Orissa

Cuttak

CC/181/2021

Smt Nirupama Mohapatra - Complainant(s)

Versus

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

N Rout & associates

25 May 2023

ORDER

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

C.C.No.181/2021

           Smt. Nirupama Mohapatra,

           W/O:Late Sudhakar Mohapatra,

           Residents of Vill:Mangalasahi,P.O: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: Khordha

 

3.      Branch Manager,

Office of the Exide Life Insurance Company Limited,

Cuttack Division,At:Link Road,

                  PS: Madhupatana,Dist:Cuttack

 

4.     SusantaSwain,Agent of this Insurance,

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

Cuttack Division,At:Link Road,

     PS: Madhupatana,Dist:Cuttack.                                                     ...Opp. Parties.

 

 

Present:            Sri Debasish Nayak,President.

                             Sri SibanandaMohanty,Member.

 

Date of filing:    03.11.2021

Date of Order: 25.05.2023

 

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

For the O.Ps no.1,3&4 :             None.

For the O.P no.2 :                          Self.

 

Sri Debasish Nayak,President

Case of the complainant as made out from the complaint petition in short is that her late husband had obtained two insurance policies bearing No.03810068 in the year 2018 and policy bearing no.04216281 in the year 2020.  The premium amounts of Rs.40,460/- and Rs.78,305/- respectively were paid as annual premium.  The policy assured sum asper the policy made in the year 2018 was of Rs.50,00,001/- and the complainant was the nominee in the said policy.  On 30.6.2020 at about 11.30 P.M the husband of the complainant expired due to cardiac respiratory failure and when the complainant applied for her death claim benefit being the nominee of her deceased policy holder husband, the O.P no.3 had rejected her claim on 7.12.2020.  The O.Ps had only returned the premium of Rs.76,339.18p in respect of the policy bearing No.04216281.  The complainant being frustrated had to file this case before this Commission seeking the assured policy amount of her deceased husband to the tune of Rs.50,00,001/- from the O.Ps and also compensation for a sum of Rs.1,00,000/- towards her mental agony and harassment alongwith interest @ 18% per annum.  She had also prayed for any other relief as deemed fit and proper.

          Together with her complaint petition the complainant has filed copies of several documents in order to prove her case.

2.       On the other hand, out of the three O.Ps as arrayed in this case, having not contested this case O.Ps no.1 & 3 have been set exparte vide order dt.31.5.2022.  The O.P no.2 however has filed his written submissions by way of affidavit wherein she has mentioned that the Ombudsman being a necessary party, this case is liable to be dismissed for mis-joinder of parties and that the case is not tenable in the eye of law.

          The complainant has filed her evidence affidavit wherein she has reiterated her averments as made by her in her complaint petition.

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

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

             After going through the complaint petition, submission as made by the O.P no.2 and the available documents in this case, it is an admitted fact that the deceased husband of the complainant was a policy holder had paid the premium amount of Rs.40,460/- relating to the policy bearing no.03810068 in the year 2018 and the assured amount in that policy was of Rs.50,00,001/-.  The death of the policy holder on 13.6.2020 is also not a matter of dispute.  As it appears from the repudiation letter of the O.Ps relating to the policy of the deceased husband of the complainant vide their letter dt.7.12.2020 addressed to the complainant of this case, it is mentioned therein that her claim application was repudiated since because the life assured had pre-existing medical condition which was not disclosed at the time of obtaining the policy.  That is to say, it is the contention of the O.Ps that there were certain pre-existing medical conditions which the life assured had not disclosed before them while opting for the insurance policy from them.  But none of the O.Ps have filed any scrap of paper in order to establish such plea as taken by them against the life assured.  Moreso, the O.Ps have not adduced any evidence in order to prove such plea as made by them.  Thus, in absence of any iota of evidence to the contrary, this Commission cannot jump to a conclusion that infact the life assured had pre-existing medical condition which he had not disclosed at the time of obtaining the insurance policy from the O.Ps and that it is for the said  pre-existing medical condition reason he had died.  Thus, in absence of such evidence and after considering the facts and circumstances of this case, this Commission comes to a conclusion that infact by repudiating the claim application of the complainant arbitrarily and unilaterally, the O.Ps were definitely deficient in their service towards the complainant.  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 undoubtedly maintainable and he is definitely entitled to the reliefs as claimed by him but ofcourse to a reasonable extent.

                                              ORDER

The case is decreed on contest against the O.P No.2 and exparte against O.Ps no.1 & 3.  The O.Ps who are jointly and severally liable here in this case are  directed to pay the complainant the assured sum of Rs.50,00,001/- towards the death liability amounts of the life assured under the policy bearing no.03810068 with interest thereon @ 18% per annum from the date of the claim till the total amount is quantified and also to pay a sum of Rs.1,00,000/- towards  compensation for her mental agony and harassment alongwith a sum of Rs.20,000/- towards the cost of  litigation of the complainant. 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 25^th day of May,2023 under the seal and signature of this Commission.          

                                                                                                                            Sri Debasish Nayak

                                                                                                                                       President

 

 

                                                                                                        Sri Sibananda Mohanty

                                                                                                                             Member