Date of filing of the case- 23.02.2016
Date of order 02.08.2017
JUDGMENT.
Sri A.K.Purohit, President.
The complainant being the nominee of deceased policy holder Sasmita Dora has preferred this case alleging deficiency in insurance service. The case of the complainant is that, deceased Sasmita Dora had taken a New Bima Gold policy from the O.P vide policy No.593131021 and paid the annual premium amounting to Rs 10,660/- on dt.17.4.2007. The sum assured under the said policy is Rs 1,85,000/- and the maturity date is 17.4.2019.During the validity period of the said policy the policy holder died on dt.10.1.2008. After her death the complainant being the nominee intimated the fact to the O.P on dt.18.3.2008 and submitted the claim form along with all documents. The O.Ps again asked for a fresh claim form as per their letter dt.27.10.2008 and in compliance with the same the complainant again submitted the same before the O.Ps along with all relevant documents. The complainant alleges that, instead of settling his claim the O.Ps have repudiated his claim vide their letter dt.22.10.2010 on the ground of suppression of material facts relating to the prior disease of the deceased policy holder. Hence the complaint.
2. The O.Ps have contested the case by filing their written version jointly. According to the O.Ps. on their informal inquiry they found ;that, prior to the date of proposal of the life assured, she was suffering from Rheumatic heart disease and had undergone nuitral valve replacement, which she had suppressed in the ;proposal form and hence repudiation on the ground of suppression of material facts by the life assured is proper and hence there is no deficiency in service on the part of the O.Ps.
3. Heard both the parties. Perused the pleadings and material available on record. Before going into the merits of the case, the learned advocate for the O.Ps raised two preliminary objection relating to maintainability of the case- Firstly the learned advocate for the O.Ps submitted that the case has been preferred beyond the period of limitation from the date of repudiation of the claim and secondly submitted that, since the matter has already been decided by the Ombudsman, this forum has no jurisdiction to again decide the same.
4. Coming to the first point of preliminary objection, it is seen from the documentary evidence available on record that, late Sasmita Dora had taken the New Bima Gold policy on dt.17.04.2007 and the policy is valid till the maturity date i.e till l17.4.2019. lIt is also an admitted fact that, the policy holder died on dated 18.3.2008 and the claim of the complainant was repudiated on dt.22.10.2010. Therefore the cause of action of the case begins from 22.10.2010 to l17.4.2019 which is date of maturity of the policy. It is also seen from the letter of O.Ps filed by the complainant that, on the advise of the O.Ps the complainant had moved to different authorities for preferring appeal against the repudiation of his claim, which shows that the O.Ps have adopted dilatory tactics in filing of the case in proper forum by the complainant. It is clear from the evidence available on record that, the cause of action of this case is continuing till the date of maturity of the policy i.e till 17.4.2011. In this context, it is relevant to refer Para 18 of the decision of the Hon’ble Supreme Court reported in 2017(2) CPR-1 (S.C.) National Insurance Co. Ltd. Vrs Hindustan Safety Glass works Ltd, where in the Hon’ble Supreme Court held that “In a dispute concerning a consumer, it is necessary for courts to take a pragmatic view of rights of consumer principally since it is consumer who is placed at a disadvantage vis-à-vis supplier of service or goods. It is to overcome, this advantage that a beneficent legislation in the form of Consumer Protection Act, 1986 was enacted by parliament. The provision of limitation in the Act cannot be strictly construed to disadvantage a consumer in a case where a supplier of goods or services itself is causing a delay in settlement of consumers claim” Accordingly the case is not barred by limitation.
5. Coming to the next point, the remedy available under the Consumer Protection Act is an additional remedy U/s.3 of the Act and there is no bar for filing a consumer complaint even if the matter has been decided by the Ombudsman. Time and again the Hon’ble Supreme Court has held that “By reasons of the provisions of Sec.3 of the Act, it is evident that remedies provided there under are not in derogation of those provided under other laws. The said Act supplements & not supplants the jurisdiction of civil court or other statutory authorities. (Civil Appeal case No.9922 of 1996, State of Karnataka Vrs Viswabharati House building Society may be referred. Hence the present consumer complaint of the complainant is maintainable.
6. Coming to the merits of the case, it is an admitted fact that deceased Sasmita Dora is a policy holder vide policy No.593131021 and during the validity of the said policy she died on dt.10.01.2008.It is also an admitted fact that, the complainant ;being the nominee of the policy holder had duly submitted the claim before the OPs. It is seen from the letter dt.22.10.2010 of the O.Ps that the O.Ps have repudiated the claim of the complainant on the ground of suppression of material information regarding the health of life assured by the time of acceptance of the policy. In such case the burden of proof heavily lies on the O.Ps to prove the same. To discharge its burden the O.Ps have relies on the Medical Attendant’s Certificate and Certificate of Hospital Treatment of their own doctor in a prescribed format supplied by them. Perused the same. In certificate of Hospital treatment the in charge Medical officer in para-7 has opined that, there was vital valve replacement due to Rheumatic heart diseases. On the other hand the complainant has filed the medical attendant’s certificate and certificate of hospital treatment of Dr.N.K.Adhikari, wherein no prior disease was found. In such circumstances the plea of the O.Ps cannot be believed without any corroborative evidence. The O.Ps have not produced any affidavit evidence of the doctor nor have produced the abstract of medical literature to show that bleeding P/V is a symptom of the said disease which cause the death of life assured . The O.Ps have also not examined the life assured by their own doctor while accepting the proposal which shows that there was no prior disease at the time of accepting the proposal. Hence the O.Ps have not produced clear land cogent evidence to believe that there was suppression of facts relating to the disease of the life assured.
7. Under the aforesaid discussion and material available on record, the non-settlement of the claim of the complainant and advised him to move to different authorities in the form of appeal amounts to deficiency in service on the part of the O.Ps. Hence ordered.
ORDER.
The O.Ps are directed to pay the assured amount of Rs 1,85,000/- (Rupees One lakh Eighty five thousand) to the complainant with an interest @ 10% per annum from the date of repudiation of the claim i.e from 22.10.2010 till payment within one month from the date of receipt of this order.
The O.Ps are further directed to pay Rs 2,000/- (Rupees Two thousand) towards cost to the complainant within the aforesaid time.
Accordingly the case is allowed.
ORDER PRONOUNCED IN OPEN FORUM THIS THE 2ND DAY OF AUGUST 2017.
(S.Rath) (G.K.Rath) (A.K.Purohit
MEMBER . MEMBER. PRESIDENT.
