Orissa

Cuttak

CC/300/2023

Sulochana Mishra - Complainant(s)

Versus

The Customer Care Officer (Customer Service), Aditya Birla Sun Life Insurance Company Ltd., - Opp.Party(s)

D Mishra

16 Mar 2024

ORDER

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

C.C.No.300/2023

 

Smt. Sulochana Mishra,

W/o: Late Sarat Chandra Mishra,

Patra Street(Soura Sahi),

Jeypore,Koraput.                                                          ... Complainant.

 

                                                Vrs.

1.     The Customer Care Officer (Customer Service),

Aditya Birla Sun Life Insurance Company Ltd.,

G Corp Tech Park,6^th Floor,Kasar Wadavali,

Ghodbunder Road,Thane-400601.

 

2.    The Authorised Person,

Aditya Birla Sun Life Insurance Company Ltd.,

Regd. Office: One World Centre, Tower 1,

                                  16^th floor,Jupiter Mill Compound,841,

Senapati Bapat Mart,Elphinstone Road,

                                  Mumbai-400013.

 

3.     The Branch Manager,

HDFC Bank Ltd.,Jeypore Branch,

                                 Jeypore.

 

4.     Branch Manager,

Aditya Birla Sun Life Insurance Company Ltd.,

Cantonment Road, Cuttack-753001, Odisha.                                    ... Opp. Parties.

 

 

Present:                       Sri Debasish Nayak,President.

                                    Sri Sibananda Mohanty,Member.

 

Date of filing:       05.09.2023

Date of Order:     16.03.2024

 

For the complainant:            Mr. D.Mishra,Adv. & Associates.

For the O.Ps.                :            None.

Sri Sibananda Mohanty,Member.

Case of the complainant in short is that she had undertaken the Life Insurance Policy from the O.Ps bearing Policy no.008478545 where the life of her husband namely Sri Sarat Chandra Mishra was assured under the plan namely “ABSLI Guaranteed Milestone Plan”, which was effected from 23.4.2021 on annual term of premium was Rs.5,22,500/-, where paying term of premium was of 6 years with sum assured value of Rs.75,00,000/- and the policy term was fixed for 12 year.  It is further case of the complainant that the policy was obtained through HDFC Bank by paying the requisite premium amount of Rs.5,22,500/-.  It is stated by the complainant that HDFC securities is a Corporate Agent of Aditya Birla Sun Life Insurance Company Ltd. and she had paid premium amount to the HDFC Bank and accordingly the policy was obtained by her through HDFC Bank.  It is stated by the complainant that she is a Govt. servant and was the proposer of the policy and her husband’s life was insured under the said policy.  It is further case of the complainant that her husband died on 17.1.2022 due to heart attack and she lodged claim on 10.6.2022 for payment of the sum assured but the O.Ps half-hazardly dealt on the death claim of the complainant and repudiated the same on 7.10.2022 on the ground that the insured/life assured  disclosed false information and untrue statement as regards to his income.   It is stated by the complainant that the O.ps repudiated the death claim of her husband without any authenticated documentary evidence pertaining to income of the life assured, so also it is stated by the complainant that while repudiating the claim of the complainant, the O.Ps had failed to follow the IRDA guidelines which stipulates that it is not mandatory to show the annual income of the life assured, if the proposer is a separate person, where the income of insured/life assured is no way relevant, who also does not need a source of income while obtaining a policy.  It is alleged by the complainant that in the proposal form, the officials of the O.Ps had filled up the form and had quoted her income as well as her husband’s income at their own sweet will at a higher side without their consent.   The complainant stated to have approached the O.Ps number of times for settlement of her claim but the O.Ps have not taken any step for settlement of her claim.  Finally the complainant sent a legal notice on 1.7.2023 by speed post to the O.Ps which remained unanswered.  It is alleged by the complainant that her husband has not furnished wrong information as regards to his income vis-à-vis no evidence has been laid by the O.Ps as regards to the income informations furnished by her husband.   As the O.Ps repudiated the claim of the complainant wrongfully, she has approached this Commission with a prayer for  direction to the O.Ps to settle the death claim of her husband amounting to Rs.75,00,000/- alongwith interest @ 18% per annum and to pay a sum of  Rs.17,00,000/- towards compensation for her mental agony and harassment as well as a sum of Rs.20,000/- towards the cost of her litigation.

