Orissa

Cuttak

CC/135/2022

Rashmiprabha Pani - Complainant(s)

Versus

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

S Panda

20 Apr 2023

ORDER

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

C.C. no.135/2022

1.          Rashmiprabha Pani,

           W/O:Late Shri KamalakantaSuar,

           R/O:5F/822,Markat Nagar,

           Sector-9,CDA,Cuttack,Odisha-753014.                         ... Complainant.

 

2.       Archita Suar,

          D/O:Late Shri KamalakantaSuar,

           R/O:5F/822,Markat Nagar,

           Sector-9,CDA,Cuttack,Odisha-753014.

 

          Vrs.

 

1.       General Manager,

MAX LIFE INSURANCE COMPANY JPVT LTD.,

M/s. Royal Tower,Link Road Square,

Madhupatna,Opp. Madhupatna Police Station,

                  ​Cuttack,Odisha-753010.

                   2.General Manager,

 

      Max Life Insurance Company Ltd.,

      2^nd Floor,90A,Sector-18,Udhyog Vihar,

                          Gurugram,Gurugam Haryana-122015.                                                      ...Opp.Parties

 

Present:            Sri Debasish Nayak,President.

                           Sri SibanandaMohanty,Member.

 

Date of filing:    05.07.2022

Date of Order:  20.04.2023

 

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

For the O.Ps  :                               Mr. R.C.Panigrahi,Adv. & Associates.

 

Sri Debasish Nayak,President                                     

Case of the complainant bereft unnecessary details as made out from the complaint petition in short is that Late Kamalakanta Suar had obtained life insurance policy under the name and style “Max Life Flexi Wealth Plus” from the O.Ps and the sum assured in the said policy was of Rs.25,00,000/-.  The annual premium for the said policy was of Rs.2,50,000/- and the said first premium was paid by Late Kamalakanta Suar to the O.Ps having initiated the risk with effect from 15.7.2020.  The said Kamalakanta Suar happens to be the husband of the complainant no.1 and is the father of complainant no.2.  On 21.9.20, Kamalakanta Suar expired due to Covid-19 and his death certificate alongwith the claim application was filed by the complainants to the O.Ps.  But on 30.3.2021 the O.Ps had repudiated the claim of the complainants mentioning that Late Kamalakanta Suar had suppressed the material facts that he had heart diseases prior to obtaining his insurance policy.  It is for this, the complainants have come with this case before this Commission seeking the sum assured of Rs.25,00,000/- from the O.Ps towards the death of the insured Kamalakanta Suar alongwith interest thereon @ 9% per annum till the total amount is quantified.  They have also prayed for compensation of Rs.10,00,000/- from the O.Ps alongwith the litigation expenses with a further prayer for any other reliefs as deemed fit and proper.

Together with the complaint petition, the complainants have filed copies of several documents in order to prove their case.

2.       Both the O.Ps have contested this case and have filed their written version jointly.  According to the written version of the O.Ps, the case of the complainants as filed is not maintainable as they had rather suppressed the material facts.  The O.Ps admit about the policy of late Kamalakanta Suar bearing Policy No.602506446 in the name and style “Max Life Flexi Wealth Plus” wherein the sum assured was of Rs.25,00,000/- and the annual premium was of Rs.2,50,000/- out of which, the first annual premium was paid.  They also admit about the death of the insured Kamalakanta Suar on 21.9.2020 but they had repudiated the claim of the complainants as because the insured Kamalakanta Suar had heart diseases which he had not disclosed while obtaining the insurance policy from them.  Accordingly, they had refunded the premium amount of Rs.2,50,000/- as paid, to the legal representatives of the life assured on 25.3.2021.  It is for this, the O.Ps have prayed through their written version to dismiss the complaint petition with cost.

          Together with their written version, the O.Ps 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 version of the O.Ps, 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  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 in this case, is taken up  first for consideration.

