Complainant by filing this complaint has submitted that he purchased one Medical Health Insurance Policy of the op Company being Policy No.611030048977 having date of commencement 31.03.2011 Primary Life Assured Sri Sankar Prosad Mazumder, Annual benefit Rs.4,90,000/-, installment Premium Rs.38,608/-, Policy Term 3 years, premium payment term 1 year and date of maturity 31.03.2014.  Complainant paid the premium by cheque in terms of the said policy which had been encashed by the op company.

          But complainant only filled-up page No.27 of the said policy and put his signature therein.  But subsequently on receipt of the policy, the present complainant noticed being surprised that all other signatures of the policy as appearing in the said policy except at page No.27 have been forged by the op/company and company have also changed the complainant’s surname from Mazumder to Majumdar and further the complainant’s mobile phone number was also changed which does not belong to the complainant as appeared in the said policy. The complainant’s mobile No. is 9831154450 whereas mobile number is noted as 7278873788.

          It is further submitted that the Biochemical, Serology and E.C.G. Medical Test/Examination reports enclosed with the said policy do not belong and have been manufactured by the op/company and complainant never underwent any medical tests/examinations with Biotech Diagnostic & Imaging Centre as mentioned therein and the medical examination report purportedly issued by the op/company attached with the said policy, has been also manufactured by the op/company and does not bear complainant’s signature therein at the column “Signature of Person being examined” and the medical tests/ examinations although has been agreed to be conducted by the op/company at their own costs and expenses in terms of the said policy, but that has not been done, thereby resulting to sufferance of extreme financial hardship by the complainant.

          Complainant undergone By-pass Surgery and not keeping good health with the passage of time and thereafter by several letters, notices, e-mails and correspondences requested the op/company to cure the defects as appearing in the said policy, but complainant’s requests was rejected.

          Subsequently op/company admitted their mistakes and folly in the matter under dispute and accepted complainant’s contentions and thereby apologized to complainant and requested the complainant to grant them some time and assured complainant to make well the faults and deficiencies as appearing in the said policy, but op/company ultimately did not rectify it and neglected to do the same.  Though complainant had a hope that the defects of his said policy shall be cured by the op/company and complainant has been waiting patiently for the op/company’s prompt and effective action in the matter, but no effect.

          Finding no other alternative the complainant sent a demand notice through his Ld. Advocate claiming of compensation of Rs.14,70,000/- towards benefit for 3 years at per Rs.4,90,000/- p.a. in terms of the policy and further sum of Rs.2,94,000/- towards the mental and physical agony, injury etc and claiming of compensation of Rs.17,64,000/-.  But all on a sudden the op/company by a letter dated 15.02.2012 unilaterally, arbitrarily, highhandedly and unlawfully terminated the said policy upon enclosing a cheque therewith for a paltry, speculative, imaginary, baseless and arbitrary amount of Rs.38,608/- purportedly issued in the name of complainant and by that letter op/company made such false statement and that complainant requested for cancellation of the said policy as alleged.  However, the complainant has not encashed the said purported cheque, instead, has returned the same to the op/company along with a reply dated 23.02.2012.

          Due to op’s negligent, whimsical and motivated acts and activities the complainant has been suffering a lot in his old age and for which complainant has prayed for compensation.

          On the contrary op/company by filing written statement submitted the entire allegation is false and fact remains that the fact regarding By-pass surgery and complainant’s being under strict medical observation were never disclosed to the op/company at time of making the proposal and had the op known of his By-pass surgery details, such risk would not have been underwritten and policy would not have been issued to the complainant and taking cognizance of the complainant’s disclosure regarding facts of having gone the Bye-pass surgery before the date of proposal and is being under strict medical observation, company vide its letter dated 15.02.2012 declared the policy null and void and refunded the premium vide cheque No.032290 dated 10.02.2012 for a sum of Rs.38,608/- to the complainant and the complainant vide his letter  dated 23.02.2012 returned the cheque to the op/company and has filed the complaint by the complainant against the op and fact remains that there was no deficiency on the part of the op and op did not prepare any paper  and entire allegation is false except one mobile number was wrongly written that is deficiency in service and fact remains that complainant had underwent Bye-pass surgery on 30.11.2007 and was still under strict medical check-up at the time of proposal and that was not shown in the policy and in the above circumstances, the complaint should be dismissed and complainant may accept the said cheque or necessary order may be passed in this regard.

