Orissa

Cuttak

CC/159/2023

Basanti Sahoo - Complainant(s)

Versus

Managing Director,Tata AIA Life Insurance Company Co Ltd - Opp.Party(s)

S Jena & associates

05 Feb 2024

ORDER

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

C.C.No.159/2023

 

1.      Basanti Sahoo,

W/o: Late Rabi Narayan Sahoo.

 

2.      Liza Sahoo,

D/O: Rabi Narayan Sahoo.

 

3.      Sakhi Sahoo,W/O:Late Dhoba Sahoo,

M/O: Rabi Narayan Sahoo.

 

4.      Swadesh Arpita Sahoo,

D/O: Rabi Narayan Sahoo.

 

All are permanent residents of

At:Syamasundarpur,P.O:Saragada Mukundpur,

Via:Jenapur,Dist:Jajpur,

Presently residing and personally working for gain

At-G-168-170,Sector-6,C.D.A,

Cuttack-753014.                                                                  ... Complainants.

 

          Vrs.

 

1.     TATA AIA Life Insurance Company Ltd.,                                                                                                                                                     14^th Floor,Tower A,Peninsula Business Park,
     

Senapati Bapat Marg, Lower Parel,Mumbai-400013,

Represented its Managing Director,10^th Floor,Tower A,

Peninsula Business Park,

Senapati Bapat Marg,

Lower Parel,Mumbai-400013.

 

2.     Regional Manager,                                                    

TATA AIA Life Insurance Company Ltd.,

                      2^nd floor,Tulasi Complex,Opposit Amrit Ganga,

Panposh Road,Rourkella-769004.

 

3.     Branch Manager,

TATA AIA Life Insurance Company Ltd.,

First Floor,M/s. Royal Towers,

Link Road Square,Madhupatha,

                Cuttack-753010.                                                             ,,,Opp.Parties

 

 

Present:         Sri Debasish Nayak,President.

                      Sri Sibananda Mohanty,Member.

 

Date of filing:    17.05.2023

Date of Order:  05.02.2024

 

For the complainant:           Mr. S.Jena,Adv. & Associates.

For the O.Ps              :            Mr. S.K.Nanda,Adv. & Associates.      

 

Sri Debasish Nayak,President       

Case of the complainants as made out from his complaint petition in short is that they are all the legal heirs of the deceased policy-holder Rabi Narayan Sahoo who had obtained one Life Insurance policy from the O.Ps wherein the assured sum was of Rs.50,00,000/-.  The said Rabi Narayan Sahoo had died on 25.1.2021.  When the claim for the assured amount was made by the complainants, the O.Ps had repudiated such claim through their letter dated 7.2.2022 on the ground that the deceased policy-holder Rabi Narayan Sahoo had suppressed certain material facts without disclosing those while he was obtaining the said policy and was executing the proposal form.  Inspite of repeated persuasions, when the complainants could not get the assured sum of the deceased policy-holder through his insurance policy being the legal heirs of the said deceased; they have approached this Commission seeking the assured amount of Rs.50,00,000/- from the O.Ps together with another sum of Rs.3,00,000/- from the O.Ps towards their mental agony.  They have also prayed for a sum of Rs.30,000/- from the O.Ps towards their litigation expenses and have further prayed for any other relief as deemed fit and proper.

             Alongwith their complaint petition, the complainants have annexed copies of several documents in order to prove their case.

2.        The O.Ps have contested this case and have stated that the case of the complainant is not maintainable which is liable to be dismissed.  They admit to have issued one Life Insurance policy bearing no.C261713929 in favour of the deceased Rabi Narayan Sahoo who had died on 25.1.2021.  They have urged through their written version that when the death claim was made by the legal heirs of the said deceased policy-holder, they had repudiated the same through their letter dated 7.2.22 on the ground that the deceased policy-holder Rabi Narayan Sahoo was suffering from Chronic Kidney Disease and had undergone dialysis for the same prior to executing the insurance proposal form.  Thus, the O.Ps through their written version have urged to dismiss the complaint petition as filed by the complainants.

