OFFICE  OF  THE  DISTRICT  CONSUMER  DISPUTES  REDRESSAL FORUM, KAMRUP,GUWAHATI

C.C.5/2010

Present:-

                             1)Md.Sahadat Hussain, A.J.S.  -  President

                             2)Smti Archana Deka Lahkar   -  Member

Smti Gulab Devi Bhansali                                          -Complainant 

Wife of Lt.Shantilal Bhansali

(Represented by Sandeep Bhansali)

R/O M.B.Building , Kedar Road                  

P.O.-Guwahati-781001

District: Kamrup, Assam.

                           -vs-

1)      Life Insurance Corporation of India,                 -Opp.parties

Eastern Zonal Office, 4,C.R.Avenue.

Kolkata-700072

2)      Life Insurance Corporation of India,

Guwahati Divisional Office, S.S.Road,

Guwahati-781001,

District - Kamrup, Assam.

3)      Life Insurance Corporation of India,

Bongaigaon Divisional Office,

Jivan Prakash Main Road,

Bongaigaon -783380, Assam

4)      Life Insurance Corporation of India,

Tura Branch Office, Rikman Shopping Pond.

P.O.Tura, Districti- West Garo Hills, Meghalaya

Appearance-           

Learned advocate Mr.Promod Kr.Bajaj for the complainant.

Learned advocate Ms Chandrama Roy Talukdar for Opp.Parties.

Date of argument -     5.4.17

Date of judgment -     17.5.17

JUDGMENT

This is a case u/s 12 of the Consumer Protection Act , 1986.

1)      The complaint  filed by Smti Golab Devi Bhansali against L.I.C.of India, Eastern Zonal Office, Kolkata, L.I.C.of India, Guwahati office, L.I.C.of India, Bongaigaon division office and L.I.C.of India, Tura Branch (Meghalaya) was admitted on 11.1.2010 and notices were served on all opp.parties and opp.parties filed their written statement on 7^th July,2010. The complainant side filed affidavit of Sri Sandeep Bhansali as evidence of the complainant and he was cross -examined by opp.party side. Thereafter, Smti Manna Bhattacharya filed affidavit as evidence of the opp.party side and she was also cross examined by the Ld counsel of the complainant side. Finally both sides’ filed their respective written argument and thenafter on 5.4.2017 we have heard oral argument of Ld advocate Mr.Promod Kr.Bajaj of the complainant and Ld advocate Ms Chandrama Roy Talukdar for the opp.parties and today we deliver the judgment which is below.

2)      The complainant’s case in brief is that the husband of the complainant namely, Shantilal Bhansali (since deceased) had done a insurance policy with the opp.party vide policy No. 488645408 commencing from 28.1.2006 for a period of twelve (12) years for a sum of Rs.2,00,000/- only and the said policy was issued by the opp.parties after being satisfied with all the required documents and doing  formalities, and the premium was paid till his death but he died on 10.7.2008, and then the complainant filed claim before the opp.parties for settlement of death claim, but the later did not settle the claim; and then the complainant vide letter dtd. 9.4.2009 again requested the Opp.Party No.4 for payment of her claim with a copy to Opp.Party No.3, but the said request remains unanswered; and then she sent a legal notice to Opp.Party No.3 & 4 on 12.5.2009 demanding for payment of the assured amount under the said policy. But then the Opp.Party No.3, vide letter dtd. 23.7.2009, informed her that the claim was repudiated on the ground that the insured withheld material information as to his health condition at the time of effecting the insurance policy with the opp.parties; and in the said letter it was also mentioned that the deceased had been suffering from Type-2 diabetes mellitus, hypertension and diabetic nephropathy prostatomegaly. The complainant  as well as  his family member was not aware about such ailment at the time of signing of insurance proposal form on 27.12.2005. On serving another legal notice on 14.9.2009 upon the opp.parties, she got information that the matter was being taken up by Opp.Party No.2, but Opp.Party No.2 did not make the payment as per claim. The deceased husband of the complainant, was not suffering from any ailment at the time of proposal of the policy. The opp.parties arbitrarily repudiated her claim on some hypothetical grounds and therefore, they committed deficiency of service towards the complainant; and therefore, the complainant is entitled to payment of the assured amount, Rs. 2,00,000/- and a bonus of Rs.32,000/- and an interest @ 12% per annum from the date of lodging the claim till filing of this complaint (Rs.30,000/-) and Rs.1,00,000/- as compensation for putting her in mental agony and causing harassment to her totaling Rs.3,62,000/-.

