BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
CACHAR :: SILCHAR
Con. Case No. 68 of 2011
Smti. Basanti Sinha, ………………………………………………… Complainant.
-V/S-
1. Life Insurance Corporation of India,
Represented by its Chaiarman, Yogakshema,
Jeeban Bima Marg, P.Box No.19953Mumbai-400 021.
2. The Zonal Manager, LICL, Eastern Zonal Office, Manager,
Hindusthan Building,4, Chitta Ranjan Avenue, Kolkata-700 072.
3. The Senior Divisional Manager,
LICI Divisional Office, Meherpur, Silchar-788 015.
4. The Branch Manager,
LICI, Main Road, Karimganj-788 710. …………………………. Opp. Parties.
Present: - Sri Bishnu Debnath, President,
District Consumer Forum,
Cachar, Silchar.
Mrs. Chandana Purkayastha, Member,
District Consumer Forum,
Cachar, Silchar.
Shri Kamal Kumar Sarda, Member,
District Consumer Forum,
Cachar, Silchar.
Appeared :- Sri Sukumar Sinha , Advocate for the complainant.
Sri Sibdas Dutta, Advocate for the O.P. Nos.1, 2, 3 & 4.
Date of Evidence……………………….. 07-06-2012, 31-12-2012
Date of written argument……………… 10-06-2015, 05-11-2016
Date of oral argument………………….. 30-03-2017, 01-04-2017
Date of judgment………………………. 16-05-2017
JUDGMENT AND ORDER
Sri Bishnu Dednath,
- Smt. Basanti Sinha lodged the complaint against LICI and its Officer U/S 12 of the Consumer Protection Act. for award of Rs. 55,000.00 (fifty five thousand) only as sum assured in respect of insurance Policy No. 491608465 and compensation of Rs. 30,000.00 (thirty thousand only as well as cost of the proceeding of Rs. 15,000.00 (fifteen thousand) only.
- The fact matrix is described below:-
The policy holder Tapan Kumar Sinha purchased the policy No. 491608465 on 14/12/2014 from the (O.P. No. 4) Branch Manager LICI, Karimganj Branch. The quarterly premium was Rs. 962.00 (Rupees Nine hundred sixty two) only. The O.P No. 4 received the said premium and issued the policy but unfortunately the insured Tapan Kumar Sinha died on 07/01/2005 at SMCH. In consequence mother of the insured submitted the claim petition enclosing all original papers claiming the amount of sum assured in respect of the afore mention policy. The O.P No. 4 received the claim application on 11/03/2005 and in course of process sent the claim intimation to the Divisional office of LICI at Silchar. Vide claim docket No. D/7/06/34 dated 22/07/2006. But the LICI repudiate the claim hence the complainant issued advance notice on 27/03/2009 demanding the sum assured money with compensation etc. But the insurance company did not satisfy the complaint hence the instant complaint lodged in this Forum.
- On receiving the notice from this Forum the LICI,(O.P No.1) the Zonal Manager, LICI Eastern Zonal Office (O.P. No. 2) Senior Divisional manager, LICI, Silchar (O.P. NO. 3) and the Branch Manager, Karimganj Branch (O.P NO.4) submitted their joint W/S. In their W/S they denied the claim of the complaint on the plea that as per the hospital record from Registrar of Medicine SMCH, the deceased insured Tapan Kumar Sinha has been suffering from bleeding per gum, vomiting off and on for last five year prior to date of his death. The decease diagnosed as Acute Myoloid Leveamia (AML) that means blood cancer by the hospital doctors. But the above fact at AML was maliciously suppressed in the proposal for the Insurance to get the policy issued from the LICI. On the above ground the O.Ps repudiates the claim.
- During hearing the complaint adduced evidence and exhibited as many as 3 documents including the original Insurance Policy the original first Premium receipt and the original death certificate, the complainant also exhibited some other document with the deposition.
- The O.P-Insurance Company also examined the administrative Officer Sri. Kaushik Pada Bhattacherjee on oath and exhibited as many as 10 documents including some medical papers. The Insurance Company also submitted addition deposition of Kaushik Pada Bhattacherjee on 16th Sep.2013. Stating inter alia a fact that the complaint petition submitted to this Forum in respect of death of Tarun Kumar Sinha but the Insurance Policy submitted in respect of Tapan Kumar Sinha. Hence the complainant is not entitled to get any compensation from Insurance Company.
- It is to be mentioned here that the copy of the additional deposition of Kaushik Pada Bhattacherjee and the copy of exhibit-J (Insurance Policy) received by the Lawyer Jayashree Baidya on 16/09/2013 on behalf of the Complainant but did not take any steps in time. That is why when I asked the party to clarify the matter, the learned advocate of the complainant approached before this Forum to allow him to rectify the clerical mistake such as deletion of name Tarun Kumar Sinha and addition of name Tapan Kumar Sinha. The prayer was allowed and accordingly both the complaint and deposition of the complainant rectified as per the procedure established by the Law.
- After going through the complaint, W/S and evidence on record we find the moot point as whether the Insurance Policy was purchased by Tapan Kumar Sinha maliciously knowing the fact that he was suffering from Blood Cancer.
