Tripura

StateCommission

A/16/2024

SBI GENERAL INSURANCE COMPANY LIMITED - Complainant(s)

Versus

SHRI BAPI DATTA - Opp.Party(s)

SHUBHAJIT CHAKRABORTY

07 Oct 2024

ORDER

Tripura State Consumer Disputes Redressal Commission Agartala: West Tripura

Case No. A.16 of 2024

 

 

 

1. SBI General Insurance Company Ltd.,

Registered Office; 9^th floor, A & B Wing,

Fulcrum Building, Sahar Road,

Andheri East, Mumbai - 400099.

 

2. SBI General Insurance Company Ltd.,

Registered Address: Sriram Plaza, Ground Floor,

Ker Chowmuhani, T.G. Road, Agartala, P.S. West Agartala, 

District - West Tripura, Pin - 799001. 

                                     [                                                .............Appellants/Opposite Party No.1 & 2

-Vs-

 

1. Sri Bapi Datta,

S/o Late Sankar Chandra Datta,

Resident of Bardowali, Near Modern Club,

P.O. A.D. Nagar, P.S. A.D. Nagar,

District - West Tripura, Pin - 799003.

…...........Respondent No.1/Complainant

2. Medi Assist Insurance TPA Private Ltd.,

(Formerly known as Medi Assist India TPA Private Ltd),

Registered office: 

Cashless Processing Centre, 

No.252/2, Kodichikkanahalli Main Road,

Opposite Kailash Building, Bommanahalli, Bangalore - 560 068.

…...........Respondent No.2/Opposite Party No.3

 

Present

HON’BLE MR.JUSTICE ARINDAM LODH

PRESIDENT, STATE COMMISSION

 

 

Smt. Daliya Saha

Member, State Commission

 

Shri Jhantu Debnath

Member, State Commission

 

 

 

 

Advocate (s) Present:

For the Appellants:                                                 Mr. Subhajit Chakraborty, Adv.

For the Respondent No.1:                                       Mr. Sampad Choudhury, Adv.

For the Respondent No.2:                                       Absent

Date of Hearing & Delivery of Judgment:               07.10.2024.

 

J U D G M E N T [ORAL]

 

This is an appeal against the final order dated 02.03.2024 passed by the learned District Consumer Disputes Redressal Commission, West Tripura, Agartala in connection with Case No.C.C.41 of 2023.

2. Heard Mr. Subhajit Chakraborty, learned counsel appearing on behalf of the appellants-SBI General Insurance Company Ltd. (in short, Insurance Company). Also heard Mr. Sampad Choudhury, learned counsel appearing on behalf of the respondent-complainant (in short, complainant). None appears for the respondent no.2, Medi Assist Insurance TPA Private Ltd.
3. Fact of the case is that complainant made a complaint petition before the learned District Commission after repudiation of claim by the appellants, Insurance Company. Against this complaint petition, learned District Commission has passed an order to pay Rs.2,65,156/- to the complainant. The plea of the appellants, Insurance Company was that the complainant (policy holder) suppressed the fact at the time of taking policy i.e. concealment of existing disease. But they were unable to produce any evidence in this regard namely, the proposal form signed by the policy holder at the time of taking a policy. However, the SBI General Insurance Company Ltd., the appellants herein, being aggrieved by the order of the learned District Commission made an appeal before this Commission.
4. After perusal of the records and on hearing the learned counsel appearing for the parties, we find that the Insurance Company has failed to produce any proof in support of their claim of concealment of pre-existing disease of the complainant, i.e. the policy holder.
5. Mr. Chakraborty, learned counsel appearing for the appellants has argued that in one earlier proposal of the policy holder (complainant) in policy No.0000000013017127 dated 06.05.201, the policy holder i.e. the complainant did not mention about any disease etc., hence, the same proposal form should continue in the subject questioned policy (Policy No.0000000017793236 dated 30.05.2020).
6. The aforesaid argument of learned counsel, Mr. Chakraborty is not acceptable to us since, the earlier policy i.e. Policy No.0000000013017127 dated 06.05.2019 was a different policy from the existing one (Policy No.0000000017793236 dated 30.05.2020). Hence, the proposal form of earlier policy would not be held valid for another policy i.e. the existing policy against which claim has been made.
7. The appellants, Insurance Company were afforded reasonable opportunities by the learned District Commission to produce the proposal form of the existing policy (Policy No.0000000017793236 dated 30.05.2020) to ascertain their claim of concealments of facts in regard to the existing disease of the complainant. But, in spite of affording opportunities, the insurance company failed to produce the same and hence, we are inclined to uphold the decision of the learned District Commission so far as the claim amount is concerned.
8. Moreover, as the appellants, Insurance Company repudiated the claim amount, we are of the opinion that there was deficiency in service on the part of the appellants-Insurance Company. Hence, a compensation of Rs.15,000/-(Rupees fifteen thousand) and litigation cost of Rs.10,000/-(Rupees ten thousand) are directed to be paid by the appellants, Insurance Company to the respondent no.1-complainant within a period of 30(thirty) days from the day of receipt of a copy of this order failing which the appellants, Insurance Company will be liable to pay interest @7% per annum after the expiry of 30(thirty) days on the whole amount.

With the aforesaid observation and directions, the instant appeal stands dismissed.