Tripura

West Tripura

CC/92/2016

Sri Sekhar Chowhan. - Complainant(s)

Versus

SBI General Insurance Co. Ltd. & others. - Opp.Party(s)

Mr.K.L.Pal, Mr.R.R.Datta.

06 Mar 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA

CASE NO:  CC-  92   of  2016

Sri Sekhar Chowhan,
S/O- Late Matilal Chowhan,
96/05 Near Madhyapara,
Udaipur, P.O.- R.K. Pur,
P.S. R.K. Pur, Gomati, 
Tripura.             ..........Complainant.

             ___VERSUS___
1. SBI General Insurance Company Limited,
2nd Floor, Lakshmi Darshan,
G.S. Road, Opp. Bora Service,
Ulubari, Guwahati, Kamrup,
Assam- 781 007.

2. State Bank of India,
Represented by 
The Branch Manager,
Branch Office, RASMECC-SARC, 
Agartala, Mantribari Road, 
P.O. Agartala, P.S. West Agartala,
West Tripura.    

3. SBI LIFE INSURANCE COMPANY LTD.,
Central Processing Centre, Kapas Bhawan,
Plot No- 3A, Sector No.10, CBD Belapur,
Navi Mumbai- 400 614. 
India.                ...........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 Rakhalraj Datta,
                   Sri Kanu Lal Pal,
                   Advocates.

For the O.P. No.2 & 3    : Sri Arindam Ray,
                  Advocate.
                                               
                

JUDGMENT  DELIVERED  ON: 06.03.2017

J U D G M E N T

        This case arises on the petition filed by Sekhar Chowan. Petitioner's case in short is that Basanti Ghosh, wife of the complainant during her life time applied for Home Loan for construction of home building. Accordingly Rs.5,92,000/- was sanctioned by the O.P. in the name of Basanti Ghosh. Basanti Ghosh then opened 'SBI Life Rinn Raksha' Plan under which borrower life covered for sum insured. Sum insured was Rs.5,92,000/-. After death of Basanti Ghosh claimant husband submitted the claim form before the O.P. Insurance company, SBI Life. Basanti Ghosh died by 'Cerebral Stroke'. But the claim was repudiated by SBI Life. Petition for review failed. Matter was claimed before the Ombudsman. SBI sent one cheque for Rs.19,640/- as refund. Finally the claim was not entertained. Therefore, for the deficiency of service petitioner was deprived. Claimed the sum assured and Rs.20,000/- for harassment. 

2.        O.P. No.3, SBI Life appeared and filed Written Statement. O.P. No.3 stated that the life insured made false declaration at the time of purchasing the policy. She stated that she had no physical deformity. No physical hypertension. Never was treated in the hospital. All declaration was false. She had kidney disease prior to the enrollment of the insurance policy. So on enquiry it was detected and finally claim was repudiated. There is no deficiency of service.

3.        On the basis of contention raised by the parties following points cropped up determination.
        (I)Whether the life insured suppressed the material fact about the condition of her health at the time of her enrollment with the policy?
        (II)Whether there was deficiency of service by the SBI Life and petitioner is entitled to get compensation? 
        
Petitioner produced the arrangement letter, Home loan, Pre-sanction inspection/ survey report, Sanction letter, Insurance Policy, Death Certificate, Cause of death certificate, death claim, letter of SBI, other letters, etc.

5.        Petitioner also produced statement of affidavit of one witness Sekhar Chowhan O.P.
        
6.        On the other hand O.P. produced the photocopy of Master Policy, Order of Ombudsman, Membership Form, Certificate of Insurance, Insurance Claim, Investigation Report, Referral Certificate, Medical Report from CMC Vellore, Discharge Summary of CMC Vellore, Claim Repudiation Letter, Letter conveying decision, Death Claim Form, RTI application & reply.

O.P. also produced the statement on affidavit of one witness Priyabrata Dey, Area Manager.

On the basis of all these evidence we shall now determine the above points.

