C.F. CASE No. : CC/11/82
COMPLAINANT : Mamata Bibi,
W/o Lt. Ohab Sekh @ Ohab Sk.
Vill. Khidirpur Madhyapara (Hattala)
P.O. Bethuadahari,
P.S. Nakashipara,
Dist. Nadia
OPPOSITE PARTIES/OPs: 1) Divisional Manager,
LIC of India
Kolkata Suburban
Divisional Office
Jeevan Prabha,
DD-5, Sector – 1,
Salt Lake City
Kolkata - 700064
- Branch Manager,
LIC of India
Krishnagar Branch – 1
5/1A D.L. Roy Road
P.O. Krishnagar
P.S. Kotwali
Dist. Nadia, Pin – 741101
PRESENT : SHRI KANAILAL CHAKRABORTY PRESIDENT
: SHRI SHYAMLAL SUKUL MEMBER
DATE OF DELIVERY
OF JUDGMENT : 23rd December, 2011
: J U D G M E N T :
In brief, the case of the complainant is that her husband Ohab Sekh purchased one insurance policy of LICI of India, table No. 091 with a sum assured of Rs. 60,000/- on 13.11.09. At the time of purchase of the policy Ohab Sekh was sound in health till his death. The first premium was received by the OP on 13.11.09 and the next premium due was on 2/10. Ohab Sekh expired on 11.12.09. After his death the complainant being his wife and the nominee of the policy submitted claim form before the OP with a request to make payment of the policy amount. On 24.01.11 the OP sent a letter to this complainant to furnish some information which were duly replied by this complainant, but the OP repudiated her claim by sending a letter on 24.01.11, inter alia, stating that late Ohab Sekh was suffering from pulmonary tuberculosis since 02.02.07 who was treated at Bethuadahari Hospital and due to this disease he expired. But at the time of purchasing policy he did not disclose his ailment in the proposal form. Rather he suppressed his disease and purchased policy by submitting wrong information. Considering this the OP repudiated the claim of the complainant. So having no other alternative this case is filed by the complainant praying for the reliefs as stated in the petition of complaint.
OP LICI of India has contested this case by filing a written version, inter alia, stating that the complaint is not maintainable in its present form and nature. It is her submission that late Ohab Sekh purchased one LICI policy on 13.11.09 and the complainant is the nominee of that policy. But it is revealed that after 28 days of date of commencement of life assured said Ohab Sekh expired due to pulmonary tuberculosis as per death certificate issued by Bethuadahari Hospital where he was admitted. But at the time of purchasing the policy from the LICI said Oheb Sekh assured the corporation that during the last 5 years of purchasing of policy he did not consult any medical practitioner for his ailment, nor he was admitted at any Hospital for treatment. But from the documents it is available that he was admitted at the above cited Hospital previously on 02.02.07 and again he was admitted there as the disease relapsed. So he was treated both for CAT-1 and CAT-II on both occasions and the first occasions was before the date of purchasing the said policy. But in the proposal form some material facts were suppressed. Pre-existing disease of the DLA was suppressed motivatedly. So this OP repudiated the claim of the complainant on the ground of withholding material information as to the health of the life assured at the time of purchasing the policy. Therefore, the complainant has no cause of action to file this case and the same is liable to be dismissed against this OP.
POINTS FOR DECISION
Point No.1: Has the complainant any cause of action to file this case?
Point No.2: Is the complainant entitled to get the reliefs as prayed for?
DECISION WITH REASONS
Both the points are taken up together for discussion as they are interrelated and for the sake of convenience.
