Orissa

Cuttak

CC/155/2023

Kamalini Mohanty - Complainant(s)

Versus

The Head,Customer care Service,Claims and central Operation, Reliance Nippon Life Insurance Co Ltd - Opp.Party(s)

P Sinha & associates

13 Dec 2023

ORDER

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

C.C. No.155/2023

Kamalini Mohanty,

W/o: Late Sri Banoja Kumar Pattnaik,Advocate,

Residing at Shanti-Vihar,Sri-Vihar Colony,

Tulsipur,Kanika Road,Cuttack-753008..                       ... Complainant.

 

          Vrs.

 

1.     The Head Customer Care Service,

                        Claims & Central Operation,

                           Reliance Nippon Life Insurance Co. Ltd.,

                        Unit Nos.4018,402,403,404,4^th Floor,

                        Inspire-BKC,G-Block,BKC Main Road,

                        Bandra East,Mumbai-400051,

                        Represented by the Chief Operating Officer.

 

2.      Reliance Life Insurance Company Ltd.,                                                                                                                                                                                                                                                                                                                                                                     Rajbhawan,1st Floor,Bajrakbati Road,Cuttack-753001                                                                                  

represented by its Authorized Officer.                          ...Opp. Parties.

 

 

   Present:      Sri Debasish Nayak,President.

          Sri Sibananda Mohanty,Member.

 

  Date of filing:    12.05.2023

  Date of Order:  13.12.2023

 

  For the complainant:           Mr. P.Sinha,Adv. & Associates.

     For the O.Ps 1 & 2   :             Nitu Roy,Adv & Associates.

 

   Sri Debasish Nayak,President

Case of the complainant bereft unnecessary details as made out from the complaint petition in short is that the agent of the O.Ps had visited the house of the complainant on 27.3.2019 and had instigated the deceased husband of the complainant in order to avail the policy from the O.Ps known as Reliance Nipon Life Super Endowment Plan.   The said policy was a half yearly mode policy and the premium was for 7 years term.  The instalment premium was of Rs,56,911.74p.  On that day the premium amount was paid in the shape of a cheque of Union Bank of India in favour of the O.P Company by the deceased husband of the complainant.  After verifying all the queries and issues and about the previous illness of the deceased husband of the complainant, the Chief Operating Officer of the O.P Company namely Srinivasan Iyengar had issued a welcome letter to the deceased policy-holder as regards to the policy availed by him wherein the sum assured was of Rs.10,00,000/-.  On 20.4.2019 as per the instruction of the insurance advisor of the O.P company a further premium of Rs.3241/- was paid by the deceased/insured as an extra premium amount for medical purposes.  Accordingly, a total premium amount of Rs.55,686/- was continued to be paid to the O.P Company by the deceased policy-holder from April,2019 till October,2020.  On 17.10.2020 at about 7.00 A.M. unfortunately the deceased policy-holder had expired due to cardiac arrest.   The death of the policy-holder was duly intimated to the O.P Company.  The legal heir certificate was also issued following the death certificate of the policy-holder.  Even though the policy-holder had expired on 17.10.2020, the premium amount was auto debited to the Insurance Company on 20.10.2020 which was accepted even if the O.P Company by then had known about the death of the said policy-holder.  On 9.1.2021, the complainant had applied for death claim of her husband who was the policy-holder but the O.P Company had repudiated her claim as per Sec-45 of the Insurance Act,1938.  On 6.6.2021 the complainant had sent e.mail to the O.P Company for returning the premium amount which were deposited through auto-debit system before and after the death of her husband who was the policy-holder of the O.P company.  But on 9.6.2021 the O.P Company had rejected such claim.  When no fruitful result had yielded, the complainant has approached this Commission claiming the assured amount of Rs.10,00,000/- from the O.P Company together with a sum of Rs.1,00,000/- for the deficiency in service of the O.P company.  She has also prayed for a compensation of Rs.50,000/- from the O.P company towards her mental, physical and financial harassment alongwith another sum of Rs.25,000/- towards the cost of her litigation.  She has claimed interest @ 12% per annum on the compensation amount.  She has also prayed for any other relief as deemed fit and proper.

