DATE OF DISPOSAL: 22.05.2024.

PER:  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 complainant is the mother and nominee of policy holder late Sujay Kumar Das in Policy Number 03792364. The policy holder late Sujoy Kumar Das was at the age of 29 years at the time of entering to policy. The policy holder was a Raj-mistry and the annual income was above three lakhs and was maintaining sound health. The policy holder made policy with the O.Ps in aforesaid policy on deposits of Rs.30,000/- only towards premium amount and the guaranteed death benefit was Rs.4,98,481/- as per letter dated 25.05.2018 of the O.P.No.1. While the matter stood thus the policy holder suffered from high fever on 16.10.2018 and contacted the local doctor at Rambha who advised for pathological investigation and accordingly it was done on 17.10.2018. Basing on the pathological investigation report the doctor prescribed medicine on 20.10.2018 and again on 22.10.2018. In course of treatment, the policy holder died on 27.10.2018 and the doctor submitted death declaration. The complainant obtained the death certificate from the registrar of Birth and Death, CHC, Khandadeuli, Ganjam on 14.01.2019. During the death certificate, the complainant filed claim application claiming Guaranteed death benefit of Rs.4,98,481/- as per policy schedule. The policy was in force and the cause death of the policy holder was natural which occurred in course of validity of the policy in question. Instead of payment of assured money of guaranteed death benefits of Rs.4,98,481/-, an amount of Rs.30,000/- was remitted to the UCO Bank account in NEFT on 02.04.2019 and was intimated in letter dated 02.04.2019. The complainant has been further advised to contact one Tool Free number if not satisfied on the actions of the O.Ps. It is submitted that the O.Ps collected all such documents relating to the policy and though the complainant contacted the Tool free number with the assistance of a local person if yielded no response and no result. The complainant has no money to approach the Insurance Ombudsman at Bhubaneswar as suggested in letter dated 02.04.2019. Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.Ps to release of Rs.4,98,481/- towards guaranteed death benefit deducting Rs.30,000/-(paid), compensation of Rs.30,000/- and litigation costs of Rs.5000/- in the best interests of justice.

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

      4. The O.Ps filed written version through his advocate. It is stated that the present complaint is not maintainable. The subject policy has been obtained fraudulently, dishonestly and by misrepresentation and suppressing the fact regarding the insurance policy obtained by him from SUD life, PNB, BSLI & Bajaj life insurance for a sum of Rs. 30,47,128/- prior to signing the proposal of the subject policy and for as sum of Rs.12.62 lakh after issuance of the subject policy. The claim was repudiated for suppression material information at the time of proposal form insurance. The present complaint is false, frivolous, vexatious and is gross abuse of process of law. The complaint is liable to be dismissed under 26 of the Consumer Protection Act. Under Section 45 of Insurance Act, 1938, the insurance company can challenge the policy on the ground of concealments of material fact by the insured within three years from the date of commencement of the policy. In the present case, the subject policy was issued on 24.05.2018 and the Life Assured was reported to have been died on 27.10.2018 within five months 3 days from the date of commencement of the subject policy. The O.Ps have rightly, legally and in accordance with the terms and conditions of the policy repudiated the claim of the complainant on the ground of intentional non-disclosure of material facts by the life assured. Hence the O.Ps prayed to dismiss the case.

      5. On the date of hearing advocate for the complainant is present and O.Ps are found absent. The Commission perused the complaint petition, written version, evidence on affidavit, written argument and documents available in the case record.

On evaluation of the evidence adduced by both the parties, it is revealed that the Opposite Parties have not filed any corroborative documents regarding issuance of insurance policies by other companies prior to obtaining of the present insurance policy in the instant case. Hence there is no suppression of material fact in non-disclosure of other insurance policies while obtaining the present policy by the complainant.

In considering the ratio decidendi in Mahakali Sujatha v. The Branch Manager, Future Generali India Life Insurance Company Limited & Another disposed of on April 10, 2024 in the Court of Hon’ble Supreme Court of India in Civil Appeal No.:3821 of 2024,  the Commission allowed the complaint of the complainant against the Opposite Parties on contest. The Opposite Parties who are jointly and severally liable to release the guaranteed death benefit of Rs.4,68,481/- with interest 9% p.a interest from the date of death of the insured i.e. 27.10.2018 to the complaint together with litigation costs of Rs.5000/- within 45 days from the date of receipt of the order. In the event of non-compliance of the above order by the opposite parties, the entire dues shall carry interest @ 12%p.a from the date of filling of the case i.e., Dated:27.08.2019  till the actual date of realization is made by the opposite parties and the complainant is at liberty to realize said entire dues with interest as above from the opposite parties in accordance to the Consumer Protection Act, 2019.

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 22.05.2024