ORDERS:

Charanjit Singh, President;

1        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 34, 35, 36 and 38 of the Consumer Protection Act (herein after called   as 'the Act') against the opposite parties by alleging that the deceased Nirvail Singh son of Daleep Singh, who was having life insurance policies bearing No. 118810035 dated 28.1.2019 for total sum of Rs. 10 Lakh through its agent Jagtar Singh having agency code No. 20856137 from the opposite party No. 2 and policy No. 118780397 dated 26.12.2018 for total sum of Rs. 2 Lakh through its agent having code No. 12071146  from the opposite party No. 3. The said policy bearing No. 118810035 dated 28.1.2019 was accepted and issued by Parminder Singh Dean Manager No. 137. During his life time, the deceased Nirvail Singh had paid premiums of his life insurance policies till his death. The deceased Nirvail Singh has died on 7.3.2019. The complainant is wife of deceased Nirvail Singh. The deceased Nirvail Singh appointed his wife Baljinder Kaur as nominee in the above said life insurance policies. The said Nirvail Singh leaves behind his wife Baljinder Kaur, son Gurdeep Singh and daughter Prabhjot Kaur. Thereafter, the complainant being the wife and nominee of deceased Nirvail Singh intimated to the opposite parties No. 2 and 3 about the death of his husband who was having life insurance policies holder of the opposite parties and requested to the opposite parties to disburse the claim amount of insurance policy of the deceased. After that the opposite parties No. 2 and 3 instructed the complainant to submit the requisite documents for getting death claim of her husband and as per the instructions of the opposite parties No. 2 and 3 the complainant submitted all the documents as demanded by the opposite parties No. 2 and 3. Despite the submission of all the documents by the complainant, till today the opposite parties have not disbursed the death claim of the deceased. Thereafter, the complainant served a legal notice dated 23.11.2021 to the opposite parties and again requested to disburse the death claim of her deceased husband, but the opposite parties did not respond to the legal notice of the complainant. The date of death of husband of the complainant is 7.3.2019, since then the complainant is requesting to the opposite parties by visiting the concerned branches of the opposite parties but the complainant is being harassed unnecessarily by the opposite parties. The complainant and her children Gurdeep Singh son of Prabhjot Kaur daughter was fully dependent upon Nirvail Singh and because of his death, the complainant and her family is facing starvation. Due to malevolent act of the opposite parties, complainant is suffering physical agony as well as mental pain from the hands of the opposite parties. The complainant has prayed the following relieves:-

1. The opposite parties may kindly be directed to release/ disburse insurance claim of both the policies of the deceased i.e. Rs. 10,00,000/- and Rs. 2,00,000/- in favour of complainant alongwith interest up to date.
2. The opposite parties may kindly be directed to pay Rs.1,00,000/- as compensation as well as Rs. 22,000/- as litigation expenses for causing harassment to the complainant by demanding illegal amount, in the interest of justice, equity and fair play.

Alongwith the complaint, the complainant has placed on record his affidavit Ex. C-1, self attested copy of Policy No. 118810035 Ex. C-2, Self attested copy of premium receipt of policy No. 118780397 Ex. C-3, Self attested copy of death certificate of deceased Nirvail Singh Ex. C-4, Self attested copies of legal notices Ex. C-5, C-6, Self attested copies of Postal receipts of legal notices Ex. C-7 to Ex. C-11, Self attested copy of I.D. Card of deceased Nirvail Singh Ex. C-12, Self attested copy of Adhar Card of complainant Exs. C-13, Self attested copy of Adhar Card of complainant’s son Ex. C-14, Self attested copy of Adhar Card of complainant’s daughter Ex. C-15, Self attested copy of complainant’s Pan Card Ex. C-16, Self attested copy of First page of Bank account of complainant Ex. C-17 and tendered in additional evidence copy of Postmortem report of Nirvail Singh Ex. C-18, Copy of histopathology report dated 28.9.2019 Ex. C-19.

