DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA

    CASE NO:  CC- 99  of  2013

           1. Smti. Pranati Ghosh
W/o- Late Jiban Ghosh,

           2. Shri Juwel ghosh,
S/O- Late Jiban Ghosh,

          3. Miss. Payel Ghosh,
D/o- Late Jiban Ghosh,         

All are residents of 
Aralia, Gopitilla,
Agartala, West Tripura.    .........Complainants.

     ______VERSUS_____

     1. Life Insurance Corporation of India,
         Agartala Branch No-1,
     Paradise Chowmuhani,
         (Hospital Road Extension),
         Agartala, West Tripura.

    2. Life Insurance Corporation of India,
     Silchar Divisional Office,
     Jeevan Prakash, Meherpur,
     (Represented by the 
     Divisional Manager).        .......Opposite Parties.
    
                    __________PRESENT__________

 SRI S. C. SAHA
PRESIDENT,
  DISTRICT CONSUMER  DISPUTES REDRESSAL FORUM,
      WEST TRIPURA, AGARTALA. 

SMT. B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

SHRI B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

C O U N S E L

For the Complainant       : Sri Bijan Saha,
                  Sri Bidyut Sutradhar and
                  Sri Saptarshi Pal,
                          Advocates. 
                           
For the Opposite Party    : Sri Nepal Majumdar,
                  Advocate.

        JUDGMENT  DELIVERED  ON : - 27.02.15.
J U D G M E N T

        This is a complaint U/S 12 of the Consumer protection Act, 1986(herein after referred to as 'the Act') filed by the complainants, namely Smt. Pranati Ghosh, W/O- Lt. Jiban Ghosh and 2 others against the O.Ps, namely LICI, Agartala Branch No1, and LICI, Silchar Divisional Office for negligence and deficiency in rendering service on the part of the O.Ps.

2.        The fact of the case as gathered from the record is that the first complainant's husband Lt. Jiban Ghosh, who was a Class- IV employee under the Tripura  Handloom and Handicrafts Developments Corporation Ltd., during his life time, had taken a policy of insurance on his own life for a sum assured of Rs.70,000/- in pursuance of the proposal No-7042 dated 20.07.11 with monthly premium of Rs.353/-.  The policy is likely to be matured on 20.07.2029. Having accepted the proposal, the insurance policy issued by the LIC is No- 492928909. The life assured died of cancer in a cancer Hospital, Agartala on 05.03.12 within 8 months of the commencement of the policy. The complainant no.1, who is the nominee u/s 39 of the Insurance Act, preferred claim under the said policy with the LIC. By a letter dated 31.01.13, the LIC repudiated the liability under the policy on account of the deceased life assured having fraudulently suppressed material facts in the proposal form regarding his preexisted ailments. According to the complainants, the O.Ps are guilty of negligence and deficiency in service. Hence, this complaint.

3.        The complaint was contested by the O.Ps stating, inter alia, that as the insurance contracts based on the principle of utmost good faith, responsibility casts on the insured to give full and correct information to the questions contained in the proposal form. As the life assured, in the proposal form, withheld material information and gave wrong answers as to his previous medical history the claim was repudiated. Further that, the life assured died within 8 months of the commencement of the policy. At the time of taking the policy the life assured was suffering from serious diseases and he underwent treatment at GBP Hospital, Agartala and CMC, Vellore on different occasions. But the deceased life assured suppressed the said fact of illness and gave false declaration in the proposal form with an intent to commit fraud upon the LIC. According to the O.Ps, they rightly repudiated the claim of the complainant for violation of the provisions of Indian Contract Act. It is denied that they were negligence and deficient in rendering service to the complainants.

4.        In support of the claim, the complainant No-1 Smt. Pranati Ghosh has examined herself as P.W.1 and has proved and exhibited the following documents:-
    Exhibit 1: Money Receipt of first premium,
    Exhibit 2: Death Certificate of the Life Assured,
    Exhibit 3: Survival Certificate  of the Life assured,
    Exhibit 4 and Exhibit 5: Letters dated 05.09.12 and 31.01.13 issued by LICI. 

5.        On the other hand, one Sri Niranjan Bal, Administrative Officer of the LICI, Agartala Branch No-1, has examined himself as O.P.W.1 as a witness of the O.P. side and has proved and exhibited the documents filed by them with firisti on 22.08.14 as Exhibit- A Series.

        FINDINGS:
6.        Points that would arise for consideration in this proceeding are:
    (i) Whether the deceased life assured suppressed material facts in the proposal form regarding his preexisted ailments at the time of taking the policy;
    (ii) Whether the O.Ps rightly repudiated the claim of the complainants and
    (iii) Whether the O.Ps are guilty of negligence and deficiency in rendering service.

7.        We have already heard arguments advanced by the learned counsel appearing for the parties. Also perused the pleadings, documents on record, evidence adduced by the parties and the memorandum of written argument filed by the O.Ps meticulously.

