A/38/2018

This appeal is directed against the final order dated 13/09/2018 passed by Ld. D.C.D.R.F, Malda. The fact of the casein nutshell is that one Sephali Paul widow of Santosh Paul raised a consumer complaint case bearing no. 2 of 2017 before the Ld. D.C.D.R.F, Malda to the effect that her husband since deceased Santosh Paul has started a Life Insurance Policy assured a sum of Rs. 1,00,000/- and quarterly premium of Rs. 5,000/- in the year of 2010. The validity of the said policy period was fixed up to 23/03/2018 and the complainant Sephali Paul was nominated as nominee to that policy. During the policy period Santosh Paul died on 06/12/2011 at Malda Sadar Hospital and after death, the complainant and other heirs of Santosh Paul intimated to the insurance company and requested the company to disburse the assured sum of Rs. 1,00,000/- and submitted in the prescribed form supplied. The insurance company then sought for some medical documents from the claimant and on good faith claimant/complainant supplied the said documents to the insurance company along with a letter dated 24/11/2012 with an affidavit. Her claim was repudiated by the insurance company on 11/07/2014. The complainant then submitted an appeal to the division manager of LIC on 24/11/2014. Insurance Company did not entertain the appeal and asked the complainant to go to ombudsman. The ombudsman settled the matter through a mediator and wanted to release Rs. 28,187/- towards the policy fixed only on NAV value. The claimant/complainant was not satisfied with the decisions of the ombudsman appointed by the LIC and for that reason, she preferred the consumer complaint. The LIC has contested the case by filing a written version denied the allegations levelled against  the company by the complainant and the specific averment made in that case is that the deceased Santosh Paul was suffering in chronic disease and suppressing the said fact, he had obtained a policy by making false representation and for that reason, the insurance company has rightly repudiated the claim. The complainant has furnished all necessary documents in support of her case and also submitted the evidence-in-chief and she was cross examined on the part of the LIC. The opposite parties did not adduce any evidence before the Ld. Forum. After hearing both sides Ld. Forum has delivered the impugned judgement, directed the insurance company to pay Rs. 1,00,000/- along with interest and Rs. 10,000/- as mental agony and Rs. 5,000/- as litigation cost.

            Being aggrieved with the said order, this appeal follows on the ground that the Ld. Forum has failed to appreciate the exact provision of law and the Forum has misjudged the value of the documents submitted before it and the Ld. Forum at the time of adjudication committed an error and the final order of Ld. Forum is liable to be set aside.

            The appeal is being heard through legal representatives of both sides.

D E C I S I O N S   W I T H   R E A S O N S

At the time of argument Ld. Advocate of the appellant that is LIC by submitting a written note of argument attacks the final order of the Ld. Forum to that count that the repudiation on the part of LIC was held on 11/07/2014 and the consumer complaint was filed in the year 2017 that is after 3 years from the date of cause of action and for that reason, the consumer complaint is liable to be dismissed under the provision of section 24 (A) of CP Act, 1986 and the Ld. Forum has overlooked the said provisions. This argument is not acceptable one as because after the disposal of insurance appeal, the appellate authority of insurance company that is zonal manager vide letter dated 24/11/2014 has asked the complainant to prefer an appeal before the insurance ombudsman. Accordingly, the complainant preferred an appeal before the ombudsman and the mediator appointed by the ombudsman disposed the appeal on 20/05/2016 and not satisfied with the said decisions of the ombudsman, the consumer case was registered in the year 2017. So, there was no delay on the part off the complainant to pursue an application under section 12 before the Ld. Forum within statutory period of limitation and there was no necessity to file condonation of delay petition and Ld. D.C.D.R.F, Malda has adjudicated this point in accordance with law and found no necessity to file condonation of delay petition and Ld. Forum, Malda has adjudicated this point in accordance with law and no irregularities detected.

            Ld. Advocate of the appellant in his argument pointed out the exhibit- 9 which discloses the fact that the deceased Santosh Kr. Paul was suffering from chronic renal failure. He further argues that according to medical jurisprudence the chronic disease is deep-seated and obstinate, threatening a long continuance. Santosh Paul was attacked in the said disease since 2007 and he highlighted the documents marked as exhibit- 9 series in this regard. After consulting exhibit- 9, it is nothing but the declaration form submitted by the insured at the time of starting the policy where he disclosed no suffering of kidney in his body or have ever suffered from ailments like lunge, kidney etc. Ld. Advocate of the appellant pointed out that chronic renal failure means he was suffering in kidney ailments for a long day and he was admitted at Malda Police Hospital time to time since 2008. He mentions before the Commission that the Insurance Co. after collecting the evidences of such sufferance of the insured, has asked the claimant/complainant to furnish the necessary documents and the complainant side has concealed the said documents without supplying it. It is pointed out further that the investigating agency of Life Insurance Co. has enquired about the pre-existing chronic ailments of the deceased Santosh Paul before entering into the policy and he was time to time admitted at Hospital due to renal problem and he was on earn leave in his service. On the part of the respondent countered these allegations by highlighting the exhibit- 15, where the complainant Sephali Paul addressing to the LIC dated 24/11/2012 by swearing an affidavit submitted that her husband had no chronic disease prior to his death. He was admitted at Malda Dist. Hospital for his treatment on 05/12/2011 and expired there on 06/12/2011. The insurance company has relied upon the document marked as exhibit- 19 that is the decision of the insurance ombudsman furnished by the complainant before the Ld. D.C.D.R.F where the ombudsman found that the deceased Santosh Paul was a patient of HTM and UTI since 2008 that is prior to two years from the date of policy. The document exhibit-19 mentioned the name of the insurer or the policy holder Aliara Khatun and not in respect of Santosh Paul. Secondly, this document also cannot acceptable right now, and not admissible in appeal as because the insurance company had the opportunity to call the ombudsman as witness before the Ld. Forum to prove that Santosh Paul the policy holder was suffering in chronic disease prior to purchase the Life Insurance Policy in the year 2010. The insurance company has lost the opportunity and it is not established before the Ld. Forum that Santosh Paul was suffering from chronic renal disorder at the time of purchasing the life insurance policy in the year 2010.

            Rather by swearing an affidavit the complainant side has rebutted the counter allegation of the insurance company that her husband was suffering in chronic disease at the time of submitting the declaration form for the insurance policy.

            In written note of argument, the respondent of this case Sephali Paul attacked the appeal case to the ground that the appellant has failed to prove their case by adducing cogent evidence before the Ld. Forum and could not discard the evidences brought before the Ld. Forum by the respondent/complainant.

After hearing the valuable arguments canvassed before this Commission and after going through the pleadings of both sides, we find that no irregularity or infirmity is detected in the order of the Ld. Forum. Therefore, the Commission thinks it fit not to interfere with the order of Ld. D.C.D.R.F, Malda under appeal. Thus, the appeal devoids any merit.

Hence it is ordered: -

That the appeal be and the same is dismissed on contest without cost. The order of Ld. Forum, Malda dated 13/09/2018 in reference to CC/2/2017 is hereby confirmed. Let a copy of this order be supplied to the parties free of cost and the copy of this order be communicated to the Ld. Forum through e-mail.