2        Notice of this complaint was sent to the opposite parties and the opposite parties appeared through counsel and filed written version by interalia pleadings that the present complaint is not maintainable. The complainant has not come to this commission with clean hands, as such, she is not entitled to the relieves claimed in the present complaint. The claim of the complainant with respect to policy No. 118810035 of the deceased Nirvail Singh was repudiated by the opposite party vide repudiation letter dated 6.4.2021 on the basis of medical certificate issued by the K.D. Hospital, Amritsar , where the said Nirvail Singh remained hospitalized and on the basis of leave record received from the employer of the said Nirvail Singh deceased. While proposing for the policy No. 118810035, he had not disclosed that he had suffered from Cervical injury. These facts were not disclosed by the deceased Nirvail Singh with the sole intention of defrauding the Corporation i.e. opposite party as the information regarding his critical ailment was in his exclusive knowledge which he concealed intentionally at the time of proposal. The complainant has not filed any death claim under policy No. 118780397 and therefore, the complaint is pre-mature on this count. The death claim under policy No. 118780397 can only be considered once the same is duly lodged and all the requisite documents are submitted to the corporation. The complainant has no cause of action.  The deceased Nirvail Singh purchased two life insurance policies, one bearing No. 118810035 for a sum assured of Rs. 10 Lakh with date of commencement of risk under the policy as 4.3.2019 from branch office Tarn Taran and another policy bearing No. 118780397 for a sum assured of Rs. 2 Lakhs with date of commencement of Risk as 26.12.2018 from Branch office Amritsar II. Only one yearly premium was received under policy No. 118810035 on 4.3.2019 and said Nirvail Singh died after three days on 7.3.2019, leading to very early claim under the policy. Under other policy No. 118780397 only one quarter premium has been received on 26.12.2018. The complainant Baljinder Kaur filed death claim under policy No. 118810035 at our branch office Tarn Taran whereas death claim under policy No. 118780397 was not filed by the claimant. The complainant only submitted the death claim papers in our branch office Tarn Taran for policy No. 118810035 and she has not filed any death claim under policy No. 118780397. The claimant has been well informed about repudiation of death claim vide repudiation letter dated 6.4.2021 which was sent to the claimant by registered post on 8.4.2021 on the address provided by her but the same was returned by the postal authorities as ‘undelivered’ . After finding her latest address from some other sources, the letter was again sent to her on 2.2.2022 through registered post.  As per certificate of K.D. Hospital, Amritsar, the deceased Nirvail Singh remained admitted in said hospital under Regd. No. N/18/229 from 10.6.2018 to 30.6.2018 and was diagnosed as a case of Cervical Injury. He was also advised bed rest for further 16 days w.e.f. 1.7.2018 to 16.7.2018 and also as per Form No. 3787, the leave record received from the employer, the deceased Nirvail Singh remained on Medical leave from 10.6.2018 to 16.7.2018. Hence the every important medical history and medical leave availed by Sh. Nirvail Singh was not disclosed at the time of taking insurance policies. While getting insured with the opposite party, the said Nirvail Singh had not disclosed that he was suffering from pre-existing critical injuries . These facts were not disclosed by the deceased Nirvail Singh at the time of proposal. The proposal form dated 4.3.2019 relating to the above said policy No. 118810035 in which the said Nirvail Singh life assured has answered the following questions as noted herein below:-

