DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

CASE   NO:   CC- 92 of 2020.

 

1. Smt. Tandra Debbarma,

W/O. Sri Dipak Paul,

 

2. Sri Dipak Paul,

S/O. Late Dhananjoy Paul,

Both are residing at Flat No.214,

Block No.2 of Shyamalima Apartments,

New Capital Complex, P.O. & P.S.-NCC, Agartala,

Dist. West Tripura....................…....…...........................Complainants.

 

-VERSUS-

 

1. The Axis Bank Limited, 

Axis House, C-2, Wadia International Centre,

Pandurang Budhkar Marg, Worli, Mumbai-400025, 

Represented by its General Manager. 

 

2. The Axis Bank Limited,

Dhaleswar Branch, Joyguru Stand,

Agartala, Dhaleswar, P.S.-East Agartala,

P.O.-Dhaleswar,

Dist.-West Tripura.

Represented by its Manager. 

 

3. The Axis Bank Limited,

Guwahati, Circle Officer, 

North East Region, PIN-871005,

Represented by Circle Nodal Officer,

North East Region. 

 

4. The Axis Bank Limited,

Cluster Head, Agartala Cluster, 

H.G.B. Road, Agartala,

P.S.-East Agartala, P.O.-Agartala, 

Dist.-West Tripura, Pin-799001

Represented by its Deputy vice presented 

Cluster Head, Agartala Cluster. 

 

5. The TATA AIG General Insurance Company Ltd.,

Registered Office at 15th Floor, Tower “A”,

Peninusla Business Park, Ganpatrao Kadam Marg, 

Off Senapati Bapat Marg, Lower Parel,

Mumbai-400013, 

Represented by its General Manager. 

 

6. The TATA AIG General Insurance Company Ltd.,

Agartala Branch, First Floor, 

Bank of Baroda Building, 

14th T.G. Road, Ramnagar, Agartala, Pin-799002, 

Dist.-West Tripura.

Represented by its Manager. 

 

7. The Family Health Plan(TPA) Ltd.,

Srinilaya, Cyber Spazio, 

Suite# 101, 102, 109 & 110, 

Ground Floor Room No.2, 

Banjara Hills, Hyderabad-500034 ….........................Opposite Parties.

 

 

 

    __________PRESENT__________

 

 SRI GOUTAM DEBNATH

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

      WEST TRIPURA, AGARTALA. 

 

DR (SMT) BINDU PAL

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION, 

  WEST TRIPURA,  AGARTALA.

 

SRI SAMIR  GUPTA

MEMBER,

  DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA. 

 

 

C O U N S E L

 

For the Complainant : Sri Pradyat Kurmar Dhar,

  Sri Bimal Deb,

  Sri Kaushik Paul,

  Sri Rama Gopal Chakraborty,

  Advocates. 

For the O.P. No.1 to 4 : Smt. Puspita Chakraborti, 

  Advocate. 

For the O.P. No.5 & 6 : Sri Prabal Kumar Ghosh,

  Advocate.  

For the O.P. No.7 : None appeared. 

 

FINAL ORDER  DELIVERED  ON: 07/10/2023.

F I N A L     O R D E R

1. Both the cases are taken up together by a common final order as parties in both the cases are same, question of law in the both cases are same and facts are slightly different. Argument was also heard simultaneously.  

The Complainants have a joint Bank Account  with the Axis Bank who are O.P. No.1 to 4. The Axis Bank is a corporate agent of TATA AIG General Insurance Company Ltd. Who are O.P. No. 5, 6 & 7.

      Facts of case No.92/2020:-            

3.     The Complainant, Sri Dipak Paul purchased a health policy from Axis Bank, Dhaleswar Branch, the O.P. No.2 to issue such policy on behalf of TATA AIG General Insurance Company Ltd. This policy was renewed on 21/05/2019 for which an amount of Rs.8,251/- was deducted from the joint Bank Account of the Complainants. But the Complainant, Sri Dipak Paul did not received the copy of policy. The Complainant anyhow collected soft copy of policy page which covers policy period from 26/05/2019 to 25/05/2020. 

4. The Complainant at the time of renewal of policy disclosed his illness of Pancreatitis. The Complainant meet with an accident and was admitted in ILS Hospital from 15/02/2020 to 20/02/2020 with advised to take rest for 45 days. He is spent of sum of Rs.1,80,520/- which the O.P. Insurance Company denied to pay on the ground of suppression of illness which was preexisting at the time of taking the policy. However, in the prayer portion the Complainant prayed for admit on the ground for mental agony due to deficiency in service on the part of the O.Ps.    

5.       During the course of argument Learned Counsel of the Complainant made it clear that there was mistake in drafting the complaint in fact this case has been filed for non-issuance of policy of insurance.

6.  The O.P. No.1,2,3 & 4 pleaded no deficiency on their part. As TATA AIG is supposed to issue of the Policy of Insurance and O.P. No.1,2,3 & 4 are only the agent of TATA AIG Insurance. 

