West Bengal

Paschim Midnapore

CC/165/2015

Tanusri Shyamal - Complainant(s)

Versus

Life Insurance Corporation of India Ltd. - Opp.Party(s)

08 Apr 2016

ORDER

                                                                DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President,

Mrs. Debi Sengupta, Member

and

Kapot Chattopadhyay, Member.

   

Complaint Case No. 165/2015

                                                        

                                                         Tanusri Shyamal…………………………....….……Complainant.

Versus

                                                         Life Insurance Corporation of India Ltd., Kharagpur Division……..Opp. Party.

 

              For the Complainant: Mr.  Satya Jyoti Das, Advocate.

              For the O.P.               : Mr. Diptendu Ghosh, Advocate.

 

Decided on: -08/04/2016

                               

ORDER

                          Bibekananda Pramanik, President – Facts of the case, in brief, is that Janardan Shyamal, since deceased, the husband of the complainant,  purchased four L.I.C. policies  in his name and on the policy no.499402152,  the complaint is the nominee of the said policy which was valid from 28/02/2011 to 28/02/2026.   Sum assured in that policy was Rs.3,75,000/-.  Unfortunately on 11.03.2012, the husband of the complainant died in Central Nursing Home at Medinipur and after demise of her husband, the complainant, being the nominee, lodged claim of that policy before the O.P. – L.I.C.I.  On receiving the said claim of insurance, O.P.-L.I.C.I. repudiated the claim on 17/04/2013 on the ground that at the time of purchase of that policy, the husband of the complainant suppressed material facts about his health.   By that letter, the opposite party suggested that if the complainant is not satisfied about the repudiation of claim, she may submit representation before the Zonal Manager.  The complainant, therefore, submitted a written representation

Contd…………..P/2

 

 

 

(2)

before the Central Office of the CLAIMS DISPUTES REDRESSAL COMMITTEE for consideration and she was suggested to file appeal before the office OMBUDSMAN at Kolkata.  On 02/07/2014, the complainant filed appeal before the office of OMBUDSMAN at Kolkata but unfortunately after hearing OMBUDSMAN confirmed the decision of the Divisional Office of the opposite party without any reason.  It is stated that the opposite party illegally repudiated the claim of policy with the plea of suppression of facts about the health of the husband of the complainant.   It is further stated the husband of the complainant was a school teacher and he regularly attended his school and he never suffered with enteric fever & Ischaemic stroke three years back prior to taking of the policy.  Such acts of repudiation of genuine claim of the complainant amount to deficiency in service.   Hence the complaint, praying for directing the opposite party to pay Rs.3,75,000/- with interest and cost.

                       Opposite party-Insurance Company has contested this case by filling a written objection. Denying and disputing the case of the complainant, it is the specific case of the opposite party- Insurance Company that at the time of purchase of the said policy and during filling up the proposal form, the husband of the complainant Janardan  Shyamal suppressed many material facts regarding his health condition.  He was suffering from Ischaemic stroke since three years back and he was treated by different doctors which will be evident from the discharge certificate dated 05/02/2012, issued by the Institute of Neuro Sciences, Kolkata.  From the said certificate, it would reveal that the specialist doctor diagnosed that said Janardan Shyamal has  i) left basal Ganglia heamatoma with (Right) the miplegia and aphasia; ii) he has been suffering from hypertension iii) he has past history of Ischamic Stroke (three years back) iv) he has been suffering from septicaemia v) he has also been suffering from pleural effusion and Ascites.  After such diagnose,  one operation in left fronto temporo – parietal craniotomy with parital removal of haematoma with bone flap in S/C abdominal pouch of said Janardan Shyamal was done on 07/01/2012 and he was admitted in the said hospital for about 30 days and he was discharged there from on 05/02/2012.  It is further contended that said Janardan Shyamal was suffering from Enteric fever since 07/01/2011 to 31/01/2011 i.e. for about 25 days and he was under treatment of Dr. Utpal Roy of Rabindra Nagar, Medinipur who treated said Janardan Shyamal and advised him to take rest and the said doctor also issued a certificate  dated 01/02/2011 accordingly. It thus appears that  just 27 days prior to purchase of the instant policy, said Janardan Shyamal  suffered from Enteric fever for about 25 days but the said fact has been suppressed by said Janardan Shyamal during filling up the proposal form at the time of purchase of the said policy. Admittedly the life assured/ deceased Janardan Shyamal used to work as Assistant Teacher in Anandapur High School within the district