          The said answers given by the said Nirvail Singh in the proposal form were false as can be clearly seen from the certificate of K.D. Hospital, Amritsar where he remained admitted from 10.6.2018 to 30.6.2018 and can also see from the leave record received from the employer which revealed that he remained on Medical Leave from 10.6.2018 to 16.7.2018. This suppression of extremely material facts related to the proposer Nirvail Singh which had a great bearing on the consideration and acceptance of risk on his life, was clearly done by the said Nirvial Singh with sole intent  to defraud the opposite parties i.e. corporation, as the information regarding his critical illness was in his exclusive knowledge which he concealed intentionally at the time of proposal. Based upon the proposal, the risk understood by the underwriter of the corporation was altogether different from the risk actually involved in the acceptance of proposal. The underwriter was grossly mislead by suppression of extremely material facts regarding health of the proposer Nirvail Singh. Had the correct facts been disclosed in the proposal form, the proposal would not have been accepted and the insurance would not have been granted by the Corporation. The complainant Baljinder Kaur herself submitted a letter to the concerned office authorities of her husband intimating therein that her husband Nirvail Singh had remained admitted at K.D. Hospital, Amritsar from 10.6.2018 to 30.6.2018 due to accident and requested for allowing the leave to her husband from 1.7.2018, the competent authority of Sh. Nirvail Singh accorded sanction for granting the Medical leave from 1.7.2018. Hence, the above said claim under policy No. 118810035 was repudiated by the opposite party vide letter dated 6.4.2021 on the basis of suppressed medical history and medical leave taken by the deceased Nirvail Singh. The opposite parties have denied the other contents of the complaint and prayed for dismissal of the same. Alongwith the written version, the opposite parties have placed on record affidavit of Sh. Anand Gupta Manager (L & HPF), Divisional Office, LIC of India, Amritsar Ex. OP 1 to 3/1, Self attested photocopy of Proposal form dated 4.3.2019  related to P.No. 118810035 Ex. OP 1 to 3/2, Self attested Photocopy of police bond bearing policy No. 118810035 Ex. OP 1 to 3/3, Self attested photocopy of status report of policy bearing No. 118810035 Ex. OP 1 to 3/4,  Self attested photocopy of claimant’s statement submitted by the complainant regarding policy bearing No. 118810035 Ex. OP 1 to 3/5, Self attested photocopy of certificate of K.D. Hospital, Amritsar Ex. OP 1 to 3/6,  Self attested copy of Form No. 3787 i.e. the leave record received from the employer of Sh. Nirvail Singh Ex. OP 1 to 3/7,  Self attested photocopy of letter sent by complainant Baljinder Kaur to the concerned office authorities requesting for allowing the leave to her husband Nirvail Singh and further acceptance of Medical leave by the employer of Sh. Nirvail Singh Ex. OP 1 to 3/8,  Self attested Photocopy of repudiation letter dated 6.4.2021 Ex. OP 1 to 3/9, Self attested Photocopy of Postal cover/ envelope of undelivered letter dated 6.4.2021 with remarks of the Postal authorities Ex. OP 1 to 3/10, Self attested photocopy of letter dated 1.2.2022 sent through Regd. Post on 2.2.2022 Ex. OP 1 to 3/11.

3        We have heard the Ld. counsel for the complainant and opposite parties and have carefully gone through the record.

4        Ld. Counsel for the complainant contended that the deceased Nirvail Singh son of Daleep Singh, who was having life insurance policies bearing No. 118810035 dated 28.1.2019 for total sum of Rs. 10 Lakh through its agent Jagtar Singh having agency code No. 20856137 from the opposite party No. 2 and policy No. 118780397 dated 26.12.2018 for total sum of Rs. 2 Lakh through its agent having code No. 12071146  from the opposite party No. 3. The said policy bearing No. 118810035 dated 28.1.2019 was accepted and issued by Parminder Singh Dean Manager No. 137. He further contended that during his life time, the deceased Nirvail Singh had paid premiums of his life insurance policies till his death. The deceased Nirvail Singh has died on 7.3.2019. The complainant is wife of deceased Nirvail Singh. The deceased Nirvail Singh appointed his wife Baljinder Kaur as nominee in the above said life insurance policies. The said Nirvail Singh leaves behind his wife Baljinder Kaur, son Gurdeep Singh and daughter Prabhjot Kaur. Thereafter, the complainant being the wife and nominee of deceased Nirvail Singh intimated to the opposite parties No. 2 and 3 about the death of his husband who was having life insurance policies holder of the opposite parties and requested to the opposite parties to disburse the claim amount of insurance policy of the deceased. After that the opposite parties No. 2 and 3 instructed the complainant to submit the requisite documents for getting death claim of her husband and as per the instructions of the opposite parties No. 2 and 3 the complainant submitted all the documents as demanded by the opposite parties No. 2 and 3. He further contended that despite the submission of all the documents by the complainant, till today the opposite parties have not disbursed the death claim of the deceased. Thereafter, the complainant served a legal notice dated 23.11.2021 to the opposite parties and again requested to disburse the death claim of her deceased husband, but the opposite parties did not respond to the legal notice of the complainant and prayed that the present complaint may be allowed.

