DIST.CONSUMER DISPUTES REDRESSAL COMMISSION, KHURDA, BHUBANESWAR:

                                                            -ooOoo-

C.C.CASE NO. 85/2011

Jyostnarani Mishra, aged about 45 years,

W/o – Late Suryanarayan Mishra, At – Kullad, PO- Bhanjanagar,

Dist- Ganjam

                                                                                                ….       Complainant

                  -Vrs.-

1.         Birla Sun Life Insurance Co.Ltd., Bhubaneswar Branch

            At- Kharvel Nagar, Near Kharvel Nagar Police Station,

            PO/PS- Kharvel Nagar, Bhubaneswar, Dist – Khurda,

            Represented through its Branch Manager.

2.         Birla Sun Life Insurance Co.Ltd.,  Indian House,

4^th Floor, 621, Makhana Road,  Marolkaka- 077,

Andheri, Kurla Road, Andheri (East) Mumbai- 400059,

Through its Authorized Signatory.

                                                                                                ….       Opp. Parties

For the complainant    :           Mr. K.C.Prusty (Adv.)

For the O.Ps.              :           Mr. L.Mishra & Associates  (Adv.)

DATE OF FILING    :           21/03/2011

DATE OF ORDER    :           28/03/2024

ORDER

K.C.RATH, PRESIDENT

1.         This is an application U/s 12 of the C.P.Act, 1986.

2.         The complainant’s case in brief is that, the complainant is the mother of deceased Tarun Kumar Mishra, who had taken a life insurance policy from the OPs on 16/02/2009. He had also procured another life insurance policy from the OPs on 6/3/2009. In each case, the matured amount of the policy was Rs.75,520/-. On 19/03/2009, Tarun Kumar Mishra  died at the government hospital, Bhanjanagar. On 09/04/2009, the complainant being the legal heir and nominee under the policies,  put her  claim for the insured amount. The OPs repudiated the claim on the ground of suppression of medical history by the insured. The complainant further avers that the deceased had no pre-existing disease, so the  question of suppression of material fact does not arise. The repudiation of claim by the OPs is illegal and unjustified. It amounts to deficiency in service.   Hence this complaint.

3.         On the other hand, the  OPs    filed written version  contending therein that,  the complaint is not maintainable. There is no cause of action to file this complaint.  The pith & substance of the pleadings of the OPs is that, the deceased,   Tarun Kumar Mishra (insured), suppressed the medical history and the deceased was suffering from illness prior to obtaining of the policies. The insured since deceased died within one month of the commencement of the risk. The investigation conducted by the OPs revealed that he had certain complications prior to obtaining the policies but while filling up of the proposal form, he denied all the questions relating to the medical history.   As the complaint bears no merit, it is liable to be dismissed with cost.   

4          Perused the materials on record.  Admittedly,  the deceased (insured) had  procured two life insurance policies from the OPs. The 1^st policy was obtained on 16/02/2009 and the 2^nd policy was on 06/03/2009.  Incidentally, the insured died of 19/03/2009. Thereafter, the claim was lodged before the OPs by the nominee of the deceased. The OPs conducted usual investigation as is required under the situation. Such investigation revealed that,  prior to obtaining of the policies, the deceased (insured)  had certain health problems for which he was taking medicines. Ext-G indicates that there was problem in Kidneys and liver. Perused the copy of the proposal form. In the said propel form,  the insured since deceased said “No” to every query relating to medical history.  Incidentally such answer on the part of the deceased (insured) amounts to suppression of material facts. The Insurance Contract being a contract of utmost good faith is vitiated when the party who knows his health condition, suppresses his health condition in the proposal form before obtaining the policy. Therefore, the complaint is devoid of any merit.   Hence it is ordered.  

ORDER

The complaint is  hereby  dismissed on contest against the OPs    being devoid of merit.

The order is pronounced on this day the   28^th  March,   2024  under the seal & signature of the President and Member (W)   of the Commission.

                                                                                                (K.C.RATH)  

                                                                                                 PRESIDENT

 Dictated & corrected by me

          President                                                                                    

I agree                                                                                                

(S.Tripathy)                                                                                        

Member (W)                                                                             

Transcribed by Smt. M.Kanungo, Sr.Steno