Shri Aswini Kumar Patra, President:

1. Captioned consumer complaint is filed by the complainant named above inter alia alleging deficiency in service & unfair trade practice on the part of the Ops for repudiation of insurance claim vide No. 432700/48/2020/000066 under policy No.432700/48/2019/169 ( Crop Saral Plus) on the ground stating there in that, insured committed breach of law with criminal intent comes under the exclusion & for delayed intimation.
2. The complainant being the nominee/wife of deceased  insured account holder namely Raghunath Jal  seeks for an order directing the Op 1(one)  to disburse the insured  claim  amount of Rs.5,00,000/- with interest  since the date of death of her insured husband under the said insurance policy to the complainant and to pay a sum of Rs.1,00,000/-  as compensation towards mental agony and harassment with litigation cost of Rs.5,000/- and further prayed for  all other equitable  relief as this commission may deem fit & proper.
3. The facts in brief as stated in the complaint petition and emerged from the documents filed there with are that, the complainant is the widow of deceased Raghunath Jal. The deceased husband of the complainant was maintaining a SB account with the OP No.2/Bank vide A/c No.1209155811 (later on the complainant conformed it as A/C No.  520291004330655 on affidavit) wherein he availed insurance coverage vide  insurance policy No. 432700/48/2019/169 under the scheme of ” Crop Saral Plus” of the OP 1/The Oriental Insurance Co.Ltd, where the complainant being the wife was featured as the nominee. Unfortunately on dt. 3.1.2019  night the husband of the complainant died for which one criminal case has been  registered before  the Sadar Police Station Bhaweanipatna vide P.S. Case No.11  dt.3.1.2019. It is further submitted  that, insured husband  of the complainant died during  the coverage of the said policy and being  the nominee/wife, the complainant has the legitimate claim of the sum insured amount of Rs.5,00,000/- along with accrued benefit there under the said policy. It is further submitted that, after sudden demise of her husband the complainant was in shocked and her mental condition got disturbed. Moreover, when the complainant find out the said pass book of her deceased husband and came to know about the insurance policy, immediately rushed to the Ops and following the due procedure the claim vide No.432700/48/2020/000066 has been lodged. Further it is submitted that, the complainant being a poor rustic villager is completely unaware regarding the law and procedure. She could not lodge her claim within 60 days of the death of her insured husband. The complainant being the bonafide claimant is entitle to be released with the insurance benefit under the said insurance policy but the insurer Op 1(one) vide its letter dt.3.7.2019 repudiated the insurance claim of the complainant without any basis which amounts to gross negligence, deficiency in service and unfair trade practice caused financial loss and mental agony to the complainant hence, this complaint.
4. The complaint is resisted by the OP 1/The Oriental Insurance Co.Ltd,  by filing their written version  containing there in that, the deceased had committed breach of law  with criminal intend in provoking  one Muna Panda  as such the  claim under the policy has been rightly repudiated by the competent authority. It is further submitted that, the husband of the claimant was killed on 3.1.2019. As per policy investigation the incident took place due to quarrel between the husband of the petitioner & accused one Muna Panda who due to sudden provoking,  there was tasseled in between the deceased as a result  Muna Panda   fired gun  shoot  to the deceased/insured and it is  false to say that, the deceased died on 3.1.2019. It is further submitted that, as per “MoU” between Corporation Bank (OP 2) and Oriental Insurance Company Ltd (OP 1) there are exclusion clauses  wherein  Clause 11(v) speaks that, insurance benefit under the policy is not payable if insured committed any breach of law with criminal intent .As  the deceased has committed breach of law with criminal intend in provoking  one Muna Panda  the claim has been rightly repudiated by the competent authority. It is further submitted that, as per MoU  under Clause 8(a)  of the policy, claim intimation  to be informed to the insurance company within 60 days from the death of the insured but the competent authority  here in this case has received the intimation of death on 24.05.2019 as such the claim is of time barred. The competent authority has rightly decided the claim of the complainant as per the provision of the “MoU “of the insurance policy and the act of the OP 1(one)  cannot be termed as unfair trade practice as such the complaint  has no merit , liable to be dismissed with exemplary cost.
5. The Opp.Party No.2/The Branch Manager Corporation Bank, (Now the Union Bank of India),Bhawanipatna  filed their written version admitting the facts there contended in para 2 of the complaint petition i.e. the deceased husband of the complainant namely Raghunath Jal has maintained one SB Account with the OP No.2/Bank  wherein he has availed insurance coverage under  insurance policy vide policy No.432700/48/2019/169 under the scheme of “Crop Saral Plus” wherein the complainant being the wife was the nominee. Further it is averred that, the death of the said account holder and lodging of criminal case in Sadar P.S. Bhawanipatna vide P.S. Case No.11 dt.3.1.2019  is beyond the knowledge of the bank authority. The Op 2/Bank asked the complainant to strict proof of the fact that, the complainant being the wife was the nominee and after death of the policy holder the complainant is entitled to the insured amount  under the said policy. However, it is admitted by the OP No.2 in the written version that, the complainant has made one application before the OP NO.2/bank on 16.5.2019  which is sent to the  OP No.1  insurer for settlement of insurance claim but the OP 1 / insurer has issued one repudiation letter dt.3.7.19 mentioning the ground therein which was duly communicated to the complainant. Moreover, the reason of delay in death intimation of the account holder is beyond the knowledge of OP No.2/Bank. Hence, denied. The complainant is called upon to strict proof of the same. The Op No.2/Bank further called upon the complainant to strict proof of the contention of Para 6 & 7 of the complaint. In Para 7 of the complaint has mentioned that, the complainant being the nominee is one of the bonafide claimant as against the OP No.1/Insurer. The matter of repudiation of insurance claim of the complainant vide letter dt.3.7.2019  of OP No.1 & regarding pass book there in the name of the Raghunath Jal is not disputed by the Op No.1/Insurar . The rest contention of the complaint petition is denied by the OP 2 /Bank and asked the complainant to strict proof of the same of the complaint averment.
6. Heard. Peruse the material on record. We have our thoughtful consideration to the submission of rival parties.
7. After perusal of the complaint petition, written version and all the documents relied on by both the parties placed in the record and evidence adduced by the parties, the points for consideration before this Commission are :-

