Complainant Priti Dey W/o Late Kartick Ch. Dey by filing this complaint has submitted that Kartick Ch. Dey was the husband of the complainant who had so many life insurance policies and said Kartick Ch. Dey (who died on 25.11.2012) purchased one LIC Policy bearing No. 498050948 for assured sum of Rs. 4,00,000/- on 28.10.2010 when he was service holder as Senior Service Holder in the Mining Department posted in Orissa. Kartick Ch. Dey applied for the said policy scheme by filing prescribed Form and also submitting relevant papers and documents required as per terms and conditions of the Policy Scheme and after scrutiny papers and documents by the authorities concerned and after satisfying in respect of required materials, accepted the premium amount for Rs. 19,216/- and issued the policy which came into force with effect from 28.10.2010.
Even after that on 26.10.2011 and 31.08.2012 next two premiums were paid. Subsequently Kartick Ch. Dey was seriously ill and after check up by renowned Diagnostic Institute the said Kartick Ch. Dey was admitted to Saroj Gupta Cancer and Research Institute, Kolkata – 700063 and after treatment the policy holder Kartick Ch. Dey died on 25.11.2012.
As per policy, complainant is the sole nominee of the said policy and on his death, complainant applied for release the insured amount of the above mentioned policy by submitting all the papers, documents including death certificate and original policy which were accepted by the Authorities and op assured the widow to wait for sometime for release of the said amount in favour of the complainant.
At the same time Kartick Ch. Dey purchased seven other policies in the name of complainant and his daughter Ipshita Dey and that was continued by Kartick Ch. Dey. But peculiar factor is that suddenly op no.2 issued a letter vide Memo No. HDO/Rept/Clm/TKR/13-14/97 dated 21.01.2014 to the complainant rejecting the claim of the complainant in respect of the present disputed policy. But reason as mentioned was not admitted at all and the decision was taken behind the back of the complainant. On the other hand it is the obligatory duty of the op no.2 to release the amount immediately after submitted the claim application as and when the death was recorded in the month of November, 2012 but that was not done and rejected letter was issued on 21.01.2014 as such more than one years expired the complainant received such letter and in fact no enquiry was done by the said Authority before rejecting the said leter nor went to the residence of the complainant for taking any cogent evidence as such the reason is not sustainable in the eye of law.
But peculiar factor is that in respect of policy Nos. 437355543, 435906758, 581072792 and 438967053 which stood in the name of Kartick Ch. Dey were released. But the claim in the present disputed policy being No. 498050948 for sum insured of Rs. 4,00,000/- was not released. Practically such sort of rejection in respect of disputed policy and released of claim in resepct of other 4 policies has created much doubt about the act of the op and in fact for their negligent and deficient manner of service, this complaint is filed praying for releasing the said sum assured including interest and compensation to the complainant in respect of the disputed policy.
On the other hand op Life Insurance Corporation of India by filing written statement submitted that policy No. 498050948 was taken by the complainant’s husband on 28.10.2010 for 16 years term. But in the Proposal Form there was certain declaration to be submitted by the insured and insured answered against such question. But truth is that prior to 28.10.2010, complainant has been suffering from Hematemesis and practically complainant did not disclose his ailment and suppressed the entire fact at the time of taking the policy knowing fully well about his condition of his health and op after taking relevant medical reports pertaining the period when the insured was suffering from Hematemesis has not been produced before this Forum also and insured deliberately suppressed the entire condition and his health and misled the op company though insured was well aware of his physical condition taking a plea etc.
The entire history of his ailment of the complainant is focused from the report of Dr. Rajat Kr. Dutta’s prescription dated 26.06.2012 where it is specifically mentioned by the said doctor that the patient had the history of Hematemesis since two years that is before commencement of the said policy in question and ultimately insured died in Cardio Respiratory failure in a case of Carcinoma Stomach with metastases which is also confirmed by the Death Certificate dated 25.11.2012 issued by the Saroj Gupta Cancer Centre & Research Institute.
