This is a complaint U/S 12 of the C. P. Act, 1986 with the prayer for an order directing the O.Ps. to pay the Loan amount of Rs.3,00,000/- with interest, to pay compensation of Rs.50,000/-, litigation cost of Rs.5,000/- and any other reliefs to the complainant.
The complaint case in short is that before death of the complainant’s husband namely Rahimuddin Ahamed who was an Assistant Teacher of Bangaram S.B. High School, Halgachi, Uttar Dinajpur, on 15.12.2008 applied for housing loan of Rs.3,00,000/- after all inspections from the O.P. No.3, United Bank of India Raiganj Branch the loan on 27.01.09 Raiganj Branch and as per condition of the Bank loan obtained an insurance policy from the O.P., Tata AIA on 27.02.2009 covering the loan amount, single premium policy of Rs.12,005.05, bearing policy No. DGML000008. Unfortunately husband of complainant died on 11.11.2009. After death of her husband, the complainant informed the matter and lodged claim before the O.P., Insurance Company for getting death claim. The complainant asserted, thereafter through the loan amount was to be paid by the O.P. insurance company but they did not settled the claim and loan account has became NPA from 30.09.2011. So, on 06-07-12 the complainant by sending a letter informed entire fact to all concerned of the Tata AIA Life Insurance Company Limited and to request them to arrange for payment to remit the Bank’s loan. Subsequently on 20.07.2012 the complainant was informed by a letter issued by O.P. No.3 that the TATA AIA Insurance Company Limited on 16.07.2012 through e-mail informed the O.P. No.3 that the said claim of the complainant has been declined by them on 06.04.2010 and the insurance company also attached a photocopy of the letter dated 06.04.20101 with that e-mail dated 16.07.2012 and the concerned Bank also informed that the Bank Authority have not received any cheque dated 06.04.2010 from the TATA AIA Life Insurance Company .
The complainant also came to know from the above letter of the Bank that the O.P. insurance company repudiated her claim on the ground that at the time of submitting the proposal Form the deceased husband of the complainant suppressed the material facts regarding his previous disease. But the complainant asserted in her complaint petition that the above noted ground for repudiating her claim by the O.P. insurance company is totally false and illegal. So, she sent two legal notices one after another to the O.P. insurance company on 20.12.2012 and 08.07.201 respectively but again Zonal Legal Manager of the Ease Zone of the O.P. Insurance Company illegally by issuing a letter on 28.08.2013 stating that since prior to the application for insurance the insured was suffering from Peheumatic Heart Disease and Dilated Cardiomyopathy since Oct’06, which he suppressed at the time of application of the insurance policy; as such the O.P. insurance company repudiated her claim. So, finding no other alternative, the complainant has filed this complaint before this Forum to get proper relief.
On the other hand the O.P. No.1 and O.P. No.3 by filing their separate written versions have contested their case denying all the material allegations against them made by the complainant rather contended that this case is not maintainable in its present form and law. Specific case of the Insurance Company O.P. No.1 is that the LA Rahimuddin Ahamed was suffering from Heart Disease and Dilated Cardiomyopathy since Oct’06 and was under treatment i.e. since prior to the application for insurance with the O.Ps. He was under treatment of Doctor and died due to cardiac arrest but the same was deliberately concealed during the proposal of insurance on which basis of that information the O.P. insurance company issued insurance policy and the Life assured died due to his illness. For non discloser of material facts Company has repudiated the said claim by letter dt. 07.04.2010 and refunded the premium of Rs 12005/- paid by the Assured. Thus as per the version of the O.P. No.1 the complainant in this case is not entitled to get any reliefs as claimed from insurance company.
The specific case of the O.P. No. 3 is that there was suppression of fact regarding the suffering from Cardiomyopathy disease Rehimuddin Ahamed before commencement of the insurance policy. Moreover, the complainant did not seek any claim from O.P. No.3 and the present dispute lies in between petitioner and the O.P. No.1 and 2. The O.P. No.3 is not involved here, So, he prays for dismissal of the petition of the complainant with cost.
It is revealed from the record that as per order No.4 dated 06.03.2014 the name and address of the O.P. No.2 was deleted by way of amendment petition filed by the complainant.
To establish the complaint case, the complainant and the O.Ps. have relied upon some document as well as affidavit-in-chief of complainant and also by the O.Ps. Both parties submitted questionnaires and given answers in this case.
DECISIONS WITH REASONS
Giving due consideration to the contents of the complaint petition, documentary evidence on record, hearing argument advanced by the Lawyers of both sides, the Ld. Forum has come to the findings as follows: -
It is admitted fact that the complainant’s deceased husband Rahimuddin Ahamed during his life time on 27.01.2009 took United Housing Loan amounting to Rs. 3,00,000/- from United Bank of India, Raiganj Branch i.e. the O.P. No.3. As per condition of the O.P. No.3 the deceased husband of the complainant also obtained one insurance policy from the TATA AIA on 27.02.2009 covering the above loan amount by single premium policy of Rs.12,005.05 as mortgage bearing policy No.DGML000008. Subsequently Rahimuddin Ahamed died on 11.11.2009 due to cardiac arrest.
