C.F. CASE No. : CC/2012/10
COMPLAINANT : Smt. Manorama Nandi
W/o Lt. Rabindranath Nandi,
Sandhyapara, Junglitala Lane,
P.O. Ghurni, P.S. Kotwali,
Dist. Nadia
OPPOSITE PARTIES/OPS : 1) The Branch Manager,
LICI, Krishnagar Branch – II,
Padia Market, R.N. Tagore Road,
P.O. Krishnagar, P.S. Kotwali,
Dist. Nadia, Pin – 741101
2) The Divisional Manager,
Kolkata Suburban Divisional Office,
Jeevan Prabha, DD/5, Sector-1,
Salt Lake City, Kolkata – 700 064
PRESENT : SHRI PRADIP KUMAR BANDYOPADHYAY, PRESIDENT
: SRI SHYAMLAL SUKUL, MEMBER
: SMT REETA ROYCHAUDHURY MALAKAR, MEMBER
DATE OF DELIVERY
OF JUDGMENT : 29th July, 2013
: J U D G M E N T :
This is the case under Sections 12 read with Sections 13, 14 of the Consumer Protection Act, 1986. The facts of the complaint may briefly be stated as below:-
The husband of the complainant, Manorama Nandy was Rabindranath Nandi. He was in the police department. He purchased LICI policy No. 427474509 on 28.05.09 for 15 years under table No. 165. The premium was Rs. 3,062/- of the sum assured Rs. 2,50,000/-. Manorama Nandi, the unfortunate wife, the complainant is the nominee of the LICI policy.
On 09.09.09, Rabindranath Nandy (husband) died at Saktinagar Hospital, Nadia.
Thus, the policy was only 3 months and 12 days old. The complainant lodged complaint with the LICI but OP No. 2, the Divisional Manager, LICI repudiated the claim by letter No. 05.02.11 (exhibit-5).
In the complaint at para 14 & 15 the complainant has stated that OP No. 1, the Branch Manager LICI, Krishnagar accepted the policy after medical examination of the deceased Rabindranath Nandi by the approved doctor and hence, the question of suppression of facts does not arise. Hence, the claim.
The written objection was filed on 27.04.12 challenging the contentions of the claimant para-wise. The main points of written objection are as below:-
The claim was barred by law and estopple. The claim petition suffered from defect of parties. There was suppression of material information regarding health of the deceased assured at the time of filing of the form. Even the form was filled in by the agent it would be resumed that Rabindranath Nandi knew the contents of the application form for insurance. There is breach of good faith committed by the insured as the insured fraudulently suppressed his known diseases, so his claim was rightly repudiated.
Additional written statement was filed by the OP on 22.06.12 wherein opposite parties emphasized that the local doctor of LICI examined the assured. The policy was accepted on the basis of declaration and no medical examination was made because the policy comes under “nonmedical” one. The policy was accepted as the insured was a public servant.
POINTS FOR DECISION
- Had the deceased fraudulently suppressed any material information regarding health of him to the LICI?
- Is the complainant entitled to get any relief?
REASOND DECISIONS
For the sake of brevity and convenience both the issues are taken up together for discussion.
Complainant filed affidavit evidence herself and she appeared as PW-1 and affidavit was filed on 14.05.12. The complainant has also filed another affidavit of PW-2 namely, Ajoy Kr Mondal, an agent of LICI who filled up the form for the deceased.
No witness is forthcoming from the sides of Insurance Company either OP No.1 or OP No. 2. We have meticulously gone through the case laws referred at the time of arguments by ld. Advocates. We have carefully gone through the written arguments filed by both parties along with the oral and documentary evidence of record.
Smt. N. Kar, ld. Advocate for the complainant filed written argument on 25.06.13, while Sri Dilip Kumar Saha, ld. Advocate for the OP submitted written argument on 05.07.13.
Ld. Advocate for the complainant has submitted that the complainant or her husband did not suppress the material fact regarding illness of Rabindranath Nandi the agent who is represented of LICI filled in the application form for the life insurance policy. Ld. Advocate, Smt. N. Kar has nicely argued in support of bonafide of the complainant. Sri Saha ld. Sr. Advocate for the OPs has strongly argued that this is a clear case of suppression of material facts which was done by the deceased at the time of filing of application form and thereafter.
