Jharkhand

Bokaro

CC/18/17

Subhash Chandra Gorai - Complainant(s)

Versus

Managing Director, Life Insurance Co. Ltd. - Opp.Party(s)

Pushpanjali Kumari

11 Dec 2021

ORDER

Complainant has filed this case with prayer to direct the O.Ps. to pay Rs. 2,00,000/- as insurance amount with 18% interest and to pay Rs. 20,000/- and Rs. 5000/- as compensation and litigation cost respectively.

2                 Case of the complainant in short is that his brother late Girish Chandra Gorai obtained life insurance Policy No. 548613791 for Rs. 2,00,000/- and its half yearly premium was Rs. 4852/- who paid three half yearly premium. Further case is that complainant Subhash Chandra Gorai has been nominated as nominee of that very policy. Further case is that insured fell ill who died on 08.11.2014 at Neelam Hospital Main Road Chas, during treatment of brain hemorrhage. Further case is that complainant made claim before the O.Ps. for insured amount which was received in the office of the O.Ps. on 26.04.2016 but in spite of repeated request no amount was paid. Then Legal Notice was served on O.Ps. having no response which compelled to file this case.

Complainant has filed following documents.

• Photo copy of Policy Bound (Annexure -1)
• Photo Copy of death Certificate issued on 25-11-2014 (Annexure -2)
• Photo Copy of Medical Attendant  Certificate (Annexure -3)
• Photo Copy of treatment Certificate dated 16-08-2015 (Annexure -4)
• Photo Copy of Status report of Policy (Annexure -5)
• Photo Copy of receipt dated 26-11-2015 (Annexure -6)
• Photo Copy of legal notice dated 26-12-20217(Annexure -7)
• Photo Copy of Postal receipts (Annexure-8)

3       O.Ps. appeared and they have filed written statement denying the claim. It is case of the O.Ps. that since death was occurred within two years of the opening of the policy hence matter was investigated   and it was found that place of death in two death certificates filed by the complainant are different in respect to deceased. Further case is that the deceased has obtained the policy with holding correct information regarding his health, Income and occupation, hence claim was repudiated as per provision of section 45 of the Insurance Act. 1938.  It is said that as per proposal form deceased was working in Electricity Department, Dhanbad but his pass book shows that there was no deposit of his salary from 28.09.2006 to 12.07.2013. As per declaration deceased was having no medical ailment but as per paper he was treated at C.I.P. Ranchi and it has come during investigation that he was suffering with mental disease which was suppressed for obtaining policy with fraudulent motive. Further case is that earlier deceased was working in B.S.L. who was terminated on 07.04.1984 because of his long absence without permission. Hence it is prayed to dismiss the case and impose Rs. 10,000/- as cost on the complainant .

Following Documents have been filed by the O.Ps.

1. Photo Copy of status report of Policy (Annexure-A)
2. Photo Copy of Policy Form (Annexure-B)
3. Photo Copy of Nelam Hospital Prescription (Annexure-C)         
4. Photo Copy of Death Certificate of Nelam Hospital (Annexure-D)
5. Photo Copy of Death Certificate of Jharkhand Govt. (Annexure-E)
6. Photo Copy of Letter dt. 29-07-2017 (Annexure-F)
7. Photo Copy of Prescription of CIP Ranchi(Annexure-G)
8.  Photo Copy of Voter I Card(Annexure-H)
9. Photo Copy of declaration letter dt. 31-05-2017(Annexure-I)
10. Photo Copy of I Card (Annexure-J)
11.  Photo Copy of BSL office order (Annexure-K)
12. Photo Copy of letter dt. 06-10-2016(Annexure-L)
13. Photo Copy of declaration (Annexure-M)
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