On a careful perusal of the petition of complaint and the written version filed by the OP along with the annexed documents filed by both the parties it is available on record that admittedly the husband of the complainant one Ohab Sekh purchased one LIC policy from the OP on 13.11.09 with a sum assured of Rs. 60,000/-. It is also available on record that within 28 days since the date of purchasing the policy, i.e., on 11.12.09 said Oheb Sekh expired. After his death the complainant being the nominee of the policy prayed before the OP to pay the insured amount which was repudiated by the OP on the ground of suppressing of material fact. Now the question is whether the complainant is entitled to get the sum assured in the policy. From the documents filed by the complainant it is available that said Ohab Sekh expired on Bethuadahari P.H.C. on 11.12.09. After his death the complainant submitted claim form before the OP on 19.04.10. The OP sent a letter directing her to furnish some documents which were also submitted by her including treatment particular like prescriptions, medical reports, discharge certificates from hospital / nursing home etc. for last three years prior to death. On the side of the OP a claim copy of the claimant’s statement filed by the complainant dtd. 29.09.10 is submitted before this Forum which speaks that the statement form was duly filled up by this complainant at which it is stated that Ohab Sekh was suffering from pulmonary tuberculosis and expired at Bethuadahari P.H.C. on 11.12.09. The OP has filed the medical attendance certificate issued by the Bethuadahri P.H.C. along with the certificate of hospital treatment. From the medical attendance certificate filed by the OP, it is available that the deceased Ohab Sekh was admitted at Hospital on 11.12.09 and on that day he expired and his disease as reported as pulmonary tuberculosis. With regard to question No. 4H regarding the time of his first visit, the Hospital authority replied that the patient attended the Hospital in 2009 for relapse since 2007, but no document is filed regarding his treatment at that Hospital in 2007 and it is categorically reported that the date of first visit was not properly told by the party nor it is stated by the medical officer of the Hospital that in 2007 the patient was treated at that Hospital as outdoor or indoor patient excepting the statement that he was treated in 2009 for relapse of his decease in 2007. Ld. lawyer for the OP has relied on this and argued that the complainant party suppressed the material fact regarding the previous ailment of the deceased who was treated at the Bethuadahari Hospital PHC in 2007. No oral evidence is adduced by this party in support of the respective contention in this case. On the side of the complainant in this connection a ruling is cited from III (2011) CPJ page 418 (NC) where the Hon’ble National Commission decided “Medical certificate produced by petitioner not proved on record – Production of a document is different from proof of same – Petitioner to settle claim with interest.” Hon’ble National Commission also has decided “It is well settled that proceedings cannot be held as evidence and in the absence of any evidence in support of the case set up, the certificate produced by the petitioner from the Hospital is of no help to the petitioner because as stated above the petitioner took no steps to prove the same; production of a document is different from proof of the same.” Another ruling is cited from 2010 CTJ page 963 (CP) (SCDRC) Rajasthan where the Hon’ble Forum has decided “No reliance could be placed on the bed head ticket unless the doctor who wrote it was produced – Not done. Therefore held : no suppression of material facts by the deceased regarding his health – Order passed by the Forum below confirmed”
On a careful perusal of the above two rulings our considered view is that these are applicable in the instant case also as in this case on the side of the OP no authentic document is produced to establish that at the time of purchasing the policy the insurer was suffering from tuberculosis and he was treated at Bethuadahari PHC. Besides this, the authorized doctor of the OP signed and put his seal on the application form of the complainant after perusing and verifying the said form filled up by the deceased Ohab Sekh.
In view of the above discussions and considering the facts of this case along with the documents filed by the parties, we find that the allegation of suppression of material facts on the part of the deceased at the time of purchasing the policy is not at all proved. Rather we hold that the complainant has become able to prove her case and so she is entitled to get the relief as prayed for. In result the case succeeds.
Hence,
Ordered,
That the case, CC/11/82 be and the same is allowed on contest against the OPs. The complainant is entitled to get the policy amount of Rs. 60,000/- along with compensation of Rs. 5,000/- for harassment caused to her plus Rs. 1,000/- as litigation cost, i.e., in total Rs. 66,000/-. The OP No. 1 & 2 are jointly and severally liable to pay this amount who are directed to make payment of the decretal amount within a period of one month since this date of passing this judgment, in default, the decretal amount will carry interest @10% per annum since this date till the date of realization of the full amount.
Let a copy of this judgment be delivered to the parties free of cost.