8.        As it appears, the O.P. No.2 by a letter dated 31.01.13 (Exhibit-5) repudiated the claim of the complainants mainly on the ground of deliberate misstatement and withholding of material information in the proposal form furnished by the deceased life assured at the time of taking the policy.
        
        The deceased life assured while taking the policy had answered to the question No-11 of the proposal form in the following manner:    
 
Questions    Answers       
(I) During the last 5 years did you consult a medical practitioner for any ailment requiring treatment for more than a week?     No       
(III) Have you remained absent from place  of work on grounds of health during the last 5 years?    No       
(IV) Are you suffering from or have you ever suffered from ailments pertaining to liver, stomach, Heart, Lungs, Kidney, Brain or Nervous system?    No       
(V) Are you suffering from or have you ever suffered from diabetes, TB, High BP, Low BP, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other diseases?    No       
(VII) What has been your usual state of health?    Good
     

9.        Admittedly, the deceased life assured died of cancer  in the cancer hospital, Agartala on 05.03.12 within the span of 8 months of taking the policy. From the medical documents on record it is seen that prior to taking the policy the deceased life assured received treatment from CMC, Vellore as inpatient from 14.04.10 to 29.04.10. He was diagnosed as (i) ESOPHAGEAL CANDIDIASIS (ii) severe Anaemia and (iii) acute onset large bowl type diarrhoea. It also appears that the deceased life assured also under went treatment at CMC, Vellore again from 11.5.11 to 21.5.11 being referred by the Medical Board, Agartala Govt. Medical College after he was diagnosed as Colon(Hepatic flexure). It further appears that the deceased life assured was on leave on medical ground for the period from 14.4.10 to 29.4.10 before the taking of the policy. Surprising enough, the deceased life assured, while giving answers to the question no-11 in the proposal form, suppressed the material facts as to his preexisted ailments. Even in reply to question no-11 (iii) he denied having remained absent from duty on medical ground during the last 5 years. 

10.        During cross examination of the O.P.W. 1 by the learned counsel for the complainant no question was put to him disputing the genuinity of the medical documents produced by the O.Ps. In this situation, we find to reason to doubt the authenticity of the medical documents produced by the O.Ps which was received from the CMC, Vellore and GBP hospital, Agartala where the deceased life assured underwent treatment. We find that the deceased life assured took the policy on 20.7.11 and he received treatment from  CMC, Vellore w.e.f. 14.4.10. In this background, it can be unhesitantly said that while giving answers to the question No-11 of the proposal form with respect to his state of health, he suppressed the material facts.

11.        In this connection, it is advantageous here to refer to the decision of the Hon'ble Supreme Court in Satwant Kaur Sandhu Vrs New India Assurance Co. Ltd. as quoted in the decision of the Hon'ble National Commission in Revision Petition No-527/07(LICI Vrs. Francis and Antony D. Souza, it is held that ''it is fundamental principle of insurance law that utmost faith must be observed by the contracting parties. Good faith forbids either party from non-disclosure of the facts which the party privately knows, to draw the other into a bargain from his ignorance of that fact and his believing the contrary.''
        The Hon'ble Supreme Court in Mithoolal Nayak Vrs LIC of India, AIR 1962 SC 814, it is held that ''The principle underlying the explanation to S. 19 of the contract Act is that a false representation, whether fraudulent or innocent is irrelevant if it has not induced the party to whom it is made to act upon it by entering into a contract. We do not think that the principle applies in the present case the terms of the policy make it clear that the averments made as to the state of health of the insured in the proposal from and the personal statement were the basis of the contract between the parties, and the circumstances that Mahajan Deolal had taken pains to falsify or conceal that he had been treated for a serious ailment by Dr. Laxmanan only a few months before the policy was taken shows that the falsification or concealment had an important bearing in obtaining the other parties consent. A man who has so acted can not afterwards turn brown and say: ''it could have made no difference if you had known the truth''. In our opinion, no question of waiver arises in the circumstances of this case, nor can the appellant can take the advantage of the explanation to S. 19 of the Indian Contract Act.'' 

12.        Having gone through the provision laid down in Section 45 of the Insurance Act and also keeping in mind the ratio of law laid down by the Hon'ble Supreme Court in the above cited decision, we are of the view that the deceased life assured while giving answers to the question no-11 of the proposal form suppressed the material facts as to his preexisted ailments. The suppression of the materials fact in the proposal form is sufficient  to repudiate the claim of the complainants. That being so, we are of the view that the O.Ps did no illegality by repudiating the claim of the complainants and no charge of negligence and deficiency in service are attributable to the O.Ps.   

13.        In the result, therefore, the complaint U/S 12 of the Act filed by the complainants is dismissed on contest being devoid of merit. However, we make no order as to costs.   
   
14.                  A N N O U N C E D

SRI S. C. SAHA
PRESIDENT,
DISTRICT CONSUMER  DISPUTES 
REDRESSAL FORUM,
WEST TRIPURA,  AGARTALA.

SRI B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM, 
  AGARTALA, WEST TRIPURA.