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

2.       Both the O.Ps have contested this case and have filed their written version jointly.  According to the written version of the O.Ps, their company received a duly filled in proposal form bearing No.TH961447 in the name of Banoja Kumar Pattnaik as the life assured on 27.3.2019 for obtaining “Reliance Nippon Life’s Super Endowment Plan”  where the  sum assured was of Rs.10,00,000/-. The mode of payment of premium in the said policy was half yearly.  In the said proposal form of the insured, certain queries were there which were answered by the said policy-holder.  But the O.Ps could notice that there was suppression of material facts, non-disclosure of those and act of fraud, misrepresentation was also there.  They received the death claim in support of the deceased policy-holder on 9.1.2021 wherein it was stated that the said policy-holder/life assured had passed away due to cardiac arrest on 17.10.2020.  The O.Ps from their investigation could know that the life assured was having  lung cancer for which he was treated at Tata Memorial Hospital at Mumbai since June,2018.  It is for the said reason, the O.Ps had repudiated the claim as made for the deceased policy-holder/life assured through their letter dated 31.3.21.  In this connection, the O.Ps have relied upon a catena of decisions of the Hon’ble Supreme Court which are as follows:

(a)     In the case of Reliance Life Insurance Corporation Vrs. Rekhaben Nareshbhai Rathod in Civil Appeal No.4261 of 2019.

(b)     In the case of Satwant Kaur Sandhu Vs. New India Insurance Co. Ltd. reported in 2009 IV CPJ-8(SC).

(c)      In the case of Export Credit Guarantee Corporation of India Ltd. Vs. Garg Sons International [2013(1) SCALE 410].

(d)     In the case of Suraj Mal Ram Niwas Oil Mills (P) Ltd. Vs. United India Insurance Co. Ltd. [(2010) 10 SCC  567].

(e)     In the case f Geneal Assurance Society Ltd. Vs. Chandumull Jain & Anr.,(1966) 3 SCR 500.

(f)      In the case of United India Insurance Co, Ltd. Vs. Harchand Rai Chand Rai Chandanlal I(2003) CPJ 393 & Vikram Greentech (I) Ltd. & Anr. Vs. New India Assurance Co. Ltd.,II(2009) CPJ 34.

(g)     In the case of Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd. Vs. Lalit Kumar Kothari,RP 1208/2014.

(h)     In the case of Prem Kumar Vs. LIC decided on 4.12.2017 by Hon’ble National Commission in R.P. No.405/2017 stated that if there is a non-disclosure/suppression of material fact Company will not be liable to pay.  That with the reference to the Judgement A.P.Venkatachalam Vs, LIC of India,HC,Madras,0329/1984 wherein the court has stated it is the duty of plaintiff to provide the details of medical conditions while filling the proposal form as the non-disclosure of these material facts certainly vitiate the insurance contract.

(i)      In the case of M/s. Grasim Industries Ltd. & Anr. Vs. M/s. Aggarwal Steel 2010(1) SC 33

(j)      In the case of Kishor Chandrakant Rathod Vs. The Managing Director, ICICI Prudential Life Insurance Co. Ltd. & Anr. (Decided by the National Commission on 21.5.2014 in R.P No.3390 of 2013).

(k)      Shrikant Murlidhar Apte Vs. Life Insurance Corporation of India(Decided by the National Commission on 2.5.2013 in R.P No.634 of 2012).

(l)      Prema and Ors. Vs. Life Insurance Corporation of India Ltd. IV(2006) CPJ 239 (NC):8.

(m)    In the case of Bharti Knitting Company Vs. DHL Worldwide Express Courier (1996) 4 SCC 704.

The O.Ps have also relied upon the decision of Hon’ble Supreme Court in Civil Appeal No.3397 of 2020 reported in SL( C) No.10652 of 2020in the case of  Branch Manager,Bajaj Allianz Life Insurance Co. Ltd. and Ors. Vs. Dalbir Kaur.

Thus by quoting the aforesaid catena of decisions of the Hon’ble Apex Court & Hon’ble National Commission, the O.Ps through their written version have urged to dismiss the complaint petition as filed.

The O.Ps have also filed evidence affidavit through one Archana Pagare working as Senior Manager,Legal in their company.  On perusal of the contents of the said evidence affidavit, it is noticed that the same is only the reiteration of the written version as filed by the O.Ps and nothing else.

The complainant has also relied upon the decision of the Hon’ble Supreme Court of India in Civil Appeal No.2014 of 2011 Arising out of SLP(C) No.18179 of 2009 in the case of State Bank of Travancore Vs. M/s. Kingston Computers (I) Pvrt. Ltd.

3.         Keeping in mind the averments as made in the complaint petition and the contents of the written version of the O.P, this Commission thinks it proper to settle the following issues in order to arrive at a proper conclusion here in this case.

                      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?

Issue no.ii.

           Out of the three issues, issue no.ii  being the pertinent issue in this case, is taken up  first for consideration here.

