DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
MUCHIPARA, BURDWAN.
Consumer Complaint No 30 of 2015
Date of filing: 28.01.2015 Date of disposal: 18.12.2015
Complainant: 1. Haydar Mondal, S/o. Late Hannan Mondal.
2. Deloyara Mondal, W/o. Late Hannan Mondal
Both are resident of Vill: Ghagra, PO: Dwarnari, PS: Galsai, District: Burdwan.
-V E R S U S-
Opposite Party: 1. The Branch Manager, Tata AIA Life Insurance Co. ltd., 1st Floor, 37/1 Gopal Bhawan, 37/A, Parbirhata, G.T.Road, PO: Sripally, PS. & Dist: Burdwan.
2. The Branch Manager, Tata AIA Life Insurance Co. ltd., City Centre, Durgapur.
3. Tata Insurance Co. Ltd., 14th Floor, Tower A, Peninsula Business Park, Senapari Bapat Marg, Lower Parel, Mumbai – 400 014.
4. The Bank Manager, United Bank of India, Galsi Branch, PO. & PS: Galsi, District: Burdwan.
Present: Hon’ble President: Sri Asoke Kumar Mandal.
Hon’ble Member: Smt. Silpi Majumder
Hon’ble Member: Sri Pankaj Kumar Sinha.
Appeared for the Complainant: Ld. Advocate, Suman Bez.
Appeared for the Opposite Party No. 1, 2&3: Ld. Advocate, Anupam Haldar.
Appeared for the Opposite Party No. 4: Ld. Advocate, Sukumar Sain.
J U D G M E N T
This complaint is filed by the complainants u/S. 12 of the C.P. Act, 1986 alleging deficiency in service as well as unfair trade practice against the OP-1,2&3 as the said Ops have repudiated their legitimate insurance claim arbitrarily and illegally.
The brief fact of the case of the complainant is that the father of the complainant no. 1 and the husband of the complainant no. 2, since deceased, purchased an insurance policy from the OP-1, 2&3 on 13.01.2012 through the OP-4 being the agent of the OP-1, 2&3. The deceased insured was not so educated. He having some agricultural land within the village used to cultivate the land and earned some money to the tune of Rs. 2, 00,000=00 only annually. The deceased was the one and only earning member of his family from which he had to maintain his family. Unfortunately on 04.01.2014 while he returning from works he was attacked cardio respiratory failure and expired at his residence. Due to sad and sudden demise of the insured the family members became very much perplexed mentally and his wife - complainant no. 2 started to work at the field as a cultivator for maintaining her family. When the complainants discovered an insurance policy in the name of the deceased then and there they rushed to the Insurance Company for getting the benefit and accordingly placed a claim on 09.01.2014 against the policy. But unfortunately the Insurance Company had repudiated the claim by sending letter dated 03.02.2014 to the complainant No.1 stating that the deceased insured was suffering from Diabetes Type II, Dilated Cardiomyopathy, Ischemic Heart Disease, Antenoseptal Myocardial Infruction prior to taking out the policy and putting signature in proposal form for the said policy. But the intending insured did not mention the said diseases in the proposal form. Though there were separate columns for disclosing his health status, but the insured did not disclose the same. The complainants have submitted that the deceased had never suffered from diabetes or any other diseases as shown in the repudiation letter in 03.02.2014 and it is also not known either to the deceased or to the complainants that the insured was a diabetic patient as mentioned by the Insurance Company. When the complainants received the repudiation letter then only for the first time the complainants came to know that his father and husband was suffering from those ailments but surprisingly the said ailments were not contributory to his death. Therefore, according to the complainants the Insurance Company have arbitrarily and illegally repudiated their genuine insurance claim based on concocted documents regarding the treatment of the deceased Hannan Mondal. After lodgment of the claim, on several occasion the complainant No. 1 visited the office of the Insurance Company but during that period it was not disclosed by the company that their claim will be repudiated, rather assured him that the claim will be settled within a very short span. But ultimately the OP-3 issued the repudiation letter on 03.02.2014. Apart from this policy, the deceased also purchased two separate LIC policy from Birla Sun Life Insurance Ltd. and LICI, but those companies have paid due amount in respect of those two policies. As the grievance of the complainants have not been redressed by the Insurance Company, having no alternative, the complainants have approached before this ld. Forum by filing this complaint praying for direction upon the OP-1, 2, 3 & 4 for making payment to the tune Rs. 2, 80, 000=00 in respect of the said policy, compensation to the tune of Rs. 1, 00, 000=00 for mental agony and harassment and litigation cost of Rs. 10,000=00.
The petition of complaint has been contested by the Op-4 contending that the activities of the OP-1, 2, 3 and the OP-4 are totally different and for this reason the Op-4 never told the insured for taking the insurance policy from the Insurance Company. Moreover, being the Manager of the Bank it has several schemes for depositing money such as fixed deposit scheme and others. Therefore, the OP-4 never requested the complainant to obtain the insurance policy. The complainant purchased the policy upon perusing the terms and the conditions of the same as per his own will and risk and exercising his discretion. So the OP-4 cannot be held responsible for non-receipt of the insurance amount. It was the duty of the complainant to be aware beforehand and the insured was not fully aware his legal heir/s is under obligation to face the consequences. According to the OP-4 this complaint is liable to be dismissed against it because within the forecorners of the complaint no allegation has been made out against it. The Op-4 has prayed for cost.
