By : SMT. BANDANA ROY, PRESIDENT

          The case of the complainant in brief is that father of the complainant Basudev Roy was an Government employee and he took a house building loan of Rs.10,00,000/-from the OP No. 1 on 04.02.2015. According to said loan agreement father of the complainant had to take a Life Insurance Policy along with the OP no.1  on and from 19.02.15 for a sum of Rs. 10,00,000/-being policy No. GTMM000006 and certificate No. 1000002340  issued to Allahabad Bank from OP No. 2 and 3 in which father of the complainant was an insured member by paying premium of Rs. 58,368/- and complainant is the nominee.  Basudeb Roy died on 12.02.2016. Being nominee, complainant claimed the death claim on 25.04.2016 through the OP no.1 from the OP No. 2 and 3 who did nothing. OP no.3 has given a letter to the complainant by which it neither repudiated the claim nor allowed the same. The OP nos. 1 and 2 did not take any steps to mobilize the said insurance claim for which there has been delay on the part of OP no.1 to pay the said amount.

     The complainant has further stated that all the OPs made deficiency in banking and insurance service for which the complainant has been facing mental agony and hardship. The complainant has prayed for the relief as mentioned in the claim application.

          By filing written version OP No.1 contested the present case. It is contended that this OP did not make any deficiency in Banking Transaction and it has no liability for the sufferings of the complainant. This OP tried his best  and informed the matter to the OP nos. 2 and 3 by registered post claiming the insurance money. This OP also sent mail to the OP no.3 but in vain. Subsequently the OP no.3 answered the complainant by a letter dt.18.08.16 stating inter alia that from the medical papers of 2013 it is established that life insured was suffering from Myeloprolifeative disorder with myelofibrosis prior to application for insurance. In view of the above the declaration has been proved to be false.  The OP 1 is not at all responsible for the damage, loss or sufferings of the complainant.   

          The only point for consideration in this case is whether the complainant is entitled to get the relief or reliefs as claimed.

          It may be mentioned that OP Nos. 2 and 3 did not contest the case. So, the case was taken up ex parte against them.

We have perused the entire materials on record.

Ld. lawyer for the OP no.1 i.e the Branch Manager, Allahabad Bank submitted that they have nothing to do regarding the allegations of the complainant because OP no.3  answered  the complainant by letter dated 18.08.16 stating that the life insured  was suffering from Myeloprolifeative disorder with myelofibrosis prior to the application of insurance and in view of the declaration of the deceased appears to be false  repudiated the payment of insurance coverage. Against this submission ld lawyer for the complainant referred to a decision 2001(1) CPR at 29 wherein it has been held  “While deceased was medically examined and declared fit before taking the policy of insurance, claim of claimants cannot be repudiated on the ground  of existing disease”.

         Ld lawyer for the complainant also referred to another decision reported in 2014(3)CPR 401 (NC) wherein it has been held “Onus  of proving the ground for repudiation of insurance claim lies heavily on the Insurance  Company alone”.

In this case we see that OP Nos. 2 and 3 did not appear to contest the case  or to controvert the complainant’s claim. It was their duty to prove that the complainant suppressed the physical condition of the decease before taking the insurance policy.

We have perused the records.  From Annexure -10, which is the death claim intimation – claim statement of policy No. GTMM 000006 it appears that medical history of the life assured was chest pain and uneasiness. But according to the OP no.1 complainant was suffering from Myeloprolifeative disorder. So, it appears that there is no nexus between the cause of death from which he was suffering. It appears that before obtaining the policy of life deceased was checked by doctors of panel and there is no proof that life assured was suffering from any ailment at the time of taking of the policy. Therefore, repudiation of claim was not proper. It is also not proved that life assured was suffering from said ailment at the time of taking of the policy. We are of the view that the pre-existing disease should not only have existed few years before taking of the policy but also should exist at the time of taking the policy.

In the light of the discussion above and on  consideration of the documents on record we are entitled to allow the claim  of the claimant.

          Hence, it is,   

ORDERED

          That the complaint case be and the same is allowed on contest against the OP No.1 and ex parte against the OP Nos. 2 and 3.

The OP Nos. 2 and 3 are directed to pay the insurance claim of the complainant with 9% interest from 25.04.16 till the actual payment within one month from the date of this order.

 OP No. 1 is directed to adjust the said loan amount of the complainant’s father against the insurance claim.

OP Nos 2 and 3 are directed to pay compensation of Rs. 25,000/- and litigation cost of Rs. 10,000/- to the complainant within one month from the date of this order, failing which they shall have to pay Rs. 100/- each per diem as punitive charge which will be payable to the Consumer Welfare Fund.

  Let the copy of the judgment be supplied to all the parties free of cost.