Orissa

Cuttak

CC/3/2022

Gobinda Chandra Moharana - Complainant(s)

Versus

Chief Executive Officer,India First Life Insurance Company Limited - Opp.Party(s)

B K Sharma & associates

12 Jan 2024

ORDER

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

C.C.No.03/2022

          Gobinda Chandra Moharana,

           S/o: Late Bishnu Charan Moharana,

At:Paikan,P.O:Somepur,Dist:Jagatsinghpur,

Presently residint At:Madhusudan Nagar,

P.O:Tulsipur,Dist:Cuttack.                                                  ... Complainant.

 

     Vrs.

 

1.       IndiaFirst Life Insurance Company Ltd.,

Represented by its Chief Executive Officer/Managing Director,

Registered Head Office:At-303,B Wing,

The Qube,Infinit Dindoshi,Film City Road,

                  Mumbai,State:Maharastra-400097.

 

2.       The Head of Claims and Financial Operations,

IndiaFirst Insurance Company Ltd.,

                At:12th  & 13^th  Floor,North(C) Wing,Tower-4,

Nesco IT Park,Nesco Center,

WesternExpress Highway,Goregaon(East),

                Mumbai,State:Maharastra-400063

 

3.       The Assistant Manager,

Customer Care, IndiaFirst Life Insurance Company Ltd.

                 At:12th  & 13^th  Floor,North(C) Wing,Tower-4,

Nesco IT Park,Nesco Center,

Western Express Highway,Goregaon(East),

                    Mumbai,State:Maharastra-400063.                                 ...Opp.Parties

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:    07.01.2022

Date of Order:  12.01.2024

 

For the complainant       :        Mr. B.K.Sharma,Adv. & Associates.

For the O.P.                      :         Mr. S.K.Mohanty,Adv. & Associates.

 

Sri Debasish Nayak,President

Case of the complainant as made out from his complaint petition in short is that the wife of the complainant had obtained a Monthly Income Policy Plan vide Policy no.70937980 on 18.3.2019 for an assured sum of Rs.50,00,000/- wherein the complainant was the nominee.  The said policy-holder Binati Moharana had died on 20.9.2020.  The complainant had intimated the O.Ps as regards to the death of his wife on 13.10.2020 which was due to cardiac arrest.  As such, death claim No.CN202010130104 was initiated but it was repudiated by the O.Ps which was communicated through their letter dt.29.1.2021 on the ground that the deceased assured had not answered  question no.15 of the proposal form  correctly and truthfully at the time of filling up the proposal form rather had given false information.  The complainant had tried his utmost to convince the O.Ps but when he could know that there would be no fruitful result, he had to approach before this Commission seeking the death claim amount of Rs.58,00,000/- towards the monthly income plan policy no.70937980 as obtained by his deceased wife together with a further amount of Rs.2,50,000/- towards compensation for his mental agony and also for any other order.

The complainant has filed copies of several documents alongwith his complaint petition in order to prove his case.

2.       All the O.Ps have contested this case and have filed their joint written version through their authorised officer namely Prasant Saini who has been working as Deputy Vice President for the O.Ps.  The O.Ps through their written version have admitted that the deceased policy-holder Binati Moharana had submitted her proposal form dated 18.3.2019 and had thereby obtained the Life Insurance policy from the O.Ps bearing No.70937980 on 23.3.2019.  But the said insured Binati Moharana had suppressed the facts that she had pearlier procured policies from ICICI Prudential Life Insurance Company through policies bearing No.33468664, 33469476 and 26945544 which were postponed in view of the Elevated Blood Sugar and Overweight.  On 13.10.2020 the O.Ps had received the death claim as they were intimated about the death of the policy-holder Binati Moharana who had expired on 20.9.2020.  The O.Ps could know that the policy-holder has suppressed the material particulars while filling up the proposal form with them but she had insurance policies from other insurance Companies worth of Rs.3,54,50,387/- i.e. to say for Rs.3.54 crores.  As such, it is prayed by the O.Ps that suppression of the material facts as desired to be disclosed hits the provisions of maxim “Uberrimai Fidei”.  At question no.15 of the proposal form of the O.Ps, it was desired to submit the true and complete information as regards to all the previous policies if have been already obtained but the deceased policy-holder had suppressed the same.  In this context, the O.Ps have drawn attention of this Commission towards the following decisions:

a.         Export Credit Guarantee Corporation of India Ltd. Vs. Garg Sons International 2013(1) SCALE 410

b.         Suraj Ma Ram Niwas Oil Mills (P) Ltd. Vs. United India Insurance Co. Ltd. [(2010) 10 SCC 567].

c.         Reliance Life Insurance Co. Ltd. Vs. Madhavacharya (Revision Petition No.211 of 2009).

d.         United India Insurance Co,. Ltd. Vs. HarchandRai Chand Raichandanlal I (2003) CPJ 393 & VikramGreentech (I) Ltd. & Anr. Vs. New India Assurance Co., Ltd. II(2009) CPJ 34.

