Orissa

Cuttak

CC/158/2014

Kanchan Das - Complainant(s)

Versus

The Branch Manager,Birla Sun Life Ins. Co.Ltd - Opp.Party(s)

A A Khan

12 Oct 2020

ORDER

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

                                                                                    C.C. No.158/2014

                               

 Kanchan Das,

W/O: Nabaghana Das,

At:Brahamanakhanda,PO:Sirlonabagram,

P.S:Kishore Nagar,Dist:Cuttack.                                              … Complainant.

 

                                                Vrs.

 

                                                               

1.       The Branch Manager,

      Birla Sun Life Insurance Company,

      1^st Floor,Sumitra Plaza,Near Govt. Bus Stand,

      Badambadi,Cuttack-753012,Odisha.

 

2.       Manager,Birla Sun Life Insurance Company Ltd.,

One India Bulls Centers, Tower-1,15^th & 16^th Floor,

Jupiter Mill Compound,841,

Senapati Bapat Marg Elphinstone Road,

Mumbai-400013.                                                                       … Opp. Parties.

 

Present:               Sri Dhruba Charan Barik,LL.B. President.

Smt. Sarmistha Nath, Member (W).

 

Date of filing:     03.11.2014

Date of Order:   12.10.2020

 

For the complainant:    Mr. A.A.Khan,Adv. & Associates.       

For the O.P No.1&2:     Mr. L.Sahoo,Adv. & Associates.    

 

Smt. Sarmistha Nath,Member(W).

                The complainant has filed this complaint before this Forum against the O.Ps for Redressal of his grievances U/S-12 of the Consumer Protection Act,1986 in terms of the prayer made in the complaint petition alleging deficiency in service on the part of O.Ps.

1. The case of the complainant in brief is that the daughter of the complainant Late Bhagabati Das during her life time had insured her o9fe for a sum of Rs.1,49,220/- under policy bearing No.005389712 issued by the O.Ps.  Copy of the insurance policy is Annexure-1.  While issuing her life the insured Late Bhagabati Das had paid a sum of Rs.9,836/- towards premium and after accepting the  premium amount the O.Ps had issued the policy which was valid from 20.2.2012 to 20.2.2032 and in the policy bearing No. 005389712, the complainant was made the nominee of the insured Late Bhagabati Das.  During the currency of the policy, the insured Bhagabati Das died on 9.7.2012.  Copy of policy document, death certificate and certificate issued by the Sarpanch are attached as Annexure-2 & 3 series.

After death of the insured her nominee, the present complainant had lodged a claim with the O.Ps on 30.10.12 claiming the assured sum under the policy.The O.Ps repudiated the claim on the ground of suppression of material facts while obtaining the policy and the ground mentioned in the repudiation letter has no relevance with the death of the deceased and without considering the same without applying their mind they have repudiated the claim of the complainant which amounts to deficiency in service and unfair trade practice.Due to illegal and arbitrary repudiation of her bonafide claim, the complainant had suffered physical and mental harassment. The complainant has prayed to direct the O.Ps to pay the sum assured under the policy along with interest @ 12% per annum as well as to pay a sum ofRs.25,000/- towards compensation and Rs.10,000/- towards cost of litigation.

2. The O.Ps have appeared through their counsel and filed written version stating that the complainant has no cause of action to proceed against the O.P and the complaint is liable to be dismissed under Sec-26 of C.P.Act.  The further plea of the O.Ps is that the policy is legal contract between the life assured and the insurer and both are bound by its terms and conditions.  Under the contract of insurance the life assured is under solemn obligation to disclose all the material fact to the insurer at the time of taking or revival of the insurance policy, failing which the policy is rendered void, illegal and unenforceable.  The life assured has submitted application under the Bachat Endowment Plan policy of Birla Sun Life Insurance Co. Ltd.(O.P.1) and had agreed to pay premium  in annual premium mode regularly. 

The insured was given detailed description about the features of the policy and also apprised with its terms and conditions before signing of the said application form.It was only after being completely aware with regard to the said policy premium, terms, risks and consequences of the said policies and the terms and conditions attached therewith in sales illustration, insured applied for same vide application with her freewill and consent.Copy of the sales illustration for the consecutive policies are annexed as Annexure-R/2.The further case of the O.Ps is that