Contd…………..P/3

 

 

(3)

of Paschim Medinipur and for his illness and long suffering from various disease, said Janardan Shyamal used to absent frequently in his service which will be evident from the certificate issued by his employer i.e. the Head Master of Anandapur High School. It is stated that from the claim form, treatment paper, prescription and other relevant documents it would be seen the said Janardan Shyamal was suffering from various ailments and he deliberately suppressed those facts at the time of taking policy.  Realizing his short span  of life, said Janardan Shyamal with mala fide intention purchased this policy and other two polices of Rs.2,00,000/- each.  If is proposer disclosed his health condition, then the opposite party-L.I.C.I might have not issued this policy in his favour.  The opposite party repudiated the death claim of the instant policy vide their letter dated 17/04/2013 and after lapse more than two years, the present complaint has been filed.  Review Committee of the opposite party also confirmed the decision of repudiation and communicated such confirmation vide letter dated 19/11/2013.  It is stated that there is no deficiency in service on the part of the opposite party and the petition of complaint is therefore liable to be rejected.

                                                                                   Point for decision

                     

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

                   

Decision with reasons

 At the very outset, it is to be stated here that in this case neither the complainant nor the opposite party adduced any sort of evidence either oral or documentary.  However, they have relied upon some documents, so filed by them in this case.

Admittedly, Janardan Shyamal, since deceased, the husband of the complainant, obtained a Life Insurance Policy being no.499402152 on 28/02/2011 from the O.P.-L.I.C.I of maturity sum assured of Rs.2,10,660/- and death benefit sum assured was Rs.3,75,000/-.  Admittedly, the present complainant Smt. Tanusri Shyamal, the wife of said Janardan Shyamal,  is the nominee of the said policy.  It is not denied and disputed that on 11/03/2012, said Janardan Shyamal died in Central Nursing Home at Medinipur and after demise of her husband, the complainant submitted a claim of insurance before the           O.P.-L.I.C.I. and O.P. repudiated the claim on 17/04/2013 on the ground that at the time of purchase of the policy, the husband of the complainant suppressed material fact about his health.  Admittedly, against the said order of repudiation, the complainant filed a written representation before the Central Office of the CLAIMS DISPUTES REDRESSAL COMMITTEE for consideration and she was suggested to file appeal before the office of OMBUDSMAN at Kolkata and after hearing of such appeal, OMBUDSMAN confirmed the

Contd…………..P/4

 

 

 

(4)

