By  : SMT. BANDANA ROY, PRESIDENT

            The case of the complainant in brief is that the complainant‘s father was a businessman and he used to earn Rs. 1,50,000/- from his  business of embroidery during his life time. On 28.12.15 one insurance consultant of OP Mr. Prasanta Majumdar approached father of the complainant to purchase a policy and being convinced his father signed the proposed form and submitted the required documents. After verification of all the documents Md. Selim deposited a sum of Rs. 12,480/- on 29.12.15 and purchased policy No. 0326280571. The complainant became the nominee of that policy. On 30.12.15 father of the complainant became seriously ill and he was taken to SD hospital at Uluberia for treatment where father of the complainant died on 30.12.15 at 3.40 AM due to Acute Myocardial infarction.  After demise of his father complainant informed the OP about the death of his father and claimed for the assured sum of Rs. 1,26,000/- from the  OP. On 25.12.16 OP sent a letter of acknowledgement of all the relevant documents including the original policy certificate. The complainant submitted all the relevant original documents but still then the OP repudiated the genuine and legitimate claim of the petitioner by sending a letter on 21.03.16.  On 16.04.16 the petitioner send a letter to the Review Committee of the OP Co. which the OP Co received on 21.04.16 but  there was no fruitful result.

Hence, the claimant has filed the instant case with the prayer for reliefs as made in the claim application.

            The OP Insurance Co. contested the case by filing written version. The OP claimed that the present application is wholly misconceived and liable to be dismissed. The complainant has no locus standi to initiate the present proceeding against the OP. The OP contends that the complainant deliberately suppressed the health condition of the life assured at the time of signing the proposal form. The various investigations confirmed that the deceased knowing well  that the Invest Gain Economy policy cannot be offered to him he purchased the policy. Thus the contract of insurance under the policy in question are null and void ab initio and liable to be dismissed.

            The point for consideration is whether the complainant is entitled to the relief as prayed for.

Decision with Reasons.

            We have perused all the documents in record. Admittedly father of the complainant made a policy on 29.12.15 for Rs. 1,26,000/- and OP accepted the premium of Rs. 12,480/- for the said policy which was deposited by father of the complainant on 29.12.15. the OP issued Insurance policy to father of the complainant on the same date being policy No. 0326280571. The complainant is admittedly nominee of the said policy. It is stated by the complainant that his father was admitted at Bagnan Rural Hospital on 30.12.15 nearabout 2.00 to 2.10 PM  and thereafter he was  transferred to Uluberia SD Hospital on 30.12.15 at about 3.40 pm due to acute Myocardial infarction. It is the specific defence of the OP that father of the complainant suppressed the material  facts of pre-existing  disease at the time of taking the policy. Hence, the OP repudiated the claim of the claimants rightly. The OP filed Xerox copy of the proposal form dated 2812.15, Xerox copy of letter dated 11.03.16 issued to the complainant, Xerox copy of letter dated 12.07.16 issued to the complainant, Xerox copy of death  certificate of the assured Sk. Md Selim, copy of treatment sheet of Uluberia SD Hospital, Xerox copy of medical papers issued by Bagnan Rural Hospital.  

            We have perused the documents filed by the OP.

Ld. lawyer for the OPs submitted that in the case of Satwant Kaur Sadhu Vs. New India Assurance Ltd. (2009) 8 SCC 316 and 2013 (3) CPR 664 (SC) it has been observed that the expression “Material fact”  has to be understood in general terms  to mean as any fact which would influence the judgement of a prudent insurer, in deciding  whether to accept the risk or not. If the proposer has knowledge of such fact he obliged to disclose it particularly while answering questions in the proposal form. Any inaccurate answer  will entitled the insurer  to repudiate  their liability because there is clear  presumption that  any information  sought  for in the proposal from is material for the purpose of entering into a contract of insurance, which is based on the principle of utmost  faith -  uberrima fides. Good faith for bids either party for non-discloser of the facts which the party privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the country.   

            Ld. lawyer for the complainant submitted that acute Myocardial infarction is the medical name for a heart attack. Heart attack occurs when the flow of blood to the heart becomes blocked .They can cause tissue damage and can even be life – threatening. A number of different factors may increase the risk for a heart attack, including high blood pressure, high cholesterol and diabetes.

            We have carefully given our anxious thoughts over the matter and we are of the view that death due to acute Myocardial infarction is a sudden death and it cannot be said that there was pre-existing disease before such death. Today due to various reasons a person has anxiety business, obesity and that it self cannot be called disease of one’s heart. When a person’s cardiac is arrested suddenly then every treatment fails and the person dies suddenly. So, it cannot be said that   there was pre-existing disease of the assured before her death.

            Complainant demanded Rs. 1,26,000/- and other benefits of the policy and we are of the view that complainant is entitled to get that reliefs from the OP but we do not want to impose any compensation on the OP for repudiating the claim of the complainant.

 Hence, it is

O R D E R E D

            That the complaint case being No 179 of 2016 be and the same is allowed on contest against the OPs.

The OPs  are directed to pay Rs 1,26,000/-  to the  within one month from the date of this order failing which the OP will be liable to pay interest at the rate of  9%  per annum from the date of filing of the complaint  till final payment. The OPs. are also directed to pay Rs.3000/-as  litigation cost  to the complainant within one month from the date of this order, in default  the OPs will be liable to pay Rs 50/- per diem as punitive charge which would be  payable to Consumer Welfare Fund.

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