As per written version of the O.P. No.1, insurer, complainant submitted the death claim Form on/ after demise of her husband. Photocopy of the document, Application Form for death claim filed by the O.P. No.1in this case shows that the complainant filled up and signed on it on 18.01.2010 and submitted to O.P. No.3, bank on the same date just after two months of the death of her husband. From this document it is not clear, on which date the complainant submitted the same to the O.P./ insurer from the illegible receiving seal and signature of the O.P./ insurer. In this case Bank authority is the policy holder. So, question arises why the Bank, O.P. No.3 did not inform the death news of his loanee to the insurer/ O.P. just after getting the same information collecting from the complainant on 18.01.2010.
It has been revealed from the letter dated 07.04.2010 issued by the O.P. insurer to the Manager, UBI, Raiganj Branch that the O.P. insurer repudiated the death claim of the complainant on the ground that the deceased insured suppressed the material fact regarding pre-existing disease at the time of submitting the proposal form and O.P./ insurer also stated in the above letter that the matter of suppression of all fact has been come out when they investigate before disbursement the death claim of the complainant. Moreover, in the above mentioned letter O.P./ insurer also stated, “In case you require further clarification on the claim decision , please contact us within 21 days receipt of this letter .In the absence of any communication from you within 21 days of receipt of this letter it shall be deemed that the company’s decision is agreeable to you ”. But those information regarding the matter of repudiation of death claim made by the O.P./ insurer had not been communicated to the complainant neither by the O.P./ insurer nor by the Bank authority before 08.10.2011; it is clear from the letter dated 06.07.2012 issued by the complainant and the letter dated 08.10.2011 issued by bank authority to the complainant. From the letter dated 08.10.2011 issued by the bank shows that the loan account of the complainant has become NPA since 30.092011. Moreover, surprisingly, we see that by issuing a letter dated 20.07.2012 the O.P. No.3, bank had informed the complainant that they once again followed up the matter but the O.P., insurer vide their e-mail has informed them the said policy has been declined by the O.P., insurer on 06.04.2010and the bank authority also informed to the complainant in this letter that as per the letter dated 06.04.2010 of the O.P., insurer they have not received any cheque from the O.P., insurer and they shall inform the complainant as soon as the bank receive the cheque. From the above discussion it is clear that till 08.10.2011 the complainant is in the dark about the repudiation of her claim which had been made by the O.P., insurer and there was a communication gape between the complainant and both O.Ps.
As per written version the O.P. insurer repudiated the death claim of the complainant on the ground that the deceased insured suppressed the material fact regarding pre-existing disease at the time of submitting the proposal form and O.P./ insurer also stated in their W.V. that the matter of suppression of all fact has been come out when they investigate before disbursement the death claim of the complainant. Now question arises why the O.P., insurer did not investigate the above matter before issuing the policy in fovour of the insured name.
To repudiate the claim of the complainant regarding preexisting disease of deceased Rahimudin, insurance company files Xerox copies of prescriptions etc of private hospital at Bangalore ‘Satya Sai Institute of Higher Medical Science’, visiting date 19.10.2006, that he was suffering from heart diseases. But the company did not take pain to prove such disease of the insured, Rahimuddin by giving evidence. There is no evidence whether Rahimuddin had been suffering from 2006 till his death in 2011 or was under continuous medical treatment for such heart disease etc. Moreover O.P., company also filed Xerox copies of medical prescriptions of some General Physicians who were not at all Heart Specialist, but general physicians like Dr. Md. Yeakub, Malda and USG Report of Upper Abdomen by Dr. Sushil Agarwal in the year 2010, Dr. S.P.Singh, General Physician of Purnia on 17.09.2009 for some other diseases. Nobody came to depose in this regard to prove those medical documents. All these medical documents do not necessarily suggest that Rahimuddin was suffering from severe heart disease or that he was under treatment and died due to cardiac arrest or that he suppressed material facts or deliberately concealed these facts of the risk, which are known or deemed to be known by the assured. Therefore the O.P., insurance company cannot rescind the claim as non-disclosure of material facts as per IRDA Guidelines. Therefore the letter of repudiation dated 07.04.2010 on the ground of non-disclosure of material facts is only for a mere defence, which O.P./ insurance company take mechanically and is not sustainable. The O.P., company is not right in repudiating the claim in strait jacket formula. Therefore, the repudiation of claim by O.P., insurance company is illegal. The petitioner is entitled to the claim inrespect of the same insurance policy of her husband. As a result the O.P. No.3 is entitled to realize its claim from O.P., insurance company and this complaint petition succeeds on contest but in part.
Fees paid is correct.
Hence it is,
ORDERED
That the complaint case being No.94/2013 is allowed on contest but in part and the O.P. TATA AIA Life Insurance Company Limited is liable to pay the sum assured under the policy, bearing No. DGML000008 to the O.P. No.3, United Bank of India, appropriate authority. OP No. 1 is directed to repay the loan amount covering the policy with in one month of passing of this order otherwise the complainant is at liberty to proceed with law.
Copy of this order be supplied to each parties free of cost.
