The case in brief is that on 24.08.2007 Abdul Mannan died due to cardio respiratory failure. Prior to his death the deceased purchased one insurance policy from the OPs/ insurers. The present complainant the niece of the deceased is the nominee under the policy. Complainant’s case is that she has repeatedly intimated the O.P. / insurer asking to settle the claim. But, the insurance company repudiated the claim due to withheld material information regarding his health at the time of effecting the assurance and advised the complainant if she disagree with the decision she may send representation within one month for re-consideration the claim to OP’s Zonal Office. Accordingly the complainant sent representation to the OP no. 3 but no response has come out from their end. The complainant therefore filed this case praying for a direction to the O.P./ insurer that sum assured under the policy be paid by the O.P. together with compensation and litigation cost.

The O.P./insurer has hotly contested the case by filing its written version. Their case is that the insured at the time of taking policy suppressed the facts regarding his health status in the proposal which attract Section 5 of Insurance Act, 1938 for suppression of material facts. On the other hand, the complainant did not file case before this Forum within two years from the date of cause of action, i.e., the date of death of the policyholder. So, the case is barred by limitation and claimant is not to get any relief. So, this insurer is not guilty of any deficiency in service and as such the present complaint is liable to be dismissed with cost.

Decision with reason

The complainant has relied upon certain documents she has filed and on her statement she made by swearing in an affidavit and she was thoroughly crossed.

  We do find it admitted that the deceased during his lifetime purchased the policy in question and on his date of death the policy had the coverage.

The disputed point is now, whether the present claim is barred by limitation – a point that has been agitated from the side of the O.P. / insurer. Now, so far as the time prescribed for limitation for bringing a case before this Forum is two years from date of rising of cause of action, i.e., from the date of repudiation of the claim in the instant case. Here, in this case we find that the O.P./ insurer repudiated the claim on 16.03.2010 and the present case has been filed before this Forum on 16.03.2011 i.e. within the limitation period prescribed by the Act of Consumer Protection, 1986.

From the case of the parties, we do find that the insured disclosed his health status as ‘good’ in his insurance proposal which has been challenged by the opposite parties/ insurers. We also do not cast doubt on the story given by the complainant regarding the circumstances under which her uncle lost his life. The doctor’s report in the claim form as well as death certificate filed here is also a help for us to say conclusively that the insured died of heart attack.  Generally claim form B is prepared by a medical attendant of the deceased in his last illness with consultation of the family member of the insured. In this case Dr. R. N. Roy Chowdhury prepared the claim form which is duly witnessed by the concerned Gram Panchayet Pradhan with consultation of the wife of deceased and found that the said deceased had been suffering from heart disease like palpitations, breathlessness and chest pain since 28.04.2004 at least three years prior taking the alleged insurance policy. We do not find any ground on which we can disbelieve the report of attending doctor which he made in claim form B.

 In the instant case, the deceased/insured did not express his actual health status at the time of preparation of proposal form for ill motive and the instant case is suffering from suppression of material facts at the relevant point of time from the end of the insured. So, we do not find any latches on the part of O.Ps / Insurers. So, this Forum holds that consumer has no case and liable to be dismissed. Hence, it is ordered,

That this case bearing No. 21/2011 is dismissed on contest without cost.

Fees paid are correct.

Furnish the true photocopies of this Final order to the parties free of cost.