Here in this case, it is not in dispute that the life assured Kamalakanta Suar had died on 21.9.2020 who had obtained a policy from the O.Ps for a sum assured of Rs.25,00,000/- and had paid the first annual premium of Rs.2,50,000/-.  After the death of the said Kamalakanta Suar, his wife Rashmiprabha Pani and daughter Archita Suar had applied for the sum assured of the policy of Kamalakanta Suar which was  obtained by Kamalakanta Suar during his life-time.  The said claim was repudiated by the O.Ps on the ground that the life assured Kamalakanta Suar had heart diseases and was having diabetes prior to obtaining the insurance policy from them;  which he had not disclosed.  According to the O.Ps, suppression of the material facts was the reason of their repudiation of the claim as made.  In order to establish their stand, the O.Ps have filed copies of several documents, which when perused, it is noticed that as per page-10 of their Annexures it is noticed that the O.Ps  through investigation could know that the life assured Kamalakanta Suar was diabetic since 2007 and was taking medicines.  He was affected by Covid-19 and had died for the same at Shrusti Hospital,Cuttack.  The O.Ps could also know that the life assured Kamalakanta Suar was taking medicines from Dr. Jayanta Panda prior to his death.  Quite interestingly, the O.Ps have not filed a single paper in order to justify that infact the life assured Kamalakanta Suar was a diabetic patient for which he was under treatment of Dr. Jayanta Panda and for the said reason he had died at Shrusti Hospital where he was also detected Covid-19.  As per the averments made in the written version of the O.Ps, they allege that the life assured Kamalakanta Suar had heart ailments prior to obtaining the policy from them which he had suppressed.  As per copies of documents, the said life assured Kamalakanta Suar was suffering from diabetes and had died at Shrusti Hospital,Cuttack where he was detected to be Covid-19 positive.  None of the documents of the O.Ps as filed reveal that the said Kamalakanta Suar had heart ailments.  That apart, there is no single document in order to establish that infact the life assured Kamalakanta Suar had heart ailments and was also diabetic prior to obtaining the policy from the O.Ps.  Though the O.Ps could know from their investigation that the life assured had died at  Shrusti Hospital,Cuttack who was  diabetic since 2007 for which he was taking medicine from Dr. Jayanta Panda.  But there is no single document to that effect filed by them.  The O.Ps have utterly failed to establish that the life assured Late Kamalakanta Suar had diabetes and heart ailments which were the cause of his death.  In this context, the complainant has relied upon a pertinent decision of the Hon’ble Apex Court in the case of Gokal Chand(D) through LRs Vrs. Axis Bank Ltd. and another, wherein their lordships have observed at page-19 that “the decision by the Insurance Company declining the policy by unilaterally refunding the insurance premium in the given circumstances, would suggest that the Respondent no.2 was deficient in rendering services to the appellant”.  It is also held therein that the activities of the Respondent no.2 show clear malafide attitude and ultimately, they had directed the Respondent no.2 therein to process the complainant’s insurance claim and remit the payable sum.  As it appears, the said decision is squarely applicable to the present case in hand.  It is because, the O.Ps have taken false and baseless pleas in order to avoid paying the sum assured to the legal representatives of the deceased Kamalakanta Suar, here in this case.  Thus, they are deficient in rendering service to the complainants and by not giving the legitimate claim amount of the complainants they have also practised unfair trade.  Accordingly, this issue goes in favour of the complainants.

Issues no.i& iii.

From the discussions as made above, the case of the complainants is maintainable and the complainants are definitely entitled to a reasonable amount of the reliefs as claimed by them.  Hence it is so ordered;

                                                          ORDER

          The case is decreed on contest against the O.Ps who are jointly and severally liable here in this case.  The O.Ps are thus directed to pay the complainants the assured sum of Rs.25,00,000/- alongwith interest @ 9%  per annum with effect from the date of repudiation, i.e., 30.3.2021 till the amount is quantified.  The O.Ps are also directed to pay a sum of Rs.2,00,000/- towards compensation alongwith cost of litigation of the complainants within a period of 30 days from the date of receipt of copy of this order.

Order pronounced in the open court on the 20^th day of April,2023 under the seal and signature of this Commission.           

                                                                                                                     Sri Debasish Nayak

                                                                                                                               President

 

 

 

                                                                                                        Sri Sibananda Mohanty

                                                                                                                           Member