IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,                   MURSHIDABAD AT BERHAMPORE.
CASE No.CC/122/2011
 Date of Filing:    28.11.2011                                                                           Date of Final Order: 27.03.2015
 
Complainant: Ayub Ali Mondal, S/O Late Jafar Mondal, Vill.& P.O. & P.S. Islampur,                                     
            Dist. Murshidabad.     
-Vs-
Opposite Parties: 1. Branch Manager, LICI, Chak Islampur Branch, Vill.& P.O. & P.S. Islampur,
                                 Dist. Murshidabad.
             2. Abhijit Sen W/O Late Prodyut Kumar Sen, Vill.& P.O.& P.S. Daulatabad,
              Dist. Murshidabad.
                                
                       Present:  Sri Anupam Bhattacharyya   ………………….President.                                 
              Smt. Pranati Ali ……….……………….……………. Member.
 
FINAL ORDER
 
Sri Anupam Bhattacharyya, Presiding Member.
The instant complaint has been filed by the complainant u/s 12 of the C. P. Act, 1986 praying for an direction upon the OP No.1 to issue a cheque in favour of the complainant for the assured amount of Rs.50, 000/- along with interest accrued thereon and to pay a sum of                     Rs.10, 000/- as harassment cost as well as agony and to pass such order which the Forum deems to be fit and proper.
The complainant's case in brief, is that on 15.03.2003 the complainant insured the life of his minor son Rabbul Alamin with OP No.1 vide Policy No. 423190941 who died on 05.12.2009 at N.R.S. Medical College & Hospital, Kolkata. The complainant informed the same to the OP No.1 through OP No.2. Thereafter, the OP No.1 issued a cheque on 09.06.2011 for a sum of Rs.18,161/- in favour of the complainant instead of assured sum of Rs.50,000/-. The complainant refused to accept the said cheque being not the assured sum of Rs.50,000/-. The complainant asked the OP the reason as to why the less amount of cheque was issued in his favour. In reply the OP No.1 stated that the claim of the complainant was repudiated but no reason was stated by the OP no.1. Son of the complainant died within the coverage of the policy. The complainant is entitled to get full assured sum of money from the OP No.1 but the OP repudiated the claim. There is deficiency in service on the part of the OP No.1.  Hence, the instant case.
The written version filed by the OP No.1/LICI, in brief, is that the impugned policy was lapsed on 15.09.2006 for non-payment of premium. On 04.04.2009 the said policy was revived on the basis of personal statement of the proposer son of the complainant regarding health fund to the effect that he was not suffering from any disease or undergone on E.C.G, X-rays and declaration of the complainant that the LA is sound in health at that time. During investigation before settlement of claim it was found that life assured was suffering from several diseases and was admitted in R.T.D.M.C at Berhampore on 21.10.2007 and released on 25.10.2007 and on 22.10.07 several tests including USG of the life assured were held and at the time of revival the same was suppressed and for that there is no deficiency in service. Accordingly, the complaint is liable to be dismissed. Hence, the instant written version.
Upon the pleadings of both parties, the following points have been framed for disposal of this case.
1.    Whether the complaint is maintainable in its present form in law and facts?
2.    Whether there is any cause of action to file this complaint?
3.    Whether this complainant is barred by law of limitation, estoppels, waiver and acquiescence?
4.    Whether there is suppression of material facts before the LICI, Op No.1?
5.    Whether the complainant is entitled to get award as prayed for?
6.    To what other relief/reliefs, the complainant may is entitled?
DECISION WITH REASONS
Point Nos. 1 to 3.
    All these three points are taken up together for discussion for the sake of convenience.
    During hearing argument the ld. Lawyer for the OP No.1 has not pressed on these three points.
    Considering the materials on record I do not find anything adverse against these points and as such all this points be disposed of in favour of the complainant.
    Hence, all these three points are disposed of in favour of the complainant.
Point Nos. 4 to 6.
    All these three points are taken up together for discussion for the sake of convenience.
This complaint is for payment of assured sum of Rs.50, 000/- plus interest and compensation.
In this case the policy was issued on 15.03.2003 and the same was lapsed on 15.09.2006 for non-payment of premium and revived on 4.04.2009 and died on 05.12.2009.
