DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KANDHAMAL, PHULBANI
C.C.NO.83 OF 2022
Date of Filing : 29.11.2022
Date of Order : 10.01.2023
Pratima Pradhan, aged about 47 years,
W/O- Late Pradeep Pradhan
AT- Burjubadi
PO/PS- Daringbadi
Dist: Kandhamal ……….Complainant
-Versus-
The Branch Manager,
Reliance Nippon Life Insurance Co.Ltd.
Uma Tower Market Complex
Dharma Nagar, Alakapuri
Berhampur,
DIST- Ganjam, PIN- 760001 ………..Opposite Party
Present: Sri Purna Chandra Mishra - President.
Sri Sudhakar Senapothi - Member.
For the Complainant: Mr. P.C. Bai Advocate & associates
For O.P.- Ex-parte
Sri Purna Chandra Mishra, President
Complainant Pratima Pradhan has filed this case U/S 35 of the CP Act 2019 alleging deficiency in service and unfair trade practice on the part of the OP for not paying her the insured amount in respect of policy no 53775330 and praying therein for direction to the OP to pay the insured amount of Rs.5,64,776/- with interest @ 12% p.a from the date of application till its realization.
- Brief fact leading to the case is that the complainant is the wife of late Pradeep Pradhan who had insured his life with Reliance Nippon Life Insurance Company Limited for a sum of Rs.5, 64,776/- vide policy no-53775330. During the force of the policy, the insured Pradeep Pradhan died on 13.1.21 in his house due to chest pain. Being the nominee the complainant lodged the claim with the OP but the OP repudiated the claim on the ground of pre-existing disease. It is pleaded that he was suffering from chest pain on the relevant day and was referred to MKCG Medical College and Hospital, Berhampur and the deceased returned to his house for arranging money and he died in his house on the same day. But the OP repudiated the claim on the ground that the deceased was diagonised with cancer prior to the inception of the policy and the same has not been disclosed in the proposal form which is completely false and fabricated. The OP accepted the premium of insurance policy after due verification of proposal form the policy was issued and he had no disease at the time of availing the insurance policy. Since the repudiation of the claim is unjustified she has challenged the action of the O.P. before this Commission praying therein for the reliefs as discussed above.
- Notice was issued to the OP from this Commission, which was served on the OP on 07.12.22. In spite of service of notice, the OP did not appear on the date fixed. As the OP did not appear he was set ex-parte and the case was taken up for ex-parte hearing.
- The complainant in support of his case has filed the copy of the repudiation letter of 24th September 2021, copy of the death certificate, copy of the insurance policy, copy of the death declaration by Medical Officer CHC,Daringbadi, copy of the prescription dated 13.01.21 of Pradeep Pradhan of CHC,Daringbadi. The complainant has filed his evidence in shape of affidavit alongwith the evidence of one Sarat Chandra Sahu in support of his case.
- The only question is whether the complainant is entitled to get the relief as claimed for?
It is settled principle of law that where the OP even after receipt of notice do not challenge the allegations made against him, it is deemed to have been admitted by him. In the instant case, the OP did not appear nor challenged the allegation made against him. So it is presumed that the OP has no defense to raise and has admitted the allegations against him.
- It is seen from the documents on record that the complainant had obtained one insurance policy for a period of 20 years starting from 10.09.2020 and valid till 10.09.2040. The mode of payment was annual. From the first premium receipt, it is evident that the deceased Pradeep Pradhan had paid a sum of Rs.32,000/- vide receipt no-11544653 on dated 10.09.2020. It is clear from the receipt that the policy was valid for one year and the date of death being 13.01.21, during the force of the policy the complainant has breathed his last. It is seen from the death declaration made by the Medical Officer Dr.Pritish Udgata of Community Health Centre, Daringbadi that the cause of the death is cardiac failure. It is seen from the OPD prescription no-82048 of CHC,Daringbadi that he was registered as an outdoor patient vide serial no- 41048 dated 13.01.21 with complain of chest pain and he was referred to MKCG, Medical College and Hospital Berhampur for better treatment and soon after that he has died at about 9 AM. It is seen from the pleadings of the complaint petition that the deceased Pradeep Pradhan had been to the hospital for treatment wherefrom he was referred to MKCG, Medical College and Hospital for better treatment and he came to his house to arrange money to go to Berhampur and he died in his house during this period on the same day. From the documents and pleadings on record, we find a connecting link with each other and the OPD ticket shows that he had gone to Govt. Hospital,Daringbadi, the doctor on duty after prescribing certain medicines referred the patient to Berhampur Medical College and Hospital for better treatment and during this period when he was busy in arranging money, he died of cardiac arrest. Neither the prescription nor the death certificate has whispered a single word that the complainant’s husband late Pradeep Pradhan was suffering from cancer. It is clear from the evidence of the complainant and Sarat Chandra Sahu that the petitioner had no disease of cancer and he was hale and hearty. The evidence let by the complainant and Sarat Chandra Sahu stands unchallenged , uncontroverted and unrebutted. In the absence of any proof before us that late Pradeep Pradhan was suffering from cancer at the time of obtaining the policy we are not inclined to accept the plea taken in the repudiation letter that the complainant was suffering from cancer prior to obtaining the policy.
- Besides, it is the duty of the OP to collect all necessary information regarding the previous health history of a person applying for availing the insurance cover for his/her life. If the insurance company is able to trace out the pre- existing diseases with a person after his death, they should do it before accepting the policy of the person going to be insured. Insurance is always taken by a person for the security of his own family. The Insurance Companies are in the habit of taking the premium without any objection from the common man through their agents and networks by giving them alluring promises and after the death of the insured, they raise different pleas and devoid the families to avail the benefit of insurance and thereby throwing the beneficiaries to very insecured situation. This short of conduct on the part of the insurance companies is highly inhuman and is also violative of the principle of natural justice and it hammers at the very root concept of life insurance.
- As the OP did not appear nor challenged the allegations raised against him, it is deemed that the OP has admitted the allegation raised against him and from the discussions made in the preceeding paragraphs, we are satisfied that the OP has caused deficiency in service and unfair trade practice and harassment to the complainant by repudiating her claim without any just and genuine reason.
- As a case of deficiency in service, unfair trade practice and harassment is made out against the OP, he is liable to compensate the petitioner for the loss and harassment sustained by her and hence the order.
ORDER
The Complaint petition is allowed ex-parte against the OP. The OP is made liable for causing deficiency in service and harassment to the complainant. The OP is directed to pay a sum of Rs. 5, 64,776(five lakhs sixty four thousand seven hundred seventy six) only with interest @ 9% PA from the date of repudiation till it is paid to the complainant. The OP is further directed to pay a sum of Rs.25000/- (twenty five thousand ) only towards deficiency in service, unfair trade practice and harassment caused to the complainant and a sum of Rs. 10,000/( ten thousand ) only - towards cost of litigation. The order is to be complied within a period of 30 days from the date of order, failing which the order as to cost and compensation shall carry interest @ 12% per annum from the date of order till it is actually paid to the complainant.
Computerized & corrected by me.
I Agree
MEMBER PRESIDENT
Pronounced in the open Commissioner today on this 10th day of January 2023.
MEMBER PRESIDENT