In the written argument, we find that the complainant has stated that her claim was repudiated after 7 months although she was not guilty of suppression of material facts. It has been argued by Smt. Kar that it is unfair trade practice by the OP who got the insurance by the agent of LICI without communicating the contents to the signatory, the insured. Hence, Smt. Kar has argued for payment of Rs. 2,50,000/- the sum assured and Rs. 1,00,000/- for harassment and mental agony. Sri Saha has highlighted in his written argument that the LICI accepted the proposal of insured with the utmost good faith but there was breach of good faith by the insured.
According to the Sri Saha, ld. Advocate for the OPs the insured purchased the policy on 28.05.09 during his ailment, but totally suppressing the same which was detected later on the death was on 09.09.09 as per death certificate.
Ld. Advocate for the OP, Sri Saha was taken us to (2006) II WBLR (CPNC) 1006, wherein repudiation of claim by the LICI was held justified on the ground of suppressing of material facts about the illness and hospitalization by the insured. This is a decision of Hon'ble National Commission.
Sri Saha has taken us to reported in 2003 CPR 57 NC, wherein it has been clearly held by the Hon'ble National Commission that the contract of insurance is based on good faith. And on the ground of incorrect information regarding health of the insured, the contract of insurance was held null and void.
Smt. N. Kar, ld. Advocate for the complainant has referred CPJ 2013 page 10, CPJ Vol. II 2000, Supreme Court page 1 referred at the time of oral argument and 2012 II CPJ page 349. Smt. Kar has placed only I (2000) CPJ 1 (SC) to strengthen her argument. It was held by the Hon'ble Supreme Court that Utmost Good Faith must be observed by the contracting parties. Good faith forbids either party from non-disclosure of facts which the parties know. Thus, this precedent goes against the complainant.
We have gone through the ‘exhibit-1 to ‘exhibit-6’ filed by the complainant. ‘Exhibit –2’ is the policy document. ‘Exhibit-3’ is the letter of the LICI. ‘Exhibit-4’ is the copy of letter addressed to LICI stating that no biological report was necessary while the insured was admitted at Kalyani Hospital.
‘Exhibit-5’ is the most important document. It gives the reasons for repudiating the claim. It analyses how the insured has given the false answers two question No. 9(i) and 9(ix). The reason for repudiation is due to deliberate misstatement and holding material information by the insured (Exhibit-5).
Now the question is whether the insured has suppressed the material fact deliberately or not. ‘Exhibit-A’ is the document of the LICI showing the date of policy purchased as 28.05.05. But unfortunately exhibit-A’s reverse side the series of questions answers by the insured to the question No. 09 suffers from deliberate mis-statement/answers. ‘Exhibit –B’ is the form signed by Rabindranath Nandi wherein he signed after knowing the contents and there is an endorsement to that effect. ‘Exhibit-D’ is the status report. ‘Exhibit-D’ is the copy of letter for repudiation of claim. ‘Exhibit-E’ includes observations of I.O. that the insured had availed of commuted leave and earned leave on medical ground during the period from 22.01.09 to 22.03.09 and 07.06.09 to 16.06.09 as he was treated as district Hospital, Nadia as outdoor patient. The condition of the health was not good. The Hospital ticket of the patient marked as ‘exhibit-R’. ‘Exhibit-G’ is the claim enquiry report showing treatment of the insured in the District Hospital the reason for death is premiocardial infraction on 09.09.09. ‘Exhibit – H’ go to show the Hospital ticket. ‘Exhibit-M’ is the status report. ‘Exhibit – O’ is the claimant statement show duration of illness from 06.02.09 to 04.02.09. This statement was made by the claimant Manorama Nandy is at variance with application form of insurance. In ‘exhibit-O’ shows the same period of illness stated by Manorama Nandy. ‘Exhibit – Q’ is the hospital document and it shows that Surgeon Superintendent of GNM Hospital has certified that the insured had unstable angina from 06.02.09 to 04.02.09 for which he was treated at GNM Hospital, Kalyani. ‘Exhibit – R’ series confirms the illness of the insured at the relevant period.
As the information supplied by the insured / deceased regarding his health and the information supplied by his wife / claimant in the claim application vary it can safely be concluded that the insured suppressed material fact of his unsuitable angina in the insurance contract form.
The case laws referred by ld. Advocate for the OPs have strongly helped the contention of the OP regarding falsification by the insured.
Hence, in view of the above discussions the points are disposed against the complainant.
Ordered,
That, the case CC/12/10 be and the same is dismissed on contest. No cost.
Let a copy of this judgment be delivered to the parties free of cost.