5        Ld. Counsel for the opposite party contended that the claim of the complainant with respect to policy No. 118810035 of the deceased Nirvail Singh was repudiated by the opposite party vide repudiation letter dated 6.4.2021 on the basis of medical certificate issued by the K.D. Hospital, Amritsar, where the said Nirvail Singh remained hospitalized and on the basis of leave record received from the employer of the said Nirvail Singh deceased. While proposing for the policy No. 118810035, he had not disclosed that he had suffered from Cervical injury. These facts were not disclosed by the deceased Nirvail Singh with the sole intention of defrauding the Corporation i.e. opposite party as the information regarding his critical ailment was in his exclusive knowledge which he concealed intentionally at the time of proposal. He further contended that the complainant has not filed any death claim under policy No. 118780397 and therefore, the complaint is pre-mature on this count. The death claim under policy No. 118780397 can only be considered once the same is duly lodged and all the requisite documents are submitted to the corporation. The complainant has no cause of action.  He further contended that the deceased Nirvail Singh purchased two life insurance policies, one bearing No. 118810035 for a sum assured of Rs. 10 Lakh with date of commencement of risk under the policy as 4.3.2019 from branch office Tarn Taran and another policy bearing No. 118780397 for a sum assured of Rs. 2 Lakhs with date of commencement of Risk as 26.12.2018 from Branch office Amritsar II. Only one yearly premium was received under policy No. 118810035 on 4.3.2019 and said Nirvail Singh died after three days on 7.3.2019, leading to very early claim under the policy. Under other policy No. 118780397 only one quarter premium has been received on 26.12.2018. The complainant Baljinder Kaur filed death claim under policy No. 118810035 at our branch office Tarn Taran whereas death claim under policy No. 118780397 was not filed by the claimant. The complainant only submitted the death claim papers in our branch office Tarn Taran for policy No. 118810035 and she has not filed any death claim under policy No. 118780397. The claimant has been well informed about repudiation of death claim vide repudiation letter dated 6.4.2021 which was sent to the claimant by registered post on 8.4.2021 on the address provided by her but the same was returned by the postal authorities as ‘undelivered’ . After finding her latest address from some other sources, the letter was again sent to her on 2.2.2022 through registered post.  As per certificate of K.D. Hospital, Amritsar, the deceased Nirvail Singh remained admitted in said hospital under Regd. No. N/18/229 from 10.6.2018 to 30.6.2018 and was diagnosed as a case of Cervical Injury. He was also advised bed rest for further 16 days w.e.f. 1.7.2018 to 16.7.2018 and also as per Form No. 3787, the leave record received from the employer, the deceased Nirvail Singh remained on Medical leave from 10.6.2018 to 16.7.2018. Hence the every important medical history and medical leave availed by Sh. Nirvail Singh was not disclosed at the time of taking insurance policies. While getting insured with the opposite party, the said Nirvail Singh had not disclosed that he was suffering from pre-existing critical injuries . These facts were not disclosed by the deceased Nirvail Singh at the time of proposal. He further contended that the proposal form dated 4.3.2019 relating to the above said policy No. 118810035 in which the said Nirvail Singh life assured has answered the following questions as noted herein below:-

          The said answers given by the said Nirvail Singh in the proposal form were false as can be clearly seen from the certificate of K.D. Hospital, Amritsar where he remained admitted from 10.6.2018 to 30.6.2018 and can also see from the leave record received from the employer which revealed that he remained on Medical Leave from 10.6.2018 to 16.7.2018. This suppression of extremely material facts related to the proposer Nirvail Singh which had a great bearing on the consideration and acceptance of risk on his life, was clearly done by the said Nirvial Singh with sole intent to defraud the opposite parties i.e. corporation, as the information regarding his critical illness was in his exclusive knowledge which he concealed intentionally at the time of proposal. He further contended that based upon the proposal, the risk understood by the underwriter of the corporation was altogether different from the risk actually involved in the acceptance of proposal. The underwriter was grossly mislead by suppression of extremely material facts regarding health of the proposer Nirvail Singh. Had the correct facts been disclosed in the proposal form, the proposal would not have been accepted and the insurance would not have been granted by the Corporation. The complainant Baljinder Kaur herself submitted a letter to the concerned office authorities of her husband intimating therein that her husband Nirvail Singh had remained admitted at K.D. Hospital, Amritsar from 10.6.2018 to 30.6.2018 due to accident and requested for allowing the leave to her husband from 1.7.2018, the competent authority of Sh. Nirvail Singh accorded sanction for granting the Medical leave from 1.7.2018. Hence, the above said claim under policy No. 118810035 was repudiated by the opposite party vide letter dated 6.4.2021 on the basis of suppressed medical history and medical leave taken by the deceased Nirvail Singh and prayed that the present complaint may be dismissed.

