DATE OF FILING - 7.1.2013
DATE OF DISPOSAL - 10.10.2013
O R D E R
Dr. N.Tuna Sahu, Member
1. The case of the complainant in a nutshell is that she is the wife of late Ramesh Chandra Behera (hereinafter referred to “the deceased’). The deceased during his life had insured his life with Reliance Life Insurance Co. Ltd. (Opposite Party) under the Reliance Super Investment Assurance Basic Plan for the assured sum of Rs.50,000/-(Rupees Fifty Thousand). The Opposite Party has also issued policy bond in favour of the complainant bearing No.17107130 valid for the period from 31.5.2010 to 30.5.2030 against receipt of first premium of Rs.10,000/- on 31.5.2010. Unfortunately, the life assured Ramesh Chandra Behera died on 8.10.2010 and the death intimation was given to Opposite Party. Subsequently, claim form was also filed for settlement of death claim. But the Opposite Party intimated in its letter dated 27.4.2010 about repudiation of the claim due to non-disclosure of previous disease of the deceased at the time of commencement of the policy. A legal notice in this regard on behalf of the complainant also did not yield any result. Finding no other way out, the complainant has preferred this present consumer complaint before this Forum under Section 12 of the C.P. Act, 1986 praying for a direction to the Opposite Party for payment of assured sum of Rs.50,000/- with interest and compensation and cost of litigation of Rs.30,000/- as a whole for the harassment and deficiency in service caused by the Opposite Party ( for short O.P.).
2. Despite receipt of notice of the Forum, the Opposite Party did not enter its appearance as a result the Opposite Party was set ex-parte on dated 10.6.2013.
3. On the date of hearing, the case is heard ex-parte from the side of the complainant. We perused the case record, written arguments and documents on record as filed on behalf of the complainant in extent so. On perusal of the case record, it is found that the deceased policy holder had insured his life with the O.P. vide policy No.17107130 dated 31.5.2012 which was valid from 31.5.2010 to 31.5.2030. It is also not is dispute that the deceased policy holder had paid a sum of Rs.10,000/- towards the first premium of the policy which was annual in nature. It is also beyond dispute that the deceased policy holder died on 8.10.2010 as evident from the death certificate issued by the death registration authority placed as an annexure in the case record.
During the course of hearing of the case, the learned counsel for the complainant contended that the policy holder had obtained an insurance policy namely Reliance Super Investment Assurance Basic Plan from the O.P. on payment of annual premium of Rs.10,000/- for an assured sum of Rs.50,000/- which was valid from 31.5.2010 to 31.5.2030. During subsistence of the said policy, the deceased policy holder died on 8.10.2010 and subsequently the nominee i.e. the present complainant submitted the death claim before the O.P. but the O.P. did not pay the death claim and paid only fund value of Rs.4811.81 towards the death claim of the complainant. Hence, the complainant filed this consumer dispute being aggrieved by this. The complainant prayed to direct the O.P. to pay the assured sum of Rs.50,000/- along with interest and cost of the dispute.
4. We heard the above arguments of the learned counsel for the complainant and perused the case record. It is revealed from the case record that the O.P. on 25.2.2012 replied the legal notice dated 22.11.2011 of the advocate for the complainant. The reply letter dated 25.2.2012 of the O.P. discloses that the claim of the complainant was repudiated on the ground of suppression of material fact about his health and the life assured had undergone a surgery during November 2009 for bladder tumour, which was not disclosed during taking of the policy. It was also mentioned in the said letter that the relevant questions more specifically question No.30 and 32 in the proposal form were also answered negatively. Hence, non-disclosure of tumour was material to the issuance of the insurance policy and since the proposer has concealed disclosing the same, the claim is repudiated rightly.
We perused the letter dated 25.2.2012 received from the O.P. insurance company which is on record and also gone through the case record and scanned all relevant documents placed in the file. With regard to question No.30 and 32 of the Proposal Form, we would like to say that the O.P. has not submitted before this Forum the photocopies of the Proposal Form to substantiate his contention but simply contended through his letter dated 25.2.2012 that the questions were answered negatively. But we are unable to understand what prevented the O.P. not to contest his case and to submit the photocopies of the original proposal form where the questions were answered negatively by the deceased policy holder. Moreover, if the deceased policy holder had suppressed material facts about his health and specifically about the tumour operation during November 2009, why the O.P. did not come to contest his case and not produced any medical papers before this Forum in support of his contentions. The O.P. has not submitted any medical papers before this Forum and there is not a single piece of paper in the case record to prove that the deceased policy holder was undergone a tumour operation during November 2009. So, we are not convinced that the deceased policy holder had undergone any surgery during November 2009 and he had suppressed this material fact about his health during taking of the insurance policy. It is also not proved that the deceased policy holder had suppressed material facts about his health since, the O.P. miserably failed to prove that the life assured had suppressed material facts about his health. The O.P. Insurance Company not produced any cogent and convincing documentary evidence to show that deceased was undergone tumour operation before taking the insurance policy. Nothing has been placed in the case record to hold that the deceased policy holder had suppressed material facts about his health during taking of the insurance policy. When the O.P. failed to prove this, he cannot repudiate the genuine claim of the complainant on flimsy grounds that he had suppressed material facts during taking of the insurance policy. In our considered view, where insurance company fails to establish that insurer had suppressed material information fraudulently, claim cannot be repudiated. So, it is the duty of the insurance company to settle the genuine claim of the complainant timely. However, if there is any bonafide doubt about the claim of the complainant, the company should investigate the matter and produce authentic medical papers before the Forum in support of his contention to establish that there was suppression of material fact which had nexus with cause of death of insurer. But, without doing so, the claim of the complainant cannot be repudiated without any basis. It is an established fact that the deceased policy holder had deposited a handsome amount as premium under a valid agreement which is not void. Where the agreement is not void, the equity, justice and good conscience say the claim of the widow complainant should be settled honestly. This is a welfare society and in a welfare state, the Insurance Company is to help the legal representatives of the deceased in their crisis period and not to even digest the deposits made by them on flimsy grounds. It is unfair on part of the O.P. to return a cheque of Rs.4811.81 towards the death claim payment under the aforesaid policy on the premise of fund value, rather it is the moral duty of insurance company to settle the death claim of the complainant and pay the assured sum of Rs.50,000/- towards death claim under the said policy. Hence, in our opinion, repudiation of claim of the complainant is unjustified and there is deficiency in service on part of O.P. for non-settlement of the complainant’s death claim. Our finding is fortified with the decision of the Hon’ble State Consumer Disputes Redressal Commission, Andhra Pradesh, reported in Consumer Law Decisions, January 2004, Vol.7, Part-4 P-424. For this arbitrary action of the insurance company, the O.P. is to compensate the loss incurred by the complainant. In a sequel to the above discussions, we hold that the O.P. is deficient in service for non-settlement of genuine insurance claim of the complainant.
5. In the result, we allow the claim of the nominee complainant against the O.P insurance company, who is liable to pay the assured sum of Rs.50,000/- to the nominee of the deceased policy holder within two months of receipt of this order along with interest @ 7% per annum from the date of filing of this case till actual payment is made. We also direct the O.P. to pay a modest amount of Rs.2,000/- to the complainant towards the cost of litigation within the same period failing which the entire amount shall be realized with interest @ 9% per annum under Section 25/27 of the Consumer Protection Act, 1986. The case is disposed of accordingly.
6. The order is pronounced in the open Forum on this 10th day of October 2013 under the signature and seal of the Forum. Copy of the order shall be served on parties free of cost.
Typed to my dictation
and corrected by me.
Member Member
I Agree President
I Agree Member
