The Divisional Manager,Life Insurance Corporation of India V/S Saudamini Mohapatra
Saudamini Mohapatra filed a consumer case on 22 Feb 2017 against The Divisional Manager,Life Insurance Corporation of India in the Cuttak Consumer Court. The case no is CC/12/2015 and the judgment uploaded on 13 Apr 2017.
Orissa
Cuttak
CC/12/2015
Saudamini Mohapatra - Complainant(s)
Versus
The Divisional Manager,Life Insurance Corporation of India - Opp.Party(s)
N Rout
22 Feb 2017
ORDER
IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL FORUM,CUTTACK.
C.C. No.12/2015
Saudamini Mohapaptra,
W/O: Late Sangramjit Mohapatra,
Vill/PO:Daulatabad,
P.S:Choudwar,Dist:Cuttack. ….Complainant.
Vrs.
The Divisional Manager,
Bhubaneswar Divisional Office,
Life Insurance Corporation of India,
Surya Nagar,Near Governor House,
Bhubaneswar.
The Zonal Manager,
Life Insurance Corporation of India,
East Central Zonal Office,
Jeevan Deep Buildings,6th Floor,
Exhibition Road,Patna. … Opp. Parties.
Present: Sri Dhruba Charan Barik,LL.B. President.
Sri Bichitra Nanda Tripathy, Member.
Smt. Sarmistha Nath, Member (W).
Date of filing: 06.02.2015.
Date of Order: 22.02.2017.
For the complainant: Mr. Niranjan Rout,Adv, & Associates.
For Opp.Parties 1 & 2 : Mr. C.R.Lenka,Adv. & Associates.
Sri Dhruba Charan Barik,President.
The complainant has filed this complaint alleging deficiency in service against the O.Ps and seeking appropriate relief in terms of her prayer in the complaint petition.
The factual aspect of the case of the complainant is that Late Sangramjit Mohapatra is her deceased husband who was working as a Teacher at Banki under education district t of Cuttack. He had taken two life insurance policies from the O.P.1 vide Policy No. 587657069 dt.28.12.2010 for a sum of Rs.1.00 lakh and policy No.597659154 dt.28.1.11 for a sum of Rs.1,05,000/- with double accidental benefits and he had been regularly paying the premium to the O.P.1 for the aforesaid two policies without any default.
On 23.5.11 he suddenly fell ill and was admitted to S.C.B.Medical College and Hospital, Cuttack but on the same day at about 5.30 A,M he expired in the hospital. He was suffering from retention of urine and constipation. It is further stated that the complainant being the legally married wife of the deceased policy holder is the nominee under both the policies as stated above. She thereafter made death claim and other benefits under the said policies which were submitted to the O.P.1 but the latter, it is alleged, repudiated the entire death claim made by the complainant arbitrarily solely on the ground of suppression of material facts by the deceased policy holder in the proposal form with regard to some pre-existing diseases. The complainant was also advised by O.P.1 to put forth her grievances in the form of appeal before O.P.2 for necessary consideration of the death claim. She accordingly put forth her grievances before O.P.2 through her advocate but there had been no response in any manner from the O.P.2.
It is revealed from the complaint petition that after the death of the policy holder, the complainant and her minor son have been driven away from her matrimonial house and leading doleful lives. They have no means to earn their livelihood. The arbitrary exercise of power by the O.Ps in repudiating her claim is tantamount to deficiency in service and as such she has prayed to direct the O.Ps to pay her all the death claims and allied benefits accrued under the above policies together with interest as well as to pay compensation and litigation expenses in the interest of justice.
She has filed copies of two L.I.C policies, death certificate of the deceased policy holder, letter of O.P.1 repudiating her claim and advocate’s notice to O.P.2 which have been respectively marked as Annexure-1,2,3,4 & 5.
Both the O.Ps have filed written version of their case mainly on the ground that there is no deficiency in service attributable to them in any manner and as such the complaint petition is not maintainable both in facts and law. It was the clear stand taken by both the O.Ps 1 & 2 that the deceased policy holder had deliberately suppressed some material facts with regard to his pre-existing disease which is apparent on the face of his bed head ticket issued by the concerned doctor of S.C.B.Medical College & Hospital,Cuttack. The copy of the said bed head ticket has been filed in this case and marked as Annexure-A. It is clearly stated that had the deceased policy holder disclosed all material facts with regard to his pre-existing diseases in the proposal form, the same could have either been discarded or would have been accepted at a higher rate of premium in comparison to that which were paid by him earlier.