1. Whether the complainant is a consumer of the Ops?
2. Whether the complainant is the widow & nominee of deceased insured Raghunath Jal ?
3. Whether the complainant is entitled for insurance benefits there under the alleged insurance policy vide policy No.432700/48/2019/169 of the OP 1(one) /Oriental Insurance Co.Ltd, on account of premature death of her insured husband Raghunath Lal?
4.  Whether the OP 1(one) /Oriental Insurance Co. Ltd, has deficient in service & unfair trade practice by repudiating the claim of the complainant under the said insurance policy?
5. Whether this complainant is maintainable before this Commission under C.P.Act 2019, and
6. Whether the complainant is entitled to get the relief(s) as claimed in this complainant?

8. Section 38(6) of C.P.Act,2019 cast an obligation on the District Commission to decide a complaint on the basis of evidence brought to its notice by the complainant and the service provider irrespective of  whether the service provider adduced evidenced or not. Decision of the District Commission has to be based on evidence relied upon by the complainant. Thus, onus through on the complainant making allegation.
9. To substantiate her claim the complainant has filed true copy of the following documents:- (a)  photo copy of repudiation letter dt.3.7.2019 issued by the OP No.1(one), (b) Photocopy/Xerox copy of pass book  vide A/c No.520291004330655 in the name of deceased husband Raghunath Jal there with the Op 2/Bank,(c) copy of Final Form/Charge Sheet in connection  with Bhawanipatna P.S. Case No.11/2021  dt.3.3.2019 and (d) Copy of Legal Heir Certificate of deceased Raghunath Jal, (e). Affidavit Evidence dt. 18.04.2023 and (f) Affidavit Evidence dt. 13.09.2023 18.04.2023 of the complainant is taken into the record for consideration.
10. The Complainant has proved her case by filling her evidence on affidavit as prescribed under Sec.38(6) of C.P.Act 2019,the contents of which are corroborated with the averment of the complaint petition remain un –rebutted. 
11. The insurer/Op 1 has filed their evidence affidavit of one Santanu Kumar Meher , Dy.Manager, Oriental Insurance Company Ltd. Bhawanipatna branch stating therein that, as per the “MoU” between the Corporation Bank/OP 2 & Oriental Insurance Company Ltd/OP 1, there are exclusion clauses 11(b) , as the deceased has committed breach of law  with criminal intend in provoking one Muna Panda  resulting gun shoot and murder of the insured. It is stated that, the claim has been rightly repudiated by the competent authority and further stated that, as per terms of the “MoU” the complainant has to submit her claim within 60 days of the incident and in this case competent authority received intimation on 24.05.2019. As per “MoU” under Clause 8(a) “Claim information to be informed to the company within 60 days of the date of death” with this the OP1/insurance Company  urged that, the claim is of time barred and that the competent authority has rightly decided the claim of the complainant as per the provision of the “MoU “of the insurance policy and the act of the OP 1(one)  cannot be termed as unfair trade practice or deficient service as such this  complaint  has no merit , liable to be dismissed.
12. The Op No.1 /insurer, to substantiate  their pleading ,has  also filed the copy of  following  of documents such as :-(a) “MoU” executed between  OIC/OP 1(one) and Corporation Bank/OP 2(two)  dt.24.1.2018, (b) copy of repudiation letter dt.3.7.2019, (c) photocopy/Xerox copy of medical certificate dt.9.5.2019, which are  taken into record  for consideration.
13. The Op 2/Branch Manager Corporation Bank (now Union Bank of India) ,Bhawanipatna Branch , to substantiate their claims, has filed the true copy of the following documents:- (a) the computer generated account statement of from dt. 01.01.2018 to 31.01.2021 vide SB A/C No. 520291004330655 there in the name of deceased Raghunath Jal ,(b) copy of nomination form of Raghunath Jal  i.e Account Opening Form  and (c) voter identity card of the deceased Raghunath Jal which are  taken into record  for consideration
14. The OP 2/Bank  also filed evidence affidavit of one Suresh Chandra Bihari, the Branch manager of the Union Bank of India, Bhawanipatna stating there in that ,Raghunath Jal was the account holder of their Bank vide SB A/C NO. 520291004330655 and an amount of Rs.100/- has been debited from his account on dt. 16.10.2018 towards premium for renewal of CSPLUS Corp Saral Plus to cover Rs.5,00,000/insurance - and the same was insured with the Oriental Insurance Co.Ltd/OP 1 and that ,his wife Lachmani Jal was the nominee of the account holder and that ,the earlier account was maintained by Corporation Bank Bhawanipatna but now it is merged with the Union Bank of India .
