DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KANDHAMAL, PHULBANI
C.C NO.47 OF 2015
Present: Sri Rabindranath Mishra - President.
Miss Sudhiralaxmi Pattanaik - Member.
Sri Purna Chandra Tripathy - Member.
Sweta Pradhan, aged 28 years
S/O: Daga Pradhan At: Judabadi PO: Simonbadi
PS:Daringbadi Dist: Knahdamal ………………………….. Complainant.
Versus .
1. Branch Manager,Reliance Life Insurance Co. Ltd.
Kaling Road, in front of office of Junior Engineer,
National High Way Section, Aska Dist: GanjamPIN-767110
2. Namajini Pradhan, aged about -33 years
W/O: Late Jangari Pradhan- Housewife.
3. Kabita Pradhan , aged about -16 years
D/O: Late Jangari Pradhan, Student.
4. Mantu Pradhan aged about 13 years
S/O: Late Jangari Pradhan , student
5. Binita Pradhan aged about 10 years
D/O: Late Jagari Pradhan, student
6. Rabita Pradhan aged about 6 years
D/O: Late jangari pradhan.
(O.P No.3 to 6 are being minor, represented by
their Mother gurdian, O.P No.2) All are resident of
Village- Kutubadi PO: Greenbadi PS: Daringibadi, Dist: Kandhamal)…………………………….. OPP. Parties.
For the Complainant: Sri Pratap Chandra Bai, Advocate,Phulbani
For the OPP. Parties: For O.P No.1: Sri J.K. Mohanty, Advocate,Phulbani
For O.P No.2 to 6: Sri Susil Kumar Behera, Advocate Phulbani.
Date of order: 30-03-2017
-2-
O R D E R
The case of the Complainant in brief is that the deceased Jangari Pradhan had purchased two policies bearing No. 18801624 and 18799611 from O.P No.1 during his life time but the deceased died on 17-05-2011 due to brain malaria. The said policies were in force at the time of his death. The Complainant was the nominee in those policies. After the death of the deceased the Complainant applied to the O.P No.1 for payment of the insured amount but the O.P No.1 repudiated the claim of the Complainant with a ground that the deceased had pre-existing decease. As per O.P No.1 the deceased was suffering from Tuberculosis since 2008 and suppressed the fact in the proposal form.
The further case of the Complainant is that the deceased also made life Insurance under Bajaj Allianz Life Insurance Company but the Company repudiated the claim of the Complainant with a similar ground. The Complainant had filed a Civil Suit before the Civil Judge Senior Division, Bhanjangar vide CS No. 60/2012 wherein the Hon’ble court had directed the Bajaj Allianz life Insurance Company for payment of insured amount as per his order dated 05-08-2014 and the Insurance company complied the said order. The sum assured to the tune of Rs. 700,000/- in the policy No.18801624 and Rs. 1, 95,000/-in the policy No.18799611. Prior to this case another complaint vide No. 11/2015 was filed by the legal hairs of the deceased before this Forum. But the same was withdrawn to file afresh which was allowed on 28-10-2015. Hence, this complaint is filed against the O.P No.1 and others for a direction to O.P No.1 to release the claim amount in favor of the Complainant with interest.
The case of O.P No.1 as per his version is that the present complaint is barred by limitation under section 24 A of C.P Act, as the claim of the Complainant was repudiated on 28-08-2011 and the cause of action arose on the said date.
The further case of O.P No.1 is that it was established upon investigation that the DLA was severe alcoholic; he was suffering from tuberculosis and was under treatment at CHC (T.B. center) which was not disclosed at the time of filling the proposal Form. The DLA was also suffering from liver disease and malaria and died on 17-05-2011.So, the claim was rightly repudiated on the ground of suppression of material facts. The suppression of pre-existing disease amounted to suppression of material fact and hence, the contract of Insurance Company is liable to be rescinded as per section 45 of Insurance Act 1993 and no benefit is payable .
The contents of the Complainant are strongly opposed by the O.P No.1 and the Complainant is not liable to get any amount for which the complaint is liable to be dismissed.
The case of O.P No.2 to 6 in brief as per version filed by O.P No.2 is that the O.P No.2 is the wife of the deceased and O.P No.3 to 6 are minor children of the deceased Jangari Pradhan for which they are represented by their mother ,O.P No.2. The deceased died on 17-05-2011 due to malaria. He had purchased 2 policies from O.P No.1 during his life time and those policies were
-3-
in force at the time of his death. The Complainant is the nominee of those policies after death of her husband. The Complainant had applied to O.P No.1 for payment of insurance amount but he repudiated the claim showing the cause that he had pre-existing disease. The allegation of O.P No.1 that the deceased was suffering from Tuberculosis since 2008 and suppressed the fact in its proposal form which is completely false and fabricated. The deceased was suffering from brain malaria and treated at CHC Darigibadi and CHD Greenbadi but he could not survive.