the insured in her application made her mother Mrs. Kanchan Das as her nominee, to whom the benefit of the insurance was to be given in case of the death of the insured as per the insurance policy. On 30.10.2012 the answering O.P received death claim intimation along with the death certificate and other requisite documents stating that the insured had expired on 9.7.12 and that the cause of death was chest pain.On receipt of the death claim intimation, the answering O.P with a bonafide intention of processing the said claim application initiated the process of claim investigation immediately in order to verify the authenticity of the said claim.The insured was suffering from pathetical eye (both eyes) and was under treatment for the same prior to her application.Disability certificate as well as concession certificate dt.15.1.2008 issued by the District Medical Board of Cuttack certifying that the life assured/DLI was suffering from permanent disability of phthisical eye in both eyes.Copy of the death certificate and copy of claimant statement has been marked and annexed as Annexure-R/3 & R/4 respectively.A copy of the investigation report has been marked and annexed as Annexure-R/5.Copy of the disability certificate issued by District Medical Board of Cuttack has been marked and annexed as Annexure-R/6.

The O.P further averred that it is evident that the life assured/DLI had concealed the said material fact that she was suffering from the aforementioned diseases at the time of availing the cover of insurance and had thereby disregarded the most principle of any insurance contract that principle of Uberrimma Fides (Utmost Good faith) and had given a false declaration of good health with a malafide intention of procuring the said insurance cover fraudulently.Had the medical history been disclosed to the answering O.P, the O.P would not have issued the said policy.

The policy was issued on the basis of the application for insurance dt.18.2.2012 by insured on her own life.In the application the insured had replied negative to question No.II(D) and question Nos.14(i) a, (ii) m, in which the insured clearly declared that she was not suffering from any physical defect, impairment deformities or any condition affecting inability sight and hearing.

The facts are that the life assured/DLI has made the policy with malafide intention to gain unlawful benefits from the answering O.P.The O.P has right and fair underwriting the policy.Thus basing on the said facts and false declaration, the O.P has rightly repudiated the claim on the grounds of material, non-disclosure and intimated the same to the policy holder vide its letter dt.13.12.12.Copy of the final repudiation letter has been marked and annexed as Annexure-R/7.

The O.P further averred that the claim is rightly repudiated on the ground of material non-disclosure and that the O.Ps have acted in consonance with the terms and conditions of the policy contract and the claim is paid by any insurance company out of the common pool of funds belonging to all policy holders of the company and the insurance company has to check the genuineness of a claim before honouring it.So the O.P prayed for dismissal of the complaint.

3. We have heard from the learned advocates of the parties at length and gone through the documents and papers filed by parties carefully.

Admittedly the deceased daughter of the complainant had insured her life in the year 2012 with the O.Ps and the policy was issued on 20.2.2012 with sum assured Rs.1,49,220/- under Bachat Endowment Plan Policy and she paid the premium of Rs.9998/-.She made her mother, the present complainant as her nominee to whom the benefit of the insurance was to be given in case of death of the insured.The insured expired on 9.7.2012 due to chest pain and the nominee intimated the same to the insurance company regarding the death of the insured/daughter claiming the sum assured under the policy but the company repudiated the claim of the complainant on the ground of suppression of material fact while obtaining policy as the insured was suffering from “Phthisical Eye”(Both eye) and was under treatment prior to her application.

During the course of argument, the counsel for the complainant submitted that the O.Ps have never adduced any evidence that the insured was suffering from both eye except annexure-R/6 which was allegedly issued on 15.1`.2008 by the District Medical Board, Cuttack.For the sake of argument, if the disability certificate is accepted not admitted, then nowhere the District Medical Board has stated that the disability is permanent and the O.Ps have also not disclosed the source from where they got the disability certificate.He further submitted that the insured died due to chest pain and not due to ocular illness.He further argued that the insured is an illiterate person and the O.Ps have neither read over and explained to her the contents of the terms and conditions.

Per contra the counsel for the O.P strenuously argued that the insured has violated the terms and conditions of the policy by concealing about the ailing eyes.

After hearing the rival submissions, we are of the considered view that the O.Ps have illegally repudiated the claim of the complainant on the ground that the insured was suffering from eye defects though the insured died due to chest pain which amount to deficiency in service and unfair trade practice on the part of O.P.

                                                                                ORDER

Basing upon the facts and circumstances stated above, complainant succeeds and the O.Ps are directed to pay the sum assured along with Rs.25,000/- towards compensation and Rs.10,000/- as litigation cost within a period of 45 days from the date of receipt of copy of this order.

 

Typed to dictation, corrected and pronounced by the Hon’ble Member in the Open Court on this the 12^th day of October,2020  under the seal and signature of this Forum.

 

  ( Smt. Sarmistha Nath )

                            Member (W)                                                                                                                                                                                                                                                                                                                                                                                                                  (Sri D.C.Barik)

 President.