The instant case was started on the basis of a petition of complaint filed by one Swapan Dr. Das of Vill: Arapur, P.O. Arapur, P.S. English Bazar, Dist. Malda (W.B.) Pin – 732 143. u/s. 12 of Consumer Protection Act, 1986 before this Forum which was registered as Complaint Case No. 47 /2016.
The fact of the case as revealed from the petition of complaint as well as from the evidence that the wife of the complainant Nilima Das, now deceased purchased one Insurance Policy bearing No. 456327106 from the Office of L.I.C. Malda Branch-1. But unfortunately the policy holder Nilima Das died on 22/07/2011leaving behind her husband Swapan Kumar Das as legal heirs. Sri Das informed and submitted duly filled up claim form along with the relevant documents to the Branch Office of LIC, Malda -732101. But in spite of repeated request of the complainant (Swapan Kumar Das) the O.P. did not issue an acknowledgement of receiving the applications. For a long time the complainant did not receive any intimation from the Authority. This is why the complainant filed a RTI application knowing about the status of his claim. On 4th day of July, 2016 the LIC Authority sent a reply through RTI application submitted by the complainant wherefrom the complainant came to know that the Branch Manager has changed the date of submission of the claim form which is completely in gross variation of the rules and the Company adopted unfair trade practice. Ultimately, the complainant did not give any fruitful result for which the complainant has come to this Forum for disbursement of claim of Rs. 2,00,000(Rupees Two Lakhs Only), Rs. 50,000/- (Rupees Fifty Thousand Only) for harassment and mental agony and litigation cost.
The petition has been contested by the O.P. LICI denying all the material allegations as leveled against the LIC Authority contending inter alia that the instant case is not maintainable in its present form. The case is barred by law of limitation. The definite defense case is that the insured Nilima Das, suppressed the real fact that she was under treatment from 24/08/2010 to 02.09.2010 and also suppressed the fact that she was undergone an operation for removal of uterus dt. 25/08/2010, more than three months before the date of date of proposal. The date of proposal is dt.06/12/2010 and date of acceptance is 10/12/2010. So the insured suppressed the real fact and by suppressing the real fact the policy was obtained. As such the complainant is not entitled to get any relief as prayed for. In order to prove the case the complainant was himself examined as P.W.-1 and cross examined Sri Arup Sankar Das was examined as P.W.-1. During the trial the complainant has proved and marked the documents from Ext.-1 to 6 as per exhibit list. On the other the LIC Authority has filed a document but no document has been proved and marked exhibited. proved prove.
Now the point for determination whether the complainant is entitled to get any relief as prayed for.
::DECISION WITH REASONS::
Now the main point is to be considered whether at the time of obtaining the policy the insured Nilima Das suppressed any fact or not and whether there was any pre-existing decease of the insured or not. On perusal of the Xerox Copy of the proposal form filed by the complainant
it is found why there was a question in the proposal form “ Have you ever been admitted to any hospital or nursing home for general check up, observation, treatment or operation. Answer is “No” and from the policy proposal it is found that the insured was good state of health. Moreover, on perusal of the proposal form it is found that the insured Nilima Das was an Assistant Teacher and her qualification was Higher Secondary Pass. So she had the knowledge about the prescribed form and on perusal of record it is found that Nilima Das was treated Microlap Nursing Home and her operation was done on 25.08.2010. So completely it is found that she suppressed the real fact as such the LIC Authority correctly repudiated the claim that the insured was suffering from pre-existing disease. As such the complainant is not entitled to get any relief as prayed for.
C.F. paid is correct.
Hence, ordered
that the Consumer Case No. 47/2016 be and the same is hereby dismissed on contest against the O.Ps with cost of Rs.500/- (Rupees Five Hundred Only) as the complainant has not come to this Forum with a clean hand.
Let a copy of the order be given to the parties free of cost on proper application.
