Orissa

Cuttak

CC/1/2020

Anita Das - Complainant(s)

Versus

Health India Assurance Co Ltd - Opp.Party(s)

B M Mohapatra

14 Aug 2024

ORDER

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

C.C.No.01/2020

 

Anita Das,

W/o: Rama Chandra Das,

At:Nimasahi,P.O:Buxibazar,

P.S:Purighat,Town & Dist:Cuttack,

PIN-753001.                                                                      ... Complainant.

 

          Vrs.

 

1.       Health India Assurance Co. Ltd.,

Neelkantha Corporate Park,

Office No.406 to 412,4^th Floor,

Korof Road/Village Vihar(W),

                 Mumbai-40086.

 

2.       The New India Assurance Co. Ltd.,

Link Road,Surya Vihar,

Arunodaya Market,Cuttack.

 

3.       The Branch Manager,

Eureka Forbes Limited,

Link Road,Cuttack.                                     ...Opp. Parties.

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:    01.01.2020

Date of Order:  14.08.2024

 

For the complainant:             Mr. B.M.Mohapatra,Adv. & Associates.

For the O.Ps 1 & 2    :             Mr. A.A.Khan,Adv. & Associates.

For the O.P No.3       :              None.

 

Sri Debasish Nayak,President

Case of the complainant as made out from the complaint petition in short is that she is the beneficiary mother of the deceased Ritesh Kumar Das who had died on 26.9.2018.  The said son of the complainant was in service under the Eureka Forbes Ltd.  when he had died and by that time, a Health Insurance policy vide Number 12030034180400000001 which was valid upto 1.3.2019 wherein the sum assured was of Rs.10,00,000/- was covering the health of the deceased Ritesh Kumar Das.  But when the death claim was putforth by the complainant before the O.P/insurers, who is the beneficiary mother of the deceased policy-holder, no response was received from them for which the husband of the complainant had issued a pleader’s notice to O.P no.1 on 17.9.2019. After running from pillar to post on several occasions, when the complainant failed to receive the assured sum, she had approached before this Commission seeking the assured sum of Rs.10,00,000/- from the O.Ps as well as all the medical expenses as incurred by her towards the treatment of her ailing son who had died subsequently, to the tune of Rs.4,11,160/-.  She has claimed a sum of Rs.50,000/- towards her mental agony and a further sum of Rs.50,000/- towards harassment to her and also another sum of Rs.20,000/- towards her litigation expenses.

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

2.       Out of the three O.Ps as arrayed in this case, having not preferred to contest this case, O.P no.3 has been set exparte vide order dated 20.4.2022.  However, O.Ps no.1 & 2 have contested this case and have filed their joint written version wherein they have stated that the case of the complainant is not maintainable which is liable to be dismissed as because the same is far from truth and is filed with oblique motives. They admit that a Flexi-Floater Mediclaim policy bearing number 12030034180400000001 which was issued by them in favour of Eureka Forbes Ltd. which was valid from 1.4.2018 to 31.3.2019 and it covered the risk of the deceased Ritesh Kumar Das.  According to the O.Ps, though  the deceased Ritesh Kumar Das had expired on 26.9.2018, the complainant had not lodged any claim before them.  Thus, settlement of any claim does not arise.  According to them, they were not aware as to when the complainant had submitted the documents for the claim and if she was the mother of the deceased policy-holder and nominee in that policy as obtained by the deceased policy-holder.  It is for those reasons, the O.Ps through their written version have urged to dismiss the complaint petition which according to them is illegal, arbitrary and unsustainable in the eye of law.

The O.Ps no.1 & 2 have also annexed copies of several documents with their written version in order to substantiate their stand.

The O.Ps have also filed evidence affidavit through one Girija Shankar Satpathy, working as Manager in their Company but the contents of the said evidence affidavit of Girija Shankar Satpathy when perused, the same appeared to be a reiteration of the contents of the written version only.

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 conclusion here in this case.

i.          Whether the case of the complainant is maintainable?

ii.         Whether there is 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.

On perusal of the complaint petition, written version, written notes of submission as filed from both the sides, evidence affidavit filed by the O.Ps 1 & 2 as well as the copies of documents available in the case record, it is noticed that undoubtedly the deceased  Ritesh Kumar Das was an employee of Eureka Forbes Ltd. and his health was covered under one Health Insurance policy obtained through O.P no.3 from O.Ps no.1 & 2 vide policy number 12030034180400000001 which was effective when the said Ritesh Kumar Das died on 26.9.2018.  It is not in dispute that the assured sum in the said insurance policy for the deceased was of Rs.10,00,000/-.  The contesting O.Ps in this case do not dispute that Ramachandra Das happens to be the husband of the complainant Anita Das.  As per the copies of documents annexed by the complainant together with her complaint petition, it is noticed that her husband Ramachandra Das had issued legal notice to the O.P. no.1 which was sent through registered post wherein it was requested for the disbursement of the insurance benefit vide policy number 12030034180400000001 which covered the health issues of his son Late Ritesh Kumar Das who had died on 26.9.2018 and was working under Eureka Forbes Ltd.  The O.Ps have not disputed regarding such issuance and receipt of the said legal notice dated 17.9.2019 as sent to them by the husband of the complainant in this case.  After getting such legal notice, they had remained silent without responding to it or disputing the insurance claim as made for the deceased policy-holder Ritesh Kumar Das.  The said legal notice also signifies that the O.Ps were well aware of the insurance claim as made for the deceased policy-holder Ritesh Kumar Das.  Thus, the plea of the O.Ps as taken subsequently while filing their written version that they were not aware about the claim if made for the deceased policy-holder appears to be afterthought and the same also clearly signifies their motive and attitude.  Such unwarranted behaviour and attitude of the O.Ps as noticed clearly unravels the ill-intention not to settle the genuine claim as and when made by this way or the other.  It is because, they do not dispute that Rama Chandra Das is the husband of the complainant Anita Das and as per the copy of Death Certificate of the deceased Ritesh Kumar Das, Rama Chandra Das is his father.  Thus, undoubtedly Anita Das is the mother of the said deceased Ritesh Kumar Das and also the beneficiary of the insurance policy which covered the health issues of her deceased son Ritesh Kumar Das.  Thus, considering the facts and circumstances of this case, this Commission comes to an irresistible conclusion that infact there was gross deficiency in the service of the O.Ps of this case who had not settled the insurance claim of the complainant with a malafide intention.  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 definitely maintainable and she is thus entitled to the reliefs as claimed by her from the O.Ps here in this case.  Hence it is so ordered;

ORDER

The case is decreed on contest against the O.Ps no.1 & 2 and exparte against O.P no.3.   The O.Ps are found to be jointly and severally liable here in this case.  The O.Ps are thus directed to settle the insurance claim of the complainant for an amount of Rs.10,00,000/- with immediate effect.  The O.Ps are also directed  to pay the complainant a sum of Rs.1,00,000/- towards  compensation for her mental agony and harassment as well as a sum of Rs.20,000/- towards her 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 this the 14^th day of August,2024 under the seal and signature of this Commission.         

                                                                                      

                                                                                      Sri Debasish Nayak

                                                                                              President

 

 

                                                                                          Sri Sibananda Mohanty

                                                                                                      Member