3)      The crux of the pleading of the opp.parties is that material facts had been concealed by the insured at the time of proposal of the policy. As per Life Insurance Policy Contract, the policy was accepted on the basis of settlement made by the policy holder; and the contract of insurance policy is a contract based on utmost good faith. The required facts for the purpose of life insurance are in the knowledge of the insured person only and he should disclose those facts during commencement of the policy, but in the present case, the insured had concealed the material facts of his previous illness (ailment) and suppressed those facts at the time of proposal of the policy. The last installment was paid on 9.1.2008. It was found that prior to commencement of the policy, the deceased was suffering from different disease and moved different doctors and hospitals for treatment, but he had not disclosed that fact at the time of taking of the policy. As per letter of the complainant dtd.9.4.2009, the date of death of her husband is 10.7.2009 instead of 10.7.2008. Prior to the proposal of the policy, the insured had also taken treatment in Apollo Hospital, Chennai and International Hospital, Guwahati, but he concealed that fact; and during declaration he also qualified that he understood the questions and he put signature on the declaration form; and he declared his personal history as.

They repudiated the claim of the complainant rightly and that fact was communicated to the complainant and the repudiation was done on valid reasons as per rules and policy congestion and therefore, the complainant is not entitled to get any amount from them and the complaint is liable to be dismissed.