                                               Decision with reasons

          Fact remains that the complainant submitted Health Plan Proposal Form showing his annual income of Rs.2,40,000/- and from the proposal form it is also found that his surname Majumdar is written and Mazumder is pen through with signature and further from the said form No.0096632 it is found that medical information as per Section-5 of the said policy was not given and it was written NA and further against health primary life before No, there is a square which is cross.  In fact complainant at the time of opening the said policy was aged about 67, height – 1.70 cms and his date of birth was written as 19.01.1949 and said policy form was written by the office of the op/company on 30.03.2011 and in the said form there are 3 signatures which are found the signatures of the complainant and it is tallying from one to another which is evident after applying our open eyes.  No doubt the policy was issued showing the date of commencement 31.03.2011 being No.0611030048977 and date of maturity 31.03.2014 but initially it was found that complainant did not filing any medical report about his health for which he was subsequently examined and necessary papers were collected when it was found that complainant before opening this policy did not disclose that Bye-pass surgery conducted on him on 30.11.2007 at Kolkata and he was always under strict medical check-up.  It is the submission of the complainant that he told everything to the present op and all his current medical tests reports were handed over to them.  But some tests again shall be conducted by them at their own cost  and choice and finally asked the signature only in form which is at Page 27 of the policy and rest were filled by them.

          Considering the material, documents including the arguments by the Ld. Lawyers of both the parties and policy considering the fact that admitted position is that in the proposal form complainant did not give details of his health condition rather it was noted nothing abnormal.  But complainant has admitted that he submitted one form with his signature for medical check-up and he also produced all the papers regarding his Bye-pass surgery subsequently and after then it is clear that in the proposal from complainant did not disclose that he underwent a Bye-pass surgery and he was under continuous check-up of the doctor.  Then invariably it is clear that op/company issued policy relying upon the statement had made in the proposal from but when they got all the papers from the complainant they found that complainant did not disclose the truth about his health and in the year 2007 he underwent Bye-pass surgery and that fact should be neglected in the column-5 of the proposal form but that was not there.  Then it is clear that complainant suppressed the fact that is health condition prior to purchasing the medical policy.  But admitted fact is that complainant underwent Bye-pass surgery and he was under constant check-up of the doctor.  Then invariably at the time of filing proposal form, the column-5 would be filled up in details by the complainant, in that case op/company may not have issued any of the policy.  But considering the entire material we are convinced to hold that complainant did not disclose his health condition at the time of filing the proposal form for previous Mediclaim Policy which is evident from the said document and the allegation is that complainant only signed one signature is completely false what were gathered after observing the other admitted signatures.

          But after proper evaluation of the entire materials, we have gathered that the complainant managed to procure this policy by suppressing the fact and when the pre existing health condition of the complainant was deducted then invariably as alleged and as per terms and conditions of the policy, the policy was declared null and void and entire deposited amount was returned to the complainant vide cheque but complainant refused it that is not the fault on the part of the op rather it is proved that complainant dishonestly filled up that proposal form for purchasing such policy to get more benefit suppressing his pre existing condition of health.

          Fact remains that complainant has not produced any paper in support of his Bye-pass surgery and subsequent treatment before this Forum also and in view of the above fact and circumstances, we are of the view that complainant suppressed the pre existing diseases and about Bye-pass surgery and subsequent continuous treatment and is suffering from several diseases only on the ground that the Forum may not come to a conclusion that he has no diseases prior to purchase this policy.  But it is admitted by the complainant in his complaint that he underwent Bye-pass surgery in the year 2007 and he is under constant treatment by the doctor but that was not present in the proposal from against coloumn-5 and for which we are of view that there was no latches on the part of the op for returning deposited premium of Rs.38,608/- by cheque No.032290 dated 10.02.2012 and as per contract his said policy was rightly declared null and void and cancelled and fact remains that complainant for some purpose filed this complaint by sending the cheque of Rs.38,608/-.  But there was no justified or legal ground to file this complaint and for which the complaint bears no merit in the eye of law but necessary order may be passed directing the op to refund the said amount of Rs.38,608/- along with some interest of Rs.3,000/- because the said amount was in the custody of the op and it was somehow used by the op.  So the said interest ought to have been awarded but that has not been award.

              Accordingly, this complaint fails.

          Hence, it is

                                                      ORDERED

          That the complaint be and the same is dismissed on contest but without any cost against the op.

          The op is directed to issue a cheque of Rs.38,608/- along with composite interest of Rs.3,000/- to the complainant within one month from the date of this order failing which the op shall be penalized in that case op shall have to pay further penal damages @ Rs.100/- per day till full payment of this amount to the complainant.