MR LAXMI NARAYAN PADHI, PRESIDENT…         The substance of complaint is that, the present complaint is the wife of her deceased husband Late Gauranga Panda who opted for a policy under the OP.1 & 2 bearing policy no.560 52362 102 for a sum of Rs.3,00,000/- on dt.05.09.2013 and he died on dt.22.10.2013 due to sudden chest pain. The complainant being the nominee of the policy applied for the assured sum with all relevant documents but the OP.s repudiated the claim with a plea that, the deceased had diabetes and hypertension during the commencement of the policy and the deceased suppressed the material fact to the OP.s during proposal. The complainant contends that, during the commencement of policy the OP examined the deceased through their penal doctor and after found fit they allowed the policy, hence the complainant claims that the repudiation of policy is illegal and there is deficiency in service on the part of OP.s. So he prayed to allow the complaint and direct the OP.s to pay the sum assured of Rs.3,00,000/- and a sum of Rs.60,000/- as compensation and cost.

2.         The counsel for OP.1 & 2 has entered his appearance and filed version wherein he averred that, the complainant is the wife of the alleged policy and nominee of the policy holder. He contends that the claim was repudiated as per procedure & provisions of IRDA as the policy holder had suppressed the material fact of his preexisting diseases like diabetics and hypertension at the time of proposal. Hence in regards to life insurance contract of utmost good faith they repudiated the policy, but however, as a special case and overlooking the contract the answering OP has paid Rs.3,00,000/- on dt.28.01.2016. Hence at this time the claim of compensation and cost is baseless, so he prayed to dismiss the case in the interest of justice.

3.         Undoubtedly, the husband of the complainant has subscribed a policy of Life Insurance coverable by Rs.3,00,000/- vide policy No.56052362102 (Flexi Smart) effective from dt.05.09.2013. Subsequently on 22.10.13, L.A.(life assured) died of cardiac arrest. The nominee complainant with all relevant documents claimed the OP to disburse the assured amount, but the OP vide it's letter dt.30.09.14 repudiated the claim on the ground that to questions in para 13(iv), (13xiii) and 13(xiv) of the proposal form were pertaining to disclosure of existing disease particulars have been suppressed with negative answers, where as the L.A. had been suffering from diabetics and hypertension.

4.         OP claims that, insurance undertaking is based on utmost good faith, but we are not convinced that if the principle of uberima fide only rests against the claims of L.A and not the insurers, has failed to disclose all the pros & cons of the policy, and entries of proposal form to the policy holder at the time of canvassing him to take the policy.

5.         From the copy of policy proposal form submitted to us by the OP.s, we have observed that, the proposal form is in standard form in English language and not in vernacular language, and form is filled in English language by one Subrat Kumar Sahu, the insurance adviser cum field officer i.e. OP.3 in the branch of OP.1. The L.A. as an illiterate, who is found to have signed incorrectly in Odia and an account holder with OP.1 branch. It is uncertain, at least in absence of any documents/affidavit in evidence filed by OP.s, it cannot be held, an officer of a busy branch of SBI, in his office hour has explained all the contents of the proposal form fairly to the L.A. at the time of signing the proposal form for the policies.

6.         Hence, it is well assumed, that the OP.s acted fairly as per the IRDA regulations (protection of interest of policy holder) 2002 at the time of getting signature of the L.A. in the proposal form.

7.         However, the OP submitted that, as a service gesture, they have remitted Rs.3,00,000/- to the complainant's SBI account No.33478057200, ondt.28.01.2016 vide UTR No.C77043776300349, after the notice on the present complaint served on them.

8.         Still then, the service deferred as such, depriving the bereaved family members of the L.A. in disbursing the sum assured, for long 2 years, accrues compensation, and the OP.s cannot claim immunity against it. Thus, the complaint is allowed against the OP.1 & 2 with cost.

                                                       ORDER

i.          The OP.no.1 & 2 are hereby directed to pay compensation of Rs.48,000/- (Rupees Forty Eight Thousand) along with a cost of Rs.2000/- (Rupees Two thousand) to the complainant.

ii.         The above orders shall be complied within 30 days of the order, failing which the total awarded sum will carry 12% interest p.a. till its realization. Pronounced on 30.06.2016.

     Sd/-                                                             Sd/-      

MEMBER                                       PRESIDENT, DCDRF,

                                                            NABARANGPUR.

Date of Preparation: 

Date of dispatch      :  

Date of received by                                                           

the A/A for Ops / Complainant  :

Initial of the dispatcher.