Order-21.

Date-20/03/2018.

       Shri Anupam Bhattacharyya, President.

The instant complaint has been filed by the Complainant u/s.12 of the Consumer Protection Act, 1986 praying for payment of policy amount along with compensation of Rs.50,000/-  for pain  and mental agony  and Rs.10,000/- for the litigation cost.

The complainant’s case, in brief, is that the complainant’s wife Smt. Sumitra Tulsian got insured during her life time under the insurance policy ‘Gold Plus Life Coverage’ having policy no.001219695 from the OP Insurance Company and payment made regularly in time. The Agent of the OPs transferred the old policy to a new policy under the name ‘BSLI Platinum Advantage Plan’ being  No.005578093 and the Complainant was the nominee of the said policy. During her life time she paid two annual premium  at the rate of Rs.25,000/- each totaling Rs.50,000/- and the accumulated amount of old policy transferred to the new policy whose accumulated sum was Rs.1.75 lac. Complainant submitted a claim application on 13.01.2014 to the OP after his wife’s death on 18^th December, 2013. Complainant received a letter dated 31.03.2014 from the OP rejecting his claim for providing false information. The Complainant on 29.05.2014 wrote a letter to the OP to settle the claim but remained silent. Lastly, the Complainant wrote a letter to the OP dated 25th July, 2015 to refund the amount deposited by his wife but the OP till kept mum. On 4^th November, 2015 the Complainant issued a legal notice, in spite of receiving the said notice the OP remained silent. Hence the instant complaint case.

The w.v. filed by the OP, in brief, is that the Complainant suppressed the fact that his wife was suffering from allergic bronchial asthma and undergoing treatment by Dr. K.N. Poddar on 13.02.2009 and 24.04.2010 clinics. She was admitted at Rameswara Nursing Home twice under the same Dr. K.N. Poddar on 18.02.11 and discharged on 23/02/2011 and on 05.11.2013 to 10/11/2013 for acute exacerbation of Bronchial asthma which is prior to issuance of the policy in dispute and he was well aware that if they would appraise the fact, the OP would not have granted her insurance policy. The policy in the instant matter has been obtained by misrepresentation. Hence, the instant complaint of the Complainant is liable to be dismissed. Hence the instant w.v.

Considering the pleading of both sides the following points have been raised:

Points for Decision

1. Whether the case is maintainable in its present form and law?
2. Whether there is any cause of action to file the case?
3. Whether the case is barred by limitation?
4. Whether the complainant is entitled to get the relief as prayed for?
5. What other relief/reliefs the complainant is entitled to get?

Decision with Reasons

Point Nos.1 to 5  :    

All the points are taken up together for the brevity of discussion and convenience.

The instant complaint for payment of policy amount of Rs.1.75,000/ along with interest  at the rate of 12 percent p.a. and for compensation of Rs.50,000/- and Litigation Cost of Rs.10,000/-.

The complainant’s main case is that the complainant no.1 purchased a policy of ‘Gold Plus Life Coverage’ which was switched over to ‘BSLI Platinum Advantage Plan’ paying Rs.25,000/- and consecutive two annual premium  at the rate of Rs.50,000/- and Rs.25,000/- to the OP-1. Complainant as a nominee of the said policy submitted a claim application on 13.01.2014 after death of his wife on 18.12.2013 which was illegally rejected for providing false information.  Then the Complainant has filed the instant complaint for non response from OPs.

On the other hand the OP Insurance Company‘s main case is that the Complainant suppressed the fact that she was suffering from allergic bronchial asthma. She was again admitted on 05.11.2013 and discharged on 10.11.2013 from the said nursing home with the same problem.  The claim of the complainant was repudiated on the ground of suppression of material information in procuring the policy by resorting to Section 45 of the Insurance Act, 1938 and the same was rightly repudiated.

The policy holder suppressed the fact that she was suffering from acute exacerbation of Bronchial Asthma at the time of procuring the policy. The policy has been obtained by misrepresentation and this complaint is liable to be dismissed.

To prove the case both the parties have adduced Evidence on Affidavit along with relevant documents and questionnaires and replies vis-à-vis by both parties.

Admittedly, the wife of the complainant had policy of Gold Plus Life which was switched over BSLI Platinum Advantage Plan paying consecutive two annual premiums  at the rate ofRs.25,000/- each amounting in total Rs.50,000/- who died on 18-12-2013 and claimed application was filed by her nominee, the complainant on 13-01-2014 which was repudiated by OP Insurance Company on the ground of suppression of material fact that she was suffering from allergic bronchial asthma. 

To that effect the OP insurance has adduced evidence as to admission and discharge of the deceased policy holder with the same symptom of bronchial asthma on 18-02-2011 and 23-02-2016 respectively. 

In this regard the Ld. Lawyer for the complainant has advanced argument that the death of wife of the complainant, the policy holder was not caused due to bronchial asthma but it is true that the policy holder was suffering from bronchial asthma and for that she was admitted at Rameswara Nursing Home Pvt. Ltd. on 18-02-2011 and discharged on 23-02-2011 and to that effect the OP has adduced the relevant document.

Considering the suppression of material fact as to the suffering of the policy holder from Acute Bronchial Asthma we can safely conclude that the complainant is not entitled to get the death benefit of the policy but we are of view that the complainant is entitled to get the amount paid as to premium paid amounting to Rs.50,000/- with interest. 

Considering the above discussion as a whole we find that all the points are disposed of in favour of the complainant in part and as such the complainant is entitled to get Rs.50,000/- along with interest  at the rate of7 percent p.a. from the date of filing of this case and litigation cost of Rs.2,000/- within 30 days from the date of this order.

In result, the case succeeds.

Hence,

Ordered

That the instant case be and the same is allowed in part on contest against OP.

            The OP is directed to return the premium amount, amounting to Rs.50,000/- along with interest  at the rate of7 percent p.a. and litigation cost of Rs.2,000/- to the complainant within 30 days from the date of receipt of this order, in default, the OPs to pay fine  at the rate ofRs.100/- per day delay and the amount so accumulated should be deposited to this Forum.

            Failure to comply with the order will entitle the complainant to put the order into execution under appropriate provision of the C.P. Act.