The dispute raised by the OPnO.1 Insurance Company is that at the time of revival on 4.4.2009 the complainant suppressed that the son of the complainant whose life was assured was admitted in Rabindranath Thakur Diagnostic and Medical Care Centre (RTDMC) at Berhampore on 21.10.07 and released on 25.10.07 and on 22.10.2007 his total bilirubin test, hemoglobin test, blood urea, serum creative test and also test of Ultra sonography of whole abdomen was held. These are suppression of material facts and for that this claim was repudiated.
In this regard the Ld. Lawyer for the OP No.1 Insurance Co. has referred to two decisions reported in I(2014) CPJ 387(NC) Shnyni Valsan Pombally vs. State Bank of India & Anr. and IV(2014) CPJ 658(NC), Life Insurance Corporation of India Vs. Neelam Sharma .
The fact of the case of reported in  I(2014) CPJ 387(NC) Shnyni Valsan Pombally Vs. SBI & Anr. is that the complainant was the  widow of Valsan Shankaran Pombally .  The husband of the complainant on 31.01.2008 had taken a housing loan of Rs.10 lakh from the State Bank of India, repayable in 222 monthly installments of Rs.10,131/- each. The complainant stood as guarantor for repayment of the said loan. The deceased had also obtained from the Insurance Company a Group Insurance Policy. Before obtaining the said policy the deceased was required and had submitted to the Insurance Company a consent-cum-authorization-cum health declaration on 4.2.2008. On 21.10.2008 the deceased was taken ill and was admitted in Manipal Hospital at Goa. He was diagnosed with cirrhosis of liver with hepatic failure with hepato-renal shutdown and died on 7.11.2008. The cause of death was recorded as 'hepatic encephalopathy, hepato-renal syndrome with alcoholic liver disease".
In that reported decision, it was held that there was suppression of material facts and the repudiation of claim was justified.
The fact of the case reported in IV(2014) CPJ 658(NC) Life Insurance Corporation of India Vs. Neelam Sharma is that Krishanavtar Sharma , who on 28.5.1998 and 30.3.1999  had taken two life insurance policies from the Insurance Company each in the sum of Rs.50,000/-. The Insured died on 31.12.1999 because of a heart-attack. The insured had been suffering from "Amoebic Liver Abscess" and had also been hospitalized from 6.6.1997 to 29.6.1997 but these material facts were not disclosed by the deceased Insured in the proposal form.
In that reported decision it was held that repudiation was justified for suppression of such material facts.
In this case the impugned policy assuring the life of the son of the complainant was made on 15.03.2003 and the same was revived on 04.04.2009 and the alleged suppression of materials fact was relating to admission on and from 21.20.2007 to 25.10.2007 and making some blood tests and USG on 22.10.07 in Rabindranath Thakur Diagnostic and Medical Care Centre(RTDMC). The alleged suppression was long before revival. The said suppression was not before initiation of the impugned policy in the year 2003.
In the aforesaid reported decision in IV(2014)CPJ-658(NC) the question of suppression of material fact was before starting the policy and the name of disease of such suppression was Amoebic Liver Abscess and the policy holder died within a short period. The said policies was issued on 28.5.98 & 30.3.99 and died on 31.12.99.
In this case the policy holder was admitted in the hospital for four days about one and half year before revival and die-d on 05.12.2009 about eight month after revival.
From the Xerox copies of the revival application filed by the OP as well as the averment made in the Written Version of OP no.2 it appears that at the time of revival son of the complainant, the policy holder gave answer against the following questions in the negative except question no.4 where he stated that the present condition of his health is good.
                       Question                                 Answer
1.    Have you ever suffered from any illness/diseases requiring treatment for a week or more?      No.
2.    Did you ever have any operation accident or injury?                                                        No.
3.    Did you ever undergo ECG, X-ray, Scanning Blood, Urine or Stool Examination?                No.
4.    Are you at present in sound health?                                                                                       Good.    
From the alleged suppression of material facts it appears that the policy holder was admitted in the hospital for four days where different blood tests and USG were held.
Where it appears from the above questions replied by the policy holder at the time of revival on 4.4.2009 that in question No.1 it was asked whether the policy holder was treated for a week or more and in question No.2 whether he was ever had any operation for accident or injury and the answers were rightly in the negative.
In question No.3 there is no question as to any test of USG.
There is question as to ECG, X-ray, Scanning- Blood, Urine or Stool examination.