            Findings and decisions:

9.        We have gone through the claim repudiation letter issued by the O.P. on 25.10. 15. It was informed that deceased life assured had given false good health statements & had not disclosed the material fact at the time of entry into the scheme. So the claim was repudiated. The p  rayer for review also rejected by the Insurance Ombudsman. It was informed by Basanti Ghosh Chowhan that she was not suffering from chronic kidney disease prior to enrollment of the policy. Death was caused by Hypertension, Cerebral stroke. We have gone through the medical report and investigation report along with profile of life assured.  Life assured went to Vellore in the year 2013 where she was diagnosed CKD Nephrotic followed by hypertension. From the referral certificate it is found that the Medical Board referred her to CMC Vellore on 16.09.13 as she was suffering from kidney disease. From the hospital report of Nephrology Department it is found that she was treated for chronic kidney disease in the year 2014. Her visit date was 7th October 2014. She also visited on 8th October, 2013 in the CMC Hospital, Vellore. On 26th September, 2015 again visited Nephrology Department and chronic kidney disease is found. Policy was purchased and she was enrolled in the year 2013. Proposal date was 10th July 2013. Date of commencement of Master Policy was 22.09.2014. She was referred to Vellore from AGMC GB Hospital on 16.09.13 before commencement of the policy. She was treated in the CMC, Vellore before commencement of the policy not after. In the repudiation letter it is found that on the basis of material report of October, 2013 the claim was repudiated. But the date of commencement is July, 2013 where name of Basanti Chowhan was absent. We have gone through the declaration form. In the declaration from she had given declaration that she did not suffer from diabetes, hypertension, blood pressure, HIV, cancer, growth of cyst and other disease. This declaration she had given before commencement of the policy.

10.        The O.P. produced convincing evidence before us to support that before the commencement of the policy on 22.09.14 she had been suffering from hypertension & kidney disease. O.P. Priyabrata Dey in the evidence on record stated that the life assured failed to discharge her duties and gave false declaration in the proposal form. She was suffering from kidney disease so she was not at all of sound health. 

11.        Petitioner on the other hand stated that he is entitled to get the insured amount Rs.5,92,000/- and also compensation Rs.20,000/-. In the statement on affidavit he did not disclose the state of health of his wife. He also  stated on the RTI form he applied for getting information about the state of health  of his wife. But it was not supplied to him. 

12.        In the case the policy commenced from 10th July 2013. at the time of commencement of the policy there is nothing before us to show that the disease was detected. From the photocopy of the form further it is found that declaration was given by Basanti Ghosh Chowhan on 08.05.14. It is absurd position that after commencement of the policy the declaration was taken. In the certificate of insurance name of Basanti Ghosh Chowhan it is written Master Policy Holder was State Bank of India. Sum assured was Rs.5,92,000/-. Principle policy commencement date 22.09.14. if we take into consideration about this policy then commencement of the policy will be 22nd May, 2014. The premium also received on 22nd May, 2014 amounting to Rs.11,034/-. On 22nd May, 2014  Basanti Ghosh Chowhan was aware about her disease and other ailments. Inspite of that she had made declaration that she had no disease or any ailment of kidney or hypertension. In the Master Policy name of Basanti Ghosh Chowahan not found but in the second policy certificate of insurance name of Basanti Chowhan is clearly found. So, it is clear that date of commencement of policy was actually on 22nd May, 2014. From the statement of account also it is found that loan disbursed on 22nd May, 2014 and insurance covered from that date. So, on 22nd May, 2014 she was aware about her illness and made false declaration. Petitioner in his evidence did not say about the state of health of his wife on the date of commencement of the policy on 22nd May, 2014. The medical report as placed before us support her ailment.
 
13.        It is settled law that ''when there is deliberate suppression of material fact pertaining to health on the part of the life assured, the contract of insurance which is based on the principle of utmost good faith gets vitiated and the cause of death becomes irrelevant.''  Hon'ble Supreme Court in Chakochan Vrs. LIC of India case clearly stated that insurer is is justified in repudiating a claim wherever there is a suppression of material fact. In this case suppression of material fact is established. There is no deficiency of service by the O.P. and the petitioner is therefore not entitle to get any compensation as claimed. Petition is dismissed. No cost.        
                    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.