It is further stated that although the complainant sent her grievances through her advocate vide Annex-5 and preferred appeal before O.P.2, the same was rejected being time barred. Hence no response was given to her in that case. It is therefore submitted that the complaint may be dismissed in limini.
We have heard the learned counsels from both the parties and gone through the annexures produced by them respectively.
The repudiation of the death claim and other benefits of the deceased policy holder made by the complainant have been repudiated by the O.Ps on the sole ground that the deceased policy holder had deliberately suppressed the material facts in the proposal form with regard to his pre-existing diseases. It is fairly submitted by the learned advocate for the O.Ps that insurance policy is based on the utmost faith and suppression of any material fact by the policy holder would go to the route of the very insurance affecting the parties bound by it, especially with regard to discharge contractual liability under the said policy by the insurer. According to him the insurance policy issued in favour of the deceased policy holder could not have been so issued but for the deliberate suppression of the material facts by the policy holder in the proposal form. With regard to suppression of material fact by the policy holder, the attention of the court is drawn to Annexure-A which is the copy of the bed head ticket of the said deceased policy holder while undergoing treatment at S.C.B.Medical College and Hospital,Cuttack. There is one line statement apparent on Annexure-A purportedly written by the treating physician of the same hospital that the deceased policy holder had similar heart attack about 2 years back. Save and except that single line observation in Annexure-A, no other document has been filed by the O.Ps to substantiate their action in repudiating the claim of the complainant.
It is settled principle of law that onus lies on the insurer to prove that the policy holder had made deliberate suppression of material fact at the time of taking the policy. The insurer is required to establish the same by clear and cogent evidence in order to dislodge their liability. Law is also equally settled that bald statement of a doctor unsupported by other evidence is not sufficient to dislodge such burden of the insurer. In the instant case as has been stated above, there is no clear and cogent evidence as laid by the O.P to prove the suppression of material fact by the deceased policy holder. Even the doctor who made entry in the bed head ticket Annex-A is not known and there is also no iota of evidence to prove the source of his information to make such an entry. As rightly submitted by the learned advocate for the complainant that the single sentence appearing in Annexure-A that the deceased policy holder had similar attack two years back cannot be implicitly relied upon for repudiation of the death claim made by the complainant. In this connection reliance may be placed in a decision of the Hon’ble National Commission reported in 1986(2005) –Consumer 9160 (N.C) (L.I.C of India Warangal Vrs. Smt. J.Vinay). It has been held by his lordship that when medical report suggests that the insured was suffering from chest pain prior to taking the policy but it is not clear from the said medical report as to who give the statement, the insurance company cannot be discharged from its liability to prove the suppression of material facts by the deceased policy holder. Accordingly the claim made by the appellant in that case was up held. Keeping in view the ratio of the aforesaid decision, the O.Ps cannot said to have dislodged their onus in establishing that the deceased policy holder had deliberately suppressed the material facts with regard to his pre-existing diseases.
It is also revealed from the case record that the complainant has not quantified the compensation and cost of litigation as prayed in her complaint. The death claim of the deceased policy holder and other allied liabilities have been repudiated by the O.Ps vide Annexure-1 on 6.11.13 and she has already undergone much hardship and mental agony during the period of more than last 3 years and she has also been fighting litigation to get her legitimate claim since 2015. Hence it is ordered;
ORDER
The prayer of the complainant is allowed on contest against the O.Ps. They are directed to release Rs.1.00lakh and Rs.1,05,000/- respectively under the two policies issued by them in favour of the deceased policy holder and other benefits together with interest @ 9% per annum and Rs.10,000/- towards litigation expenses. This order shall be given effect to within 30 days from the date of receipt of copy of this order.
Typed to dictation, corrected and pronounced by the Hon’ble President in the Open Court on this the 22nd day of February,2017 under the seal and signature of this Forum.
( Sri D.C.Barik )
President.
(Sri B.N.Tripathy )
Member.
(Smt. Sarmistha Nath)
Member(W)
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