Orissa

Cuttak

CC/46/2023

Mrs Swagat Pattanaik - Complainant(s)

Versus

Aviva LIC India Ltd - Opp.Party(s)

01 Jan 2024

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

C.C.No.46/2023

 

          Mrs. Swagat Pattanaik,

           W/o: Late Pradeep Kumar Pattanaik,

           At:Housing Board Colony MIG-1,

           Radhagobindapur,9-Near Mangala Mandir,

           Athagarh,P.O:Dhoipur,P.S:Athagarh,

           Dist:Cuttack-754029.                                                     ... Complainant.

 

          Vrs.

 

1.       Branch Manager,AVIVA LIC INDIA LTD.,                                                                                                                                                                                                                                                                                                                                                                    At: 2^nd Floor,Aditya Plaza Building,Unit-4,

Sachivalaya Marg,Bhubaneswar,

                  Dist:Khurda

 

2.       Chief Executive, Aviva LIC India Ltd.,                                                                                                                                                      401-A,4th floor,Block-A,

At:DLF Cyber Park,Sector-20,

N.H:8,Gurugaon,Hariyana-122002

 

3.        S.K.Wahid(Agent of AVIVA LIC India Ltd.,

Athagarh Branch,At:Muslim Basti,

             PS: Athagarh,Dist:Cuttack.                                           ...Opp.Parties

 

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:    02.02.2023

Date of Order:  01.01.2024

 

For the complainant:                Mr. S.N.Mishra,Adv. & Associates.

For the O.Ps No.1 & 2:                Mrs. N.Ray,Adv. & Associates.

For the O.P. No.3         :                              None.

 

Sri Debasish Nayak,President

          Case of the complainant as made out from her complaint petition in short is that her deceased husband Pradeep Kumar Pattanaik had obtained insurance policy from the O.Ps bearing policy No.10230248 which was effective from 29.4.2015 upto 29.4.2034 with half-yearly premium @ Rs.17,740/-.  The assured sum therein was Rs.30,00,000/- and the complainant was the nominee.  The policy had lapsed on 29.6.2020 but was reinstated on 19.2.2021 after observing all the formalities in accordance to the rules and that was within the knowledge of the O.Ps.  On 4.4.2022, the deceased insured was admitted to KIIMS Hospital at Bhubaneswar due to his illness but he had died on 5.4.2022.  The complainant had putforth her claim for the insurance assured amount of her deceased husband being the nominee. But on 15.7.2022 the O.Ps through their letter had intimated the complainant that they had repudiated her insurance claim and they had remitted a scanty amount to her account.  On 23.8.2022 the complainant had written to the O.Ps for reconsideration of her claim which was also rejected by the O.Ps through their letter dated 15.12.2022.  It is for the said reason, the complainant has come up with her case before this Commission claiming a sum of Rs.23,15,355/- from the O.Ps towards the policy of her late husband alongwith another sum of Rs.2,00,000/- towards compensation.  She has also prayed for interest thereon @ 10% per annum from 17.7.2022 till the total amount is quantified.  Her further prayer is for cost of her litigation to the tune of Rs.10,000/- from the O.Ps.

          Alongwith her complaint petition, she has filed copies of several documents in order to prove her case.

2.       Out of the three O.Ps as arrayed in this case, having not preferred to contest, O.P no.3 has been set exparte vide order dated 28.4.2023.  However, O.Ps no.1 & 2 have contested this case and have filed their written version jointly. 

As per the written version of O.Ps no.1 & 2 the complainant has no cause of action to file her case and they have stated that this Commission has no jurisdiction to entertain this case.  They admit to have received the proposal form of the insured Promod Kumar Pattnaik for a policy with assured sum of Rs.30,00,000/- having half-yearly premium @ Rs.17,740/-.  In the said proposal form, the assured was to submit the true and complete details relating to his ailments if any. But according to the O.Ps no.1 & 2, the life assured had mentioned in his proposal form that he was having no previous ailment.  In this context, the O.Ps have relied upon a catena of decisions of the Hon’ble Supreme Court which are as follows:

1. In the case of Virendranath Gouttam Vs. Satpal Singh AIR 2007 SC 581.
2. In the case of Satwant Kour Sandhu Vs. New India Insurance Co. Ltd. reported in 2009 IV CPJ,8(SC).
3. Export Credit Guarantee Corporation of India Ltd. Vs. Garg Sons International [2013(1) SCALE410] wherein the Hon’ble Supreme Court held that while construing the terms of the contract of insurance, the court must give paramount importance to the terms used in the said contract.
4. Suraj Man Ram Niwas Oil Mills (P) Ltd. Vs. United India Insurance Co. Ltd.[2010) 10 SCC 567 wherein the Hon’ble Supreme Court held that the words in an insurance contract must be given paramount importance and must be interpreted as expressed without any addition, deletion or exclusion.
5. General Assurance Society Ltd. Vs. Chandumull Jain & Anr.,(1966) 3 SCR 500 wherein the Hon’ble Supreme Court held that “in interpreting documents relating to a contract of insurance, the duty of the court is to interpret the words in which the contract is expressed by the parties, because it is not for the court to make a new contract, however reasonable, if the parties have not made it themselves”.
6. United India Insurance Co. Ltd. Vs. Harchand Rai Chand Rai Chandanlal I(2003) CPJ 393 & Vikram Greentech (I) Ltd. & Anr. Vs. New India Assurance Co. Ltd. II(2009) CPJ 34.
7. In Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd. Vs. Lalit Kumar Kothari, RP 1208/2014.
8. Prem Kumar Vs. LIC in RP No.405/2017.
9. Reliance Life Insurance Co. Ltd. Vs. Rekhaben Nareshbhai Rathod, SC,2019 wherein the Hon’ble Supreme Court held that “it is standard practice for the insurer to set out in the application a series of specific questions regarding the applicant’s health history and other matters relevant to insurability.

