Orissa

Cuttak

CC/182/2021

Monali Priyadarsini - Complainant(s)

Versus

Exide Life Insurance Company Limited - Opp.Party(s)

Self

04 Feb 2023

ORDER

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

                                             C.C.No.182/2021

          Monali Priyadarshini,

         D/O:Late Sudhakar Mohapatra,residents of

         Village:Mangalasahi,PO:Daulatabad,

          P.S:Choudwar,Dist:Cuttack.                   ... Complainant.

 

          Vrs.

 

1.              Complaints Officer,

Exide Life Insurance Company Limited,

JP Techno Park,1^stFloor,No.3/1,

Millers Road,Bangalore-560001.

 

2.              Asst./Dy. Secretary,

                        Office of the Insurance Ombudsman,

                        At:62,Forest Park,Bhubaneswar-751009,

                        Dist:Khurda.

 

3.              Branch Manager,

Office of the Exide Life Insurance Company Limited,

                         Cuttack Divisiion,At:LinkRoad,P.S:Madhupatna,

                         Dist:Cuttack.

 

4.               SusantaSwain,Agent of this Insurance,

Code No.60410060,C/O:Exide Life Insurance Company Limited,

                        At:LinkRoad,P.S:Madhupatna,

                          Dist:Cuttack.                                                                              ...Opp. Parties.

 

Present:            Sri Debasish Nayak,President.

                             Sri SibanandaMohanty,Member.

 

Date of filing:    03.11.2021

Date of Order:  04.02.2023

 

For the complainant:            Mr. N.Rout,Adv. & Associates.

For the O.Ps.              :           None.

 

Sri Debasish Nayak,President                                                  

          Case of the complainant as made out from the complaint petition in short is that the complainant is an unmarried daughter and also legal heir of her deceased father.  The father of the complainant was a business man and being persuaded by the O.P no.4 had taken two Life Insurance Policies.  The deceased father of complainant made one policy bearing No.03810068 in the year 2018 and another policy no. 04216281 in the year 2020.  The policy premium amount was Rs.40,460/- in the policy no.03810068 which was paid one time per year.  In the policy no.03810068, the death benefit of Life Assured was Rs.25,00,001/- where the complainant was the nominee.  As per the complainant her father had good health but suddenly on 13.6.2020 at about 11.30 P.M he felt great pain in breathing for which his son had contacted a doctor of the nearest Hospital i.e.,Sreeram Hospital,Choudwar who after treatment had opined that he died due to Cardio-respiratory failure.Her mother informed about the same to O.P no.4after she obtained the death certificate of her father.  As per the suggestion of O.P no.4, the complainant had applied before O.P no.3 for the death claim benefit of her deceased father as per the policy rule by submitting the original policy bond alongwith other necessary documents but the O.P no.3 did not acknowledge the receipt of the same.But on 7.12.2020 the O.P no.3 rejected her claim application stating that the Life Assured had pre-existing medical condition which was not disclosed at the time of taking the insurance policy.Thereafter the O.P transferred a sum of Rs.1,22,277.36p by NEFT to the complainant which was only the premium amount paid by the deceased.Being dissatisfied with the claim amount as paid by the O.Ps, the complainant approached O.P no.2 with all necessary documents but no further action was taken by the O.P no.2 on her grievances.  It is for this, the complainant has filed this case before this Commission seeking a direction to the O.Ps to pay the assured money of Rs.25,00,001/- towards death benefit of Life Assured in policy no.03810068 and also to pay a sum of Rs.1,00,000/- for harassment and mental agony caused by them to her alongwith interest thereon @ 18% per annum.

          In order to prove her case, the complainant has filed copies of several documents alongwith her complaint petition.

2.       Having not contested this case, the O.Ps were set exparte vide order dt.9.1.2023.

3.       The points for determination in this case are as follows:

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?

To further her case, the complainant has filed written notes of submission and evidence affidavit here in this case, which, when perused, it is noticed that the contents are simply the reiteration of the averments of the complaint petition and nothing else.

Point no.II.

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

          Admittedly, the father of the complainant was a business-man and being persuaded by the O.P no.4 had taken two Life Insurance Policies.  The deceased father of complainant made one policy bearing No.03810068 in the year 2018 and another policy no. 04216281 in the year 2020.  The policy premium amount was Rs.40,460/- for the policy no.03810068 which was paid one time annually.  In the policy no.03810068, the death benefit of Life Assured was Rs.25,00,001/- where the complainant was the nominee.  As per the complainant, due to Cardio-respiratory failure her father had died on 13.6.2020 night even if he was treated by a doctor of Sreeram Hospital, Choudwar.  After obtaining the death certificate of her father, her mother informed about the same to O.P no.4.  As per the suggestion of O.P no.4, the complainant had applied before O.P no.3 for death claim benefit of her deceased father as per the policy rule by submitting the original policy bond alongwith other necessary documents, but the O.P no.3 had not responded.   On 7.12.2020 the O.P no.3 rejected her claim application stating that the Life Assured had pre-existing medical condition which was not disclosed at the time of obtaining the insurance policy.  Thereafter the O.P transferred a sum of Rs.1,22,277.36p through NEFT to the complainant which was only the premium amount as paid by the deceased.  Being aggrieved with the settled amount, the complainant had approached O.P no.2 with all necessary documents but no action was taken by the O.P no.2 on her grievances for which the complainant had to file this case before this Commission.  So the O.Psare found to be deficient in their service by not settling the  claim of the complainant as per the policy rule.  This point thus goes in favour of the complainant.

Points no.i& iii.

From the discussions as made above, the case as filed by the complainant is maintainable and the complainant is entitled to the reliefs as claimed by her.

                                                            ORDER

The case is allowed exparte against the O.Ps who are found to be jointly and severally liable here in this case.  Thus, they are directed to pay the assured sum of Rs.25,00,001/- to the complainant alongwith interest thereon @ 12% per annum with effect from13.6.2020 till the total amount is quantified.  They are also directed to pay a sum of Rs.1,00,000/- as compensation towards her mental agony and harassment within a period of 30 days from the date of receipt of copy of this order.

Order pronounced in the open court on the 4^th  day of February,2023 under the seal and signature of this Commission.    

                                                                                                                   Sri Debasish Nayak

                                                                                                                             President

         

 

                                                                                                                    Sri Sibananda Mohanty

                                                                                                                           Member