Dt. 24.06.2016

HON’BLE MR. DEBASIS BHATTACHARYA, PRESIDING  MEMBER

          Being aggrieved by and dissatisfied with the Order dated 22.07.2013 passed by the Ld. District Consumer Disputes Redressal Forum, North 24 Parganas, ( in short , District Forum) in CC No. 99/2013 , the OPs thereof have preferred this Appeal. By the impugned order, the case has been allowed .

          The case of the Complainant  is that her deceased husband had a life insurance policy of the OP No.1 bearing No. 128131356 since 06.06.2009 . On his demise on 09.06.2010 due to cardiac failure , the Complainant filed death claim before the OP No.1. But, the said OP No.1 vide letter dated 08.11.2010 rejected and repudiated the claim on the alleged ground of non-disclosure of material fact of treatment of the deceased life assured for high blood pressure since two years , which is utterly baseless  and frivolous, as he was not suffering from high blood pressure. As per the said letter dated 08.11.2010, he made an appeal before the OP No.2 for review vide letter dated 27.05.2011, but without any reply . She sent an Advocate’s letter on 05.08.2011 and reminder notice on 21.10.2011 , to which also there is no reply . Accordingly, for such illegal and arbitrary repudiation , the case.

          On the other hand , the case of the OPs is that the Complainant has not approached the Forum with clean hands and has suppressed vital material facts before the Forum, which entail dismissal of the complaint. Had the facts known to the insurance company, they would not have accepted the proposal and issued the policy,  for which the repudiation of the claim. The OPs investigated the claim and on the basis of the investigations , various medical records were received and it was found that certain important facts which were known to the assured were not disclosed in the proposal form that the life assured was suffering from fever and hypertension since 2008 , and to substantiate it the prescription dated 19.09.2010 of Dr. P.N. Singh is there which shows that the deceased life assured was suffering from pre-existing fever and hypertension,  which material fact was not disclosed in the proposal form dated 05.06.2009. Thus, the Insurance Company rightfully repudiated the claim of the Complainant vide its letter dated 08.11.2010 , and the Claims Review Committee also turned down the request of the Complainant vide his letter 10.08.2011. Therefore, there is no deficiency of service or unfair trade practice of the Insurance Company.  As such, the complaint be dismissed.

          It is to be considered if the impugned order suffers from any kind of incongruity so as to make an interference thereto.  

      Decision with reasons:

          The appeal has been heard ex parte . Ld. Advocates for the Appellants has submitted that the deceased life assured was suffering from related disease which caused his death for cardiac failure, and the primary cause of his death is Hypertension, for which he was under treatment of Dr. P.N. Singh for last two years before his death,  who made a certificate to that effect. But , it was not reflected in the proposal form for life insurance by the deceased life assured.  So, the claim was repudiated rightfully. The impugned order is not based upon such facts and figures, for which the same be set aside.

          There is at all no justification to conclude that there has been a pre-existing disease of the life assured which led to his death causing for a death claim by his nominee, i.e., his wife , the complainant. The doctor has not been examined and cross-examined by the parties. Prima facie , such a proposition that he was suffering from fever with hypertension , specially fever , for last two years is not a reasonable one .Such certificate of Dr. P.N. Singh can not ipso facto prove the point of view of pre-existing disease of the OPs. Accordingly, there is no merit in the present appeal. The impugned order is affirmed. The appeal stands dismissed.