The petition of complaint have also been contested by the Op-1,2&3 by filing conjoint written version stating that the allegation as made out in the complaint is false, incorrect, baseless, malicious, misconceived and malafide and for this reason as it has no merit the same is liable to be dismissed. It is contended by the Ops that in the month of January 2012 Hannan Mondal, deceased life assured (DLA) approached before these Ops through the agent and applied for a policy, namely, Maha Guarantee of the OP. Upon receipt of duly filled up proposal form and premium amount and considering the information given by the DLA as true and correct the policy was issued. As per the terms of the policy the premium was payable for 15 years @Rs. 14,745=00 excluding service tax. The sum assured was for Rs. 1, 40,000=00. In the proposal form under the column health details there were some questions pertaining to the health condition of DLA and the same was answered in the negative by him. From the answers it is evident that the deceased life assured had mentioned that he did not suffer or was suffering from or received medical advice, investigation or treatment for stroke, anemia or blood disorder, chest pain, elevated cholesterol, heart disease, high/low blood pressure, disorder of kidney or genitor urinary system. It was answered by the DLA that he was not suffering from diabetes, hepatitis, liver disorder, HIV inspection, positive test of HIV or had been diagnosed as having HIV antibodies or suffered from aids related condition. The proposal signed by the insured was the very foundation of the insurance contract which should be based on utmost good faith. The insured was supposed to give correct answers for all questions given in the proposal as the same are very material particulars for the Insurance Company in deciding whether the proposal has to be accepted or not on the basis of the facts revealed in the proposal. Surprisingly the Ops received death claim intimation from the complainants under the policy on 13.01.2014 whereby they were intimated that the life assured died on 04.01.2014. Upon receipt the claim intimation the Ops have carried out an investigation as it was an early death claim as the life assured died within two year from the date of issuance of the policy. Through the said investigation it was revealed that the life assured suffered from chest pain and diabetes type II since 2004 i.e. prior to the date of proposal form. It is evident from the eco-cardiograph report of Astha Medical Centre dated 21.11.2010 that he was suffering from Cardiomyopathy with moderately LV Systolic Dysfunction. The DLA was suffering from high blood sugar and chest pain since 2002 and was under treatment of Dr. Ranjan Kumar Sharma. In this respect the blood sugar repot (PP) dated 04.6.2011 the prescription dated 02.9.2011 of Dr. Sharma reveal that he was suffering from diabetes. It is further revealed that the DLA was treated for Antenoceptal Myocardial Infruction between 04.11.2011 to 08.11.2011 and 31.12.2011 to 06.01.2012 for Ischemic Heart Disease and during that period he was admitted at the BMCH. The discharge summary of the said hospital reveals the same. After careful evaluation of all facts documents submitted by the complainants the answering Ops came to the conclusion that the replies to the questions in the proposal form were incorrect. As the DLA did not disclose the actual state of his health in the proposal form, due to such misstatement and concealment of facts the complainants are not entitled to get any relief. For this reason the Ops have repudiated the claim of the complainants by issuing letter dated 03.2.2014. The complainant no. 1 upon receipt of the repudiation letter requested the Ops to reconsider the claim on 21.02.2014 and the Ops have accordingly replied the letter in the negative expressing their inability to consider the same. According to the Ops the complaint is liable to be dismissed.
Op-1, 2, 3 & 4 have filed evidence on affidavit, complainants have also filed affidavit along with several papers and documents in support of their respective contentions.
We have carefully perused the entire record and the documents as available and heard argument at length advanced by the ld. Counsel for the contesting parties. It is seen by us that in the present case there are some admitted facts i.e. the deceased life assured being the father of the complainant no. 1 and the husband on the complainant no. 2 obtained one life insurance policy from the Op-1, 2 & 3 on 13.01.2012, the life assured expired on 04.01.2014 due to cardio respiratory failure, on 09.01.2014 the complainants lodged the claim form along with relevant papers and documents before the Insurance Company for getting the insurance benefit under the said policy, the sum assured of the said policy was to the tune of Rs. 1,40,000=00, by issuing letter dated 03.02.2014 the Insurance Company have repudiated the claim of the complainants stating that as the DLA was suffering from several diseases and treated by a series of doctors before taking out the policy and the same has not been mentioned by him in the proposal form rather he answered in the negative, due to such concealment of actual fact regarding his state of health the complainants are not entitled to get any relief from the Ops, upon receipt of the repudiation letter prayer was made by the complainant no. 1 to reconsider the same but the same was answered in the negative in writing by the Ops. The allegation of the complainants is that the Ops have arbitrarily, whimsically and illegally repudiated their legitimate insurance claim. During hearing the ld. Counsel for the Insurance Company has submitted that as the deceased life assured was suffering from different ailments and for that reason he was treated by some doctors and sometime he was admitted at the BMCH and as the same information had not been disclosed by him in the proposal form, due to such concealment of facts in a fraudulent manner the claim cannot be payable and the complainants are not entitled to get any relief through this ld. Forum.