15. During hearing of this case the complainant filed her additional evidence dt. dt. 13.09.2023 stating there in that, her husband has opened a SB account in the Corporation Bank  at Bhawanipatna Branch vide A/C No. 520291004330655 but in the para 2 of her complaint petition the CIF ID Vide No. 2009155811 has been wrongly mentioned instead of account Number and further stated that , in the SB account opening Form of her deceased husband in Corporation Bank the nominee name has been mentioned as Laxmani Jal instead of Lachamani Jal and that, her name in voter card has been mentioned as Lachhamani Jal instead of Lachamani Jal and that , in the account statement of her deceased husband her name has been mentioned as Laxmi Jal instead of Lachamani Jal and that , in cause title of the complaint petition her name has been mentioned as Lachamani Jal which is also mentioned in her SB account of Union Bank of India vide A/C No. 520291021795131 and in her Adhar Card vide No .5609 1008 0989 and that , the names Lachamani Jal ,Laxmani Jal , Laxmi Jal & Lachhamani Jal belongs to same & one person i.e herself remain unchallenged.    
16. The facts that, deceased Raghunath Jal is the husband of the complainant was  maintaining a SB A/C with the  Corporation Bank (now Union Bank of India)  at Bhawanipatna Branch vide A/C No. 520291004330655 and was insured with the OP1/ Oriental Insurance Company Ltd under  the scheme of “Crop Saral Plus vide insurance policy  No.432700/48/2019/169 wherein the complainant being the wife is  featured as the nominee to received all the benefits accrued there in the said  SB account and subject insurance policy  in case of pre matured death of the insured account holder and that, the said account holder Raghunath Jal died being killed on dt.03.01.2023 during the policy period is not disputed . As such we are of the opinion that, the complainant being the widow/nominee is the beneficiary there under the both the subject  SB A/C & Insurance Policy is a consumer of the Ops has locus stand to present this complaint before this Commission under C.P.Act 2019 .
17.  It may not be disputed that, a policy of insurance effected by any married man on his own life and expressed on the face of it to be for the benefit of his wife or of his wife & children or any of them shall ensure and be deemed to be a trust for the benefit of his wife. Law is well settled that, the nominee is entitled to receive the claim amount over any other legal heir and the insurer is duly bound to pay the claim to the nominee in accordance to Sec.39 of the Insurance Act until & unless the insurer is restraint from doing so by a competent court of law.
18. During hearing of this case the learned counsel for the OP 1 /Insurance company draws our attention over the undisputed Final  Form/Charge Sheet dt.03.03.2019   prepared  by the Sadar Police Station Bhawanipatna, Kalahandi with respect to FIR No 11of 2019 and on the exclusion clauses 11(a)(v) there  in the “MoU” executed  between the Corporation Bank & Oriental Insurance Company Ltd, placed on the record and submits that , as the deceased has committed breach of law  with criminal intend in provoking one Muna Panda  resulting gun shoot & murder of the insured/account holder for which the  Insurance Company /Op 1 (one) has  rightly repudiated the claim of the complainant .We have perused the undisputed copy of the Charge sheet placed on the record where the investigating officer has opined that “ due to sudden provocation there was tasseled in between the deceased and the alleged accused Muna Panda uttering slang languages in Odia and Hindi and finally accused Muna Panda brought out his personal pistol and shoot two round in the chest of deceased Raghunath Jal (Siman). As a result of which the deceased fall down on the road and succumbed to injury at the spot having severe bleeding chest injuries.”
19. Law is well settled that, merely submitting Charge Sheet or giving opinion there in the charge sheet by the investigating agency against any person regarding commission of any crime shall not ipso facto construe  involvement of that person in the commission of  crime rather it need to be proved beyond reasonable doubt in the competent court of law to hold that, he/she was involved in the offence of the committed crime .Here in this case nothing cogent evidence is adduced by the Ops /Insurance Company to hold that , any competent court of law has ever held the  deceased insured /the husband of the complainant guilty of any offence of committed crime as alleged by the insurance company/Op No 1. Hence, we are of the opinion that ,repudiation of insurance claim of the complainant on the ground of “committing any breach of law with criminal intent” is not justified rather it is found to be arbitral certainly caused deprived of getting insurance benefit resulting financial loss & mental agony to the complainant as such she need to be adequately compensated by the insurance company/Op 1(one).
