Sri Shyamal Gupta, Member

By filing this complaint case u/s 17 of the Consumer Protection Act, 1986, one Sri Manoj Choudhury has claimed, amongst other relief, the death claim benefit in respect of the life insurance policy being issued in the name of his wife.

Brief facts of the complaint case are that the her wife, Lipika Choudhury, took one life insurance policy from the OP Insurance Company on 18-12-2015.  Further case of the Complainant is that, prior to issuance of the subject policy, his wife was subjected to necessary medical tests being conducted by the panel doctor of the OP.  As ill luck would have it, his wife suddenly developed chest pain on 20-01-2016 and died due to massive heart attack.  Subsequently, the Complainant asked for due insurance benefit from the OP which, however, was repudiated by the OP vide a letter issued by it on 31-03-2017.  Therefore, this complaint case is filed.

Be it mentioned here that on account of non-submission of WV within the statutory period, the case was fixed for ex parte hearing against which necessary Appeal bearing no. 927/2018 was filed before the Hon’ble National Commission.  Vide its solemn order dated 23-10-2018, the Hon’ble Commission was pleased to direct the OP to pay Rs. 25,000/- as cost to the Complainant and file WV within two weeks of passing of the said order.  Since the OP did not show any inclination to ensure due compliance of said order, we only heard the Ld. Advocate for the  Complainant at the time of hearing. 

Although the policyholder died shortly after issuance of the subject insurance policy, no material proof is forthcoming before us to show that Complainant’s wife was suffering from any past ailment.  Further, it transpires from the Certificate dated 17-02-2017, issued by the treating doctor that, while he was examining the patient, she collapsed and died due to massive heart attack.  Said treating doctor also certified that the patient was not treated by any other doctor; nor did her family members get any opportunity to admit her in any other hospital.     It also appears that the policyholder was examined by the panel doctor of the OP. 

Notwithstanding, it is stated in the repudiation letter that the treatment sheet of the patient/policyholder revealed that she was suffering from heart disease and chronic kidney disease since February, 2015, in absence of any material proof in this regard, we cannot place any reliance on such unsubstantiated allegation. 

Accordingly, we have no qualms holding that the Complainant deserves due relief in this case.

Hence,

O R D E R E D

The case stands allowed ex parte against the OP.  The OP shall pay Rs. 30,00,000/- within 40 days from this day along with simple interest @ 9% p.a. over the aforesaid sum w.e.f. 02-06-2017 till full and final payment is made.