4)      We have perused the pleading as well as evidence of the parties and found that both the parties admit that the husband of the complainant Lt. Shantilal Bhansali had taken an insurance policy from Opp.Party No.3 (L.I.C.of India ,Bongaigaon Division Office) vide policy No. 488645408 commencing from 28.1.2006 for a period of twelve years for a sum of Rs.2,00,000/- and he had paid premiums till his death and he died on 10,7.2008. The opp.party side admits that the present complainant had filed claim before them to give her death claim of the death of her husband (the insured), but they repudiated her claim on 15.7.2009 and the ground of repudiation is that the deceased had withheld  the material information regarding his health at the time of effecting the assurance with them i.e. he had concealed that he had been suffering from Type-2 diabetes mellitus, hypertension and diabetic nephropathy prostatomegaly for which he had consulted medical practitioners and taken treatment from different hospitals. The plea of the complainant is that the deceased had not been suffering  from any ailment, diseased prior to taking insurance policy from the opp.party, but he died on 10.7.2008 suddenly. In the evidence C.W.1 (P.W.) Sri Sandeep Bhansali states that his father (the insured) died to diabetes, but he was perfectly all right at the time of proposal of the policy and he had not taken any treatment at that time and prior to taking proposal of the policy and the empanelled doctor of the opp.parties examined him and then allowed the policy. We have perused the proposal form of the insurance policy which is part of Ext. 2 and found that over the body of the proposal form the deceased gave answer that he had not been suffering any disease nor taken any treatment at that time and that Assistant Administrative Officer of New Bongaigaon branch of L.I.C.of India , Sri R.Mahanta accepted the proposal form filled up by him and over that proposal form, one Mr. Mahanta wrote a report that all special reports found normal by Divisional Medical Referee. This certificate which was given by A.A.O. New Bongaigaon branch of the opp.party, which dated 30.1.2006, clearly shows that the Divisional Medical Referee of the opp.party had done all the required clinical and pathological examination in respect of the deceased (the insured) and he found all such reports normal, meaning thereby, he was not suffering from any disease at the time of proposal of the policy . The O.P.W., Smi Manna Bhattacharya exhibited certain documents  Ex.A- certificate issued by Dr. J. N. Marak of Tura Christian Hospital, Ex.B- blood test report of the disease , Ex.C –blood uria report dtd. 3.4.2006, Ex.D-  Blood uria potacium examination report dtd.28.2.2006, Ex. E- medical laboratory report issued by Tura Christian Hospital, Medical Officer dtd. 16.2.2006, Ex. F- discharge report of Apollo Hospital, Chennai, dtd. 14.3.2008 and Ex.H- proposal form and medical report. We have perused all these exhibited documents and found that Exhibit A is a certificate issued by Dr. J. N. Marak, Medical Superintendent of Tura , Christian Hospital, Tura on 18.5.2009, and in that certificate he states that the deceased was hospitalized in their hospital on 9.7.08 , but he failed to find out the adject duration of time of illness of the deceased. Thus, Ex.A cannot be held to be a proof of suffering of diabetes or any other disease by the deceased since prior to taking the policy. Secondly, Ex.A is also not authenticated by the opp.party side by examining Dr.Marak as witness. Hence, we hold that Exhibit A is not proved by the opp.party side and Exhibit A cannot be accepted as evidence. Secondly, Exhibit B is of dated 19.5.08, Ex.C is of dated 3.4.06, Exhibit-D is of dated 28.2.2006 ,Exhibit-E of dated 16.2.2006 and Exhibit F of dated 14.3.2008. Thus Ext. B to F, which are clinical and pathological reports in respect of the insured, are of post policy period and hence, these documents cannot be held to be proof of any disease or ailment suffered by the insured . In Ext.F Apollo Hospital,Chennai gives a history of disease of the insured that the insured has diabetic nephropathy and hypertension diagnosed since January 2006 and is in regular follow up and he had normal renal function till July 2007 and he developed acute renal failure following the above complaints. This report is not supported by any prescription etc.of previous treatment. Moreover, this report itself says that the insured had normal renal function till july 2007 which means that the insured was in good health till July,2007. The opp.party side has also failed to produce any document to show that the insured had been suffering from diabetes, nephropathy, hypertension or from any disease before or at the time of filing proposal of the instant policy.

          It is already found that the empanelled medical officer of the opp.party, after doing all the relevant tests and examinations found that the insured was in good health at the time of filling the proposal of the instant policy. Thus, it is established that at the time of filling the proposal of the instant policy, the insured was in good health and was not suffering from any disease and he had not suppressed any material facts at the time of filling up the proposal form and he died of diseases suffered after taking the policy. Therefore , we hold that the ground of repudiation of the claim filed this complainant as shown by the opp.pary, is not proved at all. So, we declare that the repudiation order is illegal and the opp.parties are liable to pay the assured value of the instant policy which is Rs.2,00,000/-(Rupees two lakhs) with interest at the rate of 12% p.a. from the date of filing of the claim before them (9.4.2009) to the complainant along with  Rs.10,000/- as compensation for causing harassment to her by illegally repudiating her claim and also Rs.10,000/-as cost of the proceeding.

5)      Because of what has been discussed as above, the complaint is allowed on contest and accordingly the opp.parties are directed to pay the complainant, Smti Golap Devi Bhansali, the assured value of the instant policy (No. 488645408) Rs.2,00,000/-(Rupees two lakhs)with interest at the rate of 12% p.a. from 9.4.2009 for the death of her husband alongwith Rs.10,000/- as compensation for causing harassment to her and Rs.10,000/- as cost of proceeding, to which, all the opp.parties are jointly and severally liable. They are directed to satisfy the award within two month, in default , other two amounts shall also carry interest in the same rate.

Given under our hands and seals in  this day of the 17^th  May, 2017.

Free copies of judgment be delivered to the parties.

(Smti A.D. Lahkar )                                               (Md.S.Hussain) 

       Member                                                                 President