Sri Kamal De, President

Case of the Complainant, briefly stated, is that his wife took a Life Insurance Policy from the OP No. 1 through the OP No. 2 being Policy no. 15133513 of which the Complainant was the nominee and the insurance was for Rs. 2,39,242/-.  It is the case of the Complainant that his wife died on 07-12-2014 due to burn injury.  So, he staked insurance claim with the OP by filing all original documents on 07-01-2015, but till date the OP has not settled his claim.  So, the case.

The defense put forth from the side of the OP No. 1 is that the subject policy was issued on 25-04-2012 having yearly premium of Rs. 30,465/- for a premium paying term of 7 years and the policy term was for 15 years.  It is contended by the OP No. 1 that after getting death intimation from the Complainant, it appointed an investigator, M/s Kolkata Response Group Pvt. Ltd. to investigate the death claim of the deceased insured.  During investigation, it was revealed that the deceased LA suffered deep burn injury on 01-12-2014 by igniting herself with kerosene oil after an altercation with her family members and then the family members initially took her to Tamluk Govt. Hospital and subsequently, shifted her to Peerless General Hospital on 02-12-2014 where she expired on 07-12-2014.  The OP duly sent the repudiation letter to the Complainant on 10-03-2015.  The OP No. 1 denied any laches or deficiency in service on its part.

The solitary point for consideration is whether the Complainant is entitled to get the insurance claim from the OP No. 1, or not.

Decision with reasons

It is important to point out at the very outset that OP No. 2, Mrs. Dipsikha Mondal happens to be an agent of OP No. 1, who procured the policy from the Complainant.  It appears that the wife of the Complainant, Bina Pani Mondal took a life insurance policy being no. 15133513 from the OP No. 1 through the OP No. 2, of which the Complainant was the nominee and the sum assured is Rs. 2,39,242/-.  The wife of the Complainant (insured) died on 07-12-2014 due to burn injury.  The Complainant lodged his claim for insurance benefit on 07-01-2015.  But, such claim was repudiated by the OP No. 1 on the ground that the insured, Bina Pani Mondal committed suicide and her policy also lapsed on 25-04-2014 and was reinstated by paying renewal premium on 04-07-2014.  The Insuree expired on 07-12-2014, i.e., within one year from the date of alleged reinstatement of policy and so the death claim was repudiated.  It is argued that the Complainant has preferred the present complaint mala fide to cause wrongful loss to the company.  Point no. 8 of the Exclusion Clause of HDFC Life SL Classic Assure Insurance Plan reads as follows: 

“We shall not be liable to pay any benefit indicated in your Policy schedule other than the accrued surrender value, if any, if the death of the Life Assured is caused directly or indirectly by suicide within one year of the Date of Commencement or the date of issue or date of reinstatement/revival of the Policy, whichever is later.” 

In repudiating the claim of the Complainant, as we find, the OP No. 1 has relied on the report of the Investigator, M/s Kolkata Response Group Pvt. Ltd.  The question is whether the Insuree committed suicide or not.

We have seen the PM Report, death certificate etc.  In the PM Report, it is stated that death was ‘due to effects of burn injuries as noted above – ante Mortem in nature’.  There is nothing apparent in the PM report that the Insuree committed suicide.  It is not appearing before us whether the death was suicidal or it was accidental.  PM report does not support the contention of the OP No. 1.  We find that the Investigator has relied on a document (Xerox copy), written by one B. N. Singh, S.I. of Panchasayar P.S. addressed to the Officer-in-Charge, Chandipur P.S.  In the said letter, there is a line that Bina Pani Mondal was admitted in the hospital on 02-12-2014 at 12.30 hrs. with a history of burn and the deceased poured kerosene oil over her body and put the body on flame following a quarrel at her residence on 01-12-2014.  In the said letter, we find that SI, B.N. Singh has made some queries to the OC, Chandipur P.S., e.g., whether Post Mortem was necessary, or not, whether there was any case record over the incident with the Chandipur P.S., whether there was any foul play behind the incident, or not, etc. etc. We afraid, none of the answers to the queries raised by the concerned SI is before us.  Surprisingly, the concerned Investigator has not tried to get into the bottom of the issue by contacting the Chandipur P.S. or talking to local people.  No affidavit is filed from the side of the concerned Investigator. On the other hand, SI, B. N. Singh is not a party to this case.  He is also not examined in this case.  It is also not appearing before us whether any criminal case has been proceeded with by the concerned police station against any relatives of the deceased Insuree for abatement to commit suicide or not.  In absence of sufficient and adequate document on record, benefit of doubt goes in favour of the Complainant that the death may be accidental in nature, when we cannot hold sure that the death was suicidal. No police case as we find is also registered for the alleged committal of suicide. 

The Investigator, in its report, has candidly stated that the policy duration as on the date of death was 2 years 7 months and 10 days.  There is no document on record filed from the side of the OPs to show that the policy of the deceased got lapsed on 25-04-2014.  So, we find that the policy does not come within the purview of exclusion clause. 

Firstly, it becomes increasingly difficult to hold, without sufficient and adequate document on record that, the deceased committed suicide.  Secondly, it is also difficult to come to any definite conclusion that the policy of the insured lapsed on 25-04-2014 and was reinstated on 04-07-2014.  Thus, we find no reason to accept the version of the OP Insurer that Bina Pani Mondal committed suicide.  Consequently, we think that the OP Insurer has repudiated the claim of the Complainant most arbitrarily.  This is a clear act of deficiency in service on the part of the OP Insurer.

Hence,

ORDERED

that C. C. No. 26/2016 be and the same is allowed on contest against the OPs.  OP No. 1 is directed to pay the insurance claim of Rs. 2,39,242/- to the Complainant within 40 days from the date of this order along with compensation and litigation cost for a sum of Rs. 20,000/- and Rs. 5,000/-, respectively. In default, Complainant would be at liberty to execute this order in accordance with law in which case, OP No. 1 shall be liable to pay interest @ 8% p.a. over Rs. 2,39,242/- from this day till full and final payment is made. We make no order as against OP No. 2.