Thus according to them, the complainant has no cause of action and her complaint petition is not maintainable which is liable to be dismissed. 

They have also filed copies of several documents in order to prove their stand.

The complainant has filed evidence affidavit which when perused it is noticed that the same is only the reiteration of the complaint petition as filed and nothing else.

O.Ps no.1 & 2 have also filed their evidence affidavit through one Anchal Dutta, working as Manager of Aviva Life Insurance Company India Limited which when perused it is noticed that the same is only the precise form of contents of the written version of O.Ps no.1 & 2 and nothing else.

3.       Keeping in mind the averments as made in the complaint petition and the contents of the written version of the O.Ps no.1 & 2, this Commission thinks it proper to settle the following issues in order to arrive at a proper conclusion here in this case.

i.          Whether the case of the complainant is maintainable?

ii.         Whether there was any deficiency in service on the part of the O.Ps ?

iii.        Whether the complainant is entitled to the reliefs as claimed by her?

Issue no.ii.

Out of the three issues, issue no.ii  being the pertinent issue in this case, is taken up  first for consideration.

After perusing the contents of the complaint petition, that of the written version, written notes of submissions and evidence affidavit as filed from either sides as well as the documents filed from either sides, it is noticed that admittedly the deceased husband of the complainant had obtained one Insurance policy from the O.Ps wherein the sum assured was of Rs.30,00,000/- and it had a half-early premium @ Rs.17,740/-.  When the said insurance lapsed on 29.6.2020, it was reinstated on 19.2.2021.  Thus, during the effective coverage of such insurance, the life assured who is the deceased husband of the complainant of this case, was admitted to KIIMS Hospital at Bhubaneswar on 4.4.2022 but he expired on 5.4.2022.  As it appears from the copy of document as filed by the O.Ps no.1 & 2 here in this case vide Annexure-R/G, it is noticed that they conducted investigation wherefrom they have found that the life assured was having history of Liver cirrhosis/Alcohol Hepatitis since 10 years and was not on medication since last one year.  Quite strangely both the contesting O.Ps no.1 & 2 have not mentioned as to who were the persons those who had conducted such investigation and quite strangely infact the said persons were not examined here in this case by the O.Ps no.1 & 2.  There is also no documentary evidence to substantiate such plea of the O.Ps.  That apart, one Anchal Dutta claims to be the authorised representative of the O.Ps no.1 & 2 who had sworn in affidavit on behalf of O.Ps no.1 & 2 and has filed the written version and so also evidence affidavit on behalf of O.Ps no.1 & 2.  But there is no document put forth from the side of the said contesting O.Ps no.1 & 2 in order to apprise this Commission that if in fact the said Anchal Dutta was duly authorised by the O.P Company to sworn in affidavit and if there was any resolution to that effect.  In this context it would be pertinent to quote a valuable decision of the Hon’ble Apex Court as decided in the case of State Bank of Travancore Vs. M/s. Kingston Computers (I) Pvt. Ltd. decided on 22.02.2011 wherein it is held that, “In our view, the judgment under challenge is liable to be set aside because the respondent had not produced any evidence to prove that Shri Ashok K. Shukla was appointed as a Director of the company to file suit against the appellant and authorised Shri Ashok K.Shukla to do so.  The Letter of Authority issued by Shri Raj K.Shukla, who described himself as the Chief Executive Officer of the company, was nothing but a scrap of paper because no resolution was passed by the Board of Directors delegating its powers to Shri Raj K.Shukla to authorise another person to file suit on behalf of the company”.

          Thus considering the findings of the Hon’ble Apex Court in the said decision as cited above, the evidence affidavit so also the written version as filed on behalf of the O.Ps no.1 & 2 here in this case  cannot taken into consideration.  Moreso, when there is no iota of evidence to substantiate the plea as taken by the O.Ps no.1 & 2 that infact the life assured was having past history of Liver cirrhosis/Alcohol Hepatitis since 10 years, the same cannot be taken into account and  be believed.  Accordingly, when it is noticed that the O.Ps had repudiated the claim of the complainant here in this case they are definitely found to be deficient in their service.  Accordingly, this issue is answered.

Issues no.i & iii.

                 From the discussions as made above, the case of the complainant as filed is definitely maintainable and the complainant is entitled to the reliefs as claimed by her. Hence, it is so ordered;

 

 

                                                          ORDER

                  The case is allowed on contest against the O.Ps 1 &  2 and exparte against O.P no.3 who are all found to be jointly and severally liable here in this case. The O.Ps No.1 & 2 are thus directed to pay the complainant the death claim benefit to the tune of Rs.23,15,355/- alongwith interest thereon @ 9% per annum from the date of her application i.e. from 17.7.2022 till the amount is quantified.  The O.Ps are further directed to pay a sum of Rs.2,00,000/- to the complainant towards compensation for her mental agony and harassment as well as another sum of Rs.10,000/- towards  the cost of her litigation.  This order is to be carried out within a period of 30 days from the date of receipt of copy of this order.

                Order pronounced in the open court on the 1^st day of January,2024 under the seal and signature of this Commission.         

                                                                                              Sri Debasish Nayak

                                                                                                        President

 

 

                                                                                 Sri Sibananda Mohanty

                                                                                                              Member