Orissa

Rayagada

CC/11/2018

Smt. Bhagyabati Nayak - Complainant(s)

Versus

The Manager, Max New York Life Insurance Ltd., - Opp.Party(s)

SRI R.P. Padhi

05 Jun 2018

ORDER

DISTRICT   CONSUMER  DISPUTES REDRESSAL    FORUM, RAYAGADA,

STATE:  ODISHA.

C.C. Case  No. 11 / 2018.                                                          Date.      5   .     6  . 2018

P R E S E N T .

Dr. Aswini  Kumar Mohapatra,                       President.

Sri  GadadharaSahu,                                             Member.

Smt. Padmalaya  Mishra,                                     Member.

 

Smt. Bhagyabati Nayak, D/O: Late Narayan Nayak,  AT:Marathiguda,   Po:Gunupur,   Dist:Rayagada  (Odisha).                                                 …. Complainant.

Versus.

1.The Manager, Max New York Life Insurance Co. Ltd., 11th. floor, DLF Phase-II, Gurgaon -122 002, Hariyana.

2.The Manager,  Max House Ltd., Regd.office, 3^rd. floor, Okhla, New Delhi-  110020.

3. The Manager,  Max Life Insurance Co. Ltd.,  Near Girija  Resturent, Po: Berhampur,Dist:Ganjam.                                                                                                          .…..Opp.Parties

Counsel for the parties:                                 

For the complainant: - Sri R.P.Padhy, Advocate, Gunupur

For the O.Ps   :- Sri  Chinmoy Patra, and associates

JUDGEMENT

The  curx of the case is that  the above named complainant alleging deficiency in service  against  afore mentioned O.Ps for   non payment of assured amount towards death claim  for which  the complainant  sought compensation  inter alia  for redressal of the grievances raised by the complainant. The brief facts of the  case are summarized here.

That Smt. Sashi Nayak in her life time made insurance for her life under  Max New York life vide  policy  No. 609016480  on Dt. 6.6.2008. The life assured  Smt. Sashi Nayak died on Dt. 16.5.2017 leaving behind the complainant and the other two daughters namely Bijayalaxmi Nayak & Urmila Nayak. The  father  of the complainant  Sri Narayan Nayak (Nominee) died on  30.6.2007 . The O.Ps. have  received all the documents   from the complainant  but till date not disbursed the  assured amount  and paid deaf ear. Hence the complainant  filed this case before this forum  and prays the forum  direct the O.Ps  for payment of assured amount with  accrued bonus and such other relief as the hon’ble  forum deems fit and proper  for the best interest of justice.

On being noticed  the O.Ps filed written version inter alia  challenged  the maintainability of the  petition before the forum. The averments made in the  petition are  all false, and O.Ps  deny   each and every allegation made in the petition. The O.Ps taking other grounds in the written version   sought to dismiss the complaint as it is not maintainable  under the C.P. Act, 1986.  The O.Ps prays the forum to dismiss the complaint petition  for the best interest of justice.

 

The O.Ps   appeared and defend the case.  Heard arguments from the    learned counsel for the O.Ps   and from the complainant.    Perused the record, documents,  written version filed by the parties. 

This forum  examined the entire material on record  and given  a thoughtful consideration  to the  arguments  advanced  before us by  the  parties touching the points both on the facts  as well as on  law                    

                                         FINDINGS.

Undisputedly the O.Ps. had issued insurance policy in  favour of (DLA)Death life assured  Mrs. Shashi Nayak bearing  policy   No. 609016480  on Dt. 6.6.2008(copies of the same is in the file which is marked as Annexure-I).

The   above  policy  was  commenced on Dt. 06.06.2008 under   Max New York life scheme  assured amount  with yearly  mode of payment premium  Rs.10,000/-.  Renewal  premium  under the policy  for July, 2016   a sum of Rs. 10,000/- was paid.   The policy holder  died on Dt. 16.5.2017.

On perusal of the record this forum found  the  life assured was died on  Dt.16.5.2017 and the  complainant  Legal heir was filed the case on Dt. 30.01.2018 before  the  forum,  but  till date the O.Ps  have not settled the above   claim even after completion of 1(One) year (Legal heir certificate issued by the Tahasildar, Gunupur is in the file which is marked as Annexure-2). The Complainant consequently prayer to pass necessary order.  Hence  not  allowing   further time to the O.Ps.   this forum passed order.

During the course of   hearing the complainant examined himself and proved the payment  premium  which is marked as Annexure-3 . The complainant also filed policy bond.  The complainant  also filed  Death certificate of Death life assured (DLA) which is in the file marked as Annexure-4). The complainant also argued  due to non payment  of the above assured amount she  suffered a lot of financial trouble  and mental agony. The complainant prays the forum as the  O.Ps have   not heard any  grievance of the complainant till date   so the  O.Ps  be  directed to pay  the  amount

After carefully examining the evidence on record, we find no cogent reason  to disbelieve or discard the evidence already adduced by the complainant. The documentary evidence  tendered by the complainant clearly tends support and absolute corroboration   to  the evidence.  