20.  Learned counsel for the Op No1/Insurance Company  further draws our attention over the  terms 8(a)  of the “MoU and submits that, the complainant has to submit her claim within 60 days  of the incident  and in this case competent authority  received intimation on 24.05.2019 and with this submission the learned counsel for the Op1/Insurance Company urged that, the claim is of time barred and that, the competent authority has decided the claim of the complainant as per the provision of the “MoU “of the insurance policy & rightly repudiated insurance claim of the complainant for which  the the OP 1(one)/Insurance Company   cannot be termed as deficient service or unfair trade practice rather,  this complaint  has no merit , liable to be dismissed with cost .
21. In this regards we have seen that, the matter has been reported before the law enforcing authority soon after the occurrence of Murder of insured account holder Raghunath Jal vide P.S. Case No.11  dt.3.1.2019 of the Sadar Police Station Bhaweanipatna .Reliance may placed on the Circular dt. 20.09.2011 issued by the Insurance Regulatory & Development Authority where in repudiation on the ground of delay intimation was deprecated AND on the judgment of the Honorable National Commission in Santosh Umakant vrs TATA A.I.G General Insurance Co.Ltd, reported in 2019, NCJ 599(NC), ) it is held that, repudiation of claim merely on delayed intimation is not justified .
22. Nothing material placed on the record to hold that, the Op /Insurance Company has ever deputed any investigator and have procure the investigation report, which clearly proved that, the Op /Insurance company has violate the procedure for settlement of the claim as prescribed by the Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests) Regulations, 2017 and only on surmise & conjecture the Op has  arbitrarily repudiate the genuine claim of the complainant. Accordingly, we are of the opinion that, the Op/Insurance Company is deficient in proper service to settle of legitimate insurance claim of the complainant certainly caused financial loss & mental agony need to be adequately compensated by the OP/ Insurance Company.
23. It remain undisputed that, the husband of the complainant was an account holder of the OP 2/Bank insured under group personal accident insurance policy / CROP SARAL PLUS of the OP1/insurance company where the OP1/insurance company has promised to pay insurance benefit of Rs 5lacs per account holder for accidental death of the insured accountholder .Here it is proved on affidavit that, the husband of the complainant/the account holder died accidental being shoot two round in his  chest which remains undisputed .The undisputed  Legal heir certificate and affidavit evidence dt. 13.09.2023 of the complainant placed on the record  proved that ,the complainant is the widow of deceased account holder Raghunath Jal & she is the nominee to receive the insurance benefit under the subject insurance policy remain undisputed . As such we are of the opinion that, the complainant is entitled to get insurance benefit as claimed under the subject insurance policy there with the Op1/Insurance Company.
24. Law is well settled that, Insurance Policy is taken for reimbursement or for indemnity of loss which may be suffered on account of insured at peril, the services of the insurer cannot be said to have hired or availed for a commercial purpose hence, we are of the opinion that, the complainants is a consumers of the Op/Insurance Company. Insurance claim as repudiated by the Ops/  Insurance Company is found to be not justified rather caused injuries to the complainants as such , there is sufficient cause to file this complaint and this complaint is found to be in time well maintainable within the jurisdiction of this Commission.   
25. Based on the above discussion & settled principle of law, we are of the considered view that, the complainant is entitled for insurance benefit under the subject insurance policy and repudiation of the claim is found arbitrary & not justified which certainly caused financial loss & mental agony to complainant as such the OP1/ Insurance Company is found deficient in service & unfair trade practice. Accordingly, the op 1/ Insurance Company is liable to compensate the injuries of the complainant by releasing the insurance benefit of Rs 5,00,000/-(five lacs ) under the subject insurance policy with interest @ 6% P.A from the date of filling of this complaint i.e from 09.01.2020 till its actual payment to the complainant and to pay not less than Rs. 10,000/- as cost of this litigation. No further compensation need to be awarded towards mental agony as interest over insurance benefit payable to the complainant is awarded. We found nothing deficient service or unfair trade practiced on the part of the Op 2/Bank .Hence it is ordered.