In view of the non-disclosure of the general history of the health of the insured as per policy Form and Condition – 11 etc. it is found that he had been suffering from severe ailment. But de did not disclose it in the proposal Form though his health condition was not good. He took leave which is proved from the report as collected by the employer’s certificate that the deceased life assured was on sick leave for a number of days before taking out the policy in question. Considering all the above fact and materials and the entire fact, the said claim was repudiated. But other policies were prior to this policy and operated those policies continue for 3 years for which in respect of other 4 policies claim has been disbursed to the complainant which has been admitted by the complainant.
In the above circumstances, op has asserted that complainant has not disclosed all those facts and by suppressing that fact, complainant has purchased those policies for huge amount knowing fully well that insured was traced assured that his life is numbered and in the above circumstances complaint should be dismissed as there was no negligent and deficient on the part of the ops.
Decision with reasons
On proper study of the complaint and the written version including the argument as advanced by the complainant and op’s Ld. Lawyer we have gathered that vital document is nothing but the proposal form which was submitted by insured Kartick Ch. Dey and from the said document it is clear that insured put negative answer against question, against personal history columns whether insured consulted any medical practitioner for any treatment for more than a week prior to taking policy filing Proposal Form, whether he has been admitted to any hospital or any nursing home for general check up or observation for treatment or for operation. Whether insured was absent from his place of work on the ground of his health from the last five years. Whether he has been suffering from Tuberculosis, High Blood Pressure, Sugar, Carcinoma, Hydrosil, Hernia, Leprosy etc. and what is the position of said of health of the complainant’s insured. Practically insured in respect of all other questions put answer no but in respect of health condition, he has put answer good. In respect of all that declaration, there is no challenge by the complainant.
Fact remains that after filing this application/Proposal Form duly filled up and signed by Kartick Ch. Dey, it was accepted relying upon the complainant made by Kartick Ch. Dey. So regarding the Proposal Form, there is no challenge and about declaration of her husband in the Proposal Form admitted position is that insured paid three premiums at the rate Rs. 19,216/- first on 28.10.2010, 2nd premium on 26.10.2011 and 3rd premium on 31.01.2012.
Admitted fact is that insured Kartick Ch. Dey died on 25.11.2012 no doubt suffering from Carcinoma Metastases as per Death Certificate issued by Saroj Gupta Cancer Research Institute on 25.11.2012 that is the date of death of insured. It is undisputed fact is that the document which was supplied by the complainant to the op it is clear that on 26.06.2012 it was detected by the doctor as per statement of the insured that insured had been suffering from a history of Hematemesis since last two years.
Fact remains as per proposal form, it is found that against question 11C insured answered No. But question was whether he remains absent from the place of work on the ground of health during last five years prior to taking the policy? Fact remains that policy was taken on 28.10.2010 but as per leave certificate granted by the Employer’s of the complainant, it is clear that from that employer’s certificate dated 20.04.2013 that insured took casual leave, sick leave and P. Leave in total 42 days in the year 2008, in the year 2009, 28 days and in the year 2010, 32 days and in the year 2011 36 days and in the year 2012, up to June (25.06.2012) 13 days. Out of that sick leave was 12 days, 20 days, 24 days, 13 days and 8 days.
But peculiar factor is that insured did not disclose all those facts that he enjoyed such leaves. Reasons for sick leave was also not disclosed, not only that from the prescription of Dr. Raj Kr. Dutta, it is clear that insured had a past history of hematemesis for last two years prior to his death.
It is fact that he died on 25.11.2012 and policy was taken on 28.10.2010 and in the year 2010 insured took 32 days casual leave, sick leave and P. leave in total that was taken by the insured but that was not disclosed. Reason for taking 34 days sick leave is not explained.
Most interesting factor is that insured died due to Carcinoma Stomach Metastases and as per medical science such a disease cannot be formed within two months or three months or four months or six months. But it is continuous effect of blood vomiting etc. and fact remains that insured invariably was treated at different places during last two years and insured was aware of his health condition and he was aware of his other four policies which are very poor in respect of sum assured and relalising his fate, he suppressed his health condition and purchased said policy for a sum assured of Rs. 4,00,000/- that means he was aware of his future and he was also aware of his disease, further he was aware of his health in such a situation he filled up the disputed proposal form and he purchased the said policy of high amount against payment of high premium but suppressing all queries as made in the Proposal Form.
