DATE OF DISPOSAL: 01.05.2024

SRI SATISH KUMAR PANIGRAHI, PRESIDENT:

The factual matrix of the case is that the complainant has filed this consumer complaint Under Section 12 of the Consumer Protection Act, 1986, alleging deficiency in service against the Opposite Parties (in short the O.Ps.) and for redressal of her  grievance before this Commission.

2. The fact of the complaint that the complainant filed this case due to repudiation of insurance claim by the O.Ps on 31.12.2018. The husband of the complainant Simanchal Pradhan obtained L.I.C. policy for sum assured Rs.5,05,000/- and deposited first premium on 28.03.2018 for Rs.48,989/- and accordingly the O.P. issued  L.I.C. policy in favour of Simanchal Pradhan vide Policy No.NP011803464435. The husband of the complainant died on 13.05.2018 due to heart attack. The complainant submitted the  death certificate issued by C.H.C. Adapada vide registration No. 440 dated 21.05.2018. Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.P. to pay insured amount of Rs.5,05,000/- along with penalty.

3. The Commission admitted the case and issued notice to the Opposite Parties.

4. The O.P.No.1 & 2 appeared and filed written version, evidence on affidavit and written argument through their advocates.  It is stated that the policy was issued in favour of late Simanchal Pradhan bearing No.NP011803464435 for sum assured amount of Rs.5,05,000/- under the plan “Shriram New Shri Raksha” for a term of 15 years with annual premium @Rs.48989/- wherein Smt. Amari Pradhan was nominee.  Being an early death claim which has arisen within 43 days from the date of commencement of policy the claim was investigated to check the veracity of the claim. The O.P. found from the said investigation that the deceased life assured Simanchal Pradhan was suffering from pre-existing ailment i.e. cancer. The deceased life assured was taking treatment at Acharya Harihar Regional Cancer Centre, Cuttack. As per the medical record of DLA from the said hospital it is mentioned as “k/c/o cancer”. The DLA was admitted to the said Hospital on 11.04.2017 and discharged on 26.04.2017 vide Registration No.14838 with discharge note that he was diagnosed with tongue cancer. The O.Ps filed the medical record of DLA including Histo pathological report dated 07.11.2017. The O.P. relied upon the said report which established that’s the DLA was suffering from cancer since 2017. While proposing the policy the proposer deliberately concealed the said fact in the proposal form dated 20.03.2018. The O.Ps submitted the life insurance policies are contracts governed by the principle of “UBERRIMA FIDE” and the proposer for insurance is expected to correctly furnish all material information regarding the health, habit, family history, personal medical history, other policy etc. of the life proposed insurance. But in the instant case, the same has not carried out.  

5. On the date of hearing the complainant was found absent and advocate for the O.P. is present. The Commission heard at length on the point of issue from the parties and perused the complaint, evidence, written notes of argument and documents available in the case record. On evolution of the evidence it is revealed that the complainant has not filed any corroborative documents regarding cause of death as stated in the complaint accompany affidavit. DLA suppressed the material fact regarding the medical history in the proposal form i.e. suffering from tongue cancer since 2017. The complainants did not approach the Commission with clean hand. This Commission by relying upon a citation passed by the Hon’ble Supreme court of India in the matter of United India Insurance Co.ltd. Versus M.KJ. Corporation Civil appeal No. 6075-6076 of 1995. The Commission dismissed the case.   Hence there was no contract of insurance between the parties. As such the O.P. has to refund the paid-up-value with simple interest from the date of deposits of the premium to the complainant in the instant case. 

However on humanitarian point of view, the O.Ps is directed to refund the paid-up-value of Rs.48,989/- with 4% interest per annum with effect from  deposits of the premium i.e. on 28.03.2018  to the complainant within 45 days from receipt of this order.

              This case is disposed of accordingly.

                The Judgment be uploaded on the www.confonet.nic.in for the perusal of the parties.

             A certified copy of this Judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 2019.

            The file is to be consigned to the record room along with a copy of this Judgment.

Pronounced on 01.05.2024