e.         In the case of V.K. SrinivasaSetty V Premier LGI Co. (Mysore HC 1958) and upheld by Hon’ble Apex Court in Reliance Life Insurance Co. Ltd. & Anr. Vs. RekhabenNareshbhaiRAthod Civil Appeal No.4261 of 2019(Arising out of SLP © No.14312 of 2015).

                       f.          Oriental Insurance Co. Ltd. Vs. Munimahesh Patel, 2006(2) CPC 668(SC).

g.         UCO Bank Vs. S.D. Wadhwa in Revision Petition No.2479 of 2008 decided on 24.7.2013.

h.         Janta Machine Tools Vs. Oriental Insurance Co. Ltd. I (1991) CPJ 234(NC).

                         i.          Panalal Vs. Bank of India & Others II (1992) CPJ 487(NC).

 

The O.Ps admit through their written version that the sum assured to the policy-holder was of Rs.58,65,750/-.   The proposal to that effect was received on 18.3.2019 and the policy was accordingly issued on 23.3.2019.  The policy-holder had paid premium to the tune of Rs.10,00,000/-.  But since because the relevant material facts was suppressed by the deceased policy-holder, the death claim as made by the nominee/complainant was repudiated and as such the O.Ps through their written version have urged to dismiss the complaint petition as filed here in this case.

Together with the written version, the O.Ps have also filed copies of several documents in order to support their stand.

3.       Keeping in mind the averments as made in the complaint petition and the contents of the written version of O.Ps, 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 him?

Issue no.ii.

For the sake of convenience, issue no.ii  is taken up first to be considered here in this case.

After perusing the contents of the complaint petition, that of the written version, written notes of submissions as filed from either sides, evidence affidavit filed from the side of O.Ps as well as the documents available in the case record, it is noticed that the policy as obtained by the deceased policy-holder from the O.Ps is not in dispute.  The death of the policy-holder Binati Moharana is also not in dispute.  But the crux of the matter here in this case is that the O.Ps have harped upon the suppression of the material fact that the deceased policy-holder had not mentioned while answering to question no.15 of the proposal form towards the policy that if she had any previous policies.  It is for the said reason the O.Ps had repudiated the death claim of the complainant who is the nominee of the deceased policy-holder being her husband.  On perusal of the copy of the said proposal form which has been annexed as Annexure-I here in this case, it is noticed that at page-66 towards the bottom, the deceased policy-holder has answered the same affirmatively by ticking the column ‘yes’ and putting the “right mark” there, indicating that she has earlier policies and has mentioned details and have thus not suppressed any such material facts as alleged by the O.Ps.  Moreso, here in this case, one Prasant Saini working as Deputy Vice President of the O.Ps has filed the written version who claims to be the authorised signatory for the O.Ps.  Another Viral Joshi has filed evidence affidavit on behalf of the O.Ps claiming to be the authorised person for the O.Ps.  But the O.Ps have not filed any scrap of document here in this case to apprise this Commission that if by virtue of the resolution of the Board of Directors of the Company of the O.Ps, those two said persons were nominated as their authorised signatories and with such power, the said two persons have filed written version as well as the evidence affidavit respectively here in this case.  It is thus worthwhile to quote here a pertinent decision of our Hon’ble Apex Court in Civil Appeal No.2014 of 2011(Arising out of SLP( C) No.18179/2009, 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”.

          Keeping in mind the valuable findings of the Hon’ble Apex Court, when it is noticed that since because there is no document filed to show that Prasant Saini & Viral Joshi were authorized by the O.Ps to file evidence affidavit as well as written version on their behalf as their authorised signatories, the written version as well as the evidence affidavit as filed by the said Prasant Saini & Viral Joshi cannot be taken into consideration here in this case. 

Moreso, when it is noticed that the deceased policy-holder had actually not suppressed the material facts as alleged against him but had rather answered affirmatively to be having earlier policies, it can never be said as alleged by the O.Ps that she had suppressed the material facts.  Accordingly the repudiation as made by the O.Ps when the death claim was made by the nominee of the deceased policy-holder appears to be unilaterally and arbitrarily made by the O.Ps without proper application of mind.  Accordingly, this issue goes in favour of the complainant.

Issues no.i & iii.

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

                                              ORDER

Case is decreed on contest against the O.Ps who are found to be jointly and severally liable here in this case.  The O.Ps are thus directed to pay the complainant the claim amount of Rs.58,00,000/- with interest @ 12 per annum from the date of the claim i.e. from 13.10.2020 till the full amount is quantified.  The O.Ps are further directed to pay a compensation of Rs.2,50,000/- to the complainant towards his mental agony and harassment as well as litigation expenses.  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 12^th day of January,2024 under the seal and signature of this Commission.         

                                                                                         Sri Debasish Nayak

                                                                                                   President

 

 

                                                                                          Sri Sibananda Mohanty

                                                                                                            Member