               The O.Ps have also filed copies of several documents in order to establish their stand.

               The complainants have filed evidence affidavit of the complainant Basanti Sahoo whose contents when perused appears to be a reiteration of the averments as made in the complaint petition.

               The O.Ps have also filed evidence affidavit through one Anupam Haldar working as AVP(Legal),East Zone in their company and when the contention of the evidence affidavit of said Anupam Haldar is perused, similarly it appears to be a reiteration of the contents as made in the written version of the O.Ps.

3.             Keeping in mind the averments as made in the complaint petition and the contents of the written version of O.P no.3, 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 complainants are entitled to the reliefs as claimed by them?

Issue no.ii.

Out of the three issues, for the sake of convenience issue no.ii  which is a pertinent issue, is taken up first to be considered here in this case.

               After perusing the contents of the complaint petition, written version of O.Ps, written notes of submissions as filed from either sides, evidence affidavits as filed from both sides as well as the documents available in the case record, it is noticed that admittedly, the deceased Rabi Narayan Sahoo had obtained one Life Insurance policy bearing no.C261713929 from the O.Ps wherein the assured amount was of Rs.50,00,000/-.  It is not in dispute that the present complainants of this case are all the legal heirs of the deceased policy-holder Rabi Narayan Sahoo.  It is also not in dispute that Rabi Narayan Sahoo had died while the policy as obtained by him was in force.  But the crux of the matter is that the O.Ps have alleged about the pre-existing disease as suffered by the policy-holder Rabi Narayan Sahoo who according to them had undergone dialysis as he was suffering from Chronic Kidney Disease.  On the said ground the O.Ps had repudiated the claim of the complainants through their letter dated 7.2.2022.

                The complainants do not admit such contention of the O.Ps as made.  In this context, while perusing the copies of documents as annexed by the O.Ps here in this case, it is noticed that actually the O.Ps have collected several documents indicating that the deceased policy-holder Rabi Narayan Sahoo was infact undergoing treatment as he was suffering from Chronic Kidney Disease for which he had undergone dialysis at Tata Steel Medica Hospital,Kalinganagar which was earlier to obtaining the policy from the O.Ps.  The complainants have not disputed such contention as well as the documents as filed to that aspect by the O.Ps.

                The Insurance Policy as obtained by the deceased Rabi Narayan Sahoo from the O.Ps undoubtedly is based upon certain terms and conditions of a contract.  Definitely, the policy-holder has to abide by the maxim “Uberimai fidei” and is under the obligation to disclose all the material facts relating to his diseases or ailments if any without suppressing those and about his health condition.  When in the present case, it is noticed that the deceased policy-holder Rabi Narayan Sahoo had indeed suppressed about his ailment of Chronic Kidney Disease and had not disclosed the same and that he had undergone dialysis, such non-disclosure rather suppression of material facts violates the principles of “Uberimai fidei” and the contract thus entered into for procuring the life insurance from the O.Ps cannot be considered to be a valid one.  Our Hon’ble Apex Court has also given several decisions in that manner.  Accordingly, when after due investigation, the O.Ps could know that the deceased policy-holder Rabi Narayan Sahoo was suffering from Chronic Kidney Disease and had undergone dialysis for the same, they had repudiated the claim of the complainants through their letter dated 7.2.2022 towards getting the assured value of the policy as obtained by  the deceased Rabi Narayan Sahoo and such act of the O.Ps cannot be termed here to be deficiency in their service in any manner.  Accordingly, this issue goes against the complainants.

Issues no. I & iii.

From the discussions as made above, the case of the complainants is not maintainable and the complainants are not entitled to any relief as claimed by them.

                                              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 5^th day of February,2024 under the seal and signature of this Commission.                                                                          

                                                                                                                                                                                            

                                                                                  Sri Debasish Nayak

                                                                                              President

                                                                                             Sri Sibananda Mohanty

                                                                                                      Member