Sri S.K.Sahoo,President.
One Sukanta Ranjan Mohapatra has filed the present complaint U/s. 12 of C.P.Act, 1986 against the opp.parties.
2. The case of the complainant is that Mamata Kumari Devi his wife was serving as staff nurse in the govt. medical. She had taken a new Jeevan Anand ( with profit) life insurance policy from the opp.parties during her life time bearing policy No. 599705749 which commenced from 28.06.2014. The sum assured was Rs.2,50,000.00 . The yearly premium was fixed at Rs. 15,138.00. She had also taken another policy bearing No. 588478990 Jeevan Sathi (Double cover joint life plan with profit) . The date of commencement of that policy was 28.11.2009. The sum assured was Rs. 2,00,000.00 with yearly premium of Rs. 15,549.00 . The complainant being husband of Mamata Kumari Devi is also nominee in those policies. Due to her illeness Mamata Kumari Devi was admitted at All India Institute of Medical Science, Bhubaneswar , who died on 14.02.2015 for Cardio respiratory arrest. The complaint immediately intimated the opp.parties regarding the death of insured and placed his claim under the aforesaid policies. On 08.07.2015 and 18.08.2015 the opp.party No.2 asked the complainant to submit all the documents relating to the treatment of Mamata Kumari Devi . The complainant by his letter dtd. 26.02.2016 submitted his replly and expressed his ignorance about the sick leave of Mamata Kumari Devi and non-availability of the treatment particulars of his wife Mamata Kumari Devi . On 31.03.2016 the opp.parties repudiated the claim on the ground of suppression of material facts. Hence this case.
The complainant has also filed the photo copies of a lot of documents relating to the policies and his claim.
3. The opp.parties filed written statement through their advocate . The opp.parties admitted about the issuance of the policies in favour of deceased Mamata Kumari Devi but their plea is that Mamata Kumari Devi has suppressed some material facts regarding her illness and treatment, for which the opp.parties are not liable to pay the claim of the complainant.
4. During hearing , the complainant admitted that he has received the amount relating to policy No. 588478990. From the complaint petition and from the photo copy of the policy bearing No. 599705749 , it is clear that the date of the commencement of the risk is 28.06.2014 and the sum assured under the said policy is Rs. 2,50,000.00 .It is also clear from the documents filed by the complainant that he has submitted all the documents relating to his claim except some documents relating to the alleged treatment of Mamata Kumari Devi by doctors earlier to 28.06.2014. It is claimed by the opp.parties that Mamata Kumari Devi was on sick leave on medical ground from 04.01.2012 to 31.01.2012”. It is also alleged by the opp.parties that the complainant was asked to submit the documents relating to such medical leave. From the copy of letter dtd. 09.03.2015 addressed to opp.party No.1 by the complainant , it appears that Mamata Kumari Devi died due to Cardio respiratory arrest on 14.02.2015 at 9.15 PM at AIIMS Hospital ,Bhubaneswar. From letter dtd. 31.03.2016 of Senior Divisional Manager of LIC of India, East Central Zone office, it appears that the opp.parties repudiated the claim of the complainant on the ground that Mamata Kumari Devi was under medical treatment from 04.01.2012 to 31.01.2012 for Pyrexia by Dr,. Purusottom Pradhan of Angul but Mamata Kumari Devi supressed such material fact when she submitted the proposal form to the opp.parties. It is specifically pleaded that at paragraph-11 (i) to (vi) of the proposal form the insured suppressed about the medical treatment and her health condition. The opp.parties have filed some documents relating to the policy of deceased Mamata Kumari Devi . However, the opp.parties failed to prove by reliable evidence that the wife of the complainant Mamata Kumari Devi was suffering and under going medical treatment prior to 28.06.2014 . From the photo copy of the certificate of employer obtained by LIC of India,Cuttack Division dtd. 24.08.2015 it is clear that deceased Mamata Kumari Devi was not absent from her duty on health ground from 01.07.2009 to 30.06.2014 but she was on maternity leave from 18.11.2014 to 14.02.2015 . In view of such document it is clear that deceased Mamata Kumari Devi was not on leave on health ground prior to the submission of proposal form by her to the opp.parties. The opp.parties also failed to produce any reliable evidence that Mamata Kumari Devi was under going treatment by Dr. Purusottam Pradhan for Pyrexia for the period 04.01.2012 to 31.01.2012.
5. So after going through the pleading of the parties, documents filed it is clear that complainant being nominee is entitled for the policy amount and the repudiation of the opp.parties is not based on good reason. By refusing the claim of the complainant, the opp.parties have adopted unfair trade practice. The complainant was forced to come to litigation .Certainly the conduct of the opp.parties caused mental agony and harassment to the complainant. There is deficiency in service by the opp.parties.
6. Hence order :-
: O R D E R :
The case be and the same is allowed on contest . The opp.parties are directed to pay the sum assured and all other benefits of policy No. 599705749 along with interest @ 7% p.a from March, 2015 until payment is made. They are further directed to pay compensation of Rs. 50,000.00 (Rupees Fifty Thousand) only towards mental agony and harassment suffered by the complainant along with an amount of Rs. 30,000.00 (Rupees Thirty Thousand ) only towards litigation cost. Both the opp.parties are jointly and severally liable to pay the same within one month from the date of receipt of this order, failing which they are liable to pay all the dues along with penal interest @18% p.a to the complainant until it is paid.
