DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KOZHIKODE

PRESENT: Sri. P.C. PAULACHEN, M.Com, LLB          : PRESIDENT

Smt. PRIYA.S, BAL, LLB, MBA (HRM) :  MEMBER

Sri.V. BALAKRISHNAN, M Tech, MBA, LL.B, FIE: MEMBER

Friday the 29^th  day of September 2023

CC.22/2021

Complainant

Shyji. P,

W/o.Late Venu,

Pochayil (House)

Kakkavayal,

Kakkad .P.O,

Puthuppadi Village,

Thamarasseri,

Kozhikode. 673586.

(By Adv. Sri. K.V. Prachod)

Opposite Parties

1.                 The Chairman,

Claims Committee,

PNB Met Life Insurance Company Ltd,

                         1^st Floor, Techniplux complex,

Off Veer Savarkar Flyover,

Goregaon West, Mumbai,

Maharashra, 400062.

2.                The Manager,

PNB Met Life Insurance Compay Ltd,

Kozhikode Branch Office,

Nadakkave,

                         Kozhikode – 673006

            (By Adv. Sri. Mohanan Eravath)

ORDER

By Sri. P.C. PAULACHEN  – PRESIDENT.

This is a complainant filed under Section 35 of the Consumer Protection Act, 2019.

2. The case of the complainant, in brief, is as follows;

The husband of the complainant deceased Venu had taken a PNB Met Life endowment saving plus Insurance Policy of the opposite parties on07-05-2018 with yearly premium of Rs. 5 ,00,000/-.Rs.50,00,000/- death coverage was assured to the nominee of the policy holder with other benefits. The premium of Rs. 5,00,000/- was paid by the deceased Venu on 07-05-2018 and the policy was issued to him. On 07-05-2019, the second annual premium of Rs. 5,00,000/-was paid. The complainant is the nominee. Venu died on 27-01-2020 while under treatment in the Aster Mims Hospital, Kozhikode.

3. On 15-03-2020 the complainant preferred death claim. On 20-06-2020 the opposite parties credited Rs. 10,00,000/- to the account of the complainant towards death claim. The balance death claim of Rs.40,00,000/- was repudiated by the opposite parties stating that the deceased Venu was suffering from liver disease before the policy was issued.
4. The reason stated for repudiating the claim is false and baseless. The deceased was a healthy person and was never hospitalised or treated for any disease before the commencement of the policy. The repudiation of the claim on illegal grounds amounts to deficiency of service and it has resulted in mental agony and hardship to the complainant. Hence the complaint to direct the opposite parties to pay a sum of Rs. 40,00,000/- with interest along with compensation of Rs. 3,00,000/-  and cost of the proceedings.
5. Though the opposite parties entered appearance through counsel, they failed to file written version within the prescribed time and hence they were set ex-parte. IA No. 206/2022 filed by the opposite parties to receive the written version was dismissed as per order dated 05-09-2023.
6. The points that arise for determination in this complaint are;

          (1) Whether there was any deficiency of service on the part of the   

                 opposite  parties, as alleged?                   

           (2)  Reliefs and costs.

7. The complainant was examined as PW1 and Exts A1 to A5 were marked.
8. Heard.
9. Point No.1: The complainant is the wife of the deceased Venu who had taken PNB Met Life endowment savings plus insurance policy of the opposite parties. The sum assured was Rs. 50,00,000/-. He was in remittance of the annual premium without any default. During the subsistence of the policy, Venu died on 27-01-2020 in the hospital. The complainant has approached this commission with a grievance that the death claim put in by her, who is the nominee, was repudiated by the Insurance Company without valid reason and only the already remitted premium amount of Rs. 10,00,000/- was returned to her.
10. PW1 has filed proof affidavit in terms of the averments in the complaint and in support of the claim. She has asserted that the deceased was a healthy person and was never hospitalised or treated for any disease before the commencement of the policy. She has produced the death summary issued from Aster Mims Hospital . Ext A1is the copy  of the claim decision letter, Ext A2 is the letter dated 10-08-2020 sent by the complainant, Ext A3 is the letter dated 28-09-2020 of the opposite parties, Ext A4 is the death summary and Ext A5  is the copy of the death certificate. The evidence of PW1 stands unchallenged. The opposite parties have not produced any evidence to disprove the averments in the complaint or to rebut the veracity of the documents produced and marked by the complainant. There is no contra evidence to disprove the claim of the complainant. The case of the complainant stands proved through the testimony of PW1 and Exts A1 to A5.
11. The act of opposite parties in wrongly  repudiating the claim and thereby denying  the legitimate claim amounts to gross deficiency of service . The complainant is entitled to get Rs. 40,00,000/- towards the balance of the death claim. It goes without saying that the act of the opposite parties has caused mental agony and hardship to the complainant and she is entitled to be compensated adequately. Considering the entire facts and circumstances, we are of the view that a sum of Rs.50,000 will be reasonable compensation  in this case. The complainant is also entitled to get Rs. 5,000   as cost of the proceedings.
12. Point No. 2:-   In the light of the finding on the above point, the complaint is disposed of as follows ;

1. CC.22/2021 is allowed in part.
2. The opposite parties are hereby direct to pay the complainant a  sum  of Rs. 40,00,000/-(rupees forty lakh  only) with interest at the  rate of   6% per annum from the date of the complaint ie. 21-07-2021 till actual payment. 
3. The opposite parties are directed to pay a sum of Rs. 50,000 (rupees fifty thousand only) to the complainant as compensation for the  mental agony and hardship suffered.
4. The opposite parties are directed to pay a sum of Rs. 5,000 (rupees  five thousand only) as cost of the proceedings to the complainant.
5. The order shall be complied with within 30 days of the receipt of copy of this  order.

Pronounced in open Commission on this, the 29^th day of September, 2023

   Date of Filing: 27/01/2021

                       Sd/-                                                           Sd/                                                                Sd/-

               PRESIDENT                                              MEMBER                                                   MEMBER

APPENDIX

Exhibits for the Complainant :

Ext.A1 – Copy  of the claim decision letter.

Ext.A2 – Letter dated 10-08-2020 sent by the complainant.

Ext.A3 – The letter dated 28-09-2020 of the opposite parties.

Ext.A4 – The death summary. 

Ext.A5 – copy of the death certificate.

Witnesses for the Complainant

PW1 – Shyji. P (Complainant)

                     Sd/-                                                              Sd/                                                               Sd/-

               PRESIDENT                                                 MEMBER                                                 MEMBER

True Copy,

                                                                                                                                                                   Sd/-

                                                                                                                                                       Assistant Registrar.