                                                                                           ORDER

    This consumer complaint is allowed in part against the Op 1/ The Oriental    Insurance Co.Ltd and dismissed against the Op 2/ Corporation Bank (Now Union Bank of India) , Bhawanipatna Branch on contest with the following direction:-

1. The Op 1/ The Oriental Insurance Co.Ltd, is here by directed to release the insurance benefit Rs 5,00,000/-(Five Lacks) with interest @ 6% P.A from the date of filling of this complaint i.e from 09.01.2020 till its actual payment to the complainant
2. The Op 1 / The Oriental Insurance Co.Ltd is further directed to pay    Rs 10,000/-(ten thousand) only towards litigation expenses to the complainants.
3. As we have already awarded interest over the awarded sum insured amount, there shall be no award of further compensation towards mental agony as claimed.
4. It is further directed that, this order be complied within 45 (forty-five) days from the date of received of this order & to submit the report of compliance before this Commission failing which OP 1(one)/ the Oriental Insurance Company shall   liable to pay Rs.500/- per day as delayed compensation to the complainant till compliance of this order and further the Divisional Manager of the Op 1(one) shall be personally liable to be prosecuted under Section 72 of C.P.Act 2019.

  Dictated and corrected by me.

      Sd/-  

President

                     I   agree.     

     Sd/-                               

Member                      

   Pronounced, in the open Commission today on  this 20^th December 2023 under the seal and signature of this Commission. The pending application if any is also stands disposed off accordingly. Judgment could not be pronounced on time due to COVID -19 situations & in want of quorum. The judgment be uploaded forthwith in the website of the Commission and free copy of this order be supplied to the respective parties or they may download the same from the Confonet to treat the same as copy of the order received from this Commission .Ordered accordingly.