The complainant Sri Anil Paswan has filed this complaint petition against Branch Manager, PNB Met Life Insurance Company Ltd. Muzaffarpur and two other (o.ps) for realization of Rs. 4,88,070/- as sum assured, Rs. 51,000/- for compensation of mental agony and physical harassment and Rs. 25,000/-as litigation cost with 18 % p.a. interest on the total sought amount since the date of death of L.A. person till date of realization.
The brief, facts of the case is that the complainant’s Husband Sri Anil Paswan is nominee and husband of Life. Assured person (hereinafter be called as L.A.) Manju Devi. The further case is that the wife of complainant namely Manju Devi purchased policy bearing No.- 21310768, from the o.p company for Rs. 4,88,070/- on 30-04-2014 after payment payment of premium amount Rs. 18800/-. The further case is that on 10-07-2014 the L.A. Manju Devi complained about chest pain to the family members who in turns consulted Dr. B.K. Jha (MD) on the same day. After thoroughly check up the Doctor prescribed some medicine and assured that she would recover soon. The further case is that in the fatal evening dated 28-07-2014 she again complained about chest pain and weakness but this time after full and continuous effort of Dr. Jha, could not save her life and unfortunately she died on 29-07-2019 due to cordiorespiratory arrest. The further case is that the complainant filed death claim against aforesaid policy with all relevant documents after fulfilling all the formalities but insurance company declined the death claim filed by complainant on the ground that assured person namely Manju Devi was known case of T.B. prior to issuance of policy.
The complainant has filed the following documents with the complaint petition - photocopy of First Premium receipt annexure-1, photocopy of Death certificate annexure-2, photocopy of Prescription of Dr. B.K. Jha annexure-3 & 4, photocopy of Death Certificate granted by Dr. B.K. Jha annexure-5, photocopy of Income-Tax return for Assessment year 2013-2014 & 2014-2015 annexure-5&6, photocopy of Pan Card annexure-8, and photocopy of repudiation letter annexure-9.
On issuance of notices, o.ps appeared and filed their w.s. on 13-06-2018 with prayer to dismiss the complaint petition.
It has been mentioned in the w.s. that complaint petition filed by complainant is false, malicious, incorrect with mala fide intent. It has been further mentioned that the complaint does not fall within the definition of “Consumer Dispute” under Act as there is neither any unfair trade practice adopted by o.p nor any deficiency in service being established against the o.p Issuance of policy bearing No.21310768 with risk commencement from 30-04-2014 of the L.A, is an admitted fact. Application form and policy document has been annexed as o.p-1. Receiving of death claim from the complainant is also an admitted fact. Death claim has been annexed on behalf of o.ps as o.p-2. It has been further mentioned that the claim being an early claim, as the person insured died within a short span of time of only 4 months the o.ps, as per the procedure, carried out an investigation to settle the claim of the complainant. It has been further mentioned that during the course of investigation and assessment of the claim, it was revealed to the o.p that D.L.I did not provide true and correct information while filling up the proposal form with respect to her medical history. It has been further mentioned that D.L.I was suffering from T.B. prior to the issuance of policy. T.B. record registered of ‘ revised” National T.B. control programme clearly established that D.L.I has visited there on 22-02-2014. Under lab no.- 161 in Primary health centre of Bahari. It has been further mentioned that D.L.I intentionally concealed the material fact in her proposal form as such she played fraud upon the o.p and induced the o.p to issue the policy bond in her favour. Copy of report along with records and other supporting documents have been annexed as annexure- o.p-3. It has been further mentioned that the o.p repudiated the claim of the complainant on the ground of providing false information as to material fact with respect to his medical history at the time of filling up of proposal form. Copy of repudiation letter has been marked as annexure-o.p-4.
The complainant Anil Paswan has examined himself as AW-1 on affidavit. He has stated in para-2 of his examination in chief that L.A. was not suffering from T.B. nor treated by any doctor for T.B. in his time. He has further exhibited annexures already filed as exhibit 1 to 9.
On behalf of o.p, o.p w-1 Motty Jain (G. Manager legal) of PNB Met Life insurance company Ltd. has examined himself as o.p w-1 on affidavit. Annexure filed on behalf of o.ps has been marked as exhibit o.p. -1 to 4.
Annexures-9 filed on behalf of complainant and annexure- o.p-4 filed on behalf of o.ps are same documents i.e. repudiation letter of the o.ps. The o.p company has repudiated the claim on the ground that L.A. failed to provide information as to material fact with respect to his medical history at the time of filing of proposal form and she was suffering from T.B. prior issuance of policy bond. The complainant AW-1 has denied this fact in his examination- in -chief. This question has been raised on behalf of o.ps, so the burden lies on them to prove the fact. No doctor has been examined on behalf of o.ps to prove that the L.A was suffering from T.B. prior to the issuance of policy bond. On behalf of o.ps, o.pw-1 has been examined who is a formal and hearsay witness, not the expert. The o.ps have annexed the photocopy of test of revised national Tubercolousis control programme laboratory form for SPTUM examination of Manju Devi on dated 30-06-2012 which shows that the result of examination was ‘negative’. So, document produced on behalf of o.ps also does not support their contention. No other document has been produced on behalf of o.p to prove the fact that the L.A. was suffering from T.B. before filing of proposal form so the above fact is not proved on the evidence adduced on behalf of o.ps.
Learned Lawyer for complainant relied on the decision of the case of PNB Met Life Insurance Company V/s Veena Devi observed on 24-09-2018 by Hon’ble National Consumer Dispute Redressal Commission New Delhi in C.C. No.- 32/2015 Hon’ble N.C.D.R.C has relied on judgment of the commission titled as Sushil Kumar Jain Vs United India Insurance Company Ltd. –I ( 2012) CPJ 204 (N.C) in which Hon’ble N.C. has observed as follows –“Doctor’s prescriptions have to be substantiated by an affidavit of the said doctor , specialy in the light of the fact that it is being disputed by the complainant. In the instant case the Insurance company has not produced the affidavit of the concerned doctor nor did the said doctor answer any interrogatory by way of evidence before the fora below. At the cost of repetition, it is reiterated that the burden to prove that the L.A. was suffering from any pre-existing disease lies with the insurance company and the Insurance company had not filed any documentary evidence or Affidavit of the treating doctor in support of their contention”.
None appeared on behalf of o.ps to argue the case though many opportunities have been provided him to argue the same.
On the basis of above discussions we are of the considered opinion that the o.ps have failed to establish their case and there is deficiency on part of o.ps.
Accordingly, complaint petition is allowed and o.ps are directed to pay Rs. 4,88,070/- as sum assured, with 7 % p.a. interest from the date of filing of the complaint petition that is on 06-04-2016, Rs. 20,000/- as compensation for mental agony & physical harassment and Rs. 10,000/- as litigation cost within two months from the date of receipt of the copy of the order, on failure they shall be responsible for payment of aforesaid amount with 9 % interest p.a. till realization. Let a copy of this order be furnished to both the parties as per rule.
