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Judgment
Vide the present Revision Petition, the Petitioner Insurance Company, hereinafter referred to as "Insurance Company" has challenged the order of the State Commission dated 31.07.2019 in Appeal No. 450 of 2019 whereby the Appeal of the Insurance Company was dismissed. This Appeal was filed by the Insurance Company against the order of the District Forum dated 22.05.2019 in Complaint No. 15 of 2018.
The brief facts of the case are that husband of the Complainant/Respondent Sh. Dilip Kumar Soni was holder of an insurance policy bearing No. 50414029 under Cash Flow Plan and had paid a premium of Rs. 1,00,000/-. The said policy was issued to him on 28.09.2012. He had been regularly paying the annual premiums. On 03.06.2014 the insured jumped into Indrawati river in Chitrakoot and died. Thereafter the claim was filed before Permanent Ombudsmen Court, Jagdalpur, District Bastar Chhattisgarh by his LRs wherein the Insurance Company had also appeared and showed its willingness to pay the insurance amount and started the procedure and obtained all the information and got the relevant forms filled and also collected the documents and issued a receipt dated 10.01.2017. Despite having received all the documents from the Complainant, the Insurance Company again issued a letter dated 25.02.2017 demanding documents. The fact that the Insurance Company had already collected all the documents was conveyed to them. The Insurance Company did not pay the insurance amount to the Complainant and stopped further communication. The Insurance Company did not attend the proceedings before the District Forum despite being served of the Complaint and the District Forum on the basis of documents and evidences on record allowed the Complaint and issued the following directions:-
(1) The defender has to pay to the plaintiff insurance amount of Rupees 13,48,380/- (Rupees thirteen Lakh Forty Eight Thousand Three Hundred Eighty only) within one month of time period.
(2) The defender also has to pay to the plaintiff 9 percent of interest amount on the above mentioned amount calculating from application submission dated 15/05/2018 till the date of payment.
(3) The defender also has to pay to the plaintiff Rupees 20,000/- (Rupees Twenty Thousand only) as the compensation for financial and mental sufferings.
(4) The defender also has to pay to the plaintiff Rupees 2,500/- (Rupees Two Thousand Five Hundred only) for the cost of the application."
This order was impugned before the State Commission and the State Commission has dismissed the Appeal and the plea of the Insurance Company that they were not served of the Complaint was rejected by the State Commission.
In the present Revision Petition the same contentions have been raised by the Insurance Company. It is argued that the Insurance Company was not served of the Complaint and that since the death had occurred due to suicide, the Complainant was not entitled to any relief in view of exclusion clause. All the documents and contentions have been dealt with in detail by the Foras below. Regarding the service of the Complaint upon the Insurance Company the State Commission has noted the following facts:-
"As per order sheet dated 06.09.2018, despite service of the notice, there was no representation on behalf of the appellant/O.P, goes to show that the appellant/Opposite Party himself had chosen not to appear and take part in the proceedings of the concerned District Forum. With this, no option left to the concerned District Forum except to decide the matter on the basis of the complaint, affidavit and documents filed by the respondent/complainant before the concerned District Forum."
Although there was no defence before the District Forum that the insured had committed suicide, as the case of the Complainant was that the insured had died an accidental death yet on the basis of the documents and evidences on record the District Forum considered the issue as to whether the insured had committed suicide or died accidental death. It reached to the conclusion that the insured had committed suicide. Thereafter the District Forum proceeded to determine whether in view of the cat, that insured had committed suicide, the complainant was entitled to the relief and has held as under:-
"8. In the view of the above argument, presented statement, affidavit and documents have been observed. As per the document presented by the plaintiff with Exhibit C-13, the plaintiff's husband Mr. Dilip Kumar Soni jumped into Chitrakoot Flood on date 03/06/2014 and committed suicide. Now it should be observed that, has the suicide been committed within 12 months (one year) from dated 28/09/2012 which is the policy issuance date to the husband of the plaintiff as per the terms of the policy? As per the Exhibit C-1 of the document, the policy on the name of the husband of the plaintiff has been issued on dated 28.09.20212 and the incident took place on dated 03.06/2014. Thus, the plaintiff's husband has committed suicide after one year i.e. 01 year 08 months 06 days from the date of policy issue. In such circumstances, the Policy Condition No. 9 "Suicide: The Company will not pay any claim on death if the life Assured, whether sane or insane, commits suicide within 12 months from the date of issue of this Policy or the date of any reinstatement of this policy" has not been breached. As per Exhibit C-17 of the document, it is certified that, the plaintiff's husband Dilip Kumar Soni died on dated 03/06/2014. The defender has remained one-sided during the hearing of the case. Therefore, the statement and evidences of the plaintiff are not denied.
