Tripura

West Tripura

CC/7/2016

Sri Uttam Sarkar. - Complainant(s)

Versus

Reliance Life Insurance Company Ltd. & 1 another. - Opp.Party(s)

Mr.U.Das, Mr.A.Das.

10 Aug 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA :  AGARTALA

CASE   NO:   CC- 07 of 2016

Sri Uttam Sarkar,
S/O- Lt. Naresh Sarkar,
Mainaman(Bangali Para),
Chailengta,
Longtharai Valley,
Dhalai Tripura.            …..…...Complainant.

       VERSUS

1. Reliance Life Insurance Company Ltd.,
Registered office, 
H.Block, 1st Floor, 
Dhirubhahi Ambani Knowledge City,
Navi Mumbai, Maharastra.     

2. Reliance Life Insurance Company Ltd.,
Agartala Branch Office,
Netaji Chowmuhani,
Agartala, West Tripura-799001.    .........Opposite parties.

      __________PRESENT__________

 SRI A. PAL,
PRESIDENT,
  DISTRICT CONSUMER  
DISPUTES REDRESSAL FORUM,
      WEST TRIPURA, AGARTALA. 

SMT. Dr. G. DEBNATH
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

C O U N S E L

    For the Complainant        : Sri Utpal Das,
                          Sri Alik Das,
                          Advocates.
                         
For the O.P. No.1 & 2        : Sri S. Daga,
                      Smt. Shelly Singh,
                      Advocates.    

        JUDGMENT  DELIVERED  ON:  10.08.2016

 

J U D G M E N T

        This case was filed by one Uttam Sarkar U/S 12 of the Consumer Protection Act. Complainant case in short is that he purchased one Insurance Policy No- 50977148 from the Reliance Life Insurance Company Ltd. Sum assured was Rs.1,03,110/-.  Half yearly premium was Rs.4599.87/-. Nominee was Uttam Sarkar, elder brother of the assured. Policy commenced from 2013, maturity date 07.05.2029. After purchasing  policy on 20.11.13 the policy holder was admitted to Rajib Gandhi Memorial Hospital, Kailashahar with chest pain and expired due to heart attack. So Uttam Sarkar, nominee of the policy approached to Insurance company for payment of sum assured. But after 7 months he was informed that claim is repudiated as the deceased had been suffering from cancer and the fact was suppressed. Petitioner approached the O.P. Insurance company but his grievance was not redressed. So, he filed this case claiming total Rs.1,84,000/-.  

2.        O.P. No. 1 and 2, Insurance company appeared, filed W.S. It is stated that the policy holder died within 6 months of commencement of the policy and this is a case of early claim. Investigation was done into the genuineness of the claim. During investigation it was found that life assured at the time of proposal suppressed that he was suffering from Carcinoma prior to his death. Report of  Dr.Subbhankar Bhattacharjee disclosed the same. He declared incorrect health state at the time of proposal. So, rightly his claim was repudiated and petitioner wa not entitled to get any amount. 

3.        On the basis of contention raised by both the parties following points cropped up for determination;
    
        (I) Whether the petitioner suppressed the material facts at the time of purchasing the policy?
        (II) Whether the petitioner is entitled to get the benefit of the policy and also compensation?

4.        Petitioner produced voter I.D. Card, death certificate, claim form, policy schedule, photocopy of challan, investigation report, bed head ticket, medical certificate about the cause of death. Petitioner also produced statement on affidavit of nominee,  Uttam Sarkar. 
        
5.        O.P. produced no evidence, either documentary or oral. So, on the basis of all the evidence we shall now determine the points.

            Findings and decisions;
    
6.        O.P. in the written statement only contended that material facts was suppressed by the policy holder. It was suppressed that he was suffering from carcinoma prior to his death. It is stated in the W.S. that some copies of clinical notes were annexed. Such clinical notes are not found in the annexure and no evidence given to support it. The investigation report also not produced. It was contended that he had suppressed the material information regarding his previous illness. Report of Dr. P.A. Ahmed, Dr. Subhankar Bhattacharjee, Dr.N. Tripura not produced to support this. Some photocopies are filed. But those can not be treated as primary or secondary evidence. In this photocopies nothing written to support that deceased Santa Sarkar was a patient of Carcinoma. Photocopy of death claim, investigation report is produced. It is written that the investigator talked with the neighbors of life assured who informed that the life assured had been suffering from carcinoma of gall bladder and jaundice prior to his death. Who was the neighbors not disclosed and even the investigator not produced before this Forum. In the repudiation letter it was informed that in the question No. 30 and 32 the reply given to by the deceased was false. And then it was observed that non disclosure of disease cancer was material at the time of issuance of the policy which ought to have been disclosed.

7.         Petitioner on the other hand, produced statement on affidavit of complainant, Uttam Sarkar who stated that suddenly his brother Santa Sarkar was ill and admitted in Rajib Gandhi Memorial Hospital, Kailashahar. Doctor certified that death caused due to Myocardial Infraction. We have examined the bed head ticket of the IGM Hospital and also the medical certificate regarding cause of death. From the death certificate it is found that death was natural. The patient was 25 years old. Nothing written in the death certificate to support that Santa Sarkar was suffering from cancer. When the specific ground is taken by the insurance company for repudiating the claim then burden lies on it to prove that false declaration was made by the life assured. The investigator met with the doctor who treated at IGM hospital. He informed that the patient had been suffering from chest pain. Investigator relied on the information given by the neighbors, not on the death certificate or any medical report. Investigator was not produced before the court to support this report. On the other hand death certificate reveals that the death was natural not by cancer. There is no evidence to support that the life assured Santa Sarkar was under medication or suffered illness, disorder or injury during past 5 years requiring medical specialists examination. There is also no evidence to support that life assured suffered any medical ailment, diabetes, high blood pressure, cancer, respiratory disease, kidney or liver disease, stroke, blood disorder, heart problems, hepatitis or TV, psychiatric disorder, depression, HIV, AIDS or related infection. In absence of any such evidence it can not be said that life assured Santa Sarkar at the time of obtaining policy had given false answer to the question No.30 and 32 and suppressed the material facts. O.P. Reliance Life Insurance Company repudiated the claim without proper investigation, without any sufficient cause. This is deficiency of service by Reliance Life Insurance company Ltd., O.P. No.1 and 2. Petitioner therefore,  is entitled to get the redress as per terms and condition of the policy and sum assured Rs.1,03,110/- as he paid the premium. Petitioner being the nominee is also entitled to get compensation Rs.10,000/- as claim was repudiated without just cause and cost of litigation Rs.10,000/- total Rs.1,23,110/-. Point No.1 and 2 decided accordingly.

8.        In view of our above findings over the two points the claim of the petitioner is partly allowed. We direct the Reliance  Insurance company Ltd., O.P. No.2, Agartala Branch to pay amount to the Uttam Sarkar, nominee of the policy. Amount is to be paid within 2(two) months otherwise it will carry interest 9% P.A.    

                     Announced.

SRI A. PAL
PRESIDENT,
DISTRICT CONSUMER  DISPUTES 
REDRESSAL FORUM,
WEST TRIPURA,  AGARTALA.

 

 

SMT. DR. G. DEBNATH,
MEMBER,
 DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM, 
WEST TRIPURA, AGARTALA    SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.