ORDER
(Passed on 20/06/2019)
PER SHRI.ATUL D.ALSI, PRESIDENT.
The complainant has filed this complaint U/s 12 of the Consumer Protection Act,1986 against the Kotak Mahindra Old Mutual Life Insurance Co.Ltd. and
Magma Fincorp Ltd.alleging arbitrary repudiation of her life insurance claim for the reason of alleged suicidal death and paid only Rs.4,414.87/-, and praying for insurance amount of policy amounting to Rs.5,25,000/- alongwith compensation and cost of proceeding.
2. The facts in short giving rise to this petition are that the complainant is the widow of deceased late Janardan Ballawar. The deceased was the owner and driver of truck bearing No.MH-34 M-8888 which was purchased on finance from OP NO.2 and insured with OP No.1 with comprehensive cover as the security for loan under the policy bearing No.G-000134 for the period from 20/8/2015 to 19/8/2019 for the sum assured of Rs.5,25,000.
3. On 28/7/2016, the deceased had gone in search of job for earning livelihood, but he did not returned back. Hence the complainant lodged missing complaint with the police station. On 4/8/2016, the complainant received a telephonic message from Lathi Police Station, Tah.Rajura, Distt.Chandrapur intimating her that a dead body was found in river Wardha. Hence the complainant approached the police station and identified the body as of her husband on the basis of description and the clothes found on the person of the decomposed and cremated body. Thereafter, the complainant filed insurance claim alongwith requisite documents, but the OP, without offering any opportunity of hearing, holding that the death of the insured was suicidal one, granted only Rs.4414.87 i.e. 80% of the premium paid till the alleged suicidal death, and credited the said amount directly in the account of the complainant as full and final settlement of her claim under exclusion clause No.9 of the policy which deals with the suicidal death of the insured. The OP insurance company company accordingly issued repudiation letter dated 3/2/2017 to the complainant. Therefore, the complainant immediately issued legal notice to the OPs on 16/5/2017 through Adv.Kullarwar for the arbitrary settlement of insurance claim and prayed for revival and reconsideration of her insurance claim, but the OPs failed to comply. Hence, the complainant has filed this complaint.
4. The complaint is admitted and notices were served on the OPs. The OP No.1 and 2 filed their respective reply to the complaint.
5. The OP No.1, in its written version denied allegations against it but it admitted that the group insurance policy bearing No.G-000134 towards comprehensive cover and as the security for loan, for the period from 20/8/2015 to 19/8/2019 for the sum assured of Rs.5,25,000. It submitted that the insured was indebted hence he left home and committed suicide in the river Wardha and his decomposed body was found on 4/8/2016 which was cremated as unclaimed body. As per the report filed by Police Station Officer dated 4/8/2016, the death of the insured occurred due to suicide, and hence on the basis of that report, the insurance claim was closed and as per exclusion clause No.9 of the policy 80% amount of the premium paid till then an amount of Rs.4414.87 has been credited into the account of the complainant towards full and final settlement of her insurance claim. Therefore, there is no negligence in the settlement of insurance claim. On the other hand, the complainant should have approached the Ombudsman for redressal of her grievance and Consumer Fora has no jurisdiction to entertain the petition. Therefore, the petition is liable to be dismissed with cost.
6. The OP No.2 filed its reply and submitted that the deceased insured had taken loan from OP No.2 for purchasing truck bearing No. MH-34 M-8888 and for security of life and social benefits, the insurance policy has been issued by the OP No.1. The OP No.1 has processed and settled the insurance claim as per norms and as per terms and conditions of the insurance policy. There is no deficiency in service on the part of OP Nos.1 & 2. The OP No.2 has no role in settling the insurance claim and hence the petition is liable to be dismissed as against OP No.2.
7. Counsel for the complainant argued that the complainant has filed copy of the insurance policy at Exh.A-1, SDM report at Exh.A-2, FIR at Exh.A-3, missing report at Exh.A-5, final investigation report at Exh.A-6, Inquest Panchnama at Exh.A-7, PM report at Exh.A-9, legal notice at Exh.A-10 and further argued that the OP has not given any opportunity of hearing at the time of processing of her insurance claim and wrongly held that the death of the insured was suicidal one. As per SDM report which is filed at Exh.A-2, the deceased had died due to asphyxia due to drowning. This report is based on the report given by Medical Superintendent, Rural Hospital, Gondpimpri who has conducted the post mortem of the deceased. Therefore,the OP No.1 has calculated the amount of Rs.4414.87 with an intention to avoid its liability under the insurance policy and as such, the petition deserves to be allowed. He relied on an array of judgments as under..