(9) Now it should be checked that, was the insurance policy effective on death of the plaintiff's husband Dilip Kumar Soni on dated 03/06/2014? As per the Exhibit C-1 of the insurance policy, the policy period was from 28/09/2012 to 28/09/2030, but the insurance policy holder had to pay annual insurance premium amount of Rupees 99,999.57/- each year. The deceased Dilip Kumar Soni has paid his first premium during his life-time on dated 28/09/2012, and the second premium payment dated was 28/09/2013, but the premium was not paid on the above mentioned date but instead it was paid on dated 25/02/2014, and its receipt has been presented with Exhibit C-23. As per Exhibit C-23 of the document, under premium detail, A previous renewal date: 28/09/2013 is mentioned and next renewal date: 28/09/2013 is marked, whereas 28/09/2014 should be there in place of next renewal dated 28/09/2013, which is typo error of the plaintiff. Thus, the insurance policy was effective on death dated 03/06/2014 of the plaintiff's husband Dilip Kumar Soni and the plaintiff is entitled to receive the insurance amount of Rupees 13,48,380/-, which is not paid by the defender. It is obvious that the plaintiff suffer extreme mental pain due to the above mentioned act of the defender.
(9) After the above consideration, this forum comes to the conclusion that, the plaintiff has been fully successful to proved her application that the defender has committed error in service providing and extreme carelessness by not paying the insurance amount to the plaintiff. As a result, this application presented by the plaintiff is accepted." (Emphasis supplied).
The order of the District Forum was confirmed by the State Commission in appeal. The Ld. Counsel for the Petitioner has failed to point out that there is a jurisdictional error in the impugned order or that the orders are perverse. It is apparent that the orders are based on the evidences led before the Foras below and the Foras below have considered each and every document on record. I find no illegality or infirmity in the impugned order. The present Revision Petition has no merit.
Looking into the conduct of the Insurance Company I feel great pain. First of all it did not bother to contest the Complaint, still carried the matter to this level, without offering any defence before the District Forum. The petitioner is also aware that the District Forum had acted judicially and though there was no defence of the petitioner that insured had committed suicide, on the basis of evidences reached to the conclusion that it was a case of suicide. In appeal the petitioner was unable to prove from evidences on record that the case of insured was covered under exclusion clause, yet challenged the findings in this revision petition without having any valid ground of challenge. Every conduct of the petitioner reflects on their callous attitude towards their customers. The facts on record shows that that the Petitioner had collected all the relevant documents from the Complainant got the relevant forms for the claim, filled in proceedings before Ombudsman Court. Before that Court the Petitioner gave assurance that they would soon decide the claim of the claimant. Although petitioner jad collected all the documents from the Complainant yet they vide letter dated 25.02.2017 demanded again the same documents from the Complainant. They went into silence mode when informed that the documents had already been given to them on 10.01.2017. They sat over claim of the Complainant complacently. Such conduct of the service providers needs to be dealt in such a manner that it serves as a deterrent to other service providers and they deter doing it. The facts and circumstances of this case calls for imposing exemplary cost on the petitioners. While dismissing the present Revision Petition I impose a costs of Rs. 1,50,000/- on the Petitioner. Out of this Rs. 75,000/- shall be deposited with the NCDRC Consumer Legal Aid Fund and the balance shall be paid to the Complainant within four weeks by way of demand draft.