Assam

Nalbari

CC/12/2017

Pranab Kalita - Complainant(s)

Versus

Reliance Nippon Life Ins. Co. Ltd. - Opp.Party(s)

Amirul Islam

29 Sep 2021

ORDER

:: BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION:: NALBARI::

:: DISTRICT-NALBARI :: ASSAM ::

 

Present: 1) Shri BK Sen, AJS. President.

              2) Mrs. G. Buzarbaruah. Member.

             3) Mr. P.K. Sarma. Member.

 

CONSUMER CASE NO. CC/12/2017

(Under Section 12 of the Consumer Protection Act, 1986.)

 

Sri Pranab Kalita

S/o- Late Amrit Kalita

Vill. - Kotalkuchi

P.O - Kamarkuchi

P.S.- Nalbari

Dist. – Nalbari (Assam) …………….          Complainant.

 

-Versus-

 

        Reliance Nippon Life Insurance Co. Ltd.

        Nalbari Branch,Dist. – Nalbari (Assam)  …… Opp. Party.

 

Appearance-

                For the Complainant   … Md. A. Islam, Advocate.

                For the OP                 … Ms. K. Dutta, Advocate.

 

Date of Argument – 29-09-2021.

Date of Judgment – 29-09-2021.

 

J U D G M E N T

 

           The Case of the complainant, Sri Pranab Kalita, in brief, is that his deceased mother, hereinafter for short deceased, Bhalmai Kalita, had opted for Reliance Nippon Life Insurance Policy bearing policy number 51691800 namely, "Endowment Plan" for a period of 25 years commencing from 23.06.2014. That prior to death, the deceased had been suffering from chronic Asthmatic Bronchitis since 10.12.2015 and died on 22.08.2016. She was under medical treatment of Dr. S.C. Chakraborty, Medical Officer of Kamarkuchi PHC. After death of Bhalmai Kalita, her son Sri Pranab Kalita, the present complainant, being nominee filed insurance claim petition before Branch Manager, Reliance Life Insurance Co. Ltd (OP), Nalbari Branch. The OP repudiated the claim blaming the deceased to have concealed material facts while obtaining the said policy. Being aggrieved, the complainant approached the Insurance Ombudsman against the decision of the OP but the decision of the OP was upheld. Hence, the complainant filed the instant petition claiming compensation to the tune of ₹.3,44,500/- under different heads.

 

2.        In response to the notice issued OP filed written statement contending, inter alia, that the present complainant is frivolous, without any cause of action and is not maintainable, that the deceased Life Assured (LA) suppressed material facts regarding her pre-existing disease in the proposal stage to procure the Insurance cover, thus have committed fraud upon the OP and misled the OP to issue the Insurance Policy and thus the Policy has been obtained by fraud and misrepresentation and hence the policy was void ab-initio, that the deceased LA and complainant misled OP to grant the insurance cover on the terms as stated in the policy documents, that had the deceased LA revealed her correct and actual health condition, the OP would not have granted insurance cover, that the policy in question was maliciously obtained by fraud and misrepresentation and the consent of the insurance company was obtained by fraud as defined in section 14 of the Indian Contract Act, 1872, that admittedly, the policy holder was suffering from Asthma and Bronchitis and has been under treatment for the same before different doctors since December, 2012. However, the aforesaid pre-existing medical conditions were suppressed by the deceased LA in the proposal Form to fraudulently induce the OP to issue of insurance cover.

 

3.       It is submitted by the OP that the deceased policy holder had opted for policy bearing Policy No. 51691800 (`Endowment Plan') with risk covering from 23.06.2014. That on 22.08.2016, the policy holder died. Subsequently, the claimant i.e. the present complainant submitted the claim statement claiming the sum insured amount from the Opposite Party by submitting the death certificate of his deceased mother. It was mentioned by the present complainant that the reason of the death of the Life Insured is due to Chronic Asthmatic Bronchitis. It was even admitted by the complainant in the Claim Form filled by the Complainant that date of First Complaint of illness is mentioned as 26.06.2012. Since, the claim being an early claim, the same was investigated by an independent investigation company, wherein it was found that the deceased policy holder was suffering from Asthma and Bronchitis and has been under treatment for the same before different Doctors since December, 2012 i.e. before the issuance of the insurance policy, and was diagnosed for the same. That in para 3 of the Complaint, the complainant had admitted that the Life Assured died from Asthma and Bronchitis and it is also admitted by the Complainant in the Claim Form that she was first treated and complained of Asthma and Bronchitis since 26.06.2012, as such, it is admission on the part of the Complainant about suppression of material facts, hence, on the specific admission made by the Complainant, the instant complaint should be dismissed at the threshold. That as the Policy Holder was suffering from Asthma and Bronchitis and was under treatment since December, 2012 and the same stood admitted by the complainant in the Claim Form, the present complaint is liable to be dismissed outright.

