Sri Sudhakar Senapothi  - Member.

Complainant Anusaya Barik has filed this case u/s 35 of CP Act-2019 alleging deficiency of service on the part of the Opposite Parties for non-payment of the insurance claim to her praying therein for direction to the Opposite Parties to pay a sum of Rs. 10,00000/- under insurance policy No. 98183740 with interest @ 18% per annum from 07.10.2021 till its realization and a sum of Rs. 2,00,000/- towards deficiency and harassment and a sum of Rs. 1,00000/- towards cost of litigation. 

1.           Brief fact leading to the case is that the complainant is the nominee and adopted niece of the deceased Arakhita Barik who had a Life Insurance Policy in ICICI Prudential Life Insurance Company Ltd. bearing Policy No. 98183740. The policy was effective from 20.04.2021 and the annual premium was Rs. 1,00000/- and the sum assured was Rs. 10,00000/-. During the course of the policy, Arakhita Barik died in accident and the complainant being the nominee of the policy claimed the amount. But the Opposite Parties repudiated the claim of the complainant on the ground of suppression of the material facts by the insured at the time of obtaining of policy. It is submitted that the insured has never produced any forged documents and never made any false statement to defraud the company and no questions have been asked to the insured and therefore the repudiation of the claim is illegal and arbitrary for which she approached this Commission for the reliefs as discussed in the preceding paragraph.

2.           After receipt of the notice, the OPs appeared through their Advocates and filed their joint written statements. In their written statements, the OPs stated that deceased late Arakhita Barik was covered under the insurance policy for a term of 17 years with an annual premium of Rs. 1,20,250/- for a premium payment of Rs. 1,20,250/- with premium payment mode 12 years and the sum assured of Rs. 9,51,656/-. In the proposal form, the complainant had declared that he had read and understood the terms and conditions of the insurance plan/policy obtained. After being convinced and satisfied with terms and conditions explained in the relevant literature and illustration, the complainant had filed and duly signed the proposal for issuance of the said policy. The Opposite Parties after taking due consideration of the afore said proposal of the deceased had accepted the same and issued the insurance policy. It was mentioned in death claim form that late Arakhita Barik had died on 06.12.2021 due to cardiac arrest. After receipt of the proposal form, one investigator was appointed and it was reported by the investigator that the deceased was 43 years old, male, unemployed and the local residents could not state anything regarding the whereabouts of his wife and the nominee Anusuya Barik is in no way bloodly related with the deceased. The insured in his proposal form has specifically mentioned that he was a salaried employee in District Welfare Department, Nuapada working as Junior Clerk with annual income of Rs. 5,80, 000/-, 3 months’ salary slips as income proof and bank statement showing salary for the period from 01.04.2020 to 19.03.2021. It was revealed after investigation that all these information are false and his previous proposal has been declined by several insurance companies. As the insured had furnished false information for obtaining the policy, the claim was repudiated and there is no question of deficiency in service on their part and pray for dismissal of the case with costs.

3.           The complainant in support of this case has filed the copy of the insurance policy bearing No. 98183740, copy of the death certificate of Arakhita Barik, copy of the Adhar Card of Anusuya Barik, letter of ICICI Prudential Life Insurance dt. 14.12.2021 and the repudiation letter issued by the Insurance Company. On the other hand, the Opposite Parties has filed the copy of the proposal form and customer declaration form, copy of the policy terms and conditions sent to life assured, copy of the death claim form dt. 13.12.2021, copy of the E-Mail sent to DWO, Nuapada, copy of the pay slip and bank account statement submitted by the LA at proposal stage, copy of the E-Mail of DWO, Nuapada and intimation given to the complainant by the Insurance Company declaring the policy null and void.

4.           From the pleadings and counter pleadings of the parties, it is to be ascertained whether the life assured had given false and misleading information to the Insurance company at the time of submission of the proposal form? The Insurance company has filed the copy of the pay slip, copy of the bank statement which was submitted along with the proposal form regarding his job and income. These documents are claimed to be forged ones. The Opposite Parties have filed the copy of the proposal, form before this Commission. We have gone through the proposal form thoroughly.  On scrutiny, it is found that the proposal has been made electronically. But, the proposal form does not contain the signature of the deceased Arakshita in electronic mode. So, it is very much clear from the proposal form that it has not been signed by the proposer and the fact mentioned therein were not there in his knowledge.

5.           Besides, the most important thing is that the proposal has been obtained by one Madhusudan Sahu who happens to be Insurance agent of the Opposite Parties who is a local person. Khariar is a small town  and the people residing in this town are known to each other and the agent must have known the life assured, his profession, income and conduct. When the agent who happens to a local, while filling of the form  electronically must have gone through the proposal form and intimate it to the company regarding his income and profession. Since the agent has not raised any objection to the entries made in the proposal form, it is crystal clear that the proposal form has been created for the purpose of repudiating the claim. The evidence filed by the complainant goes to show that late Arakhita was an illiterate person and he does not know reading and writing of English nor any signature has been obtained in the proposal form and their agent collected the premium from the deceased Arakhita. Since the deceased was unaware of English Language, his signature has been obtained by the local agent and he has been given wrong information.

6.           In view of the discussions made in the preceding paragraphs, it is very much clear that the signature of the deceased was not obtained in the proposal form nor there is any evidence to substantiate that the signatures made in the  documents of the LA as the evidence led by the complainant remains unchallenged and uncontroverted. Therefore, the repudiation of the claim made by the Opposite Parties is not sustainable in the eyes of law and they are squarely liable for causing deficiencies in service to the complainant.

7.           As a case of deficiencies in service is made out against the Opposite Parties, they are liable to compensate the petitioner and are liable to compensate her for the loss and harassment sustained by her and hence the order.

O R D E R

The complaint petition is allowed on contest against the Opposite Parties. The Opposite Parties are directed to pay a sum of Rs. 10,00000/- (Rupees Ten Lakh) only with interest @ 12% per annum from the date of repudiation. The Opposite Parties are directed to pay a sum of Rs. 1,00000/- (Rupees One Lakh) only towards compensation for causing deficiency in service and harassment and a sum of Rs. 25, 000/- (Twenty-Five Thousand) only towards cost of litigation. The order is to be complied with within a period of 30 days from the date of order failing which the order as to cost and compensation shall carry interest @ 12% per annum from the date of order till its compliance.