Orissa

Cuttak

CC/83/2021

Sanjay Kumar Swain - Complainant(s)

Versus

Max Life Insurance Co Ltd - Opp.Party(s)

S K Mishra & associates

15 Jul 2023

ORDER

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

C.C.No.83/2021

          Sanjay K. Swain,

           S/O: Prafulla Kumar Swain,

           Niladrivihar,Chauliaganj,

           Nayabazar,Cuttack,Odisha.                                       ... Complainant.

 

          Vrs.

 

1.      Max Life Insurance Co. Ltd.,

At:Plot No.90A,Sector-18,Gurugram-122015,

                 Haryana.

 

2.      Max Life Insurance Co. Ltd.,

Having its registered office at:419,

Bhai Mohan Singh Nagar,

                 Railmajra,Tehsil Balachaur,Dist-Nawanshahr,

​                 Punjab-144533.

3.      Axis Bank Ltd.,

Mahanadi Vihar,Cuttack,

Represented through its Branch Head.                                                       ...Opp. Parties.

 

 

Present:            Sri Debasish Nayak,President.

                             Sri SibanandaMohanty,Member.

 

Date of filing:   20.04.2021

Date of Order:  15.07.2023

 

For the complainant:                   Mr. S.K.Mishra,Adv. & Associates.

For the O.P no.1& 2    :             Mr. PR.C.Panigrahi,Adv. & Associates.

                 For the O.P no.3:                         None.    

Sri Debasish Nayak,President.

Case of the complainant bereft unnecessary details as made out from the complaint petition in short is that Anand Swain, brother of the complainant had obtained four number of Life Insurance policies from the O.Ps no.1 & 2 vide policies bearing no.565208865,568629075,600455117 & 602467268 through seller of O.Ps no.1 & 2 who is O.P no.3 in this case.  Thus, the said Anand Swain had availed the services of the O.Ps no.1 & 2 in the year 2018 for three number of policies and one of the policy was obtained in the year 2019.  Anand Swain was admitted as a patient to Shanti Memorial Hospital on 9.1.19 but unfortunately,he had passed away on 10.1.19.  The complainant being the nominee in policies bearing no.201917501032&201917501030 had applied for the claim amount thereof but on 24.9.19 the Deputy Manager of the O.Ps had sent a letter to the complainant repudiating the claims as made with an endorsement that the life insured i.e. Anand Swain was suffering from chronic liver disease prior to executing the proposal form.  The complainant has mentioned in his complaint petition that prior to entering into those policies, his brother Anand Swain had undergone medical check-upby the empanelled doctor of the O.Psto which the authorized agent/seller of the O.Ps was witnessed.  The said agent/seller O.P no.3 had given a declaration wherein it was mentioned that the said insured “Anand Swain does not suffer from any physical and mental abnormalities or handicapped or had been hospitalised/undergone any surgery or treatment……….”.  The policies were thereafter granted in favour of Anand Swain after the said medical check-up.  Thus, according to the complainant, such repudiation of the claim was malafide in nature only to harass him mentally and physically.  The complainant had sent legal notices to that effect dt.21.10.19 and 22.10.19 to the O.Ps.  When the things could not materialise inspite of repeated persuasions by the complainant, he had approached this Commission claiming the matured value of the policy bonds issued in favour of his deceased brother Anand Swain to the tune of Rs.75,46,516/- together with a sum of Rs.20,00,000/- towards his mental agony from the O.Ps.  He has also prayed for interest on the maturity amount @ 18% per annum since from the date of his brother Anand Swain had died and also he has requested to pass any other reliefs as deemed fit and proper.

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

2.       Out of the three O.Ps as arrayed in this case, O.P no.3 having not preferred to contest in this case, he has been set exparte vide order dt.21.4.202.  However, O.Ps no.1 &2 having contested this case have filed their joint written version wherein they have mentioned that the case of the complainant is not maintainable.  They admit about the four number of policies as obtained by the deceased Anand Swain who is the brother of the present complainant.  They also admit about the policy holder Anand Swain to have expired on 10.1.19 and thaton 3.1.19 the last policy was obtained by the deceased policy holder Anand Swain.  The O.Ps no.1 & 2 through their written version have urged that the complainant had suppressed the material facts by not disclosing that his deceased brother Anand Swain was suffering from chronic liver disease.  From the abdomen sonography test of the deceased life assured done on 1.5.2018, it was made out that he had chronic hepatic parenchymal disease, Minimal Ascites & splenomegaly.  Again in 6.12.2018 from the ultrasound of the Abdomen & Pelvis report of the deceased life assured Anand Swain it was revealed that he had cirrhosis of liver, Dilated PV + SV + Moderate Splenomegaly + Moderate to Gross ascites (Portal Hypertension).  On 18.9.18, the said life assured Anand Swain had visited SCB Medical College & Hospital where he was diagnosed to be having Hepatitis positive which is an inflation of liver caused by infection with the Hepatitis E virus.  Thus, due to such medical findings, the O.Ps had repudiated the claim of the complainant when he had put forth his claim being the nominee of his brother the deceased life assured Anand Swain.  Accordingly these two O.Ps have prayed to dismiss the complaint petition with exemplary cost.