i) First Appeal No.A/06/441 SCDRC,Maharashtra (Nagpur Bench) in the
matter of Sapana Satarde Vs.LIC decided on 6/1/2017
ii) NCJ 2013 NCJ 22(NC)
iii) II (2012) CPJ 50 (NC)
iv) II (2006) CPJ 258 (NC)
v) 2005 CJ (NCDRC) 422
vi) I (2010) CPJ 175
vii) I (2011) CPJ 496
viii) III (2016) CPJ 114 (Raj)
ix) II (2016) CPJ 99 (NC)
x) 2001 (1) CPR 267
xi) III (2008) CPJ 82 (NC)
xii) II (2002) CPJ 48
xiii) III (2003) CPJ 113
8. Counsel for the OP No.2 argued that the death claim filed under the policy by the complainant has been settled as per norms and terms of the policy as the death of the insured is suicidal one. There is no role of OP No.2 in settlement of insurance claim and hence the petition deserves to be dismissed against OP No.2.
9. We have gone through the complaint, written versions filed by OP No.1 and OP Nos.2 & 3, affidavit, documents and WNA filed by the parties. We have also heard the oral arguments advanced by parties.
Points Finding
1. Whether there is deficiency in service on the part of
OP No.1 ? Yes
2. Whether there is deficiency in service on the part of
OP No.2 ? No
3. What order? As per final order.
FINDINGS
As to issue No.1
10. The basic dispute is repudiation of insurance claim holding the death
of the insured as suicidal one. The police station report as well as the investigation report submitted by the panel advocate of OP No.1 insurance company, mensions that the insured might have committed suicide. Therefore, relying on these remarks in these two reports, the OP No.1 insurance company held that the death of the insured occured due to suicide and hence the exclusion clause No.9 of the terms and conditions of the policy gets attracted. As per the provision of exclusion clause No.9, in the event of insured member committing suicide within one year of commencement of membership, 80% of premium paid till then will be payable to the nominee. Holding so, the insurance company, fully and finally settled the insurance claim of the complainant at Rs.4414.87 i.e. 80% amount of the total premium paid till the suicidal death of the insured. However, we do not agree with the argument advanced by OP No.1 the death of the insured is suicidal one as neither of the report conclusively affirm that the death of the insured occured due to his committing suicide. There is no suicidal note left by the insured neither the circumstances points out at accrual of suicide. It is pertinent to note that the police station report as well as the investigation report submitted by the panel advocate of OP No.1 insurance company, mentions that the insured might have committed suicide. These wordings itself goes to show that these authorities have expressed their suspicion regarding cause of death as suicide but there is no conclusive proof thereof with them. The report of the Sub Dvnl.Magistrate, Gondpimpri which is filed at Exh.A-2 clearly mentions that the death of the insured is accidental one. The cause of death as per post mortem report and the report given by the SDM Gondpimpri are corroborative evidence to establish that the death of the insured is accidental one and not due to suicide as alleged by the OPs. Mere statement of Police Officer that the death occurred probably due to suicide, can not be accepted as evidence without corroborative evidence. Therefore, the repudiation of insurance claim by the OP No.1 and settling it as per exclusion clause No.9 of the policy at Rs.4414.87 only, amounts to deficiency in service as per judgment of Hon’ble State Consumer Disputes Redressal Commission, Maharashtra, Nagpur Bench in first appeal No.A/06/44 between Smt.Sapana Satarde Vs. LIC of India decided on 6/1/2017 by Hon’ble preciding Member Shri.B.A.Shaikh and Hon’ble Member Mrs.Jayashree Yengal. Therefore the petition deserves to be allowed and the complainant is entitled to the full insured amount i.e.Rs.5,25,000/- after deduction of 80% of the premium amount paid i.e.Rs.4414.87 already paid to the complainant by the OP No.1 alongwith interest and adequate costs.
As to issue No.2
11. The deceased had availed loan from OP No.2 for purchasing the truck. However, OP No.2 is noway concerned with the settling of insurance claim which is the prerogative of OP No.1 insurance company. Hence the complaint is liable to be dismissed as against OP No.2.
As to issue No.3
12. In view of our observations as above, we pass the following order..
Final order
1. The Complaint is partly allowed.
2. The OP No.1 shall pay to the complainant insured amount under the policy i.e. Rs.5,25,000/- after deducting Rs.4414.87 therefrom, alongwith 9% interest per annum from the date of admission of the complaint i.e.14/6/2017 till its realization.
3. The OP No.1 shall also pay to the complainant an amount of Rs.15,000/- towards compensation for mental torture and cost.
4. The complaint stands dismissed as against OP No.2.
5. Copy of the order be furnished to both the parties free of cost.
(Smt.Kalpana Jangade (Kute) (Smt.Kirti Vaidya (Gadgil) (Shri.Atul D.Alsi)
Member Member President
