Orissa

Cuttak

CC/70/2018

Mrs Manjusa Pradhan - Complainant(s)

Versus

Chairman-cum-MD,Kotak Life Insurance Company Limited - Opp.Party(s)

R K Pattanaik & associates

19 Apr 2022

ORDER

IN THE COURT OF THE DIST. COINSUMER DIUSPUTES REDRESSAL COMMISSION,CUTTACK.

                                                                    C.C.No.70/2018

Mrs. Manjusa Pradhan,

W/O:Late Balaram Pradhan,

                 At-Burupada,PO-Saliadam

                PS:Banapur,Dist-Khurda,Odisha-752031

                                    Vrs.

1.       Chairman-cum-Managing Director,

Kotak Life Insurance Company Ltd.,

Regd. Office:7^th Floor,Zone-4,Bldg.No.21,

Infinity Park,Off Western Express Highway,

Goregaon,Mulundi Link Road,

                  Malad(E),Mumbai-400097

 

2.       Branch Head,

Kotak Life Insurance Company Ltd.,

Kailash Plaza,Link Road,Room No.29,

                 2^nd Floor,Cuttack-753012

 

Present:           Sri Debasish Nayak,President.

                        Sri Sibananda Mohanty,Member.

 

Date of filing:    11.07.2018

Date of Order:  19.04.2022

 

For the complainants:   Mr.  R.K.Pattnaik,Adv. & Associates.

For the O.Ps.:                 Mr. D.P.Tripathy,Adv. & Associates.

 

Sri Debasish Nayak,President.

           

The case record is put up today for orders.

The complainant has filed this case since because the O.P insurer had illegally repudiated her claim on the plea of suppression of facts.  According to the complainant, the O.Ps have taken premium as consideration amount without indemnifying to the nominee of the policy holder.  The cause of action arose on 13.3.2018 when the decision of repudiation taken arbitrarily by the O.Ps was communicated to the complainant.

As per the complaint petition the deceased husband of the complainant had given a proposal to the O.P insurance company for insuring his life on 24.8.2016 and the O.P by accepting such proposal had issued a policy in favour of the said deceased husband of the complainant; vide policy bearing no.03518663.  The said policy was for a period of 15 years and the assured sum was of Rs.3,92,635/-.  Premium payable per annum was Rs.15,000/-.  The said policy had a death benefit of Rs.3,92,635/-.  During subsistence of the said policy, the assured (husband of the complainant) had died on 10.3.2017.  The death certificate was issued by the C.H.C,Gambharimunda of Khorda.  Subsequently on 20.11.2017 the widow wife of the assured, who is complainant in this case, had made a claim before the O.Ps but the O.Ps after elapse of 4 months had repudiated the claim of the complainant as regards to the death of the life assured suspecting about suppression of facts like income and occupation.  According to the complainant, her late husband was treated at Poorvi Hospital and she has submitted copies of all the relevant documents supporting her claim.  According to her, neither she nor her late husband had suppressed anything and rather the O.Ps have illegally and arbitrarily repudiated the claim for which she has approached this Commission with a prayer for release of the assured sum of Rs.3,92,635/- along with interest @ 12% per annum from the date of repudiation till payment to the quantified, another sum of Rs.50,000/- towards mental agony and harassment and a further claim of Rs.20,000/- towards litigation cost.

2. The O.Ps have conjointly contested this case and have filed their written version.  They admit in their written version to be having business of providing life insurance coverage to the customers by obtaining license from IRDAI.  According to them, the complainant has made false, frivolous and vexatious petition which is liable to be dismissed.  The further claim of the O.Ps is that the complainant is not a consumer under the Consumer Protection Act and that this court has no jurisdiction to entertain the complaint petition as filed.  The O.Ps have averred that the assured deceased had obtained other insurance policies with coverage of Rs.11,43,150/- and Rs.4,48,380/- having a total coverage of Rs.20,00,000/- within a span of 40 days to which they smell something illegal.  The O.Ps  have further averred that the assured deceased had suppressed certain material facts for which the claim as made is not to be disbursed as the claim has been repudiated.  They have relied on the following reported judgments.

