: J U D G M E N T :
The brief fact of the case is that the father of the complainant Laxmikant Debnath now deceased made one insurance policy bearing No. 428652013 with the OP having the sum assured Rs. 1,00,000/- along with other benefit covered under the policy. As per terms of the policy Laxmikant Debnath used to pay the premium of Rs. 1225/- quarterly. The name of the complainant figured as a nominee of the said policy. Laxikant Debnath died on 16.11.2011. Thereafter, the complainant submitted claim form along with all required documents in the office of OP, but till today the OP did not pay any claim amount to the complainant. No repudiation letter was issued by the OP till today. There is a gross negligence and deficiency in service on the part of OP. The complainant is suffering from mental pain and agony as the OP adopted unfair trade practice, so the complainant has knocked at the door of the Forum for getting his relief.
The OP Insurance Company contested this case by filing written version stating, inter alia, that LICI issued insurance policy being No. 428652013 in favour of said Laxmikant Debnath. The date of the commencement of the said policy was 16.09.2010 wherein the sum insured Rs. 1,00,000/- subject to the terms and conditions. In the proposal form the complainant stated that he knew his father (life proposed) two years only and the complainant also stated that there was no relation between him and his father. OP also stated that LICI is a contract of utmost good faith. So it is the duty of the assured to disclose all material facts. If he has failed to disclose the full facts the principle of utmost good faith is violated. The OP also stated that the life assured was suffering form various diseases along with Diabetic Nephropathy since long but at the time of opening insurance policy he has failed to disclose the same causing violations of terms and conditions of the insurance policy. The age of DLA was 55 years shown in the form but. On inquiry it appears that the date of birth was DLA was 02.01.1950. So, the age of DLA was more than 60 years. It is a clear case of suppression of material facts. So the complainant is not entitled to get any relief as prayed for. There is no fault or gross negligence on the part of Insurance Company. So the case liable to dismissed with cost.
POINTS FOR DECISION
- Point No. 1: Is the complainant a consumer?
- Point No. 2: Is there any deficiency in service on the part of the OPs?
- Point No. 3: Has the complainant come the Forum in clean hands?
- Point No. 4: What relief the complainant is entitled to get?
DECISION WITH REASONS
For the purpose of brevity and convenience all the points are taken up together for discussion.
It is admitted position that the complainant Tarak Debnath is a consumer as nominee and heir of Laxmikant Debnath his father.
Now the question is whether the Branch Manager, LICI, Nabadwip Branch, Nadia is deficient in service. We have gone through the pleadings of the parties, examination-in-chief of Tarak Debnath filed on 04.09.14 containing 16 paragraphs. We have also gone through the interrogatories of the LICI filed on 07.11.14 and the reply thereto filed on 18.11.14.
Documentary Assessment
Annexure – 1 series i.e., the LICI form filled in by Tarak Debnath the agent of LICI licence No. 029 2532160. The proposal No. is 5527.
Annexure – 2 is the transfer certificate of Laxmikant Debnath who signed on the form in Bengali. There is interpolation in the form at the column of nature of age proof submitted.
From the application it reveals that the date of birth of Laxmikant Debnath is 12.06.55.
There is another interpolation in the column of age of the applicant, Laxmikant Debnath.
Initially, at the age column 57 years was written, thereafter it was written as 55 years. Eraser was used which is palpable.
At the second page of the application we find that in column No. 9(ix) of the application form, the applicant or his son (agent), Tarak Debnath has written the condition of the applicant as “ good”.
On careful scrutiny we find that the case of the complainant has become weak due to non-availability of documentary and circumstantial evidence.
At column 6A, Tarak Debnath has admitted that he is a son of Laxmikant Debnath, the applicant of the LICI.
In Annexure – 5, Tarak Debnath has further stated in column No. 1A that he knows the applicant, Laxmikant Debnath only for two years. This is not expected from a son who is the agent (agent code 7714015) of the LICI. Thus Tarak Debnath, the complainant has lied to the LICI at the time of filing the form, Annexure – 5 and Annexure – 1. The false statements made by son have become dangerous and pernicious.
Moreover, in column No. 1(b) in Annexure – 5 Tarak Debnath, the complainant has written “No” in answer to the question “Are you related to him / her? If so, give details.” This is a blatant lie and Tarak Debnath, the complainant has not come to the Forum with clean hands.
Annexure – 2 shows a transfer certificate of Laxmikant Debnath which indicates that the date of birth according to admission register of the school was 12.06.55. The father’s name of the Laxmikant Debnath since deceased was Radhakanta Debnath which is tallying with the form (Annexure – 1), but this document is doubtful and could not be relied upon without original.
Annexure – 4 is the election identity card of Laxmikant Debnath which shows the age of the father of the complainant as 45 as on 01.01.1995. Thus, in 2010, Laxmikant was 45 + 15 = 60 years old. We rely upon this document.
The policy was purchased on 16.09.2010.
Laxmikant died on 16.11.11, i.e., after one year two months from the date of inception of the policy. Laxmikant Debnath expired due to diabetic nephropathy.
It is clear from the certificate of the Hospital treatment F. No. 3816 dtd. 08.02.12 and 07.02.12. Annexure – 6 is the para-wise condition of the claim case policy No. 428652013. Annexure – 8 series Hospital treatment certificate go to show that the patient Laxmikant Debnath was admitted on 16.11.11 and died on 16.11.11 (on the same day).
Diabetic Nephropathy is not a sudden illness. In diabetes the patient remains under long treatment. Thus, in the application form Laxikant Debnath and Tarak Debnath both suppressed the prolonged illness that means diabetes.
Knowing fully well the precarious condition of health of Laxmikant Debnath his son Tarak Debnath took the advantage of his association with LICI and defrauded the LICI by suppressing the actual health condition of his father Laxmikant Debnath. As the complainant is a agent he also took the advantage of reducing the age of his father by 5 years. Actual death of birth of Laxmikant Debnath was not 12.06.55 but 02.01.1950 as per status report of policy No. 462855439, Annexure – 9 series. Thus, the complainant has come to the Forum with ulterior motive. Hence, the Forum cannot accept the argument of the Ld. Advocate that the complainant was bona fide in advancing the claim.
We accept the argument of the officer manager of the LICI, Minati Dewan who have sincerely, systematically and consistently placed before us her oral argument supported by documents, Annexure – 1 to Annexure – 9 in order to establish the mala fide on the part of the Tarak Debnath, the complainant. Sri Rajkumar Mandal Ld. Advocate for the LICI has also assisted the Forum like Sri S. Roy, Ld. Advocate for the complainant.
The LICI / OP has successfully established that fraud has been committed by the complainant by suppressing material condition of health and date of birth of Laxmikant Debnath. Thus, the complainant is not entitled to get any relief and there is no deficiency in service on the part of the LICI. All the points are disposed of accordingly.
Hence,
Ordered,
That the CC/2014/61 be and the same is dismissed on contest. No cost.
Let the copy of this order be supplied to the parties free of cost.