          Alongwith their written version, the O.Ps no.1 & 2 have also filed copies of several documents in order to prove their stand.

3.       Keeping in mind the averments as made in the complaint petition and the contents of the written versions of the O.Ps no.1 & 2, 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 was any deficiency in service on the part of the O.Ps  and if they have practised any unfair trade ?

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 is taken up  first for consideration here in this case.

After perusing the contents of the complaint petition, that of the written version and also after perusing the copies of several documents as available in this case record, it is noticed that admittedly Anand Swain, the deceased life assured had obtained four number of policies from the O.Ps no.1 & 2 and the said life assured had expired on 10.1.2019.  He had obtained his last policy on 3.1.2019.  It is also not in dispute that the complainant Sanjay Kumar Swain is the brother of the said deceased life assured Anand Swain.  Admittedly, the claim for the assured amount of the policies of the deceased brother Anand Swain were claimed by the present complainant which was repudiated by the O.Ps no. 1 & 2.  It is the contention of the complainant that prior to executing the proposal form for the policies, the deceased life assured was medically examined through the agent/seller  of the O.Ps no.1 & 2, who is O.P no.3 in this case.  According to the complainant, after clinically examining his brother Anand Swain through the empanelled doctor of the O.Ps no.1 & 2, O.P no.3 had given a declaration that the proposer/life assured (Anand Swain) do not suffer from any physical or mental abnormality etc.  Per contra, the O.Ps no.1 & 2 have urged that prior to executing the proposal form, the deceased life assured Anand Swain had several ailments/diseases which they could know from their enquiry and these ailments being much earlier to the execution of the proposal form by Anand Swain, according to the O.Ps no.1 & 2, the said Anand Swain had suppressed the material facts and had obtained the policies fraudulently.  To justify their averments, the O.Ps no.1 & 2 have filed all the relevant documents to that effect which ofcourse reflect that the deceased life assured Anand Swain had been to several tests and had gone as a patient to the SCB Medical; College & Hospital,Cuttack prior to entering into the proposal form for the policies as obtained by him from the O.Ps no.1 & 2 and the copies of documents as filed by the O.Ps reflect the series of ailments/diseases of the said deceased life assured Anand Swain which were much prior to his obtaining the said insurance policies.  It is the contention of the complainant that the O.P no.3 is the agent/seller of O.Ps no.1 & 2 and before getting the proposal from his brother Anand Swain the said O.P no.3 had clinically examined his brother Anand Swain through the empanelled doctor of O.Ps no.1 & 2 and could know that Anand Swain had no physical ailments/abnormalities. This contention of the complainant that his brother Anand Swain was examined by one empanelled doctor of the O.Ps no.1 & 2 has not been amply proved here in this case since because, the complainant has not filed any scrap of document to that effect.  There is also no document placed before this Commission by the complainant in order to apprise that infact the O.P no.3 had acted as the agent/seller of O.Ps no.1 & 2 and thereby had executed the proposal form with his deceased life assured Anand Swain for obtaining the insurance policies for him.

When it is made out that the deceased life assured Anand Swain had infact certain serious ailments/diseases much prior to obtaining the insurance policies from the O.Ps no.1 & 2; who had expired on 10.1.2019 i.e., seven days after obtaining the last policy from the O.Ps no.1 & 2 on 3.1.19; by repudiating the claim of the complainant, the O.Ps cannot be found to be deficient in their service by considering the facts and circumstances of this case which are supported with valid copies of medical evidences.Accordingly, this issue goes in favour of the O.Ps.

Issuesno.i&iii.

From the discussions as made above, the case of the complainant is not maintainable and the complainant is not entitled to the reliefs as claimed by him.

                                              ORDER

Case is dismissed on contest against the O.Ps 1 & 2 and exparte against O.P no.3 and as regards to the facts and circumstances of the case without any cost.

Order pronounced in the open court on the 15^th day of July,2023 under the seal and signature of this Commission.          

                                                                        

                                                                                                        Sri Debasish Nayak

                                                                                                                  President

                                                                                                          Sri Sibananda Mohanty

                                                                                                                      Member