The Hon’ble Supreme Court in the case of P.C.Chacko and another Vs. Chairman LIC & Anothers reported AIR 2008 SC 424.

 

The regulation 2(1)(D) of the IRDAI protection of policy Interest holder 2022.

Satvant Kaur Sandhu Vs. New India Assurance Co. Reported in 2009 Vol. 8 SCC 316.

3.         Keeping in mind the averments as made in the complaint petition as well as in the written version, it is felt proper to adjudicate the following issues;

i. Whether this court has jurisdiction to entertain the complaint petition as filed?

ii. Whether the complainant is a consumer under the Consumer Protection Act.

iii. Whether this case is maintainable?

iv. Whether the complainant is entitled to the benefits as made in her complaint petition?

Issue No.1,2 & 3.

            For the sake of convenience issues No.1,2 & 3 are taken up combinedly at first.  While going through the definition as elucidated in the Consumer Protection Act one cannot ignore the complainant of this case, strictly saying that the complainant is not a consumer.  When the complainant as well as O.P No.2 reside within the jurisdiction of this Commission and the complainant has filed the complaint petition under the C.P.Act.  This court has definitely jurisdiction to entertain the complaint petition and as such the case is maintainable.  Accordingly, all the three issues are answered in the affirmative in support of the complainant.

Issue No.4.

            Now coming to the vital issue as to if there was any real suppression of fact, non-disclosure of the previous policies by the deceased-assured which would leads to a conclusion of depriving the complainant from the claim made by her.  Undoubtedly the O.Ps have agreed to be having business of life insurance coverage extending to customers.  They had accepted the proposal of the deceased-assured and had issued policy thereby covering his risk of life and had also accepted the premium advanced by the said deceased-assured.  They have not disputed anything in this regard.  Thus, it was a contract in between the deceased-assured and the insurer (O.Ps) that in the event of death of the deceased-assured the nominees/legal heirs of the deceased-assured are to get the assured amount together with other benefits of the policy.  The O.Ps have taken the plea that the deceased-assured had suppressed his income and occupation which are material and mandatory for the purpose of insurance which tilts our eye brows.  It is because, how could the O.Ps accept the proposal of the deceased-assured without proper inquiry and further probing into the matter.  Moreso, law does not debar any assured to have more than one policies and disclosure of the same is also not mandatory.  Thus, the barrier raised by the O.Ps in this case does not hold good against the claim as made by the complainant. The decisions relied upon by the O.Ps in this case differs as regards to the facts and circumstances of this case in hand and thus cannot be said to be applicable in the present case. It is therefore, crystal clear that the claim of the complainant should have been duly honoured without frivolous pleas as raised by the O.Ps; which imbibe us to pass the following orders.  Accordingly, this issue is also answered in the affirmative and in favour of the complainant.

                                    ORDER

The case is decreed in favour of the complainant.  This Commission directs the O.Ps  to immediately release all the death benefits along with the sum assured of Rs.3,92,635/- to the complainant forthwith within a month hence along with interest @ 8% per annum till payment is completed.  The O.Ps are further directed to pay a sum of Rs.50,000/-  towards the mental agony and sufferings caused to the complainant by them by delaying the process unnecessarily and the O.Ps are also directed to pay a sum of Rs.20,000/- to the complainant towards the litigation fee.

The order is to be complied within a month hence.

Order pronounced in the open Court on this the 19^th day of April,2022 under the seal and signature of this Commission.

                                                                                                                                                                                                                                                             Sri Debasish Nayak

                                                                                                                                    President

.                                                                                                                            

                                                                                                                         Sri Sibananda Mohanty

                                                                                                                            Member.