Orissa

Cuttak

CC/170/2019

Swarnalata Das - Complainant(s)

Versus

Divisional Manager,LIC of India - Opp.Party(s)

B N Udgata & associates

16 Feb 2023

ORDER

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

 

C.C.No.170/2019

 

              Mrs. Swarnalata Das,

W/O:LatePrabira Kumar Das,

At:Dakshinabandha,P.O:Sankuani,

Via:Mangalpur,Jajpur,Dist:Jajpur,

At present residing at

Chintamani Samantray Colony,

Gamadia,P.O:Buxibazar,

Town/Dist:Cuttack-1.                                         ... Complainant.

          Vrs.

 

1. The Divisional Manager,

LIC of India,Cuttack Divisional Office,

At:Nuapatna,P.O.Box No.36,

                   PO-Buxibazar,Town/Dist-Cuttack-753001

 

2. The Branch Manager,

LIC of India,Jajpur Town,

           At/PO-Jajpur,Dist-Jajpur

 

3. The Grievance Redressal Officer,

The Grievance Cell,

LIC of India,

ED(CRM) LIC of India,

                4^th floor,Yogoshema JB Marg,

                    Mumbai-21

4. Insurance Ombudsman,

Office of the Insurance OMBUDSMAN,

62, Forest Park,

                   At/Po- bhubaneswar,Dist-Khurda                                                                       ...Opp. Parties..

 

Present:            Sri Debasish Nayak,President.

                             Sri SibanandaMohanty,Member.

 

 

 

Date of filing:    27.12.2019

Date of Order:  16.02.2023

 

For the complainant:            Mr. B.N.Udgata,Adv. & Associates.

For the O.Ps no.1,2 & 3     : Mr. R.K.Pattnaik,Adv. & Associates.

 

Sri Debasish Nayak,President.  

Case of the complainant as made out from the complaint petition in short is that her late Husband Prabira Kumar Das during his life time had obtained two number of LIC policies from the O.Ps  which are New Janarakshya policy bearing no.598918038  and New Bima Goldunder policy no.598586771.    During the subsistence of the said two policies, her husband had expired but the O.Ps when asked to settle the claim as made by the complainant,  had repudiated her claim without paying the assured sum of Rs.50,000/- in policy no.598918038    dt.28.06.2012 and also a sum of Rs.1,00,000/- in policy no.598586771 dt.28.11.2011.  In the said two policies of Late Prabir Kumar Das, the complainant being his wife was the nominee.  The premium amount for the said two policies were to be paid @ Rs.709/- till 28.3.2033 and @ Rs.1322/- till 28.8.2031.  The premiums were being paid regularly by the late husband of the complainant but inadvertently he could not pay some of the instalments for which the said two policies had lapsed but subsequently he had revived the said two policies from 9/2012 to 12/2013 in respect of policy no.598918038 and from 11/2012 to 2/2014 in respect of policy no.598586771.  The late husband of the complainant suffered from cancer which was detected on 16.3.2016 and he died on the said date.  After the obsequies were observed, the policy papers were submitted by the complainant to the O.Ps for settling the policy claims.  The O.P no.1 through his letter had intimated the complainant on 30.4.16 that the deceased life assured was suffering from Gall-bladder Carcinoma with impression “port site tissue shows Aden carcinomatous deposits” as per the histo-pathology report of Patholab, Mangalabag,Cuttack on 4.3.2014 and reported on 8.3.14 by Dr. Rabi Narayan Mallick,MD.Consultant.  The complainant has sent letters to the O.Ps for reconsideration of her claim but her claim was repudiated by them under reference no.ECZO/CRM/CDRC/CUT(16-17) dt.30.1.2017.  The complainant had also contacted the Ombudsman in this aspect and ultimately when no fruitful result had yielded, she had filed this case before this Commission seeking from the O.Ps the sum assured in both the two policies to the tune of Rs.1,50,000/- together with interest thereon and further a sum of Rs.50,000/- towards her mental agony, a sum of Rs.50,000/- towards her litigation expenses andfurther compensation of Rs.50,000/- .  In this manner the complainant has sought for a sum of Rs.4,50,000/- from the O.Ps.

          In order to prove her case, she has filed copies of several documents including the copy of the repudiation letter and copies of the insurance policies together with the death certificate copy of her late husband alongwith her complaint petition.