 decision of repudiation by their divisional office.  According to the complainant, her husband did not suffer from any Enteric fever & Ischaemic stroke three years back prior to taking the policy and her husband attended his school as teacher regularly.  As against this, it is the case of the opposite party, as disclosed in their written objection, that at the time of taking the said policy and during filling up the proposal form, the husband of the complainant i.e. the proposer of the policy Janardan Shyamal  suppressed material fact regarding his health condition. It is stated by the opposite party that said Janardan Shyamal was suffering from Ischaemic stroke since three years back and as such he was treated by different doctors as well as in the Institute of Neurosciences, Kolkata, where an operation in left fronto temporo- parietal craniotomy with partial removal of haematoma with bone flap in S/C abdominal pouch of said Janardan Shyamal was done on 07/01/2012.  Further according to the opposite party, said Janardan Shyamal was suffering from Enteric fever since 07/01/2011 to 31/01/2011 i.e. for about 25 days and he was under treatment of Dr. Utpal Roy and that would be evident from the certificate dated 01/02/2011 of the said doctor as well as the certificate issued by his employer i.e. the Headmaster of Anandapur High School.  All such facts have been suppressed by the said Janardan Shyamal at the time of purchase of the said policy.  It is stated by the opposite party that if the proposer disclosed about his such illness and treatment in the proposal form, then the O.P.-L.I.C.I might have not issued the policy in his favour and therefore they rightly repudiated the claim of insurance policy.  In support of their said case, the opposite party has filed copies of medical treatment and certificate regarding the illness of the said Janardan Shyamal.  Although those documents were not admitted in evidence but genuineness of those documents have not been challenged by the complainant.  It appears from the discharge certificate dated 05/02/2012, issued by the Institute of Neurosciences, Kolkata that Janardan Shyamal  was admitted in the said Institute on 07/01/2012 with past history of Ischaemic Stroke of three years back, hypertension, septicemia and other diseases and an operation was also done on his left fronto – temporo-parietal craniotomy with partial removal of hematoma with bone flap in S/C abdominal pouch on 07/01/2012.  Admittedly, the deceased was a school teacher by occupation and from the certificate issued by his employer i.e. Head Master of  Anandapur High School issued in favour of L.I.C.I. that he was on medical leave from 07/01/2011 to 31/01/2011 i.e.for 25 days.  From the certificate issued by Dr. Utpal Roy, we further find that said Janardan Shyamal was suffering from Enteric fever from 07/01/2011 to 31/01/2011 and he was advised rest by him.  The policy in question was purchased by  Janardan Shyamal on 28/02/2011 i.e. after about 27 days from his recovery of illness of Enteric fever.  We have already found that it is  evident from the discharge certificate, issued by the

Contd…………..P/5

 

 

 

(5)

 Institute of Neurosciences, Kolkata that on 07/01/2012 Janardan Shyamal was admitted there with past history of Ischaemic stroke three years back from that day on 07/01/2012 for which he was also operated there.  From the certificates issued by the Head Master of Anandapur High School as well as by Dr. Utpal Roy that prior to purchase of the said policy on 28/02/2011 he was suffering from Enteric fever from 07/01/2011 to 31/01/2011.  So the deceased had knowledge regarding his said ailments but we find from the proposal form of the said policy, so filed by the opposite party in this case that while filling up the said proposal form, Janardan Shyamal answered all questions  regarding his personal history in column no.11 in negative thereby indicating that he never suffered from any ailment.  We have already found that the deceased had the history of Ischaemic stoke three years back from the date of admission on 07/01/2012 i.e. prior to his purchase of the said policy.  We have already found that two months before the date of purchase of the said policy, the deceased had suffered from enteric fever for which he was under bed rest from 07/01/2011 to 31/01/2011 under the advice of Dr. Utpal Roy.  Suppressing  all those facts of  his ailments, the deceased answered all questions regarding his health history in negative while filling up the proposal form.  It is well settled that if any such information about medical condition of a person which could influence mind of a prudent  insurer is not disclosed to him, it amounts  to suppression of material facts and insurer is very much within his rights to repudiate claim.  So under the above facts and circumstances of the case and the discussions made above and in view of aforesaid settled law, we are of the opinion that the opposite party-Insurance Company was quite justified in repudiating the claim of insurance policy in question and therefore it cannot be held that the O.P.-L.I.C.I. is guilty of deficiency in service as alleged by the complainant.  The petition of complaint is therefore liable to be dismissed.

                                                   Hence, it is,

                                                                               Ordered,

                                                 that the complaint case no.165/2015  is hereby dismissed on contest but in the circumstances without cost.

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

            Dictated & Corrected by me

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

                         President                    Member                   Member                         President

                                                                                                                               District Forum

                                                                                                                            Paschim Medinipur