          Perused the contents of the complaint petition, written version, the written notes of submissions as filed from either sides, evidence affidavit filed from the side of O.Ps as well as copies of the documents as available in the case record.  It is needless to mention that the proposal form when duly signed by the intending policy-holder who desires to have a policy and after executing the said proposal form when the premium to that effect is paid which is accepted by the insurer Company, the policy comes into existence in favour of the policy-holder.  It is ofcourse true that the life assured is to signify in the said proposal form about all his previous ailments, medication, hospitalisation etc without suppressing any of those.  Here in this case, it is alleged by the O.Ps no.1 & 2 that the life assured/deceased Banoja Kumar Pattnaik was suffering from lung cancer for which he was under the treatment at Tata Memorial Institute of Mumbai but he had not mentioned the same while entering into and opting to avail the policy from the O.Ps.  The document as filed by the O.Ps to that effect lacks authenticity as it is not submitted alongwith any affidavit from the concerned hospital nor it is proved properly through any cogent evidence.  Thus, the said document cannot be taken into consideration here in this case.  Be that as it may, here this Commission is to scrutinize that if due to such suppression of the disease like cancer, the policy-holder/life assured had died.  While scrutinizing the available copies of documents on record, it is noticed that the life assured Banoja Kumar Pattnaik had died due to cardiac arrest but no where the O.Ps had come out successful to establish that such death of the deceased policy-holder/life assured was due to his prolonged disease like lung cancer and the said lung cancer led the policy-holder to die.  In absence of any convincing evidence to that effect from the side of the O.Ps, this Commission cannot simply jump into a conclusion that since because the O.Ps have quoted a catena of decisions of the Hon’ble Apex Court as well as Hon’ble National Commission, it is to be concluded abruptly here in this case that there was no deficiency on the part of the O.Ps.  On the other hand, while going through the decision of the Hon’ble Supreme Court as relied upon by the complainant in Civil Appeal No.2014 of 2011(Arising out of SLP( C) No.18179/2009, in the case of State Bank of Travancore Vs. M/s. Kingston Computers (I) Pvt. Ltd. decided on 22.02.2011 wherein it is held that, “In our view, the judgment under challenge is liable to be set aside because the respondent had not produced any evidence to prove that Shri Ashok K. Shukla was appointed as a Director of the company to file suit against the appellant and authorised Shri Ashok K.Shukla to do so.  The Letter of Authority issued by Shri Raj K.Shukla, who described himself as the Chief Executive Officer of the company, was nothing but a scrap of paper because no resolution was passed by the Board of Directors delegating its powers to Shri Raj K.Shukla to authorise another person to file suit on behalf of the company.

In the result, the appeal is allowed, the impugned judgment is set aside and the one passed by the trial Court dismissing the suit of the respondent is restored.”  Thus, the written version as filed here in this case cannot be taken into account since because the O.Ps have not filed any Letter of Authority by their company thereby authorising Archana Pagare, Sr. Manager(Legal) to file the written version.

It would be worthwhile to quote a pertinent decision of our Hon’ble Apex Court as decided in Civil Appeal No.8245(Arising out of S.L.P( C) No.13589 of 2015) in the case of Sulbha Prakash Motegaonkar and others Vrs. Life Insurance Corporation of India on 5.10.2015, where it has been held by the Hon’ble Supreme Court that LIC, cannot repudiate the claim, even if suppression of fact if that suppression does not lead to any disease for which life assured had died. 

Moreso, when the O.Ps have utterly failed to bring out cogent and clinching evidence in order to imbibe this Commission that infact by such suppression of material fact there was an oblique motive hidden in the mind of the policy-holder  that the life assured had died due to his prolonged illness such as  lung cancer which resulted to cardiac arrest ultimately resulting to his death.  Accordingly, after considering the facts and circumstances of this case, this Commission is of opinion that the O.Ps could not establish their stand as taken by them rather the complainant has come out successful to show that when her husband had died due to cardiac arrest, she made the insurance claim in order to get the assured amount and  by not settling her claim, the O.Ps are definitely found to be deficient in their service for which this Commission comes to a conclusion that the O.Ps were undoubtedly deficient in their service as alleged by the complainant.  Accordingly, this issue is answered in favour of the complainant.

 

 

Issues no.i & iii.

              From the discussions as made above, the case of the complainant when filed is definitely maintainable and the complainant is entitled to the reliefs as claimed by him. Hence, it is so ordered;

                                                          ORDER

                The case is allowed on contest against the O.Ps 1 &  2 who are all found to be jointly and severally liable here in this case. The O.Ps are thus directed to pay the complainant death claim benefit of Rs.10,00,000/- alongwith interest thereon @ 9% per annum from the date of her application i.e. from 9.1.2021 till the amount is quantified.  The O.Ps are further directed to pay a sum of Rs.1,50,000/- to the complainant towards compensation for her mental agony and harassment as well as a sum of Rs.25,000/- towards the cost of her litigation.  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 the 13^th day of December,2023 under the seal and signature of this Commission.  

 

                                                                                              Sri Debasish Nayak

                                                                                                        President

 

 

                                                                                                Sri Sibananda Mohanty

                                                                                                              Member