7.   The case has been proceeding ex-parte against O.P. No.7.  The O.P. No. 5 & 6 in written objection at Paragraph No.6 admitted that policy and Insurance No.0285280267 was issued w.e.f. 12/06/2018 to 11/06/2019 as premium was received on 02/06/2018. The Policy was issued subject clearance of Section 64 VB of the Insurance Act. The O.P., Insurance Company denied the fact that the Complainant disclosed the preexisting diseases.

8.   Thus, in this case the real dispute is according  to the Complainant premium was paid on 21/05/2019 but policy was issued on 12/06/2019. 

9.    Both the parties submitted evidence on affidavit.

Facts of case No.92/2020:-       

10.  In this case pleading both parties are similarly as indicated in case No.92/2020 the main grievance the ventricular is that the Complainant, Sri Dipak Paul meet with a motorbike accident and was admitted in ILS Hospital, Agartala from 15/02/2020 till 20/02/2020 with advised to take rest for 45 days. He is spent of Rs.1,80,520/- which he claimed for reimbursement with the O.P., Insurance Company. But the O.P., Insurance Company denied the reimbursement on the ground that the Complainant was patient of PANCREATITIS since the 1997 which the Complainant suppressed. All though the Branch Manager, Axis Bank took the details of the Complainant at the time of issuing of the policy and also assured the Complainant that the Manager of Axis Bank shall fill up the necessary form and send the same to the Insurance Company. As such the Complainant never sawing the terms and conditions of the policy of the Insurance as pleaded in Para No.8 of the complainant. Even the medical test of the Complainant was not conducted before issuing of the policy of the Insurance. This fact has been pleaded in Para No.9 of the Complainant.

11.   In this case the Complainant claimed compensation for deficiency in service. 

12.   Both the parties submitted evidence on affidavit and documents.                                                                                                                        

13. The following points are taken up  for discussion and decision:

     (i). Whether in case NO.92/2020 there was any deficiency either by Axis Bank or by TATA AIG as Policy of Insurance in the month of June?   

       (ii).  Whether the Complainant suppression preexisting diseases at the time of taking the policy of Insurance?    

   

14. All the points are taken up together for discussion and decision. 

DECISION AND REASONS FOR DECISION:-

15.     The Complainant in case No.92/2020 by Bank Account Statement proves that on 21/05/2019 of Rs.8,251/- was deducted from his bank account as premium of policy of insurance. In fact this amount was deducted by Axis Bank, Dhaleswar Branch, the corporate agent of TATA AIG General Insurance Company Ltd. Which was communicated to the TATA AIG General Insurance Company for which the policy was issued w.e.f. 12/06/2019 i.e. after a delay of about 20 days. In fact the Complainant never filed any complaint alleging such any deficiency. He made with an accident and admitted in ILS Hospital, Agartala. The Complainant raised claimed for reimbursement which was denied by the O.P., Insurance Company on the ground of suppression of fact of PANCREATITIS.

16.  In case No.93/2020, the only question involve is whether the Complainant, Sri Dipak Paul _______ the fact the preexisting diseases of PANCREATITIS at the time of taking policy of Insurance. 

17.  The Complainant pleaded that in this case even he did not fill up the proposal form as the Branch Manager of Axis Bank informed that he nothing was required. Be that, as it may, it cause to the function of conduct insurance if the Complainant did not fill up the proposal form by to be his signature. As such in the eye of law there was no contact in between the Complainant and TATA AIG General Insurance Company Ltd. 

18. It is also not believable that the Complainant being a Government Employee could go such mistake and the Branch Manager, Axis Bank being the responsible officer would asked the Complainant only to pay of premium without fill up the proposal form and optimum signature of the Complainant. On the top of it such pleading in missing in other case filed on the same date against the same parties. Therefore, there is contradictory stand taken by the Complainant in the both cases and such stand of the Complainant is neither ________ nor tenable in law.   

19.       Therefore, we have no hesitation to conclude the Complainant is and was guilty of suppression of material facts at the time of taking the policy of insurance and has not come forward before this Commission also with a clear cut stand. 

20.   Both points are decided accordingly the against the Complainant.                  

21.  In the result, it is ordered that case No.92/2020 & 93/2020 here dismissed however without cost.  

          Supply a certified copy of this final order to both the parties free of cost.  

          Keep the original copy of this final order in case No.92/2020 and a photograph of this order in case No.93/2020. 

  However, operative portion of this final order in the order sheet of both the cases.                        

 Announced.

 

 

SRI  GOUTAM DEBNATH

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA

 

 

 

DR (SMT)  BINDU  PAL

MEMBER, 

DISTRICT CONSUMER DISPUTES 

REDRESSAL COMMISSION, 

WEST TRIPURA,  AGARTALA

 

 

SRI SAMIR  GUPTA

MEMBER,

 DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA.