SMT M.PADHI, MEMBER……..             The brief history of case is that, the late husband of complainant had procured two number of insurance policies vides policy no.1) 573330895 in the name of Minati Tripathy, nominee is Debendra Sahu, dt.of commencement was 27.08.2011, premium of Rs.919/- quarterly, sum assured of Rs.75,000/- & another Policy no.573339603 in the name of Debendra Sahu, whereas nominee is Minati Tripathy, the present complainant, dt.of commencement was 15.10.2012, premium of Rs.766/- quarterly, sum assured is Rs.62,500/- respectively. The counsel for complainant contends that, as the policy holder was a conductor of private bus and due to his ill health and bedridden he could not deposit some premium of one policy bearing no.573330895. He further contends that the deceased policy holder ailing seriously admitted at Indus Hospital, Visakhapatnam during the month of January’2015, where the doctor found cancer and due to financial crunches he was admitted at Acharya Harihara Regional Cancer Centre, Cuttack but unfortunately he died on 22.12.2015 at Nabarangpur. Moreover the complainant herself suffered from two critical diseases one is in her heart and another is tumor in her breast, however having financial difficulties and help from her relatives she did her open heart surgery at Appolo Hospital at Visakhapatnam and made breast surgery at Christian Hospital at Nabarangpur. That though the complainant was under continuance medical treatment and severe mental and financial hardship could not submit her claim in time but at later stage she filed her claim application along with required document before the OP.no.1 but the OP.1 though supplied claim form for one policy but bluntly repudiated her claims. So he contends that the action of OP.s is illegal which amounts to deficiency in service, hence he contends that due to the inaction and arbitrary manner of OP.s she sustained mental, physical and financial losses, so he prayed before the forum for the assured amount of both policies along with Rs.50,000/- as compensation and Rs.5000/- as cost.

2.         The counsel for OP.s filed his counter and averred that, the policy no.573339603 was issued in favour of Debendra Sahu under Plan 165-16 for sum assured of Rs.75,000/- with quarterly premium of Rs.766/- maturing on 15.10.2028 but the another policy no.573330895 was issued in favour of the present complainant and as the complainant is alive no death claim has arisen against the policy. Furthermore under the policy no. 573339603, the present complainant is the nominee and under policy no.573330895, issued against Minati Tripathy and the deceased Debendra Sahu was the nominee. He further submitted that, the complainant stated that the DLA had gone for treatment from Jan’2015 and found cancer in the month of Feb’2015, but the DLA revived the policy on 24.02.2015 stating sound health. He contends that the DLA was treated on 16.10.2014 as OPD patient vide No.9333 at Acharya Harihar Regional Cancer Center, Cuttack and the deceased treated under Chemo there from 12.10.2014 to 30.01.2015 for his cancer, and revived the policy on 24.2.2015 with sound health, and as the complainant suppressed the material facts at the time of revival of the policy on 24.2.15 the present claim was repudiated as per the above grounds.

3.         The counsel for complainant has filed certain relevant documents along with an affidavit in support of his claim. On the other hand the counsel for OP.s also filed copy of some documents along with an affidavit in support of his claim. Case heard from both sides at length and perused the record.

4.         From the above submissions, it reveals that, the deceased policy holder had procured two number of insurance policies vides policy no. 1) 573330895 name of policy holder Smt Minati Sahu @Tripathy dt.of commencement was 27.08.2011 premium Rs.919/- quarterly, sum assured of Rs.75,000/- & another Policy no.573339603 in favour of Debendra Sahu, dt.of commencement was 15.10.2012 premium of Rs.766/- quarterly, sum assured is Rs.62,500/- and the present complainant is the nominee respectively. We are not inclined to concentrate the first policy bearing no. 573330895 in the name of Smt Minati Tripathy, as she is alive and filed the present lis, wherein the nominee was her husband late Debendra Sahu.

5.         However as far as Policy no.573339603 is concerned, without going to the unwarranted details it is seen that, the DLA deceased life assured had procured the policy on dt.15.10.2012 appointing nominee to his wife i.e the present complainant and revived/deposited the up to date premium until 24.02.2015 and thereafter the policy holder Debendra Sahu died on 22.12.2015 at Nabarangpur suffering from cancer. Later the complainant also gone through scanner of two severe operations i.e open heart surgery at Appolo hospital and also did breast surgery to remove tumor at Christian hospital at Nabarangpur. The complainant admitted that, going through agonize due to the death of her beloved husband and after two severe operations in her body she could not deposited the premiums for some subsequent quarters and also could not file claim application in time. But on later stage facing financial hardship she filed the claim form along with required documents before the OP.s, but the OP.s repudiated her claim on a plea of pre existing diseases and for suppression of material facts. The counsel for OP.s vehemently contends that the DLA for policy no. 573339603 was admitted at Acharya Harihara Regional Cancer Center, Cuttack on 10.10.2014 and until 30.01.2015 he was under treatment of Cancer with Chemotherapy there. So he contends that the OP.s legally repudiated the claim of complainant basing on documentary evidences. It is pertinent that the deceased policy holder had commenced the policy on dt.15.10.2012 and got suffered from cancer in the year 2014 i.e. later 02 years of commencement of his policy since there was no evidence submitted by the OP.s that the DLA had any symptoms of cancer etc prior to commencement of the policy. But the OP.s repudiated the claim taking vogue plea of suppression of material facts basing on documentary evidences during the year 2014 which cannot be acceptable in accordance of law. Hence it is crystal clear that the deceased policy holder had proposed the said policy with good and sound health in the year 2012.

6.         It is further seen that,  according to I.R.D.A. guidelines the basic concept of life insurance is to provide protection to the continuous livelihood of the dependents of the life insured. It shall not be treated as investment or savings. It is a means of providing an instant estate for the survivors on the death of an insured person or head of the family or the earner of the family. Ordinarily when the earning member of a family dies, the cash flow which was the basic of livelihood of non earning dependent collapses, and the basic needs and dignity of the dependents is shattered for day to day survival. Life insurance is thus opted, for protection of the family members from financial disasters, on the death of the bread earner insured.

7.         We also observed in most of the cases that the OP.s being oldest insurance company of the great nation having its penal doctors along with attractive assurances collecting premiums from the policy holders directly or through their agents at the time of proposal ignoring health condition of the policy holder but at the time of claim they outrightly repudiated the claims taking one plea or the other of pre existing disease and suppression of material facts. They shall have properly examined the present health condition of policy holder at the time of commencement of the policy prior to take the premiums. In the instant case the DLA being an uneducated serving as a conductor in a private bus having his less knowledge signed the proposal where the agent shows.   

8.         However in our view the OP.s repudiated a genuine claim with a vogue plea of suppression of material facts and non disclosure of pre existing diseases, which the complainant is lawful beneficiary and entitled for the assured sum. Hence we feel that the action of OP.s in the entire transaction is highhanded, unscrupulous and unfair which amounts to deficiency in service and for which illegal action the complainant going through financial crunches deprived of to get her legitimate monetary benefits, hence the OP.s found guilty under the provisions contemplated in the C.P.Act 1986.

                                                             ORDER

i.          The opposite parties 1 & 2 supra are severally & collaterally hereby directed to pay the sum assured as agreed in policy no. 573339603 i.e. Rs.62,500/- (Rupees Sixty two thousand & five hundred) deducting the unpaid premiums, inter alia, to pay Rs.10,000/-(Fifteen thousand) as compensation and a sum of Rs.5000/-(Five thousand) towards the cost of litigation to the complainant.

ii.         All the above directions shall be complied with in 30 days of receipt of this order, failing which, the total sum will bear 12% interest per annum till its realization. Pronounced on this the 09th day of April' 2018.

MEMBER                          MEMBER                                    PRESIDENT

Memo No_______________DF         Dt………………………

            Copy to the parties concerned.

                                                                                                PRESIDENT, DCDRF,

                                                                                                      NABARANGPUR