4.        In view of the facts and circumstances narrated above, OP prayed for dismissal of the complaint in the interest of justice with exemplary cost.

 

5.         Complainant examined three witness (PWs) in order to establish the case and produced some documents. PW1 (complainant) submitted additional evidence to produce medical certificate dated 06.02.2017 stated to have been issued by Dr. S.C. Chakravorty. OP examined one witness only. Heard both sides.

 

Decision & reasons thereof

 

6.        OP- Insurance Co. issued Life Insurance Policy bearing number 51691800 namely “ Endowment Plan” with risk commencing from 23.06.2014 for a policy term of 25 years in favour of deceased LA, Bhalmai Kalita, the mother of the complainant, for SA ₹ 249200/-. It is admitted position that Bhalmai Kalita died on 22.08.2016, prior to completion of the term of the policy. Therefore the complainant being the son as well as nominee of the LA made claim in respect of the policy before the OP, but the claim was repudiated by the OP on the ground that the policy was obtained by fraud suppressing the material fact that prior to issuance of policy, date of commencement of policy being 23.06.2014, the LA had seen suffering from Asthma and Bronchitis which is revealed in the Claim Form filed by the complainant. In the Claim Form it is specifically mentioned that the LA made complain of illness first on 26.06.2012 and the direct cause of illness is Chronic Asthmatic Bronchitis and the same was diagnosed first on 10.12.2012. Being aggrieved, complainant approached Insurance Ombudsman for redressal but the decision of the OP was upheld.

 

 

7.           Complainant (PW1) in his evidence before this Commission states that his mother, the LA, died on 22.08.2016 as she had been suffering from Chronic Asthmatic Bronchitis and was under treatment of DR. S.C. Chakravorty, Medical Officer of Kamarkuchi PHC since 10.12.2015. In contrary Claim Form (Claim Form B Medical Attendant Certificate by the last treating doctor) submitted by the complainant shows that the deceased (LA) was first diagnosed on 10.12.2012. Thus as per Claim Form the LA had been suffering from Chronic Asthma and Bronchitis prior to 23.06.2014, i.e. the date of commencement of the Policy. OP contended that the LA suppressed the material fact of suffering from Chronic Asthma and Bronchitis during the material period of issuance of Policy and obtained the Policy by fraud and hence the complainant is not entitled to get any relief in the instant case. In support of the claim complainant (PW1) produced a medical certificate dated 06.02.2017 stated to have been issued by Dr. S.C. chakravorty, Medical officer of Kamarakuchi PHC, wherein it is mentioned that Late Bhalmai Kalita was under his treatment since 10.12.2015 instead of 10.12.2012 appearing in his report (Claim Form B- Medical attendant certificate by the last treating doctor). Moreover the date of first complain was on 26.06.2015 instead of 26.06.2012. It is mentioned in the aforesaid certificate dated 06.02.2017 that the above discrepancies as regards date occurred due to mistake. Mere production of a document does not itself prove the contents of the same. Complainant (PW1) stated that the doctor issuing the said certificate dated 06.02.2017 already expired. The complainant made no effort to prove the said certificate dated 06.02.2017 in accordance with section 67 of the Evidence Act, by calling a person acquainted with the handwriting of the person by whom the document is supposed to be signed or written. In view of the above, the aforesaid certificate is not legally proved. Moreover the complainant has not produced any medical document/paper to indicate that the LA had been suffering from Chronic Asthma and Bronchitis since 26.06.2015, subsequent to 23.06.2014 i.e. the date of commencement of the policy. Further, the complainant offered no explanation as to why any medical document / paper could not be produced in support of his claim that his deceased mother (LA) was suffering from Chronic Asthma and Bronchitis since 26.06.2015.

 

8.                     In view of the foregoing discussion it clearly comes out that no case of deficiency of service on the part of the OP- Insurance Co. is made out and hence the complainant is not entitled to get any relief as prayed for,

 

                         In the result, this Case stands dismissed.

                                                                                                                       Sd/-

                                                                                                                   (BK Sen, AJS)

                                                                                                                      President

                                                                                     District Consumer Commission,Nalbari.

 

                                                                                                                       Sd/-

                                                                                                             (G.Buzarbaruah)

                                                                                                                       Member,

                                                                                                  District Consumer Commission,Nalbari.

                                                                                                                         Sd/-

                                                                                                                    (P.K.Sarma)

                                                                                                                     (Member)

                                                                                                District Consumer Commission,Nalbari.