DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KEONJHAR

                                    CONSUMER COMPLAINT CASE NO 3 of 2019

Kamala Mahanta, aged about  46 years

W/O- Kshetrabasi Mahanta is the legal claimant of death claim on Exide Life Star Saver Plan of the deceased policy number-3591396,residing at vill-Gandabarei, PO-Ukhunda, P.S-Baria

Dist-Keonjhar…………………………….………….………….....… Complainant

                     Versus

1.The Managing Director & C.E.O.

Exide Life Insurance Company Ltd.

JP Techno park,1st floor,No.3/1 Millers Road,Bangalore-560001.

2.Cluster Manager,

Exide Life Insurance Company Ltd.

4^th Floor, Vinayak Complex,96^th Janapath, Kharvel Nagar, Bhubaneswar

3.Saroj Kumar Mishra,

Territory Manager, Exide Life Insurance

C/o-Anil Kumar Sahoo, The Keonjhar Central Co-Operative Bank

At/Po-Keonjhargarh, P.S-Town

Dist-Keonjhar………………………………………………………… Opp.Parties

Present:

Sri B.N.Patra,President

Sri. J.K.Behera,Member I/C

Advocate for complainant : K.N.Nanda

Advocate for O.Ps               : Biswa Bhusan Das

Date of  filing- 05.02.2019                                                                      Date of order- 30.12.2022

 Sri B.N Patra (President)

Brief facts of the   case is that the complainant husband Kshetrabasi Mahanta had purchased a life insurance policy under Exide Life Insurance Company Limited. The scheme of policy was Star Saver Policy bearing  policy No- 03591396 dtd-26.06.2017.Sum assured on death is 3,50,000 premium P.A Rs 50,000 and PPT(Premium Paying Term) was five years. Policy term is 15 years. After being convinced by conditions by policy the then territorial manager prepared all documents and finally Kshetrabsi Mahanta purchased the policy. But unfortunately the said policy holder expired on 26.08.2017 after 2 months of D.O.C (Date of Commencing) of policy. After the death of complainant’s husband his wife the nominee submitted all documents with death claim application. The Inquiry officer inquired the matter and demanded Rs 30,000/- bribe to settle the death claim. But on refusal to give bribe the inquiry officer submitted negative report. The company finally repudiated death claim on dtd. 23.09.2018. Complainant send a letter to Ops for such illegal and arbitral steps taken by Ops.  to consider it.

Under the above situation the complainant filed this complaint petition against ops praying to pay the claim amount Rs. 3,50,000/- and  Rs. 50,000/- for mental agony and Rs. 50,000/- for litigation expenses.

Under the above complaint this commission admitted the case, issued notice to OPs for appearance & file written version. In this case ops appeared and filed their written version.

The complainant relied on the following documents:

1. Xerox copy of death certificate.
2. Voter card of complainant.
3. Proposal form of policy.
4. Policy covering letter of Exide Insurance Co.
5. Application for settlement of claim.
6. Application to territorial Manager  

OPs have relied on the following documents

1. Hi- Tech Medical College Hospital admission record.
2. Death intimation cum death claim form  
3. Investigation report.
4. Repudiation of death claim on policy no. 03591396
5. Proposal form

On the above situation the following issues are farmed to attend the case before passing any order.

1. Whether the case is maintainable?
2.  Whether any cause of action arises on the case?
3. Whether the ops have made any unfair trade practice to the complainant?
4. Whether the complainant has concealed pre existing diseases to pay less premium?
5.  Whether Insurance Territorial Manager /agent demanded bribe to settle the claim?

On the above situation OPs submitted that the complainant has suppressed the material information to the Hon’ble Commission pertaining to past medical history of chronic liver disease and ascites. The complainant has not approached the forum on clean hands. He is not entitled to get any relief Op-1 submitted that as per medical documents of Hi-Tech Medical College BBSR the life assured was a known case of chronic Liver disease and ascites and hospitalized for the same on dt. 15.05.2017 i.e. prior to signing the proposal. There is no deficiency of OPs as laid down in complaint.

It is the duty of every life insurance company to see the medical certificate issued by doctor authorized by the company during the time of under writing of policy. It is the duty of agent/ authorised officer to look into the detail of policyholder before depositing premium. It has to prove by the complainant. But complainant has not pro ceed any deficiency of service by OPs.

Here the commission came to point of determination that natural justice should be applicable in the case of law in hurdles. That question does not arise.

The OPscompany has cited the decision as follows-

1. One who seeks justices must come with clean hands.(Arunima Basua Vs Union of India 2007 SCC -120)
2. Section 45(2) of Insurance amendment Act 2015 has been reproduced below for ready reference

“A policy of life insurance may be called in question at any time within three years from the date of insurance of policy or the date of commencements risk on the date of revival policy or the date of rider to the policy which ever later on the ground of fraud, provided that insurer shall have to communicate in writing to the insured or the legal representative or nominee or assignee or the insured the grounds and material on which such decision is based. “

The complainant has failed to show deficiency in service on the part of the OPs. The policy holder had suppressed his past medical history about his chronic liver disease and ascites to ops and also made false declaration in proposal form.

In the present case the policy was issued on 26.06.2017, policy holder expired on 26.08.2017 i.e. within two months from the date of commencement of the policy. OPs have legally and in accordance with term and conditions repudiated the claim of complainant on the ground of intentional  non-discloser of material facts  of  life insurer.

Prior to the purchasing of policy he was admitted in medical for the said disease on  dt.15.05.2017 at Hi-Tech Medical College and Hospital BBSR. So far as the demand of bribe by territorial manager to settle the claim. There is no base of complainant to establish this allegation. The complainant being the consumer of Ops have every right to prove the settlement of claims. But in this situation the complainant has failed to prove its case. So the question of unfair trade practice or deficiency of service by the Ops is not proved. The policy holder has concealed pre existing disease for chronic liver disease and ascites. So the complainant is not entitled to get any relief.

ORDER

The Complaint petition of complainant being  devoid of merits is dismissed  without any cost.

The order pronounced in open Commission today i.e on  30^th   December 2022.

Free copy be supplied to parties, if applied for.

Pronounced on 30^th   December.2022

I  agree

 ( Sri J. K. Behera)                                                                                             ( B.N Patra )

   Member I/C                                                                                                  (President)

DCDRC,Keonjhar                                                                                          DCDRC,Keonjhar

                                                          Dictated & Corrected by

                                                                     ( Sri B. N. Patra)                                                                                                                           President

                                                                   DCDRC,Keonjhar