West Bengal

Paschim Midnapore

CC/19/2017

Mallika Singh - Complainant(s)

Versus

PNB Metlife Insurance Co.Ltd. - Opp.Party(s)

31 Jan 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.                           

                                                                                                      

Bibekananda Pramanik, President,

 Pulak Kumar Singha, Member

and

 Sagarika Sarkar, Member.   

Complaint Case No.19/2017

 

Smt. Mallika Singh, W/o-Late Anil Kumar Singh,

Vill & P.O.-Duan, P.S.-Debra,

District-Paschim Medinipur

                                                                ..………..……Complainant.

Vs.

1. The Branch Manager, PNB Met Life India Insurance Co. Ltd., near Inda College, P.O.-Kharagpur,  P.S.-Kharagpur(T), Dist-Paschim Medinipur
2. The Regional Manager, PNB Met Life India Insurance Co. Ltd., R.O., Unit No.101, 1^st floor, Techniplex-1, Techniplex Complex, off Veer Sawarkar Flyover, S.V.Road, Goregaon West Mumbai-400062

                                                                                .…...……….….Opp. Parties.

                                                    

                For the Complainant  : Mr. Rittik Ranjan Raj, Advocate.

                For the O.P.                 : Mr. Debashis Maiti, Advocate.

 

                Decided on:31/01/2018

                               

ORDER

            Pulak Kumar Singha, Member :

                 Complainant files  this case u/s 12 of the C.P. Act, 1986.

                  In short the case of the complainant is that the husband complainant late Anil Kumar Singh purchased one Life Insurance policy from O.P. no.1 vide policy no. 21463591, issued on 01/09/2015 by paying annual premium Rs.80,000/-. Said  policy was 10 years premium paying term and policy term was 38 years complainant paid Rs.80,000/- as 2^nd premium of the policy on 18/04/2016. Due illness of policy holder, Anil

                                                                                                                                                           Contd……………P/2

 

                                                                                   ( 2 )                                                                                                  

 Kumar Singh was treated on 20/04/2016 by Dr. A.K. Adhikari at Ganga Nurshing home thereafter Spandan Diagnostic Centre Pvt. Ltd. at Kharagpur and lastly admitted on 24/04/2016 at South Eastern Railway Central Hospital, Kolkata and died thereon. After death of said policy holder, as nominee complainant lodged claim on 08/08/2016 with all documents before O.P. no.1 but O.P. repudiated the claim assigning false reason complainant approached before this Forum for getting redressal as per prayer of complaint.

               O.Ps. contested the case by filing written statement denying the allegation of complainant, stating inter alia, that the complaint is false, incorrect and misconceived. Insured suppressed the material fact in respect of health condition in the proposal form before issuance of the policy as such O.P. repudiated the claim of the complainant and prayed for dismissal of the complaint.                                                                                                          

                                                  Decision with reasons

                We carefully perused the complaint, written statement, evidence and documents and it appears that complainant purchased one life policy from O.P. no.1 for a term of 38 years and premium paying term was 10 years.  Insured since deceased Anil Kumar Singha paid two years premium by paying Rs.80,000/- each. Policy was issued on 01/09/2015 and present complainant is the  nominee of the said policy. Insured died on 24/04/2016 but O.P. repudiated the claim on the ground suppression of material fact of the health condition of insured.

Complainant to prove her case adduced evidence and terndered herself as PW-I  and she was cross-examined by O.Ps. where she admitted that O.P.-Insurance Co. deposited Rs.1,49,315.18/- and Rs.179.65/- in her bank account P.W.-2, Dr. Vicky Gaewal who prepared the death certificate of deceased Anil Kumar Singh. In cross-examination Dr. said if a patient is taking eco-spring medicine then it can be said that the patient had the deceased of symptoms of   Malena & Hamaturia. Evidence adduced on behalf of O.Ps. also and in the written statement O.Ps. stated that at the time of filled up proposal form insured deliberately suppressed the medical history i.e. he was suffering from hemalemesis and melena and signed the proposal form in the verified column. On good faith policy was issued by O.Ps. O.Ps. further stated in their written statement that health   card was issued by South Eastern Railway, clearly established that DLI was suffering from hematemesis and melona since 2009 and proposal form filled up on 26/12/2014. From the prescription of S. E. Railway, Kharagpur in health check up card it revels in the H/O hematuresis Ċ Melena and suggested emergency medicines and injections on 09/09/2009. Cause of death also mentioned in the death certificate that CVA-hemoorrliagiac stroke , HTN (irregular treatment).

                                                                                                                                                          Contd……………P/3

 

( 3 )

O.Ps. submitted written argument stating that insured by suppressing his health condition submitted proposal form to the O.P. no.1 and on good faith Life Insurance policy was issued. In the written argument O.Ps. referred some decisions of Hon’ble High Court and Hon’ble Supreme Court and in a case LIC of India (Vs.) B. Chandravathamma reported in AIR 1971, AP-41 Division Bench of Hon’ble High Court passed their views that in any case deliberate misrepresentation the contract of insurance would become void and the amounts paid there under shall be forteited. In another case LIC (Vs.) Smt. G. M. Channabasemma reported in AIR 1991, S.C. 392 Hon’ble Supreme Court held that

the assured is under solemn obligation to make full declaration of material facts which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not.  In policies of life insurance there is an understanding that the contract is uberrima fides and no party is allowed to play hide and seek but each will have to place his cards on the table and even mental reservations of any kind are not allowed. This uberrima fides in a two way traffic contracts of  insurance, being contracts of faith, impositions by either party will constitute good sound for avoidance.

In view of the above discussions herein before we find from the documents the insured i.e. husband of complainant has deliberately suppressed in the proposal form that he was suffering from hemabmesis and melena since 2009 and was treated at S.E. Rail Hospital and dies on the cause of same deceased.  Suppression of health condition is ten amounts to violation of policy condition. O.Ps. have refund back the premium paid amount to the nominee (Complainant) subject to deduction of official cost as per IRDA guide line and complainant also admit the same in her deposition. O.Ps. have no deficiency in rendering service rather complainant has fails to prove her case.  

                        Thus complaint case fails.           

                         Hence, it is,

                                                 Ordered,

                        that the complaint case be and the same is dismissed on contest but without cost.

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

             Dictated and Corrected by me

                          Sd/-P.K. Singha                              Sd/- S. Sarkar                          Sd/-B. Pramanik. 

                               Member                                          Member                                     President

                                                                                                                                    District Forum

                                                                                                                                Paschim Medinipur