West Bengal

Paschim Midnapore

CC/21/2015

Mousumi Bhunia - Complainant(s)

Versus

Future Generali India, Life Insurance Company Ltd. - Opp.Party(s)

Mr. A.K.Dutta.

23 Feb 2016

ORDER

                                                            DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President,

Mrs. Debi Sengupta, Member

and 

Kapot Chattopadhyay, Member.

   

Complaint Case No.21/2015

                                                        

                                        Smt. Mousumi Bhunia…………..….……Complainant.

Versus

 

1)Future Generali India, L.I.C.I,

2)   Future Generali  L.I.C.I...………........Opp. Parties.

 

              For the Complainant: Mr.  Asim Kumar Dutta, Advocate.

              For the O.P.               : Mr. Debasis Maity, Advocate.

 

Decided on: -23/02/2016

                               

ORDER

                          Bibekananda Pramanik, President – Facts of the case, in brief, is that Pratik Bhunia, since deceased, the husband of the complainant obtained a Insurance policy being no.01154491 from the Opposite party-Insurance Company on 30/09/2013 against payment of premium of Rs.14,545/-.  Complainant, being the wife of Pratik Bhunia, is the nominee of the said policy.  At that point of time, the husband of the complainant also purchased another Life Insurance Policy from Life Insurance Corporation of India in his name.  At the time of obtaining such policy, the husband of the complainant was aged 40 years.  Unfortunately Pratik Bhunia died on 24/05/2014.  Complainant, being the nominee of the Insurance Policy in question, informed the death news of her husband in the office of the opposite party along with original policy death certificate, receipt of premium and all other relevant papers within time.  Unfortunately, the opposite parties repudiated the

Contd………………P/2

 

 

 

 

( 2 )

 insurance claim on 30/11/2014 on the ground of suppression of fact regarding the health of the deceased-husband of the complainant and about his treatment.  In the mean time,

L.I.C.I. settled the claim of the deceased and issued cheque accordingly.  It is stated that the Opposite party-Insurance Company most illegally repudiated the genuine claim of the policy and such type of act of the opposite party amounts to deficiency in service.  Hence this complaint, praying for directing the opposite party to make payment of Rs.1,31,225/- under the said policy with interest and cost.

                  The Opposite party-Insurance Company has contested this case by filling a joint written statement.

                   Denying and disputing the case of the complainant, it is the specific case of the opposite parties that on 30/09/2013, the life assured after understanding  all the terms and conditions of the policy “Future Assure” applied for a life insurance policy  and filled up a proposal form bearing application no.TNA0025821 and in the said proposal form all questions regarding health and illness were answered in the negative.  On the basis of information provided in the said proposal form and believing the same to be true, the Opposite party-Insurance Company on 30/09/2013 issued the life insurance policy  bearing no.01154491.  On 11/11/2014, an intimation was received from the complainant stating therein that the life assured has passed away on 24/05/2014.  In view of the demise of the life assured within approximately 8 months from the date of commencing of the policy,  the opposite party initiated an investigation with respect to the claim and during the course of investigation, it came to light that the life assured had been suffering from Essential Hypertension With Left Ventricular Dysfunction with Trifascicular Block and was admitted in R.G. Kar Medical College & Hospital from 11/04/2010 to 14/04/2010 which is 3.5 years prior to the date of application and he also availed treatment from one Dr. K.K.Mitra on 14/05/2013 which is approximately 5 months prior to the date of application.  Had a disclosure of the above medical history of the life assured been made in the proposal form,  the decision of the Opposite party-Insurance Company would have been different and the said policy may not even issued by the Opposite party-Company.  It is stated that such act on the part of the life assured amounts to misrepresentation and suppression of facts rendering the policy contract void and hence the Opposite party vide it’s letter dated 30/11/2014 declined the claim made by the complainant towards the said policy on account of material non-disclosure and misrepresentation regarding the life assured’s health and medical adversities made at the time of filling the proposal form.  Opposite party, therefore, claims dismissal of the complaint.

Contd………………P/3

 

 

 

 

                                                            ( 3 )

Point for decision

                       Is the complainant entitled to get the reliefs, as sought for ?                    

   Decision with reasons

In this case, the complainant has examined herself as Pw-1 by tendering a written examination-in-chief supported by affidavit and during her evidence on oath, five documents have been marked as exhibit 1 to 5 respectively.  On the other hand, opposite party though filed a written examination-in-chief, supported by affidavit but the same was not tendered in evidence.  However, opposite parties have relied upon some documents, so filed by them.

In this case, the facts remained admitted that Pratik Bhunia, the deceased husband of the complainant, obtained a life insurance policy being no.01154491 from the Opposite party-Insurance Company on 30/09/2013. From the death certificate (Exhibit-4), filed by the complainant, we find that Pratik Bhunia died on 24/05/2014.  It is also undisputed that after the death of Pratik Bhunia, the complainant, being the nominee-wife, submitted claim before the Opposite party-Insurance Company and the Opposite party-Insurance Company repudiated the insurance claim on 30/11/2014 vide their letter dated 30/11/2014 on the ground that their investigation revealed that the insured was diagnosed of and was suffering from Essentials Hypertension with Left Ventricular Dysfunction with Trifascicular Block and was under treatment for the same even prior to his application date and for suppression of such material fact, the contract became void.  In support of their said ground of repudiation of the claim, the opposite party has filed xerox copies of discharge certificate dated 14/04/2010, issued by R.G. Kar Medical College & Hospital and a xerox copy of prescription of one Dr. K.K. Mitra.  Original copies of those documents have not been produced and no competent person was examined by the opposite party to prove those documents.  In view of that, no reliance can be placed upon those documents for arriving at a decision that the insured Pratik Bhunia was at all admitted in the said hospital and he suffered from any such disease.  In absence of such cogent evidence, the ground for repudiation is not at all convincing to us and we are therefore constraint to hold that the opposite party was not justified in repudiating the insurance claim of the complainant on such alleged ground. Complainant, is therefore, entitled to an order for payment of the insurance benefit under the said policy in question.  The petition of complaint is therefore deserves to be allowed.

                                                  Hence, it is,

                                                     Ordered,

                                                        that the complaint case no.21/2015  is

Contd………………P/4

 

 

 

 

( 4 )

allowed on contest.  Opposite party-Insurance Company is directed to pay Rs.1,31,225/-  towards Insurance claim in respect of the policy no.01154491 with interest @ 9% p.a. from the date of filing of this complaint till payment. Opposite party is also directed to pay Rs.2,000/- as litigation cost to the complainant.  All such payment shall be made by the opposite parties to the complainant within a month from this date of order.

Let copy of this order be supplied to the parties free of cost.

               Dictated & Corrected by me

                                Sd/-                                 Sd/-                          Sd/-                      Sd/-

                           President                          Member                    Member              President

                                                                                                                             District Forum

                                                                                                  Paschim Medinipur