The ld. Counsel for the complainants has submitted that the DLA was never suffering from any diseases as mentioned by the Ops and for this reason he had mentioned the actual state of his health in the proposal form and no misstatement was given by him. In this respect we have noticed that the Ops have stated that the DLA was suffering from chest pain since 2002, diabetes type II since 2004 i.e. prior to the date of proposal form, eco-cardiogram report of Astha Medical Centre dated 21.11.2010 reveals that he was suffering from cardio-myopathy with moderately LV systolic dysfunction, ischemic heart disease, ante- noceptal myocardial infraction in the year 2011 and was admitted at BMCH. According to the Ops as the above statement have not been disclosed by the DLA the complainants are not entitled to get any amount.
In this respect we have perused carefully the above-mentioned documents and papers on which the ld. Counsel for the Ops has relied on. It is seen by us from the Annex ‘D’ page-29 & 30 of Astha medical centre from which it is evident that the said report was issued in the name of Abdul Hannan Mondal, Annex ‘E’ page-31 reveals the blood sugar report (PP) of one Abdul Hannan Mondal, page-32 & 33 reveal the prescription of Dr. Ranjan Kumar Sharma which was also issued on 02.9.2011 in the name of Abdul Hannan Mondal. Not only that the discharge certificate of BMCH along with some prescriptions also reveal the name of Abdul Hannan Mondal. It is pertinent to mention that on the above-mentioned documents the ld. Counsel for the Ops–Insurance Company have relied on in support of their contentions, but it is noticed by us that the name of the deceased life assured is Hannan Mondal, not Abdul Hannan Mondal, therefore, Hannan Mondal and Abdul Hannan Mondal were same and identical person or not, in this respect no evidence has been adduced by the Ops. Therefore, we cannot take those above-mentioned documents as true for adjudication of this dispute because those documents were issued by different doctors/authorities in the name of Abdul Hannan Mondal. So for adjudication of this complaint those relied documents have no legs to stand upon. On the other side, the complainants have submitted the copy of the Insurance Policy, Policy Information Page, Voter Identity Card, PAN Card, Addhar Card, Death Claim intimation etc. from where it is evident that the name of the decease life assured is Hannan Mondal, not Abdul Hannan Mondal. Therefore, as the Ops have miserably failed to prove their contentions, in our view the complainants are entitled to get the relief as sought for. As the concealment of fact regarding the state of health of the DLA has not been proved by the Ops by producing any documentary evidence, we are not in a position to hold that the DLA had given mis-statement regarding his heath in the proposal form at the time of taking out the policy. It is true that the Ops have repudiated the legitimate insurance claim of the complainants and for such repudiation the complainants have to run from pillar to post for getting the insurance benefit but without finding any other alternative being compelled had to approach before the court of law for redressal of their grievance, therefore, it is crystal clear that there was deficiency in service on behalf of the OP-1, 2 & 3 and for such deficiency the OP-1, 2 & 3 are liable to pay compensation to the complainants. It is further admitted fact that as the complainants have approached before the court of law and incurred some expenditure for this proceeding, they are also entitled to get some amount towards litigation cost form the OP-1, 2 & 3.
It is pertinent to mention as the complainants have not made out any allegation within the forecorners of the complaint against the OP-4 and upon considering the complaint as well as the written version of the OP-4 we are of the view the action/activity of the OP-4 does not suffer from any deficiency in service and for this reason the complainants are not entitled to get any relief from the OP-4.
Going by the foregoing discussion, hence, it is
O r d e r e d
that the Consumer Complaint being no. 30/2015 is hereby allowed on contest against the OP Nos. 1, 2 & 3 with cost and the complaint is dismissed on contest against the OP-4 without any cost. The OP Nos. 1, 2 & 3 are hereby directed to pay Rs. 2, 80,000=00 as insured amount to the complainants jointly or severally within 45 days from the date of passing of this final order/judgment, in default, the amount will carry an interest @9% per annum for the default period. The OP Nos. 1, 2 & 3 are also directed to pay Rs. 3,000=00 as compensation to the complainant for mental pain, agony and harassment and Rs. 1,000=00 as litigation cost within 45 days from the date of passing of this order, in default, the complainants are at liberty to put the entire decree in execution as per provisions of law.
Let plain copies of this final order/judgment be supplied to the parties free of cost as per provisions of Consumer Protection Regulations, 2005.
(Asoke Kumar Mandal)
Dictated and corrected by me. President
DCDRF, Burdwan
(Silpi Majumder)
Member
DCDRF, Burdwan
(Pankaj Kumar Sinha) (Silpi Majumder)
Member Member
DCDRF, Burdwan DCDRF, Burdwan
