Sri Shyamal Gupta, Member

As Appeal bearing Nos. A/906/2017 and A/961/2017 arise out of the Order dated 21-07-2017 of the Ld. District Forum, Kolkata, Unit-II in CC/72/2017, the same are disposed of through this common order.

A complaint case was filed before the Ld. District Forum by Smt. Sudipa Ray alleging gross malpractices in the matter of issuance of the disputed policies.  All the material allegation made in the petition of complaint was, however, denied by the Insurance Company, viz., Religare Health Insurance Co. Ltd.

In this context, we heard the submission advanced by the parties and perused the documents on record thoroughly.

Ld. Advocate for the OP Insurance Company refused to accept the contention of the Complainant that the first proposal form did not bear her signature.  It was argued that the dispute surrounding the signature could only be put at rest by a hand-writing expert and therefore, without referring the matter to an expert, it was highly improper on the part of the Ld. District Forum to put its stamp of approval to the allegation of the Complainant. 

In this regard, we have carefully scrutinized the signature contained in Proposal Form No. A 1100400768215 vis-à-vis other documents on record. On due scrutiny, we find that a bare eye view was suffice to discern the difference in signature.   Thus, we do not think that by deciding the dispute on its own, the Ld. District Forum committed any jurisdictional error.

That apart, when we take into consideration other circumstantial evidences of the case, we come across several incriminating facts which squarely disapprove the defence being taken by the OP Insurer.

First, it is common prudence that any sensible person would prefer to enjoy the accrued benefits of earlier health insurance policy while migrating to another company.  Against such backdrop, it is hardly believable that the Complainant decided to forgo all accrued benefits of the previous insurance policy on her own volition. 

Secondly, notwithstanding the Complainant disputed the authenticity of the medical reports banking on which her proposal for issuance of a new health insurance policy was turned down by the OP Insurer, it is strange indeed that the latter did not make any endeavour to prove the said documents by furnishing due affidavit from the concerned diagnostic centres.  Similarly, though the Complainant disowned the signature contained in some of the medical reports being attributed to her, the OP did not impress upon the Ld. District Forum to clear the dust in this matter by referring the disputed documents to a handwriting expert.

Thirdly, in the disputed medical reports purported to have been issued in the year 2016, the age of the Complainant was mentioned as 65 years; whereas, it appears from the PAN Card of the Complainant that her date of birth is 13-10-1948.  Going by this, she was 68 years old in the year 2016.  It is not at all believable that one would intentionally fudge one’s age while opting for medical tests.

Fourthly, it is alleged by the OP Insurer that the Complainant intentionally did not disclose her medical conditions while filling up the first proposal form.  However, as she disclosed such facts in the second proposal form, considering the underwriting guideline of the OP, the proposal of the Complainant was turned down.  If we take an empirical view of the matter,  it is highly unlikely that one, who chooses to hide something, would voluntarily disclose such fact subsequently.

Fifthly, it is an open secret that proposal forms are filled up by the agents of the Insurance Companies behind the back of the prospective policyholders.  In case the disputed proposal forms were indeed filled up in presence of the Complainant, the OP Insurance Company could prove such fact following due process of law.  However, for the reasons best known to it, the OP simply sidestepped the issue. 

It is a fact that the Complainant suffered greatly owing to the malpractices of the concerned personnel of the OP Insurance Company.  However, we cannot lose sight of the fact that the Complainant too was liable to some extent for her own misery – she ought to remain wide awake and put her signature on the first proposal form only after satisfying herself about the correctness of the information being given in the form. 

In view of this, we are fully at one with the findings of the Ld. District Forum.  In the facts and circumstances of the case, the award being given by the Ld. District Forum also appears to be in order. Accordingly, we refrain from interfering with the same in any manner whatsoever.

Accordingly, both the Appeals stand dismissed. Parties do bear their respective costs.

Let the original copy of this order be kept in the case record of A/906/2017 and a photocopy thereof in A/961/2017.