The O.P No.2 to 6 are the legal hairs of Jangari Pradhan. So, the Insurance assured amount may be divided in equal share with the Complainant. The O.P No.1 may be directed to release the assured amount in the name of the Complainant for the benefit of the Complainant as well as the legal hairs of her deceased husband.
During course of hearing the Complainant had filed an affidavit in token of his evidence. He was examined and cross examined. Exit-1 to Exit -6 were marked upon documents on behalf of the Complainant.
We have gone through the Complaint petition, the version filed by the O.P No.1 & 2 separately, the affidavit filed by the Complainant and O.P No.1, the deposition of the Complainant and the documents filed by both the parties including the Exhibits. We have also heard the learned counsel appearing for the parties. As per pleadings of both the parties the following issues are framed for better adjudication of the case.
- Whether the Complaint is barred by limitation?
- Whether the deceased had any pre-existing disease prior to the signing of the proposal form and there was willful concealment of the material facts at the time of filling of the proposal form?
- Whether the Complainant is entitled to get any relief as claimed by him?
Issue No.1: It is an admitted fact that the legal hairs of deceased Jangari Pradhan have filed C.C No. 11/2015 earlier. In this case they filed a petition to withdraw the complaint on the technical ground and to add the O.P No.2 as Complainant being the nominee of the deceased. Exit-6 is the order dated 28-10-2015 of C.C No. 11/2015 in which the Complainant was allowed to withdraw the case in order to file fresh complaint within 30 days from the date of receipt of the order. It is seen that the order of C.C No.11/2015 was received by the Complainant on 09-11-2015 and the present complaint was filed on 08-12-2015 which is within time. In the original case vide C.C No. 11/2015 the limitation petition filed by the Complainant under section 24 A of C.P Act was allowed and the delay in filing the complaint was condoned as per order dated 11-05-2015 . Hence, the present complaint is filed within time.
Issue No. 2: 3: On perusal of Exit -1 it is seen that the deceased Jangari Pradhan submitted proposal Form on 28-03-2011. The O.P No.1 categorically stated that the deceased was suffering from Tuberculosis prior to signing the proposal form. The same allegation was reflected in
-4-
the version and affidavit filed by the O.P No.1 but onus lies on O.P No.1 to prove the same through suitable evidence . In this connection the O.P No.1 neither examined any doctor nor examined the field investigator on his behalf to support the investigation report. The affidavit which was filed by O.P No.1 cannot be accepted as evidence because the said affidavit neither showrned by the deponent nor executed before any notary public or Executive magistrate. So, O.P No.1 has not produced any substantive piece of evidence to prove his allegation against the deceased. It is the settled principle of law that the onus of proving the grounds for repudiation of insurance claim lies heavily on the Insurance Company. There is absolutely no evidence in the record that the deceased had pre-existing disease at the time of filling the proposal form and he was aware of any disease and concealed the same at the relevant time. It is seen from Exit-3, the report given by the Medical Officer CHC Daringibadi that the deceased Jangari Pradhan was admitted for chronic alcoholism and it is also seen from the said report that the deceased Jangari Pradhan was cured on 08-06-2005 as per Sputum Examination. It reveals from Exit -4 that the deceased was suffering from fever during the period 01-05-2011 to 11-05-2011 and was under treatment of medical officer G.H.D Green-badi of Kandhamal District who prescribed homoeopathic medicine to him. So, on 28-03-2011 at the time of submitting the proposal form before the O.P No.1, the deceased Jangari Pradhan was not under treatment for tuberculosis or any serious disease as alleged.
It is admitted fact that the deceased Jangari Pradhan died on 17-05-2011. It is also admitted that the deceased during his life time had started 2 Insurance Policies vide policy No. 18801624 and 18799611 for assured sum amounting Rs. 7,00,000/- and Rs. 1,95,000/- respectively. It is admitted that the Complainant is the nominee of the above policy being the brother of the deceased and the O.P No.2 to 6 are the legal hairs of the deceased. As the O.P No.1 , the Insurance Company failed to establish the pre-existing disease of the deceased during the period it is on 28-03-2011 the date of filing the proposal form, the Complainant is entitled to get relief from the death benefit of the policy. Accordingly the Complaint filed by the Complainant is allowed on contest against O.P No.1. Hence, the O.P No.1 is directed to release the Insured amount of the deceased Jangari Pradhan in connection with the above 2 policies in favor of the Complainant /Nominee within 30 days from the date of receipt of this order .In case of failure the O.P No.1 shall be liable to pay interest at the rate of 12 % per annum on the entire amount from the date of filing of this case it is on 08-12-2015 till the date of payment .
The Complainant after receiving the insured amount will disburse the same
equally among the O.P No. 2 to 6 being the legal hairs of the deceased.
The C.C is disposed of. Supply free copies of this order to both the parties at an early date.
MEMBER MEMBER PRESIDENT