6        We have gone through the rival contentions of the parties.

7        In the present case, the complainant has claimed regarding the two polices i.e. policy No. 118810035 and other policy Number is 118780397.

8        Firstly regarding policy No. 118780397, insurance policy is not disputed and according to complainant, he has submitted the claim to the opposite parties but the opposite parties have not given the insurance claim to the complainant but on the other hands in Para No. 4 of the written version it has been alleged by the opposite parties that the complainant has not filed any death claim under policy No. 118780397 and therefore the complaint is pre mature on this count. The death claim under Policy No. 118780397 can only be considered once the claim is duly lodged and all the requisite documents are submitted to the corporation.

9        Perusal of the file shows that with regard to Policy No. 118780397, neither the complainant nor the opposite parties have placed on record any document i.e. repudiation letter which reveals that the claim of the complainant has been decided. Infact with regard to Policy No. 118780397the claim has not been decided so far and the same is still pending.  Moreover, the opposite parties have specifically pleaded in Para No. 4 of preliminary objection of written version that ‘the complaint of the complainant is premature’. In case Balu Waman Kadam vs. ICICI Lombard General Insurance Co. IV (2013) CPJ 16A (CN) (Mah.), the matter was similar, wherein the Insurance Company was asking the complainant to submit the documents again and again and the complainant was alleging that he had already submitted the requisite documents to the Insurance Company. In such circumstances, the Hon’ble State Consumer Disputes Redressal Commission Maharashtra disposed of the matter, by directing the Insurance Company to reconsider the claim of the complainant within one month on receipt of the required documents from the complainant. 

10      While relying upon the above said authority, the Hon’ble State Commission, Punjab, Chandigarh passed the similar orders in case M/s Trends, through its Proprietor vs The Oriental Insurance Company Limited & Anr. Consumer Complaint No.245 of 2015 decided on 04.08.2017; and M/s Gurbir Rice Mills v. United India Insurance Company Ltd. & Ors. Consumer Complaint No.404 of 2016, decided on 09.10.2017, directing the Insurance Company to reconsider the claim of the complainant after submission of requisite documents by the complainant to it. 

11      In view of our above discussion as well as keeping in view the ratio of above said judgments, with regard to Policy No. 118780397we are of the opinion that the ends of justice would be met, if the Insurance Company be directed to decide the claim of the complainant, after the complainant submit all the requisite documents.  However, the opposite parties have not mentioned in the written version that which documents are to be submitted by the complainant to the opposite parties.

12      In view of the above discussion with regard to Policy No. 118780397, the present complaint is disposed of with the following directions

(a)               The opposite parties will submit the list of requisite documents to the complainant within 15 days from the date of receipt of copy of this order.

(b)               The complainant will submit the claim with requisite documents to the opposite parties -Insurance Company for deciding the claim within a period of further one month and on approaching the complainant for supplying the requisite documents, the opposite parties will issue proper receipt acknowledging the same.

(c)               The opposite parties shall decide the claim of the complainant within a further period of two months therefrom

In case of failure on the part of the opposite parties the claim case of the complainant deemed to have been accepted.   