Together with her complaint petition, the complainant has filed copies of certain documents in order to prove her case.

The complainant has also filed evidence affidavit which when perused, it appears to be the reiteration of the contents of the complaint petition and nothing else.

2.         Having not preferred to contest this case, the O.Ps have been set exparte vide order dt.16.10.2023.

3.              The points for determination in this case are as follows:

i.          Whether the case of the complainant is maintainable?

ii.         Whether there was any deficiency in service on the part of the O.Ps ?

iii.        Whether the complainant is entitled to the reliefs as claimed by her?

Point no.ii.

Out of the three points, for the sake of convenience, point no.ii is taken up  first for consideration here in this case.

It is admitted fact that the complainant was the proposer of the policy issued by the O.Ps, namely “ABSLI Guarantee Milestone Plan” bearing policy no. 008478545, where the life of her husband namely Sri Sarat Chandra Mishra was assured on payment of yearly/instalment premium amount of Rs.5,20,500/-.  The said policy was effected from 23.4.2021.  The complainant’s husband died due to heart attack on 17.1.2022 while the policy was in force.  The complainant after death of her husband applied to get insurance amount to the O.Ps on 10.6.2022, but the O.Ps repudiated her claim vide their letter dt.07.10.2022 on the plea that the life assured had disclosed  false information as regards to his annual income.  It is alleged by the O.Ps that the life assured had disclosed his income as Rs.28,00,000/- whereas his real income was Rs.4,80,000/-.  As per the O.Ps, the husband of the complainant withheld his annual income and gave a false information for which they had repudiated the death claim of the complainant.  But the complainant has disputed such facts.  It is stated by her that she as well as her husband never disclosed their income at a higher side and has alleged that the officials have quoted such figures of their own without their consent.  The allegations of the complainant have not been controverted.  Hence, it is presumed that the officials of the O.Ps  have quoted the income of the complainant as well as her husband at a higher side of their own.  At this juncture, it is relevant to go through the IRDA guidelines in this respect as filed by the complainant, where the proposer is not the insured.  The IRDA guidelines clearly stipulates the life assured does not need a source of income, where the proposer is someone else.  Here the complainant was the proposer and her husband’s life was insured.  As such, the life assured ‘s income has no relevancy in the present policy.  Even if it is presumed that the life assured had withheld his income, the O.Ps cannot repudiate the claim on that ground.  Hence, repudiation of the claim by the O.Ps is bad.    So, the O.Ps have committed deficiency in service in repudiating the genuine claim of the complainant.   Hence, this point goes in favour of the complainant.

Points no.i & iii.

From the discussions as made above, the case of the complainant is undoubtedly maintainable and the complainant is entitled to the reliefs as claimed by her.

ORDER

Case is allowed exparte against the O.Ps who are found to be jointly and severally liable here in this case.  The O.Ps are thus directed to pay the complainant the death claim assured amount of Rs.75,00,000/- with interest @ 8% per annum thereon from the date i.e. 10.6.2022, when the claim was made by the complainant till the total amount is quantified.  The O.Ps are also directed to pay a sum of Rs.1,00,000/- towards compensation to the complainant for her mental agony and harassment as well as another sum of Rs.20,000/- towards her litigation expenses.  This order is to be carried out within a period of 30 days from the date of receipt of copy of this order.

                Order pronounced in the open court on this the 16^th day of March,2024 under the seal and signature of this Commission.

                                                                                                                                   Sri Sibananda Mohanty

                                                                                                      Member

                                                                                      Sri Debasish Nayak

                                                                                              President