This case has been arising out of the complaint filed by the complainant against the O.Ps named above u/s. 12 of the Consumer Protection Act, 1986. The case of the complainant is that his wife Monika Rani Ray Sarkar since deceased had one life insurance policy under Rural Postal Life lnsurance Scheme bearing No.  R-WB-SG-EA-34184 in the year 2005 for a monthly premium of Rs. 250/- having sum assured of Rs. 1,00,000/- for 25 years coverage. The said Monika Rani Ray Sarkar died on 28/07/2010 at her residence and on 19/01/2011 the complainant submitted his claim with the O.Ps by filing up Form No. LI–9 and produced all necessary particulars and documents. The procedures regarding the clear of the policy have been started and O.P No. 2 on 02/05/2011 forwarded all the papers in original for settlement to O.P No. 3 and subsequently communications have been made between O.P Nos. 1 and 2 for settling the claim. In the year 2013 the O.Ps conducted a physical enquiry and collected postmortem report from the complainant with assurance to settle the claim very soon. But till date the O.P did not settle the claim and not to pay the amount to the complainant who is the husband of insured as well as nominee of that policy. The complainant since 2014 on several times visited the office of O.P No. 2 to know the progress of his claim but he got no official information from the O.Ps. The O.Ps neither have repudiated the claim nor settle the case they have just put the case into freeze which reflects the negligence and deficiency in service from the part of the O.Ps. The complainant made several communications with the O.Ps since 2014 and ultimately on 04/12/2017 he wrote a letter to the Post Master General, North Bengal & Sikkim Region, which was forwarded to O.P No. 2 Vide Office Memo No. SG/RO/PLI-RPLI/MISC/PART – III,    Dated – 17/01/2018.  The complainant has claimed his insurance claim of Rs. 1, 00,000/- which was occurred due to the death of his wife along with Rs. 80,000/- towards mental agony and suffering and Rs. 10,000/- as litigation cost.

The O.Ps have contested the case and filed written version. They have denied all the allegations made therein. Regarding the insurance policy in the name of the wife of the complainant is admitted. But the gist of the written version is that the complainant during the proposal of the insurance policy suppressed the facts that his wife was suffering from insanity she was under the treatment of the doctor. They have further stated that due to her insanity she committed suicide. The O.Ps have collected the medical certificate and the Postmortem report which reveals that the insured Monika Rani Ray Sarkar was suffering from insanity he was treated by Dr. Atanu Majumder, who was a Neuro Psychiatrist and in the prescription the doctor noted that the insured suffering from insanity that is from fearfulness, anxiety etc. and ultimately the insured committed suicide. So, according to the O.Ps the said facts were suppressed by the complainant at the time of proposal of insurance policy and accordingly he will not get any claim from the O.Ps. They have prayed for dismissal of the case.

           We have perused the materials on record meticulously. Considering the above pleadings the following issues are necessarily come out to consideration to reach just decision of the case.        

                                                  POINTS FOR CONSIDERATION

1. Is the complainant a consumer u/s.12 (1)(d)(ii) of Consumer Protection Act, 1986 ?
2. Has this Forum jurisdiction to entertain the instant case?
3. Have the O.Ps any deficiency in service as alleged by the complainant?
4. Is the complainant entitled to get any relief/reliefs as he prayed for?

                                       DECISION WITH REASONS

           Considering the nature and character of the case all the points are taken up together for consideration for the sake of brevity and convenience.

           In this case the wife of the complainant was the insured under Rural Postal Life Insurance since 31^st March, 2005. She was paying insurance premium regularly. The present complainant being the husband of the insurdr is the nominee of that policy. On 28/07/2010 the insurdr Manika Rani Roy Sarkar died by committing suicide and on 19/01/2011 the complainant has submitted his claim to the O.Ps but the O.Ps did not settle the claim petition filed by the complainant. Here according to the provision of Consumer Protection Act the Manika Rani Roy Sarkar was the consumer and after her death the present complainant being the nominee as well as the husband of the deceased has the right to claim the said insurance amount and this Commission has the jurisdiction to try this case as the office of O.P No. 1 is within the jurisdiction of this Commission and the complainant also resides as the cause of action arose within the jurisdiction of this Commission.

In this case it is admitted position that Manika Rani Roy Sarkar was the insured of a Rural Postal Life Insurance No. R-WB-SG-EA-34184 amounting to Rs. 1 lakh (sum assured) and that policy was initiated and the risk was commenced from 31^st March, 2005 and the maturity date was 31^st March, 2040. It was also admitted that the premium was regularly paid by the insurer in time.

