Tripura

West Tripura

CC/4/2016

Mrs. Rita Majumder. - Complainant(s)

Versus

Branch Manager, State Bank Of India & 1 another. - Opp.Party(s)

Mr. S.Chaudhury.

10 Nov 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
WEST TRIPURA :  AGARTALA

CASE   NO:   CC- 04 of 2016 

Mrs. Rita Majumdar,
W/O- Lt. Bijoy Majumdar,
8 Officer's Qtr. Lane, Krishnanagar,
Agartala, P.S. West Agartala,
District- West Tripura.            ..…..…...Complainant.

       VERSUS

1. State Bank of India, 
Represented by 
The Branch Manager, 
RASMEC Agartala, 
having his office at 
Mantri Bari Road, 
Agartala, West Tripura.

2. SBI Life Insurance Company Ltd.,
Represented by its Head- Claims, 
Central Processing Centre, Kapas Bhavan, 
Plot No. 3 A, Sector No. 10,
CBD Belapur, 
Navi Mumbai- 400 614.

(Notice to be served at 
Agartala SBI Branch Office,
Joynagar, South side of Fire Service,
P.O. Agartala, P.S. West Agartala,
West Tripura.                    ..........Opposite parties.

 

      __________PRESENT__________

 SRI A. PAL,
PRESIDENT,
  DISTRICT CONSUMER  
DISPUTES REDRESSAL FORUM,
      WEST TRIPURA, AGARTALA. 

SMT. Dr. G. DEBNATH
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

 

C O U N S E L

    For the Complainant        : Sri Surajit Choudhury,
                          Advocate.

For the O.P. No.1            : None appeared.

For the O.P. No.2             : Sri Arindam Ray,
                      Advocate.

 

        JUDGMENT  DELIVERED  ON:  10.11.2016

 

J U D G M E N T

        This case was filed by one Rita Majumdar U/S 12 of the Consumer Protection Act. She filed the case against the State Bank of India and against the SBI Life Insurance Company Ltd. Fact of the case in short is that her deceased husband Bijoy Majumdar had taken a loan for Rs.5 lakhs from State Bank of India. While taking the loan deceased husband of the complainant enrolled himself in the 'Rinn Raksha Home Loan' Scheme of SBI Life Insurance company. But just after commencement of the policy after about 7 months Bijoy Majumdar died. Thereafter petitioner being the legal heir of the policy holder, Bijoy Majumdar claimed the sum assured Rs.5,81,587/-. But her claim was repudiated by SBI Life Insurance on the ground that deceased Bijoy Majumdar suppressed the material fact about his serious illness at the time of purchasing the policy. Being aggrieved and dissatisfied by the action of the SBI life she filed this prayer and claimed the sum assured and also 1 lakh for deficiency of service by SBI life. 

2.        SBI, O.P. No.1 did not appear to contest the case as no relief was claimed against them. But O.P. No.2 appeared and filed W.S denying the claim. It is contended that the policy holder Bijoy Majumdar had given false declaration about his health condition. As he had given the false declaration about his state of health so his legal heirs are not entitled to get the policy benefit or the sum assured. 
        
On the basis of assertion denial made by the parties following points cropped up for determination;

        (I) Whether Bijoy Majumdar, policy holder had given false declaration about the condition of his health?
        (II) Whether the petitioner being the nominee  and legal heir is entitled to get the policy benefit and compensation for any deficiency of service by SBI Life?
        
4.        The claimant petitioner produced the photocopy of Insurance certificate, medical attendance certificate, hospital treatment certificate, demand notice, RTI reply. Petitioner also produced the statement on affidavit of Rita Majumdar, petitioner of this case. 
        
5.        O.P. on the other hand produced the original copy of SBI Life, membership form, requirement letter, Employer's certificate, referral outside state certificate, patient record of Susrut Foundation, claim repudiation letter.  O.P. also produced the statement of one witness namely Debjyoti Choudhury, DSM, Agartala. 

        
On the basis of all these evidence on record we shall now determine the aforesaid point.

