Sri Utpal Kumar Bhattacharya, Member

Instant Appeal u/s 15 of the C.P Act, 1986 has been filed by the Appellants/OP Nos. 1 and 2 challenging the judgment and order dated 24.08.2017 passed by the Ld. District Forum, Bankura in Complaint Case No. CC/112/2014 allowing the complaint on contest against the Appellants/OP Nos. 1 and 2 with cost and dismissing the same ex-parte against the Respondent No. 2/OP No. 3.

The facts, in brief, having relevance with the instant complaint were that the Respondent/Complainant, being misconvinced by the Respondent No. 2/OP No. 3, purchased one SBI Life Insurance Policy from the Appellants/OP Nos. 1 and 2 in the name of his wife since deceased. The wife of the Respondent/Complainant was examined by the panelled doctor of the Appellant/OP Insurance Company on 20.03.2013 and the subject insurance policy of sum assured of Rs.3,50,000/- and an annual premium of Rs. 50,000/- was issued in the name of the said wife after the said panelled doctor certified her to be medically fit for taking the policy.

The wife of the Respondent/Complainant, the policy holder herein, on 13.09.2013 suddenly felt a chest pain at her husband’s paternal house at Dubrajpur, Bankura. She had to be admitted to BSMCH at Bankura on 16.09.2013 where she passed away on 19.09.2013.

The Respondent/Complainant, being the husband of the deceased, filed the death claim before the Appellant/OP Insurance Company which repudiated the said claim through its letter dated 25.06.2014 communicated to the Respondent/Complainant. An aggrieved Respondent/Complainant then filed the Complaint Case before the Ld. District Forum. The judgment and order passed by the Ld. District Forum in the said Complaint Case has been put under challenge in the instant Appeal.

Heard all sides through their respective Ld. Advocates.

Ld. Advocate appearing on behalf of the Appellants/OPs, drawing the notice of the Bench to the letter of repudiation, running page 23, submitted that the letter itself was revealing about the fact that the claim was repudiated by the Appellants/OPs on the ground of the Respondent/Complainant’s resorting to suppression of material facts. The said letter of repudiation dated 25.06.2014, as contended, mentioned about three vital quiries put forward in the proposal form, running page 46, under question Nos. 13(iv), 13(xiv) and 13(xv) relating to the present health condition of the insured so as to enable the insurer OP company to ascertain if any disease was pre-existing with the insured deceased. The insured deceased, as the Ld. Advocate continued, responded to all the queries in the negative, suppressing her pre-existing diseases.

Referring to running pages 95 to 107, being the copies of the prescriptions of treatment of the deceased insured, the Ld. Advocate submitted that one of the prescriptions dated 13.05.2011 at running page 95, issued prior to the date of initiation of the policy, corroborated the claim that the deceased insured had some pre-existing diseases which she had suppressed violating the good faith reposed on her before entering into the agreement of a contract.

The Ld. Advocate went on to refer to a series of judgments mentioned at running pages 127 to 129, being the part of the evidence on affidavit by the Respondent/Complainant which were speaking about the fact that acceptance of claim for reimbursement of cost of treatment was not binding upon the insurer where there was suppression of material facts.

With the above submission, the Ld. Advocate prayed for the Appeal to be allowed setting aside the impugned judgment and order.

The Ld. Advocate appearing on behalf of the Respondent/Complainant, contrary to the above submission, pointed out that the deceased insured was an illiterate person and had taken the policy after being assured of better coverage for life and treatment on payment of a fair amount of Rs. 50,000/- as annual premium.

As continued, the condition of health of the wife of the Respondent/Complainant was examined by the panelled doctor of the Appellant/OP Company and policy was issued in favour of the said wife only after she was certified to be fit for being insured under the policy. There was no mention of any pre-existing disease in the report.

As continued further, the prescription stated to have issued prior to the initiation of the policy prescribed certain medicines with no confirmatory findings about the disease that the Respondent/Complainant was apprehended to have been suffering from. Said prescription also recorded a PP blood sugar of 126 mg/dl which indicated that the patient was non-diabetic. No other disease could be established by furnishing any corroborative testing report. The patient, as contended, was reported to have died of Cardio Respiratory failure which cannot be treated as any pre-existing disease.

With the above submission, the Ld. Advocate prayed for the Appeal to be dismissed affirming the impugned judgment and order.

The Ld. Advocate appearing on behalf of the Respondent No. 2/OP No.3 submitted that the Respondent No.2 /OP No. 3 who was an agent of the Appellant/OP Nos. 1 and 2 had briefed the insured about the terms and conditions of the policy. As continued, he himself had taken the insured to one panelled doctor of the company. The insured was medically examined by the said doctor in presence of two officers of the company and the policy was issued only after the medical report certifying the patient to be fit for bringing under coverage of the policy by the said doctor.

Since, as an agent, there was no lapse on the part of his client, the Ld. Advocate submitted that the Respondent No. 2/OP No. 3 did not have any liability in connection with the instant issue which was rightly observed by the Ld. District Forum in the impugned judgment and order.

Perused the papers on record. Considered submissions of all the three participating sides.

It appeared that the insured was examined by the panelled doctor of the insurance company and only after clearance being given by the said doctor towards fitness of the insured for being brought under coverage of the policy that the insurance policy was issued in the name of the insured.

It would not be out of place here to record that the Bench was convinced about the fact that the doctor being an enlisted one in the Company’s panel, would have made no mistake in recording the disease had the same been pre-existed with the insured.

The record did not contain any indication as to wherefrom the prescriptions of the insured were obtained by the Appellant/OP. presumably the copies of the prescriptions were collected from none else than the insured herself. In that case it would be evident that the patient had made no suppression about her health condition. If that be so, the question of repudiation of the proposed claim of the insured, medically tested with no objection from the testing physician, did not arise at all.

Moreover, what we collected from the record was that the insured was having a PP blood sugar of 126 mg/dl which was well within the normal range. The record also failed to produce any documentary evidence in the form of medical test that the patient was suffering from any other disease at the time of taking the policy.

In view of the facts and circumstances narrated above, we are of the considered view that the Ld. District Forum made no mistake in passing the impugned judgment and order and accordingly, it did not deserve any intervention from this end.

Hence,

ORDERED

that the Appeal be and the same stands dismissed. The impugned judgment and order stands affirmed. No order as to costs.