DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

KANDHAMAL, PHULBANI.

                                                     C.C.NO.05 OF 2018

Present:  Miss Sudhira Laxmi Pattnaik   - President I/c

                Sri Purna Chandra Tripathy   - Member.

Jaya Prakash Narayan Mishra, aged 38 years.

S/O: Late Ramesh Chandra Mishra

At: Nuagan PO: Biswanathpur Via: Sakhigopal

Dist: Puri.

At present

At: Nandikhandi Sahi

PO/PS: Phulbani Town

Dist-Kandhamal                                 ………….      Complainant.

                         -Versus-

1. Divisional Manager,

Life Insurance Corporation of India

Divisional office, Berhampur

AT: Jeevan Prakash, Khodasingi PO: Berhampur

Dist: Ganjam, PIN-760010.

2. Branch Manager,

Life Insurance Corporation of India

Chatrapur Branch

 At/PO- Chatrapur, Dist: Ganjam.        …………….  Opp. Parties.

For the Complainant: Advocate Sri Monoj Kumar Sahoo & Associates.       

For the Opp-Parties: Advocate Sri B. K Mohanty, Phulbani.

Date of Order:  25^th February 2021.

The case of the complainant is that his deceased father Sri Ramesh Chandra Mishra  had a insurance policy under the OP No-2  bearing Policy No- 573821289 which commence from 28/02/2013 for a term of 15 years with half yearly premium of Rs 5953/-. The insured had deposited the premium till 23/03/2015 against the above policy. During the in force of the policy, the insured was died on dated 01/06/2015. After the death of the insured the complainant submitted the claim with the relevant documents as per the instruction of the OP No- 2. Despite of  that the OPs did not disburse the claim amount in favour of the complainant. So on dated 05/07/2017 the complainant sent a letter to the OP No- 1 through Registered Post with a request for settlement of the claim. Subsequently the complainant shifted to Phulbani in August 2017 and on dated 25/08/2017 the complainant sent a letter of his changing address to the OP No- 2 for further correspondence in the given address, but the OP No- 2 did not make any correspondence.  Result of which the present complaint filed by the complainant with a prayer for issue direction to the OPs for payment of the insured amount of Rs. 1, 50,000/- along with interest @ of 18% P.A from the date of filing to till the date of payment, further prayed for grant of litigation cost of Rs. 5,000/- and compensation of Rs. 20,000/- in his favour.

Accordingly the complaint was admitted and issued notice to the OPs for appearance and filling of version.  On receipt the notice the OPs appeared through their counsel and filed their written version.  The OPs  denied the allegation made by the complainant and justified the repudiation of the claim stating the  ground that the “death occurred within 3 years from the date of commencement of the Policy , as per the established rules and procedure claims were investigated to establish the genuiness of the claim and during the process of investigation it was found that the deceased life assured had suppressed the material information as regard his suffering / treatment and deliberately suppressed it and not disclose at the time taking the policy with an intent to defraud  the corporation” . In order to establish their stand the OPs submitted some relevant papers (i) Copy of Proposal Form (ii)          Policy Bond (iii) Certificate of Executive Engineer RWSS, Mechanical Division, Bhubaneswar .(iv) Prescription of Gopinath Hospital, Sakhigopal dated-12/03/2012 & 20/04/2012 and Pathology report of dated 23/03/2012.

During the course of hearing the counsel for the OPs submitted that deceased life assured had deliberately suppressed material information as regards of his illness /treatment at the time of taking the policy with an intention to defraud the Corporation. The counsel for the OPs also tried to bring the attention of the commission that the deceased policy holder answered the questions from 1 to 3 as “No” in the proposal form and claim for dismissal of the complaint.

We heard both the counsel for the parties in length, peruse the entire evidence advanced by the counsels in their support. It is clearly evident that the insured Sri Ramesh Chandra Mishra was suffering from Typhoid along with other diseases and he was on leave from 01/03/2012 to 31/05/2012 as per the report of the employer in claim form “E”. The insured was under continuous treatment at Gopinath Hospital Sakhigopal, Puri vide O.P.D No.1842 dated 12/03/2012, O.P.D No.2839. It is also found that the complainant made an appeal before the Zonal Manager L.I.C of India, Patna against the repudiation of claim dated 07/08/2017.

We relied upon the decision of Hon’ble Supreme court of India in Civil Appeal No. 3397 of 2020(arising out of SLP (C) NO.10652 0F 2020) Branch Manager vrs. Dalbir Kaur, the apex court held that “the contracts of insurance including the contract of life assurance are contracts “uberrima fides” and every facts of material must be disclosed otherwise, there is good ground for recession of the contract. If there are any mis- statements or suppression of material facts, the policy can be called in question.”  From the forgoing discussion, we do not find any negligency and deficiency in service on the part of the OPs. Hence order.

ORDER

The case of the complainant is dismissed against the OPs with no cost.  Order pronounced in the open court today the 25 the day of February 2021.

Accordingly the C.C disposed off.  Free copy of this order be supplied to the parties.

MEMBER                                                                  PRESIDENT