13      The bare perusal of repudiation letter dated 6.4.2021 reveals that the opposite parties have repudiated the claim of the complainant qua the policy No. 11788844 and 1181035 of Nirvail Singh on the ground that the deceased suppressed the material facts which have had a bearing on the getting of risk, was clearly done with intent to deceive the corporation. Hence, it has been decided to repudiate all the liability under afore stated policy on fraudulent basis and all the money received by the Corporation under this policy forfeited in terms of policy terms and conditions on the basis of medical certificate issued by the K.D. Hospital, Amritsar, where the said Nirvail Singh remained hospitalized and on the basis of leave record received from the employer of the said Nirvail Singh deceased. While proposing for the policy No. 118810035, he had not disclosed that he had suffered from Cervical injury. These facts were not disclosed by the deceased Nirvail Singh with the sole intention of defrauding the Corporation i.e. opposite party as the information regarding his critical ailment was in his exclusive knowledge which he concealed intentionally at the time of proposal. To prove their case, the opposite parties have placed on record certificate of K.D. Hospital Ex. OP 1 to 3/6 but to prove the genuineness of said certificate, the opposite parties have not placed on record affidavit of the concerned doctor/authority who issued the said certificate. In this regard, a reference can be made to the judgment of the Hon'ble National Commission in Revision Petition No. 200 of 2007 "Mr. Satinder Singh versus National Insurance Co. Ltd." decided on 24.1.2011 wherein it has been observed that "recording of history of patient in the above stated manner does not become a substantiate piece of evidence and convincing evidence be brought on record that complainant was aware of preexisting disease." Further, it has been observed by the Hon'ble National Commission in the III 2014 CPJ 340 (NC) "New India Assurance Company Limited through its duly Constituted Attorney, Manager versus Rakesh Kumar" that people can live months/years without knowing the disease and it is diagnosed accidentally after routine checkup and on that ground repudiation is not justified. Further it has been observed by the Hon'ble National Commission in its judgment IV (2008) CPJ 89 (NC) "Life Insurance Corporation of India & Ors. Versus Kunari Devi" that history recorded in the hospital bed head ticket is not to be taken as evidence as Doctor recording history not examined and suppression of disease not proved. In the present case, except the medical record of the present ailment, Ops have not placed on the record any independent evidence that the insured had the knowledge or that he had been taking the treatment of the disease, in question, before purchasing this policy and in the absence of any specific evidence on the record how the disease, if any, to First Appeal No 220 of 2020 which the insured does not have the knowledge can be termed as pre-existing disease.  Even the medical records of hospital pertain to treatment of deceased on which the doctor of K.D. hospital has issued the certificate is not placed on record. Therefore, we are of the opinion that repudiation of the claim is not justified. Similarly the opposite parties have placed on record documents Ex. OPs 1 to 3/7 and Ex. OPs 1 to3/8 but the opposite parties have not placed on record affidavit of any employee to prove the genuineness of said documents. 

14      The opposite parties have rejected the claim of the complainant qua polices No. 118808404 and 118810035 on the ground that the complainant has given wrong answers qua his health but we are not agree with the same because the Nirvail Singh was about 50 years at the time of getting the policy and it was the duty of the opposite parties to medically examine the insured before issuance of insurance policy in question.  In support of his contention Ld. counsel for the complainant placed reliance upon I.R.D.A.I Rules and Instructions with regard to thorough medical examination if the insured is more than 45 years which is reproduced as under:-

“As per instructions issued by the Insurance Regulatory and Development Authority of India (IRDAI), it was bounded duty of the insurer to put insured to thorough medical examination in case Mediclaim insured was more than 45 years and if insurance company failed to do so then insurance company has no right to decline the insurance claim on account of non disclosure of the facts of pre existing disease when the policy was taken. The above observations is supported by law cited in SBI General Insurance Company Limited Vs. Balwinder Singh Jolly” 2016(4) CLT 372 of the Hon’ble State Commission, Chandigarh.”

15      Further Ld. Counsel for the complainant contended that the no terms and conditions have ever been supplied to the life assured and same are not supplied or explained to him at the time of inception of insurance policy. He placed reliance on citation 2001(1)CPR 93 (Supreme Court) 242 titled as M/s Modern Insulators Ltd Vs The Oriental Insurance Company Ltd, wherein Hon’ble Apex Court held that clauses which are not explained to complainant are not binding upon the insured and are required to be ignored. Furthermore, It is usual with the insurance company to show all types of green pastures to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of DharmendraGoel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.UshaYadav& Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.        The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

16      From above discussion it proves that the opposite parties have wrongly withheld the claim of the complainant and have wrongly repudiated the claim vide repudiation letter dated 6.4.2021 and it amount to deficiency in service and unfair trade practice on the part of the opposite parties.

17      In view of above discussion, we allow the present complaint and opposite parties are directed to pay the insurance claim qua insurance policy No. 1188100035 to the complainant. The complainant has been harassed by the opposite parties, the complainant is also entitled to Rs. 25,000/- as compensation on account of harassment and Rs. 11,000/- as litigation expenses. Opposite Parties are directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant shall be entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realisation.  Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.

Announced in Open Commission

18.12.2024