In this case of alleged suppression there were some blood tests on 22.1.07 and the reply given at the time revival on 4.4.2009 after about one and half year from the earlier test. Further, out those for questions , only in question No.3 where there is question of scanning blood examination along with several other tests and the last question is question No.4 which is for the present condition of health of the policy holder and the same was admittedly good and the answer to that question No.4 was rightly given as good.
      The blood test done on 22.10.2007 was relating to the admission for four days which is not coming under the purview of the question No.1.
    The question of blood test as asked in question No.3 being relating to question No.1 which is not required to answer, already discussed, is not required to answer the question No.3.
Rather it can be said that the questions asked for in the printed form of the LICI at the time of revival was rightly answered.
    From the certificate of RTDMC filed by the OP No.1 LICI relating to suppression of material facts it appears that Rabbul Alamin, son of the complainant was suffering from Hemolytic anemia c Jaundice with portal vein cenernoma.
    Also, from the certificate of Panchayat Pradhan of Daulatabad G.P. dated 19.8.10 filed by the OP No.1 it appears that Rabbul Alamin, son of the complainant was admitted in RTDMC hospital at Berhampore on 21.10.07 with blood vomiting in Berhampore Hospital and referred to NRS Medical College, Kolkata and died there on 15.12.2009.
    It is true that Rabbul Alamin, son of the complainant was admitted in RTDMC hospital for four days but this period of treatment is not coming under the first question sought for at the time of revival of policy on 04.4.09.
    Further, the question of suppression of fact as referred in the aforesaid reported decisions are about two years before issuing the original policy.
    But, in this case the original policy was issued on 15.03.03 and revived on 04.4.09 where alleged suppression is regarding admission on 21.10.07 and died on 15.12.2009.
    In the case of reported decision in IV(2014)CPJ-658(NC) two policies were issued and in the reported decision in I(2014)CPJ-387(NC) loan of Rs. 10 lacs was taken which was insured and thus question of financial gain of Rs. 10 lacs was involved.
Whereas, in this case only one policy of Rs.50000/- was issued on 2003 and there was no case of suppression of material facts before issuing such policy and Rabbul Alamin, son of the complainant was admitted in RTDMC hospital on 21.10.07 long after issuing the policy in the year 2003 and the policy was lapsed on   15.06.2003 and revived on 04.4.09, long after alleged suppression and for that the question of intention of wrongful gain cannot be raised in this case.    
Considering the above discussion as a whole including the decisions of the above reported decision, we can safely conclude that in this particular case alleged suppression of material facts cannot be treated as suppression of material facts or in other words, we find that son of the complainant has not suppressed any material facts at the time of revival of the policy.
In the complaint petition there is no claim against Op No. 2. Also in the evidence on affidavit filed by the complainant as well as the documents filed by the complainant there is no material claiming any relief against OP No.2 who is agent of OP No.1 and as such the case against Op No. 2 be dismissed ex parte.
    On the basis of above discussion we find that all the issues are disposed of in favour of the complainant and the complainant is entitled to get award of Rs.50,000/- plus interest @ 9% p.a. from the date of death i.e. 5.12.2009 till the realization plus cost of Rs.2000/-.
    Hence,
ORDERED
that the Consumer Complaint No. 122/2011 be and the same is allowed on contest in favour of the complainant against the OP No.1 and dismissed ex parte against the OP No.2.
The complainant is entitled to get award of Rs.50,000/- plus interest @ 9% p.a. from the date of death i.e. 5.12.2009 till the realization plus cost of Rs.2000/-.
The OP No.1/ LICI is hereby directed to pay Rs.50,000/- plus interest @ 9% p.a. from the date of death i.e. 5.12.2009 till the realization plus cost of Rs.2000/- to the complainant within 30 days from the date of this order, failing which the OP has to pay @Rs.50/- per day's delay till the compliance of the order and the amount so accumulated shall be deposited in the State Consumer Welfare Fund.  
Let a plain copy of this order be made available and be supplied free of cost, to each of the parties on contest in person, Ld. Advocate/Agent on record, by hand under proper acknowledgment / be sent forthwith under registered post with A/D to the concerned parties as per rules, for information and necessary action.

                       Member                                                                            President
    CDRF, Murshidabad.                        CDRF, Murshidabad.