The case of the complainant as follow:-
That Baharati Majhi w/o Badal Chandra Majhi, mother of the complainant opened a Life Insurance Policy with Birla Sun Life Insurance Co. Ltd. being policy no 005584614 issued on 19.05.2012 from the Branch Office of Purulia.
The complainant Monochar Majhi, son of Bharati Majhi is the nominee as well as legal heir of the said policy holder. The mode of policy was Semiannual and the policy holder paid a sum of Rs.9951.52 as premium for the first time.
That at the time of opening of the policy necessary verification and investigation was made by the investigator on behalf of the Birla Sun Life Insurance Co. Ltd and on satisfaction the policy was issued in favour of Bharati Majhi, the mother of the complainant.
That the policy holder namely Bharati Majhi, mother of the complainant died on 01.07.2012 in Cardio Respiratory Failure as per death certificate issued by Dr S.K.Pati, Chest Medicine Specialist Ex M.O., Raghunathpur S D Hospital. Further death certificate was also issued by Hensla Gram Panchayet.
That after the death of the said policy holder, the nominee namely Monochar Majhi approached before the Branch Office of Birla Sun Life Insurance Co. Ltd at Purulia for the claim of the insurance coverage of her mother but the said insurance company by the letter dated 09.07.2013 refused to pay the same on the plea that the policy holder Bharati Majhi was suffering from decease prior to opening of the policy which was suppressed. Further during investigation it was told that no medical fit certificate was required in this case as the policy holder was at that right moment below forty years and their personal level verification and investigation was enough and sufficient to issue policy to the deceased. As the O.Ps refused to pay the death benefit upon several pleas, the complainant has no other alternative but to move before this Forum and filed the instant case in order to get relief.
The O.Ps after receiving notice did not appear in this case even did not file W/V though several adjournments were allowed since filing of this case before this Forum on & from 9.10.2013. The O.Ps did not take any step to defend the complaint though reasonable and sufficient opportunities of being heard were allowed and date of hearing was finally fixed on 13.03.2014. However the O.Ps did not appear on call though complainant along with his lawyer was present. Heard the ld. Lawyer of the complainant and relevant documents were examined. It appears that the O. Ps was determined not to appear and defend their position. So the case is determined experte on the basis of documents and relevant papers available in the file and upon hearing the complainant. We therefore, proceed to complete the case exparte accordingly.
Points for determination:-
- Is the complainant is a consumer?
- Is the case maintainable at all?
- Is there deficiency on the part of the Ops?
- Is the complainant entitled to get relief’s as prayed for?
Decision with reasons:-
Point 1 & 2
Though by contract of insurance the person whose life is being insured is a consumer as well as the beneficiary other than the person who hires such services also comes under the preview of the consumer u/s 2 (l) (d) (ii) of the Consumer Protection Act. So we are of the opinion that the case is maintainable also.
The complainant’s mother namely Bharati Majhi opened a Life Insurance Policy with Birla Sun Life Insurance Co. Ltd being policy no 005584614 issued on 19.05.2012 from the Branch Office at Purulia and the complainant was the nominee and legal heir. In case of death of a consumer his legal heir or representative who or which makes complaint is also a consumer u/s 2(1)(b)(v) of the C.P.Act 1986.
Point 3 & 4
These points are taken up together for the sake of convenience of discussion as they are interlinked.
The policy holder Bharati Majhi died on 01.07.2012 in Cardio Respiratory Failure and death certificate has been issued by Dr S.K.Pati Chest Medicine Specialist Ex M.O Raghunathpur S D Hospital in this regard.
The Branch Office of Birla Sun Life Insurance refused the complainant to pay the insured coverage sum though he is a nominee and legal heir on the plea that the life assured was suffering from cancer and had undergone treatment for the same much prior to application for insurance, the only ground cited for repudiating the claim for the benefits under the said policy. In support of such an allegation the O.P. did not file any documents that can substantiate their claim of disease prior to application for insurance though the O.P. was allowed sufficient and reasonable opportunities of being heard and defend their position. Moreover, investigating/inspecting officer under the company after necessary verification recommended issue of Life Insurance Policy under Birla Sun Life Insurance Co. Ltd to the complainant. So the cooked up story of the O.P. has no leg to stand at all without filing any supporting documents to the effect that the life assured was suffering from cancer prior to issuance of Life Insurance Policy.
On perusal of the death certificate issued by Dr S.K.Pati dt. 01.07.2012 (Annerture-4) we find no where a single uttering of the disease of Cancer instead it was certified that Bharati Majhi died due to Cardio Respiratory Failure.
In view of the above facts and findings we are of the opinion that the OPs have the deficiency in service in respect of non payment of claim to the complainant. If somebody does not perform his part of the contract, it amounts to deficiency in service. This also amounts to ‘unfair trade practice’ for adopting unfair method and deceptive practice. Considering the facts and circumstances of the case we are of opinion that the complainant does get decree in part. Complainant is entitled to get Rs. 1, 06,000/- of the Insurance Policy coverage along with interest @ 10 % p.a from the date of filing the present complaint till the date of realization and Rs 5,000 as litigation cost and Rs 5,000 towards compensation for harassment and mental agony and that will meet the ends of justice. Hence,
O R D E R E D
That the Consumer Complainant no 30/13 be allowed Ex-parte against the OP nos. 1, 2 & 3.
That the complainant do get Rs 1,06,000/- only from the OP s no 1,2 & 3 along with interest @ 10 % p.a from the date of filling the present complaint till the date of realization.
That the complaint do get Rs 5,000/- only for harassment & metal agony.
That the complainant do get Rs 5,000/- only towards litigation cost.
The OP s are directed to pay the aforesaid awarded amount to the complainant within 30 days from this date, failing which the complaint shall be at liberty to proceed in accordance with law.
Let the copies of the judgment be given to the parties free of cost.
