DIST. CONSUMER DISPUTES REDRESSAL FORUM
NORTH 24 Pgs., BARASAT.
C. C. NO-148/2017
Date of Filing: Date of Admission Date of Disposal:
21.03.2017 11.04.2017 16.01.2019
Complainant :- Smt. Pratima Mukherjee,
W/o. Late Mrityunjoy Mukherjee,
(Mother of policy holder Dibyendu Mukherjee,
presently deceased of 29/A, N.N. Bagchi Road,
P.O. Barrackpore, P.S. Titagarh, Kol-700120,
Dist- North 24 Pgs, W.B.
Sign and represented by her legal constitute
attorney namely:-
Mrs. Sukla Mukherjee,
W/o. Late Dibyendu Mukherjee,
29/A, N.N. Bagchi Road, P.O. Barrackpore,
P.S. Titagarh, Kolkata-700120,
Dist- North 24 Parganas, West Bengal.
=Vs=
Opposite Parties:- Bajaj Allianz Life Insurance Company Ltd,
office situated at Barrackpore Ghosh Para Road,
(Near Atindra Cinema Hall), 2nd Floor, Kol-120,
Dist- North 24 Parganas, West Bengal.
P R E S E N T :- Sri. Bankim Chandra Chattopadhyay………..…..President.
:- Smt. Silpi Majumder ……………………………………Member.
:- Smt. Monisha Shaw …………………………………….Member.
Judgment
This complaint is filed by the Complainant u/s 12 of the Consumer Protection Act, 1986 alleging deficiency in service against the O.P as the O.P did not provide her.
The complainant- Smt. Pratima Mukherjee being the mother and Smt. Sukla Mukherjee wife of deceased namely Dibeyendu Mukherjee constituted attorney have filed this complaint.
The brief fact of the case of the complainant is that the said deceased Dibeyendu Mukherjee took three insurance policies vide Nos. 0325835638 dated 26.11.2015, 03263074491 dated 28.12.2015 and 0326886016 dated 22.01.2016 from the O.P for assured sum on maturity amount of Rs. 1,55,230/-, Rs. 2,73,020/- and as per calculation respectively. The O.P granted the said policies in consideration of the premiums paid and to be paid and agreed to pay the amount to the executors, administrators of Dibeyendu Mukherjee (presently deceased). The
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said sum was accrued in the said three policies. Three months notices have been received by the O.P about the death of said Dibeyendu Mukherjee who died intested on 16.06.2016. Prior to his death all necessary premiums under the policy was fully paid and cleared. The complainant issued a notice to the O.P informing the death of the policy holder as the policies were still in force. The said Dibeyendu Mukherjee died leaving behind wife –Sukla Mukherjee and minor daughter Madhumanti Mukherjee as well as his mother – Smt. Pratima Mukherjee
who is the nominee of the aforesaid policies. The wife of the said deceased and minor daughter has no objection if the mother of the deceased took the said money. The complainants demanded to get the said sum of money from the O.P after death claim of the deceased in respect of the policies mentioned above. After receiving the death claim the O.P issued three letters on 16.09.2016 to the complainant. Thereafter the O.P sent a letter to the complainant. The O.P subsequently had issued a letter dated 25.10.2016 to the complainant with regard to repudiate the claim. The O.P on receiving the claim, intimation of the above policies made an investigation. It was observed that ‘hospitalization of the treatment as a diagnosed case of hypertension and Ischemic heart disease since 2014 was pre-proposal’. The fact was deliberately and fraudulently suppressed in proposal form with an intention to deceive the insurer and induce the insurer to issue policy, resulting into fraud (active concealment of the fact) by the insurer having knowledge and believe of the fact. As such the deceased obtained the life insurance. Had these facts been disclosed the company would not cover the risk of the above policies under said terms and conditions and hence ‘claim case has been repudiated’.
The complainant averred that the O.P’s version in this matter is baseless and concocted. The deceased has not been suffered any disease as mentioned by O.P. On several occasions the complainant requested the O.P to re-open/ re-investigate or enquiry in proper way. The O.P rejected the payments of three policies up to this date.
The complainants have alleged that they have got assured sum of the policies which were purchased in the name of the deceased in PNB Metlife Insurance. The O.P unnecessarily harassed the complainants and willfully violated the terms and conditions of the policies. Subsequently on 12.01.2017 the complainants issued a letter to the O.P through their Ld. Advocates, but no effect. The O.P did not pay the death claim to the complainant. The O.P has made deficiency in service and unfair trade practices as per C.P. Act. As the complainant being the mother of deceased is an aged widow and suffering from various ailments so she is not in a position to contest the case. In the situation the wife of the deceased namely Mrs. Sukla Mukherjee being appointed legal constituted attorney filed this case.
