police Report it is not specifically mentioned the death caused for homicidal or suicidal or accidental or natural death. But in the Police Report it has been mentioned that the cause of death was due to fall and accident and considering the above fact case of death was found suspicious. So, op investigated by external investigation agency Banerjee associates and the said investigation revealed that either the life assured committed a suicide or it is a case of murder and death was not accidental and accordingly op considering all the above fact ultimately released that amount but not the entire amount as per clause 8.5 and for which op repudiated the claim in respect of the entire sum assured of Rs. 3,50,000/- but only sent a cheque of Rs. 43,539.33 paisa being the fund value of the said policy and the said cheque was duly encashed by the complainant. So there was no negligence and deficiency on the part of the op and for which the complaint should be dismissed.
Decision with reasons
On in depth study of the complaint and written version including the argument of the Ld. Lawyers of both the parties and also considering the fact of unnatural death of the insured Rajendra Kumar Choudhury on 30.06.2012 we are convinced to hold that it is a stand point of the op that complainant has failed to produce any document issued by the post mortem doctor that nature of death was suicidal or homicidal or accidental or natural and no doubt complainant has failed to produce any opinion of the post mortem doctor in the post mortem that death was accidental or suicidal or homicidal or natural and that is the ground for repudiating the entire claim against that insurance policy being No. 15948741.
Anyhow admittedly truth is that the said insured died on 30.06.2012 invariably due to fall from the top floor of the apartment where he used to reside and after considering the Police Final Report, it is found that death is for fall due to accident and it is the observation of the Police Investigation Report. Then there is no other alternative on the part of the op but to rely upon that Final Police Report regarding the cause of death of the insured Rajendra Kumar Choudhury.
But peculiar factor is that op did not consider the same but they relied upon some matters that the insured as Chartered Accountant was not doing well in his profession and he was depressed and all those matters became very vital against the Final Police Report regarding the cause of death “fall due to accident”. So, in our view op cannot anyway deny or discharge the finding of the Police Investigation about the cause of death of Rajendra Kumar Choudhury on 30.06.2012 and no doubt in the opinion of the police it was fall due to accident. So, it was no doubt an accidental death and question of suicidal death does not arise in this case when Police Final Report confirmed that cause of death of Rajendra Kumar Choudhury “fall due to accident”.
When it is accidental death, there was no chance on the part of the op to repeatedly asked for Final Police Report because the Police investigated the case and submitted that Final Police Report and that report was within the pocket of the op. But it is common practice of the private insurance companies not to give insured amount on the death of unused person but to collect premium with smiling face.
But at the time of discharging their liability to the heirs of the insured, they are found depressed and this is the practice of the private insurance companies in India. Whatever it may be after considering the materials on record which are also in the pocket of the op we are convinced to hold that the death was completely accidental in nature as per investigation of the Police report and as per said Police Final Report the death of Rajendra Kumar Choudhury was “fall due to accident”. So, it was accidental death and invariably there was no necessity on the part of the op to crawl over the dead body of Rajendra Kumar Choudhury to smell whether it was accidental/homicidal/suicidal/natural death. When the cause of death has been confirmed by the police and that is “fall due to accident”. So, it is accidental and only to take such decision, op again and again asked the complainant to file Final Police Report probably the insurance authority the op is not aware of any English Language and they are not aware of the police investigation process and also does not know what is the meaning of “ fall due to accidental death” for which they repudiated the claim as per their observation as if they are the police officer or they the executing authority of as per Cr. P.C. but fact remains the whole presumption as taken by the op is baseless and without any findings and without any foundation and for which we are not relying upon the defence of the op and for which we have come to a conclusion after giving proper evaluation over the entire Police Investigation Report and the result including the post mortem report that the death was accidental in nature and there is no question on the part of the Forum also to think over the matter otherwise when there is no doubt about the cause of death of the insured Rajendra Kumar Choudhury that it was completely accidental for which invariably op is bound to release the entire sum insured amount after deducting already paid amount of Rs. 43,539.33 paisa.
In the result the complainant is entitled to get balance amount of sum insured of Rs. 3,50,000/- i.e. balance amount of Rs. 3,06,461/- from the op and op is legally bound to pay in favour of the complainant without any further attempt to discharge the claim of the complainant and repudiating the claim by op is baseless when op’s findings are uncalled for and completely mischievous in nature.
In the result, the complaint succeeds.
Hence, it is
ORDERED
That the complaint be and the same is allowed on contest with cost of Rs. 5,000/- against the op.
Op is hereby directed to pay Rs. 3,06,461/- as final settlement of insurance claim of the complainant of Rs. 3,50,000/- and the sum insured within 15 days from the date of this order failing of which for each day’s delay, op shall have to pay Rs. 500/- per day as penal damages and interest over the said amount till full satisfaction of the decree and if it is collected it shall be paid to this Forum’s account.
Op is directed to comply the order within the stipulated period as per order of this Forum failing which further penalty and fine may be imposed after starting the proceeding of the provision u/s 27 of C.P. Act 1986 for which op shall be responsible and liable for that.