The case of the complainant is that on 28/07/2010 the said Manika Rani Roy Sarkar died at her home and he submitted the claim application before the O.Ps on 19/01/2011 but the O.Ps did not settle the said claim in spite of several pursuance by this complainant. In the year 2013 a physical inquiry was conducted by the O.Ps and have collected the Post Mortem Report from the petitioner with an assurance that the matter will be settled very soon. But till now the O.Ps did not settle the claim nor repudiated the said claim and it is pending due to the negligence and laches from the side of the O.Ps which is completely deficiency in service from the part of the O.Ps. From the written version, it appears that the pacific statement of the O.Ps are that the said Manika Rani Roy Sarkar committed suicide at her home and she was suffering from insanity and treated by the psychiatrist which the complainant has suppressed before them during the proposal of policy. According to them the claim application of the complainant was returned form their Regional Office with an instruction to resubmit the documents to the effect of satisfying the relationship between insured and the claimant/nominee with doctor certificate indicating cause of death. The complainant submitted Post Mortem Reports and other relevant documents of local Gram Panchayat etc. which was verified by the O.Ps and the O.Ps resubmitted to same to the Regional Office but the Regional Office returned the said claim petition again. As the insurant suffering from insanity from last seven years and it was not disclose at the time of taking policy and her insanity was actually suppressed. The complainant did not submit the require documents from which the claim settlement being delayed.

 After considering of the view of both the parties we find that the insured Manika Rani Roy Sakrar committed suicide which is an admitted position and her death was caused after  5 years of policy. Regarding insanity of the deceased as alleged by the O.Ps has not been proved by any medical documents. It was argued by the Ld. Lawyer by the O.Ps that the said insured was suffering from insanity and he was treated by Dr. Atanu Mazumder who is the doctor of Neuro Psychiatrist but from the side of the O.Ps no medical document is filed that the said insured was suffering from insanity prior to commencement of this insurance policy. The complainant has totally denied the said fact. Apart from this allegation the O.Ps have nothing to say regarding the delay of settlement of the policy.  The complainant has filed Annexure - A which is the policy documents as admitted by the O.Ps. On the reverse of the documents regarding terms and condition in Para - 12 it is clearly stated that ‘in the event of an insured committing suicide at any time from the date of acceptance of the policy but before the second policy anniversary then the policy will be treated as void and no claim will be entertained in regard to this policy’.  Here in this case it appears that the said policy commencement on 31/03/2005 the insured Manika Rani Roy Sarkar committed suicide on 28/07/2010 that means after lapse of five years. So according to the rule of this insurance there is no bar to get the claim from this insurance policy as the insured committed suicide after five years. But the O.Ps did not consider all these matters and it appears that the said claim petition is pending since 19/01/2011. After lapse of eleven years the O.Ps neither settle the claim nor repudiated the said claim. The entire documents file by the complainant as Annexures –B, B2, B3, B4, B5, B6 and B7 indicates that several correspondence were made amongst the several offices of the O.Ps but ultimately after 11 years of time no settlement was there. The rules permits the O.Ps to settle the claim in case of a suicide as the suicide was caused after 5 years of the policy. There is no evidence of suppression of any material facts by this insurer at the time of commencement of the insurance policy regarding her illness.  It is also evident from Annexure - A that the present complainant is the nominee of that policy and in relation he is the husband of the deceased.  In spite of that the O.Ps continued to verify the relation of the complainant with the deceased. We find that there is gross laches and negligence from the side of the O.Ps to settle the disputes and they have delayed the said settlement taking several pleas one after another which has already fulfilled by the complainant. 11 years of time from the date of claim is not a matter of joke. There is definitely gross deficiency in service from the part of the O.Ps for that reason the complainant is not getting his insurance claim amount as well as he has been suffering from mental harassment and agony. We find that inspite of the valid claim of the complainant the O.Ps delayed the settlement with intentional negligence. The complainant is entitled to get relief from this Commission and we find that the complainant will get Rs. 1,00,000/- as insurance amount along with 6% interest Per Annum over the said insurance amount from 19/01/2021 to till realization of that amount. The complainant also entitled to get Rs, 50,000/- as compensation for his mental agony and suffering as well as harassment. He is also entitled to get Rs. 10,000/- as litigation cost.  The O.Ps have to pay the claim amount against the Insurance Policy with interest along with the other compensated amount and litigation cost to the complainant.   

Thus all the points are disposed of accordingly.

                Hence, for ends of justice; it is;-

                                                                ORDERED

           that the instant case be and same is allowed on contest against the O.Ps. The complainant do get the award of Rs. 1,00,000/- for insurance claim with 6% interest Per Annum from 19/01/2021 to till the payment of that amount and he also do get an award amounting to Rs. 50,000/- as compensation for his mental agony and sufferings and also Rs. 10,000/- as his litigation costs; total decreetal amount of Rs. 1,60,000/- (One Lakh Sixty Thousands) along with interest. The O.Ps are hereby directed to pay the decreetal amount along with interest as stated above till the payment is made to the complainant. The O.Ps are directed to the pay the said award to the complainant  within 30 days from this day, failing which legal action will be taken against him.

Let a copy of this final order be sent to the concerned parties through registered post with A/D or by hand forthwith for information and necessary action.

Dictated & Corrected by me