KUNDAN KUMAR KUMAI

This is an appeal preferred under Section 15 of the Consumer Protection act 1986, against the order dated 29/11/2017, passed by the Ld. DCDRF, Siliguri in Complaint case No. 19/S/2017.

Brief facts of the appellant case are that, father of the respondent Satyadev Jha whose life had been insured by the appellant no. 2, on 06/10/2015, vide policy no. 278059092 and the premium had been fixed, at Rs. 77,625/- (Seventy-seven thousand six hundred twenty-five) only and the same had been paid to be appellant. The policy holder, deceased Satyadev Jha, had been medically checked by the appellant company and initially the appellant company, denied to accept the proposal form, being no. 277900908 of the policy bearing no. 278059092, but when the question of return of the premium amount was raised, the appellant company finally accepted the proposal, being proposal no. 277900908. On 02/04/2016, the insured Satyadev Jha, expired and the said fact was brought to the notice of the appellant company by the present respondent and who also had submitted his claim form for the minimum death grant amount of Rs. 9,56,951.79/- (Nine lakh fifty-six thousand nine hundred fifty-one and paisa seventy-nine) only, being the nominee, along with all the relevant documents. On 08/08/2016, the appellant company, repudiated the claim made by the respondent, on the ground that the medical disclosure as required in the proposal form, had not been made by the deceased Satyadev Jha. The respondent made repeated requests, for reconsideration of the claim, but the appellant company failed to re-considered such request. The appellant company also returned, the premium amount of Rs. 75,000/- (Seventy-five thousand) only. Hence this case.

The appellant has entered the appearance, but as they failed to file the written version within the stipulated period, the case was heard ex-parte. 

The Ld. DCDRF, Siliguri, after considering the evidence and the series of documents filed by the respondent, passed the impugned order.

Being aggrieved by the impugned order, the appellant filed the instant appeal on the ground that the, Ld. DCDRF, Siliguri, had erred in law and facts, while passing the impugned order and has relied in the judgments passed in LIC Vs. Rukma II (2012) CPJ 44 (NC), Narinder Kaur Vs. LIC [III (2012) CPJ 593 (NC)], Life Corporation of India Vs. Asha Goel (2001) 2SCC160, Kapil Rai Vs. Life Insurance Corporation 1(2009) CPJ 275(NC) and in P.C Chacko Vs. Chairman LIC of India  (2008) 1 SCC 321.

Decision with reason

None appeared on behalf of the appellant, but from the written argument filed on behalf of the appellants, their main contention, against the impugned order, appears to be none disclosure of the diseases, the deceased was suffering,  before and at the time of buying the policy, suppression of medical history and had been admitted to a hospital in 2015.

 The Ld. Advocate for the respondent, had filed brief notes of argument and also submitted at the time of final hearing that, the insurance had been purchased through one Meena Shukla, who had been instrumental in getting the proposal form, being accepted. The said Meena Shukla was an agent of the appellant company.  He had further submitted that the proposal form, had been filed up by the appellant company after due medical examination and therefore, to repudiate the claim is nothing but, unfair trade practice. Moreover, the deceased being an illiterate person was able to sign only in English, but unable to   understand the requirements in the proposal form. That apart the application for the certified copy of the impugned order, had been made on 27/11/2017, whereas the impugned order had been passed on 29/11/2017, indicating that the delay in filing the case was not satisfactorily explained.

After going through the bring notes of argument filed by the parties and submissions and also going through the citations relied by the parties, it transpires that as per Section 45 of the Insurance Act, it becomes uberrima fides upon the insured to disclose all the related disclosures. But the factual aspects also, needs to be considered is that, the proposal form submitted by the deceased Satyadev Jha had been initially not accepted, but finally accepted, which means that the appellant company had being convinced of the medical condition of the deceased. Moreover, the deceased had been medically examined by the appellant company after which the appellant company, had initially rejected their proposal. Furthermore, the said appellant company has not been forthcoming with the kind of disclosure or arguments which prompted them to accept the proposal form, being no. 277900908. That apart, there was nothing to prevent the appellant company, even though, they could not file the written version within the stipulated period, from questioning the respondent, by placing the documents they had in their possession, while repudiating the claims made by the respondent. But the appellant company did nothing of the sort nor did the appellant prefer an appeal, when their case was taken up for ex-parte hearing. On the contrary, the appellant company has preferred this appeal knowing fully well, that should this Commission remand the case to the Ld. DCDRF, Siliguri, it would not only reopen the case, but would circumvent the mandatory limitations of 30 days and 15 days, provided under Section 13 (2) (a) Consumer Protection Act 1986 and discouraged by the Hon’ble NCDRC and the Hon’ble Supreme Court, in series of judgments. Moreover, from the certified copy of the judgment itself it can be seen that the application for the certified copy had been filed on 27/11/2017, whereas the order itself had been passed on 29/11/2017. This indicates that the appellant company, had been keenly keeping a watch over the Ld. Lower Forum’s proceedings, with a motive which can be best explained by the appellant company. But no such explanation is forthcoming from the appellants. Therefore, the conduct of the appellant company appears to be suspect and their contention cannot be relied on.

However, from disclosure made by the respondent himself that, the premium payment done by the deceased amounting to Rs. 75,000/- (Seventy-five thousand) only had been returned to him, for which reason the Ld. DCDRF, Siliguri, ought to have deducted the said amount while passing the impugned judgment. Therefore, on this count itself intervention from this Commission in the form of modification of the impugned order needs to be done.

As a result, the instant appeal succeeds in part.

It, is therefore

ORDERED

That the instant appeal be and the same is allowed in part.

The impugned order is modified to the extent that the amount of Rs. 75,000/- ( Seventy-Five thousand) only be deducted from the amount Rs. 9,56,251.79 ( Nine lakh fifty-six thousand two hundred fifty-one and seventy nine paisa) only  totaling to Rs. 8,81,271.79 ( Eight lakh eighty one thousand two hundred seventy one and seventy nine paisa) only, with the remaining portion of the order, remaining unchanged.

Copy of the order be handed to both the parties free of cost.

Copy of the order be sent to the Ld. DCDRF, Siliguri, for necessary compliance.