Order
The complainant has filed this case of claim on 15-02-2017 against o.p for claim of Rs. 10,80,000/- sum assured amount, Rs. 1lakh for physical, mental, harassment with interest @ 18 % p.a and has further claim for Rs. 10,000/- as litigation cost.
The case of complainant appears from his complaint petition supported with an affidavit that he is nominee and father of L.A Randhir Kr. In the insurance policy purchase by him in his life time bearing two policies no.- 01220916 and 01223641 of 18-07-2014 and 13-08-2014 respectively now L.A Randhir kr son of complainant is no more and suddenly faildown on 03-02-2015 and fanted due to electric shock. He was treated by Dr. but Dr. declared him died. The accident was happen in his house because of that FIR was not lodged and postmortem was not done, Panchnama has prepaired, signed by the Villagers, Mukhiya, and Sarpanch, accordingly the complainant has filed death claim of both policies with all relevant documents by fullfiling the formalities as the L.A died within risk coverage period of the policies. The company assigned the said death claim to the Pvt. Agency to investigate and submit report the investigator came to the complainant on 20-01-2016 and taken the signature of the complainant blank on paper on which he will get type the matter as the statement of complainant and will be send to company, the complainant has signed over the said paper innocently and the investigator demanded Rs. 50,000/- from the complainant as brive and threaten him if he will not pay. He will get type against him. The complainant became stunned and he discussed about the fact with the Villagers and he has filed informatory petition to the court of C.J.M. Hazipur 31-01-2016. He has further alleged that o.p has neither settled the claim not repudiated till filing of this case. About more than 14 month than have passed away in awaiting and filing of this case that the o.p may settled his claim. He has made his claim on 30-11-2015 and as per IRD circular the insurance company had either to settled the claim are repudiated within 3 month and after several request o.p has not taken care of claim of complainant accordingly he has filed this case with aforesaid claim.
The complainant has filed Xerox copy of certain documents as such first premium receipt of both policies, death certificate of Randhir Kr issued on 04-02-2015 find mentioned his date of death is 03-02-2015, policy schedule, Panchnama dated 15-02-2015, mentioning the date of death of L.A is 03-02-2015, Certificate of Sarpanch dated 22-02-2015 , certificate to Mukhiya dated 09-02-2015, certificate of Dr. dated 03-02-2015, certificate of Aaganbari Sevika. All certificates are regarding the death of L.A, PAN card, Pass book of L.A information petition NO. 375/2016 filed before C.J.M Hazipur dated 30-01-2016, letter indorse to public information officers cum B.D.O dated 10-09-2015, letter indorse to first appellate authority under RTI dated 09-11-2015, petition of RTI dated 19-12-2015 letter dated 23-01-2016 for supply of death certificate and family Member certificate issued by C.O Vaishali. The complainant has further filed Xerox copy of decisions passed by State Commission vide order dated 07-10-2016 and J.D 31-05-2018 (NC)
In this case o.p no.1, 2,3 &4 appeared and filed his w.s dated 30-05-2017 supported with an affidavit alleged therein that case is false, frivolous, abuse of process of law and liable is to be dismissed and has challenged the pecuniary jurisdiction of this forum and becoming the consumer of complainant and have admitted both policies of L.A and also admitted that the complainant is nominee of the said policies and have only objected that it come under the knowledge of the company that L.A had pass away more than 4 years prior to the date of application to purchase the policies on 14-01-2010 that the death certificate shows his death is on 03-02-2015 and after calculating the birth register and death the concealment of facts arises and have been frudently taken by the L.A amounting to Rs. 50,lakh/-. He had another policies and has suppressed the fact by L.A and the company has repudiated the claim of complainant by two separate letters dated 29-03-2016. Regarding the previous policies o.p has metioned in his w.s. and has relied on several decisions as such appeal no. 1560/2004 SC, (1984) I (SCC), (2000) 6 SCC 724 was 2013, (1) SCALE 410 (2010) 10 SCC 567 revision petition NO. 211/2009, 1966, 35 CR 500, II 2009, CPJ 34 extra.
o.p has filed supplementary affidavit dated 26-06-2018 with same fact nothing new fact has been added only he has alleged that it has been gathered that the complainant is trying to play big rackete by taking multiple insurance policies of L.A who had already died almost 4 years ago.
O.P has filed his written argument on 26-06-2018 alleging the same fact nothing new plea has been taken.
O.P has filed several Xerox copy of certain papers, as such policy certificate in the name of Randhir Kumar L.A policy No.- 18761316 for death benefit of Rs. 3 lakh, first premium receipt dated 23-07-2014 for the same policy, proposal form initial premium deposited receipt dated 18-08-2014 proposal form , PAN CARD, Pass book, claim application dated 02-01-2016, Policy Schedule , Diagnosis certificate dated 16-07-2014 of L.A Randhir Kr, Medical examination report of LA dated 16-07-2014 premium receipt of policy No.- 140714157406 dated 25-07-2014 traditional proposal form dated 16-07-2014 and 11-08-2014, terms conditions of policy application form for claim dated 30-11-2015, death certificate of L.A dated 04-02-2014, date of death as mentioned as 03-02-2015, family registered issued by secretary Gram Panchayat
Considering the facts circumstances material available with the record and allegation of respective parties it is admittedly clear that the complainant is nominee of L.A Randhir Kr. Also his father of L.A the policy has been admitted and it is not objected that the L.A was died before deposited of premium only o.p has objected that the L.A was died before 4 years of taking polices if it is correct then how and why the o.p has issued aforesaid two policies in the name of L.A and have taken the premium of policies it is best known to them only on mere objection shake him it could not be considered without any effective evidence there is no effective evidence to substantiate this fact no other objection has been raised by o.p regarding the jurisdiction the case of claim is total for Rs. 12,50,000/- including the litigation cost mental physical harassment comes and pecuniary jurisdiction of this forum. Regarding the racate this forum is not entitled to give any further against that. Further Axil point of this case has alleged by the o.p that the L.A was died before 4 years in the 2010 and after that in the 2014. He has taken alleged appoint is now frustrated by documents of Biochemistry test , ECG and Diagnostic report dated 16-04-2014 filed by himself then it appear before us this document goes to defeat the allegation of o.p regarding the 4 year before death of L.A
Accordingly we are of the opinion that the complainant is found able to prove his case and the entitled to get the death claim of two policies of L.A This document is it self to defeat his objection.
Accordingly the case is allowed o.p is directed to pay Rs. 4lakh sum assured amount for policy no.- 01223641 and Rs. 6, 80,000/- lakh for the policy no.- 01220916 with interest @ 8 % p.a from filing the case and o.p further directed to pay Rs. 20,000/- physical, mental, harassment, including the litigation cost. Both payment should be made within one month of the order, otherwise the complainant is entitled to get it recover from the process of law.
Member President