- To answer the above moot point, we have gone through the evidence on record very meticulously. It is admitted fact that Tapan Kumar Sinha was insured in connection with Insurance Policy No. 491608465. The policy was commenced on 14-12-2004. The sum assured was 55,000.00 The Insurance Company received the first insurance premium for first quarter of RS. 962.00. His Mother Basanti Sinha was the nominee. It is also admitted fact that the insured died on 23rd day of the commencement of the Insurance Policy i.e. on 07-01-2005. So the above facts are not required to prove on the reasoning that admitted fact need not require to prove. But in this case the complaint disposed that insured Tapan Kr. Sinha while maintaining his sound mental and physical health approached the O.Ps for purchasing of the Insurance Policy and upon satisfaction of his sound health condition the O.Ps enter in to a contract with Tapan Kumar Sinha and issued the Insurance Policy after receiving the premium for the first quarter. Exhibit-1 is the Insurance Policy, Exhibit-2 is the first quarter premium receipt. She further deposed that most unfortunately after commencement of the Insurance Policy Tapan Kumar Sinha suffered from the disease of Gum Bleeding for which he took admission in the Department of Medicine in Silchar Medical College and Hospital on 06-01-2005 and expired on the following day at about 8-15 P.M. Exhibit-3 is the Death Certificate. All the exhibited documents above are remained unrebutted in the evidence on record.
- In the evidence of the complaint nothing found clearly whether insured Tapan Kumar Sinha was suffering from Blood Cancer prior the date of the Insurance Policy but the plea is taken by the O.Ps that Tapan Kumar Sinha was suffering from Blood Cancer prior to the commencement of the Insurance Policy. As the O.Ps have taken the aforesaid plea for repudiation of the claim of the complaint it is their burden to prove the onus that the decease insured Tapan Kumer Sinha was suffering from Blood Cancer prior to the date of the commencement of the Insurance Policy or in other ward it is their onus to establish the plea that the decease insured Tapan Kumar Sinha purchased the Insurance Policy suppressing his disease Blood Cancer.
- In this aspect the witness of the O.Ps exhibited Medical Papers including prescription dated 05-01-2005, claimant statement Medical Attendant’s Certificate, certificate of hospital treatment vide exhibits A, F, G, and H. Respectively we have gone through the aforesaid exhibited and other relevant documents. In exhibit-A, it is revealed that deceased Tapan Kumar Sinha was advised for hospitalization. The advice was given on 05-01-2005 by Dr. G. Kar. In the exhibit-F, it is also mentioned in Point. No. 6 that he has not been consulted any doctors since last three years. In the exhibit-G, it is mentioned that he has been suffering from this diseased before his death for one day at SMCH and in exhibit-H, it is mentioned in Point. No. 5 that as per history reported by the patient he was suffering from bleeding per gum off and on for five years. Except the aforesaid information we do not find any relevant fact in the Medical Papers that the attending doctor diagnosed and detected that the deceased was suffering from Blood Cancer from last 5 years. The relevant Colum regarding bleeding per gum off and on for 5 years and fever for 10 days etc. are nothing but the history reported by the deceased as well as some of his attendant. Does it mean that the said statement of the deceased or his attendant is sufficient to determine or diagnose that deceased the was suffering from Blood Cancer?
- In our prudent mind, it is dictated us that to diagnose a disease, the opinion of doctor is indispensable. The facts revealed from the Colum No.5 is not at all the opinion of a doctor. That is why it cannot be conclusively proved that the insured Tapan Kumar Sinha was suffering from Blood Cancer (AML) for 5 years prior to his death. But in the Exhibit-G the doctor opined that the primary cause of death of Tapan Kumar Sinha was AML,LCH.
- As the aforesaid evidence are not sufficient to conclude that the deceased was suffering from Blood Cancer prior to the commencement of the Insurance Policy or in other ward the deceased was aware of the fact that he was suffering from Blood Cancer prior to the commencement of the Insurance Policy, so O.Ps tried to bring some other Medical Papers to establish the fact that deceased was aware of the fact of Blood Cancer prior to the commencement of the Insurance Policy. Accordingly the O.P prayed before this Forum to ask the Medical Authority of the SMCH to produce the Medical Record but the SMCH failed to produce any record and replied on 02-06-2014 that the bed-heed ticket of Mr. Tapan Kumar Sinha was missing but at the same time informed that from the admission register of Medical Department the deceased Tapan Kumar Sinha was diagnosed as Acute Myoloid Leveamia with intracerebral haemorrhage.
- Therefore, the evidence on record does not justified that the deceased Tapan Kumar Sinha was aware of the fact that he was suffering from Blood Cancer prior to the commencement of his Insurance Policy No. 491608465. Hence, in this case we do not find any justification to repudiate the claim of the complainant to get sum assured of RS. 55,000/- (fifty five thousand) only on account of death of her son the insured Tapan Kumar Sinha.
- Thus the O.Ps are both severally and jointly liable to pay the sum assured of Rs. 55,000/- (fifty five thousand) only to the complainant because she is nominee as well as natural mother of the deceased insured Tapan Kumar Sinha. The O.Ps are also liable to pay the cost of the proceeding of Rs. 5,000/- (five thousand) only.
- However, this Forum is not inclined to award any more compensation considering the facts and circumstances of the case. The O.Ps are asked to pay the awarded amount within 45 days from today. In default of payment of the awarded amount within the stipulated period the O.Ps are liable both severally and jointly to pay interest on the total awarded amount at rate of 10% per annum with effect from the 46th day till realisation of the full amount.
- With the above order, this case is disposed of on contest. Supply free certified copy of Judgment and award to the parties of the case.
Given under the hand of the President and Members of this District Forum and seal of the Office of the District Forum on this the 16th day of May, 2017.