Further  the death certificate of  Late  Sri  Narayana Nayak (Nominee) is in the file which is marked as Annexure-5. Further the O.Ps have received authorization  from the complainant which is marked as Anneuxre-6. Again the O.Ps have  received  NEFT –Mandate form   the complainant    which is marked as Anneuxre-7

On the  strength  of   Death certificate  of  Late  Sri  Narayana Nayak (Nominee)  inter alia  Legal Heir certificate   issued by the Tahasildar, Gunupur  in favour of the complainant along  with the above said   documents   this forum   allow this case.

This forum observed there is no reason to disbelieve the evidence put forth  by the  complainant  before the forum  whose evidence  suffers from no infirmity. The evidence adduced by the complainant  clearly   leads     us   to   arrive   at   just conclusion that there is not only

deficiency  in service  but also negligence  on the part of the O.Ps  in not   reimbursing the assured amount   to the complainant  towards death claim   as per the  provisions laid down under section 14 of the  C.P. Act.

On careful analysis   of the evidence on record both oral and documentary, we are clearly of the opinion  that inspite of doing the needful, the O.Ps are failed to redress the grievances of the complaint which amounts to  deficiency in service  as a result the complainant was constrained  to file this complaint before the forum claiming the relief as sought for.  In that view  of the matter the O.Ps  jointly and severally liable.

On perusal of the record  this forum found  the O.Ps  had continuously received the premium w.e.f. 2008 till  Dt. 20.7.2016 @ Rs.10,000/- per year  with the above  assurance but when the claim is placed for  such reimbursement towards death  claim as per policy condition they  are avoiding  the same and as  such  it is a deficiency of service and they have never intended to extend  such benefit to the consumers and with false representation they are continuing  the policy  named  as Max New York life scheme. This forum observed the O.Ps  are only intended to collect the premium  and not to pay back the same at the event death of  DLA Death life assured.

Further this forum perused the case law  in the instant case. It is held and reported in  CPC- 1991, page -540 the  Hon’ble  Hariyana State  Commission held that when ever there is any delay or dilatoriness in finalizing  the insurance claim, the same would be tantamount to a  deficiency  in service and thus comes squarely within the  purview of Consumer Forum.  Once it is held that default or negligence in the  settlement of an insurance claim is a deficiency  in service then an arbitrary  or mischievous  rejection  of an insurance claim  would patently  be a default  within its larger  meaning. On principle , it would   seem  some what manifest that the mere repudiation of the insurance claim cannot itself operate  as a  jurisdiction bar for redressel forums under the Act.  This is further  made it clear and  it is held and reported  in CPR-1991(2), page No.18  the Hon’ble National Commission  clearly defines  the mere unilateral  rejection of an insured parties  claimed by the insurer does not  per  se  operate as jurisdictional bar to seek redressal before  the forums under the Act. It is on the strength of the  above decision  the instant case is admitted by this forum.

               Again it is held and reported  in SCC  (1979) 4 SCC 176 has held that  the Hon’ble Supreme Court  observed  “Resort to the plea of limitation by public authority to defeat just claim of citizen depreciated – Though permissible under law, such technical pleas should only be taken when  claim is not well founded”. Again the Hon’ble Supreme Court opined that, “ It is high time that Governments and public authorities adopt the practice of not  relying upon technical pleas  for the purpose of defeating legitimate claims of citizens and do what is fair and just to the citizens. Further the Hon’ble Supreme Court   in deciding the said U/S - 136 of Constitution of India has  kept in mind, the constitutional duty imposed on the public sector company/organization. Being public sector company/organization, are supposed to facilitate the  concept of welfare state and interest of the citizens and to  not extract monetary benefit by rejecting just claim of the citizen on technical  grounds.

            Again   the Insurance Regulatory and Development authority has also  issued direction through circular No. IRDA/HLTC/Misc/CIR/216/09/2011 Dtd. 20.9.2011 that rightful claim should not be rejected on the mere technical ground.

Not responding to the grievance of a genuine consumer amounts to deficiency in service and in that line we hold that all the parties  are jointly and severally liable.

             Hence to meet  the  ends  of  justice,  the following   order is  passed.

                                                                        ORDER.

            In  resultant the complaint petition stands  allowed in part    against  the O.Ps

The O.Ps are  ordered  to  pay  death benefit   of the assured amount  with accrued bonus  as per the terms of the policy   under  Max New York life scheme vide  policy  No. 609016480  inter alia  to pay Rs.2,000/-    litigation charges to the complainant.

 

             The OPs  are ordered to make compliance the aforesaid Order within  30 days from the date of receipt of this order, failing which   it shall carry interest @   Rs. 9% per annum   from the date of  death  of  DLA   i.e.  Dt. 16.5.2017  till realization

 

 Service the copies of the order to the parties free of  cost.

Dictated and corrected by me

Pronounced on this              5th.day of   June, 2018.

MEMBER.                                                MEMBER.                                                    PRESIDENT.