    Findings and decision:
        
We have gone through the policy certificate. Policy commenced from 28.09.2013. Sum assured was Rs.5,63,935/-. premium is to be paid for 5 years premium amount is Rs.11,380/- with service tax amount is Rs.1,407/- total, Rs.12,787/-. Premium was paid. So, it is established that during insurance coverage period Bijoy Majumdar the life insured died. Rita Majumdar being nominee claimed the sum assured and O.P. SBI Life repudiated the claim vide letter 18.02.15. Being aggrieved by that letter this case filed within the limitation period. We have gone through the repudiation letter issued by SBI life. It is stated in the letter that 'As deceased life assured had given false good health declaration and had not disclosed material fact at the time of entry into the scheme, the claim has been repudiated'. We have gone through the declaration given by the life assured Bijoy Majumdar. Some question were put to him 1st question was whether he consulted any doctor for surgical operations or have been hospitalized. He answered - 'No'. 3rd question was 'Have you ever been treated  for or told that you have diabetes or raised blood sugar, high blood pressure, heart attack.' He answered : 'No'. 5th question was 'Have you been suffered from any other disease?' He answered : 'No'. 6th question was 'Are you at present taking any medication or any special diet or on any treatment?' He answered 'No'. O.P. No.2 SBI Life produced the Employer's certificate of Bijoy Majumdar life assured. Employer's certificate is issued by Manimoy Debbarma Under Secretary, Govt. of Tripura. It is for the period from 25.11.11 to 29.03.14. There it is written that Bijoy Majumdar went to outside state for treatment from 25.11.11 to 17.12.11. Office record of the department of Secretary where Bijoy Majumdar worked also produced. That information from the office record is given by Samarendra Debbarma, Section officer(TSS). In that information record particulars of illness and amount taken for medical treatment was given. From that record it is found that from 23.11.11 to 02.03.12 Bijoy Majumdar has taken Rs.1,346/- for diabetes treatment. Again he had taken Rs.1,390/- on 23.02.13 for diabetes treatment. From 28.02.13 to 06.04.13 he had taken Rs.657/- for diabetes treatment. From 25.03.13 to 01.04.13 he had taken Rs.41,545/- for eye treatment. Many other treatment he had gone in the period between 2011 to 2013. But Bijoy Majumdar purchased the policy on 28.03.13 and gave declaration that he was not suffering from any illness and not a diabetic patient. O.P. produced the referral certificate issued by medical board on 24.10.13. In that referral certificate it is clearly written that Bijoy Majumdar was suffering from severe non NPDR (non proliferate diabetic retinopathy). Eye problem and retina was effected due to diabetics.

8.        Rita Majumdar P.W.1 stated that her husband was mislead by SBI life and asked to sign in the declaration. It is stated that her husband did not suffer from diabetes or any other illness. He had no preexisting disease. Petitioner produced photocopy of medical attendance certificate. Cause of death is written CRF & Uraemia. In that photocopy it is written by doctor that patient had diabetes and RTI HTN. Certificate is issued by Dr. Surpiya Mallik. So, from this certificate also history of diabetic comes out. Petitioner could not produce any other document to support that her husband Bijoy Majumdar was medically fit and had no disease on date of commencement of policy from 28.09.13. From the evidence by the parties  it is revealed that Bijoy Majumdar had pre-existing disease at the time of taking the policy but he had suppressed the material fact at the time of purchasing the policy. The policy of life Insurance may be called in question at any time within 3 years from the date of commencement as per section 45 of the Insurance Act. O.P. referred the decision of the National Commission in Revision Petition No- 1935 of 1999 decided on 23.01.06. O.P. also referred the decision of National Consumer Forum in Revision Petition No- 148 of 1998 decided on 03.09.2002. in this case National Forum affirmed that opinion of doctor can be taken into consideration without his appearance. It was certified that life assured was diabetic. That certificate was taken into  consideration and accordingly claim was repudiated. In this case from the certificate on record and the doctors report certificate it is found that Bijoy Majumdar was suffering from diabetic since 2011. He had taken medical reimbursement from the department for diabetes treatment since 2011. He also went to Susrut Eye Hospital for eye treatment. And his eye problem  was caused by diabetes. All this facts were suppressed by him and he had given false declaration. Therefore, O.P. No.2 rightly repudiated the claim for suppression of material fact. There is no deficiency of service by SBI Life and petitioner is not entitled to get the amount as claimed. Points are decided accordingly.

9.        In view of our above findings over two points this petition is dismissed. Parties are to bear their own cost. 
        

                     Announced.

SRI A. PAL
PRESIDENT,
DISTRICT CONSUMER  DISPUTES 
REDRESSAL FORUM,
WEST TRIPURA,  AGARTALA.

 

SMT. DR. G. DEBNATH,
MEMBER,
 DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM, 
WEST TRIPURA, AGARTALA    SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.