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As such the complainants have prayed for direction to the O.P. to pay the death claim as the sum assured on maturity amounting to Rs. 1,55,230/-, Rs. 2,73,020/- and as per calculation. The complainant have also prayed for direction upon the O.P to pay a sum of Rs. 3,00,000/- for causing mental pain and agony and litigation cost amounting to Rs. 50,000/-.
The OP has contested the case by filing a written version on 30.08.2017. OP has alleged that the complainant has breached the principle of utmost good faith by suppressing the material fact. It is evident from the post claim investigation that the insured has suppressed his health condition in the proposal form. The health history is material information required to assess the risk coverage. Suppression/misrepresentation results breach of term of insurance. According to O.P the complaint is not maintainable and liable to be dismissed. It is the binding duty of the life to be assured to disclose all the material fact to assess the risk prior to enrolment of the policy. In accurate answer will entitle the insurer to repudiate his liability in contract of Insurance. The deceased misrepresented his health condition by suppressing the fact of having heart disease, MI and HTN who were under treatment of Dr. Alok Chakraborty, Kolkata since the year 2014 but he declared to have no ailment of any nature in respect of those policies in between Nov 2015 to Jan 2016 when the policies were issued. The deceased has expired on 16.6.16 i.e. within 2 years of insurance policy and under the provision of 45 of insurance act. Investigations were launched in respect of said death. Investigation report reveals that deceased were suffering from ailments like ischemic heart disease, Mi and hyper tension and said doctor certified the said fact during investigation which was filed before this forum. It is a contract of insurance. According to terms of agreement of the contract act, 1872 u/s 17 the contract is void ab initio. There is no negligence of deficiency in service on the part of the OP. The OP after observing the investigation by them being insurer repudiated the claim as it is a case of suppression of material fact. The insurer did not disclose at the time of entering into insurance contract that he was under treatment of Dr. Alok Chakraborty since 2014 while he was suffering from heart ailment. The proposer will answer every question put to him with complete honesty. The OP has repudiated the claim of the complainant based on investigation report and evidence obtained from the doctor who treated the deceased. The decision of repudiation of claim by the insurance company was intimated to the claim review committee and there is no room to consider the repudiation.
As there is no case of the complainant, so the case is liable to be dismissed.
Both parties have adduced evidence in respect of their case. But the complainants are absent at the time of hearing argument, so heard argument only from the side of O.P. We have meticulously gone through the evidence of both sides and the material on record. The documentary evidence of complainant goes to show that the three insurance policies were purchased in the name of deceased being policy number 0325835638 on 26.11.15 sum assured on maturity amounting to Rs. 1,55,230/-, policy number 0326307491 on 28.11.15 sum assured on maturity
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amounting to Rs. 2,73,020 and policy number 0326886016 on 22.01.16 sum assured on maturity as per calculation. The fact remains that insured Dibyendu Mukherjee died on 16.06.16 i.e within 2 years from the date of the commencement of the policy but in view of the report of investigating agency it was detected that the deceased did not disclose his ailments in the proposal form of those insurance policies and accordingly the death claim of deceased Dibyendu Mukherjee has been repudiated by the OP. The documentary evidence goes to show that the appellate authority of the investigation authority did not differ with the observation of the investigating authority. Though the complainant had filed the complaint and it is not shown that the same was filed with affidavit. Actually the pleadings of the complaint have not been supported by any affidavit wherein we cannot rely on the averment made in complaint. The complainant did not file any questionnaire in respect of the case of OP. No proposal form or policy of insurance have been filed in this case by the respective parties but on going through the documents as filed by the complainant annexure B,B1 dated 25.10.16 that the OP repudiated the claim of the complainant to the effect that the complainant did not disclose the ailment of deceased since 2014 which was pre-proposal and it was informed that if the complainant is not satisfied with the decision of OP this may write claim’s review committee for consideration within 30 days from this letter. The annexure P1 goes to show that said doctor viz. Dr. Alok Chakraborty had given certain facts during investigation that he treated the deceased while the deceased were suffering from ailments and treated under the said doctor since 2014. The deceased was suffering from hyper tension and ischemic heart disease. The complainant did not deny the said fact in this case. We do not find any deficiency of service.
Therefore having heard the Ld. Advocate for the complainant and on going through the materials on record, we are inclined to observe that the complainant has not been able to substantiate her case and accordingly we are in view that the complaint should be dismissed as the complainant fails to prove her case.
Hence
it is Ordered,
that the complaint case no 148/17 is here by dismissed on contest against OP without cost.
Let a copy of the judgment be supplied to the parties free of cost as per CPR, 2005.
Member Member President
Dictated & Corrected by