2.       The O.Ps have contested this case and have filed their written version jointly.According tothe written version of O.Ps no.1,2 & 3, the case of the complainant is not maintainable, barred by law of limitation, this Commission lacks territorial jurisdiction since the insurance policies as obtained were from Jajpur branch.  Ofcourse, the O.Ps have admitted about both the two policies of the deceased/assured wherein the sum assured for policy no.598918038 was of Rs.1,00,000/-and the sum assuredin policy no.598586771 is of Rs.50,000/-.  They also have stated about the revival of the said two policies which had lapsed.  The life assured had declaredabout his good health during the revival of the said two policies.  It is the contention of the O.Ps through their written version that after getting the claim application of the complainanton discreet examination they could know that the life assured was suffering from gall-bladder Carcinoma prior to revival of his two policies which came to their knowledge through the report of the Patholab of Mangalabag,Cuttack and was confirmed by Dr. Rabi Narayan Mallick,Consultant.  Thus, it is the contention of the O.Ps that when the deceased/assured had given declaration about his good health but was suffering from gall-bladder Carcinoma, they had repudiated the two policy claims of the complainant through their letter dt.30.9.16.  The O.Ps have alleged about the suppression of material facts by the deceased assured and the complainant as well .  Accordingly, the O.Ps have urgedthrough their written version to dismiss the complaint case as filed by the complainant.In order to support their case, they have filed various copies of documents in the like manner.

3.       Keeping in mind the averments as made in the complaint petition and the contents of the written version of the O.Ps, this Commission thinks it proper to settle the following issues in order to arrive at a definite conclusionhere 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 her?

Issue no.II.

Out of the three issues, issue no.ii  being the pertinent issue is taken up  first for consideration here in this case.

          After going through the averments as made from either sides in this case through complaint petition and written version as well, one thing is noticed that infact the deceased husband of the complainant late Prabira Kumar Das had obtained two LIC policies which were revived after being lapsed, by making payments of the premiums and thus were made active.  The saidPrabir Kumar Das had expired during the subsistence of the said two policies.  The claim was put-forth by the complainant before the O.Ps as regards to the said two policies but were turned down by the O.Ps on the ground of suppression of material facts that the deceased husband of the complainant who was the life assured in the said two policies, was suffering from gall-bladder Carcinoma which they could know after a discreet  enquiry.  Be that as it may, the death of Prabir Kumar Das is not in dispute here in this case.  The subsistence of the two policies of the Prabir Kumar Das is also not in dispute but the O.Ps dispute that the deceased/assured had suppressed thathe was suffering from gall-bladder Carcinoma which they could know later  on their discreet enquiry after getting the claim application from the nomineewife, who is the complainant in this case.  The complainant has stated that her husband had died due to cancer on 16.3.2016 which was detected on the same day only.  On perusal of the copies of the documents as annexed to the written version of O.Ps no.1,2 & 3, it is noticed that the deceased policy holder Prabira Kumar Das had revived his aforesaid two policies on 20.3.14 by submitting fresh declaration about his good health.  But the report of the “Patholab” reflects the histo-pathology of Prabira Das that he had impression of “port site tissue shows Aden carcinomatous deposits” and the same was reported on 8.3.14.  Thus, by the time of reviving the two policies the deceased policy holder was aware about his Gall-bladder Carcinoma which he hadnot disclosed.  The repudiation of the claim of the complainant as made by the O.Ps No.1,2 & 3 was on the same ground and the complainant has not differed to thecontentions/observations as made by the O.Ps no.1,2 & 3 while repudiating her claim.  When it is made out thatthere was suppression of material facts which was intentionally not disclosed by the policy holder when he was reviving his two lapsed policies through O.Ps no.1,2 & 3, this Commission finds no deficiency in service on the part of the O.Ps here in this case.  Accordingly, this issue goes in favour of the O.Ps.

Issue no.i.

          The O.Ps no.1,2 & 3 through their written version have urged that this case is bad on the point of limitation.  On perusal of the case record and the documents as available therein, it is noticed that the said O.Ps had repudiated the claim of the complainant through their letter dt.29.3.17.  The complainant has approached this Commission by filing her complaint petition on 27.12.2019.  There is absolutely no explanation as regards to the delay in filing the complaint petition beyond the statutory period of two years.  Thus, it is also noticed that the case is bad on the point of limitation and accordingly, this Commission opines that the case of the complainant cannot be said to be maintainable.

Issue no.iii.

          From the discussions as made above, the complainant is not entitled to the reliefs as claimed by her.

                                              ORDER

Case is dismissed on contest against the O.Ps and as regards to the facts and circumstances of the case without any cost.

Order pronounced in the open court on the 16^th day of February,2023 under the seal and signature of this Commission.  

                                                                        

                                                                                                   Sri Debasish Nayak

                                                                                                                                            President

Sri Sibananda Mohanty

                                                                                         Member