The complainant Sri Rajendra Sah has filed this complaint petition against Branch Manager, Reliance Life Insurance Company, Savita Complex opposite to the M.D.D.M. College Mithanpura Muzaffarpur and two others (o.ps) for realization of Rs. 1 lacs as sum assured, Rs. 50,000/- for compensation of physical and mental harassment and Rs. 10,000/- as litigation cost. total Rs. 160,000/- with 18 % p.a. interest from the date of death of insured till realization.
The brief, facts of the case is that the father of the complainant namely Bijli Sah had got Life Insurance Policy bearing No.- 51425064 for sum assured Rs. 1 lacs/- from Reliance Life Insurance Company for period of 16 years. The further case is that he paid Rs. 9730/- on 31-12-2013 as first premium. The further case is that on 02-03-2014 insured person fell ill and he was admitted in the clinic of Dr. Arvind Kr. Pusa Samastipur, for his treatment. He died on 03-03-2014 during course of treatment due to heart attack. The further case is that after few days of the death of insured person the complainant filed claim petition on 21-10-2014 and 25-02-2015 with relevant papers. The further case is that on 03-09-2014 insurance company asked complaint’s account. The further case is that the complainant approached at many times for payment of the claim to the officers of the o.p at Muzaffarpur. On 28-05-2015, the Insurance Company repudiated the claim of the complainant on the ground that the insured person suppressed the material fact at the time of filing of proposal form. It has been further mentioned that insured person was healthy and he had no disease.
The complainant has filed the following documents with the complaint petition- Photocopy of initial premium deposit receipt –annexure-1, photocopy of certificate of treatment and death of Bijali Sah by Dr. Arvind Kr.-annexure-2, photocopy of claim form-A – Annexure-3, photocopy of pay out form for death annexure-4, photocopy of repudiation letter annexure-5.
On issuance of notices, o.p. no. 1 & 2 appeared and filed their w.s. on 29-09-2016 with prayer to dismiss the complaint petition with exemplary cost. It has been further mentioned in the w.s. that the complaint petition is false, frivolous, vexatious & abuse of the process of this Forum. It has been further mentioned that the complainant has not disclosed any cause of action to proceed against the o.ps as the claim has been repudiated on he grounds of non disclosure of material facts. It has been further mentioned that the present complaint does not raise any “Consumer Disputes” as defined under the Consumer Protection Act. It has been further mentioned that in the present case there was concealment & misrepresentation on “Health Condition & Medical ailment of Life assured.” It has been further mentioned in the w.s. that on review and documents collected during investigation of claim, it was found that Life assured was suffering from chronic myeloid leukemia and was on treatment since December 2011 i.e prior to making of proposal of insurance on 31-12-2013. It has been further mentioned that there is no deficiency in service or negligence on the part of the o.ps. Issuance of policy bond bearing policy no.-51425064 in the name of Late Bijali Sah for the period of 16 years is an admitted fact. O.ps have annexed the photocopy of proposal form as annexure-A. Receiving of death intimation is also an admitted fact. The o.ps have also annexed the photocopies of medical report dated 2011 as annexure-B and photocopy of repudiation letter as annexure-C.
O.P. No.-3 also appeared and filed his w.s. on 19-09-2016 with prayer to expunge / struck down his name from the complaint petition. It has been further mentioned in the w.s. that the o.p is one of the Corporate Agents of the Insurer, Reliance Life Insurance company Ltd. and his status and position, authority and power are guided by Insurance Regulatory and Development Authority (Licensing of Corporate Agents) Regulations 2002 and nothing beyond those regulations. It has been further mentioned that D.L.A Bijli Sha had obtaining of cash flow from policy No.-51425064 from Reliance Insurance Company. It has been further mentioned that proposer has not disclosed his previous disease of chronic myeloid leukemia in his proposal form.
The complainant RAjendra Sah has examined himself as AW-1. On behalf of complainant, AW-2 Sheela Devi (wife of complainant) has also been examined on affidavit.
On behalf of o.ps no.1 & 2 o.p w-1 Rajnish Kr., has been examined on affidavit.
Learned Lawyers for both th parties have already been heard.
The o.p company Reliance Insurance Company Ltd. has repudiated the claim of the complainant on the ground that Late Mr. Bijli was treated for chronic myeloid leukemia disease since December 2011 and he concealed the material fact in his proposal form. The complainant has annexed the repudiation letter as annexure-5. The same document has been annexed by the o.ps no.- 1 & 2 as annexure-C. It has been mentioned in the repudiation letter that late Mr. Bijili Sah submitted proposal form for Insurance on 31-12-2013, relevant questions in the proposal form and answered provided by disease are reproduced follows-
Question no.-29 -Are you currently taking any medication any drugs other than minor conditions, ( e.g. cold and flue), either prescribed or not prescribed by a doctor, or have you suffered from any illness, disorder, disability or injury during the past 5 years which has required any form of medical or specialized examination (including chest x-rays, gynecological investigations, pap smear, or blood tests), consultation, hospitalization or surgery?- Answer No.
Question-30- Do you suffer from any medical ailments e.g. diabetes, high blood pressure, cancer, respiratory disease including asthma), kidney or liver disease, stroke, any blood disorder, heart problems, hepatitis B or tuberculosis, psychiatric disorder, depression, HIV AIDS or a related infection?-answer No.
The same is verified with annexure-A. The complainant Rajendra Sha (AW-1) has not denied the above facts of concealment of the previous disease in his examination-in-chief AW-2, Sheela Devi has stated in para-7 of her examination-in-chief that her husband has no disease prior to taking insurance policy or after policy. On behalf of o.ps 1 & 2 . Photocopies of examination of treatment of Bijili Sah in Mahavir Cancer Sthan Phulwari Sariph Patna has been annexed as part of annexure-B which shows that Bijli Sah was examined on 06-12-2011. It was found that there was impression of Chronic Myeloid Leukemia –Chronic Phase. The complainant also filed consent letter for treatment for examination of his father of cancer Sansthan, who also treated Late Mr. Bijli Sah so documentary evidence contradict the statement of Aw-2 Sheela Devi. AW-1 has not deny the above facts. So, it transpires that the D.L.A had suppressed the material fact of his disease prior to the filing of proposal form and he has not disclosed the material facts regarding the chronic myeloid Leukemia.
On the basis of above discussions, we are of the considered opinion that the D.L.A had suppressed the material fact of his disease chronic myeloid leukemia in the proposal form and misrepresented the o.p. no.- 1 & 2 for the issuance of policy certificate, so there is no deficiency on part of o.ps and the complaint petition is liable to be dismissed.
Accordingly, the complaint petition is dismissed.