Ld. Lawyer for the op submitted that is the cause for repudiation. No doubt in this regard we have gone through the principle of law as laid down in so many judgements wherefrom we have gathered that statement made by an insured must be taken into consideration at the time of considering the release of insurance claim by the legal heirs of the insured and it is settled principal of law that declaration as made by the insured in the Proposal Form is found otherwise on his death when it was palpably within his knowledge that the statement as made by the insured is palpably false and if it is found that it is clear suppression of material fact in regard to the health of the insured in that case insurance company is fully justified in repudiating the insured contract and in this regard the judgement passed by Hon’ble Supreme Court in Civil Appeal jurisdiction by CA No. 2776/2002 Satwant Kaur Sandhu – Vs – New India Assurance Company and also the judgement passed by Hon’ble Justice Ashok Bhan and Member S.K. Naik by NCDRC, New Delhi in R.P. No. 1987/2006 (Kokilaben Narendrabhai Patel – Vs – LICI) are considered and after proper consideration of the entire materials we have gathered no doubt there is no ground to disbelieve the medical certificate produced by the complainant to the op and nature of treatment, past history of disease and also considering the fact of suffering from Carcinoma with Metastases and after studying medical journals and other about Carcinoma Metastases, it is found that it cannot be caused within a few months but it is a continuous damage of the stomach and invariably there was a history of blood vomiting for the last two years prior to taking of insurance policy and the document was produced by the complainant and that document has made it clear that about the information of past history of the deceased husband of complainant upon which we have relied.
But peculiar factor is that prior to this death of her husband he took sick leave for 24 days in the year 2010 but treatment sheet has not been filed. In the year 2009 he took sick leave for about 20 days and also other leave. But no treatment sheet is filed for what reason he took leave and considering that fact it is clear that insured did not give truthful answer in respect of history of the insured against Column – 11 of the Application Form and after considering the present documents, filed by the complainant, it is clear that insured suppressed about his health condition and practically he purchased the policy knowing fully about his future and life expectancy.
At the same time it is proved after considering other four policies in respect of which claim has been already disbursed by the op to the complainant, it is clear that the said amount was meagre in number but it was continued for some period for which sum matured amount has been given. But truth is that in respect of that four policies, premium amount was very meagre whereas in respect of disputed policy yearly premium was Rs. 19,216/-. So, considering that fact, it is clear that only to save the family of the insured, insured purchased it surprisingly the truth of his health condition and about his suffering about his taking sick leave and in all cases he put answers as NO and regarding ill health he put answer GOOD. But the complainant’s own document does not support the fact but on the contrary it is proved that insured did not give material fact, truthful history about his health. When there are mis-statement and suppression of material of facts invariably the policy can be called in question and for that determination no doubt op collected all papers and truth is that suppression material fact was in exclusive knowledge of the insured and knowing fully well about his health condition he took the policy and he was aware of the fact if he used negative answer that he took different types of leave in that case policy cannot be issued but that matter may be checked and verified before issuing any policy but that scope was not given by the insured but insurance company relied upon his statement but at the time of determination of the claim it was found that the insured was absent from his place of work on the ground of health from last five years and there is no explanation for what reasons the insured did not disclose it in the Proposal Form to disclose the fact.
Considering all the above fact and circumstances, we are convinced to hold that any inaccurate answer will entitle the answer to repudiate the liability because there is clear violation of the policy terms and conditions when information is in the proposal form made by the insured is material for the purpose of entering into a contract of insurance.
Taking into all the above materials on record we have no hesitation to come to a conclusion that the statement given by the insured in the proposal form about the health condition, about his absence from place of work within last 5 years etc. and also about his health status are palpably incorrect and up to his knowledge and there was clear suppression of material of facts with regard to his health so insured was justified for repudiating the contract of the insurance.
In the result, complaint fails.
Hence, it is
ORDERED
That the complaint be and the same is dismissed on contest against the ops but without any cost.
