Hon’ble Mr. Manojit Mandal, President
This is a petition u/s 12 of the C.P. Act, 1986.
The petitioner has stated interallia that deceased Anita Paul was his wife and during the life time of his wife, his wife took out two insurance policies viz. RLIC guaranteed money back policy from the opposite party insurance company. The policy Nos. were being No. 51203907 and 51203687. The opposite parties issued policy docket in favour of the life assured “policy holder” with regard to said two polices. The policy holder i.e. Anita Paul nominated the complaint Sri Sankar Paul as nominee, being her husband. The stipulation of those policies were that the yearly premium to be paid for a period of 5 years and if such premiums had been made, the policy holder is entered to get all the benefits.
Further case of the Complainant is that apart from some assured against the policies in question the company provided other benefit as per policy conditions including lump sum payments to nominee on the death of life assured, guaranteed maturity addition and accrued guaranteed loyalty addition.
Further case of the Complainant is that deceased Anita Paul paid all the 5 yearly installments as is stipulated and insurance company issued the premium receipt thereby. Owing to non collection of yearly premium by the Agent of the opposite party company, the policies were lapsed and ultimately there insurance company took out a policy to revalidated the lapsed policies when the policies of Anita Paul have been re-inforced on taking premium by the company and in this way the life assured paid all the premiums. During subsistence of the said policies deceased Anita Paul felt ill in or about the month of April, 2015 and she was detected with Adeno carcinoma on her lung and her treatment was started forthwith. Anita Paul was treated at Rajiv Gandhi Cancer institute and Research Center New Delhi as indoor patient on and from 16/04/15 to 20/04/15 for Chemotherapy and she was advised to re-visit on 24/04/15 with C.B.C. for review. Said Anita Paul, thereafter, was brought to Mathabhanga and as per advice of the Doctor her treatment was continued but unfortunately Anita Paul died on 30/09/17 at her residence after long illness due to Cardio- respiratory failure as a result of Adeno Carcinoma of lung.On demise of said life assured, Anita Paul being the nominee of both policies. The Complainant applied for settlement/benefit of death claim against the said policies.
Further case of the Complainant is that the opposite parties insurance company must illegally and arbitrarily repudiated the insurance claims to deprive him on the ground that the life assured made false statement at the time of revival of policy. The opposite parties are liable to pay the entire benefits against the policies in question. Hence, this case.
Notices were duly served to the opposite parties but the opposite parties did not enter appearance in this case and did not contest this case.
POINTS FOR CONSIDERATION
- Is this case maintainable in its present form?
- Whether there is any deficiency in service and unfair trade practice on the part of the opposite parties as alleged?
- Whether the Complainant is entitled to get any relief as prayed for?
DECISION WITH REASONs
Point Nos.1, 2, & 3.
All these points are taken up together for consideration as they are inter related each other.
We have carefully examined the entire materials on record including the examination in chief of the Complainant and the documents on record. We have also given a thoughtful consideration to the argument advanced by the Complainant before us.
Upon hearing both sides and on perusal of the evidence and the materials on record it is found that the wife of the Complainant, Anita Paul obtained insurance policies bearing No. 51203907 and 51203687. It is also found that the insurance policies were lapsed for non-depositing of yearly premiums. It also found that the said two policies have been re-inforced on taking premium by the insurance company. It is also found that the wife of the Complainant, Anita Paul was treated Medically on and from 26.04.2015 to 20.04.2015 at Rajiv Gandhi Cancer institute and Research Center, New Delhi and ultimately she died on 30.09.2017. It is also found from the evidence that the Complainant being the husband as also the beneficiary under the policies submitted insurance claim with the opposite parties/ insurance company.
The insurance claim, however was repudiated vide letter dated 30.11.2017 on the ground that Anita Paul has submitted false statement in the declaration of state of good health DGH signed by life assured on 22.04.2015 which was prior to reinstated of these two policies and these policies were reinstated on the basis of said statement and the relevant questions in the DGH form and answers provided by the deceased.
According to the Complainant, the repudiation of insurance claim by the opposite parties is not justified because the contention of the opposite parties/ insurance company are false and have been projected just to deprive the Complainant from getting the valid insurance benefits.
Now, I shall have to consider as to whether the said Anita Paul submitted declaration of state of good health by concealing the correct information or not.
The Complainant has no where denied on oath that his wife did not submit the declaration of state of good health signed by his wife on 22.04.2015 rather it is, the case that the said declaration is forged and false. On careful perusal of the letters dated 30.11.17 issued by insurance company (Annexure I & J), we find that in the questionnaire about the life style and physical health of the insured given in the DGH form, the life assured had given following answers in the DGH form dated 22.04.2015.
Questions Answers
- Are you now in good health and entirely free from
Any Mental or physical impairments or deformities? Yes
- Have you had or been advised to undergo Hospital
treatment or surgery in the last one year? No
- Have you consulted a physician for any reason,
including routine examinations and blood tests, or
have you received any blood transfusions within the
last one year? No
From the above questions and answers, it appears to us that the above answers given by the life assured are false as the Anita Paul was treated at Rajiv Gandhi Cancer institute and Research Center, New Delhi on and from 16.04.2015 to 20.04.2015 as indoor patient and Anita Paul was advised to re-visit on 24.04.2015 with CBC for review. On perusal of the above noted information given by the assured in her DGH form dated 22.04.2015, it is clear to us that Anita Paul had concealed the information regarding her treatment and disease by answering the relevant questions referred to above in the negative and submitting that her usual state of health is good. On perusal of the said two letters dated 30.11.2017, (Annexure I & J) it appears to us that there is nothing on it to disbelieve the documents. Since the declaration of state of good health was submitted at the time of reinstatement of policies of deceased Anita Paul, it may be presumed that it was duly submitted by her and signed by her. Therefore, it is evident that Anita Paul reinstated her policies by practicing fraud and concealing the material information regarding her physical health.
Under this facts and circumstances and on perusal of the evidence and the materials on record, we have no hesitation to hold that the Complainant has failed to prove his case and as such, he is not entitled to get any relief in this case.
The points are thus decided and disposed of accordingly in favour of opposite parties and against the Complainant.
The Complainant fails to succeed.
Court fees paid an correct.
Hence, it is
Ordered,
That the complaint case be and the same is dismissed ex-parte against the O.Ps without any cost.
Let plain copy of this Order be supplied to the parties concerned by hand/by Post forthwith, free of cost for information & necessary action. The copy of this Final Order/Judgment is also available at www.confonet.nic.in.
Dictated and corrected by me.
