BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
CACHAR :: SILCHAR
Con. Case No. 28 of 2016
Ms. Missma Begum,
P.O- Kalinagar, P.S.- Panchagram,near Kandigram
Mosjid, Bakrihawar-10, Hailakandi, Assam – 788001 Complainant.
-V/S-
1. The Branch Manager, Reliance Life Insurance Co. Ltd.
2nd & 3rd Floor, Jagannath Apartment, Hospital Road
Silchar-788005, Dist- Cachar, Assam O.P No.1.
2. Regd. Office,
H Block, 1st Floor, Dhirubhai Ambani Knowledge City,
Navi Mumbai – 400710, State- Maharastra. O.P No.2.
3. The Grievance Redressal Office
Reliance Nippon Life Insurance, Reliance Centre, 5th Floor,
Off Western Express Highway, Santacruz East,
Mumbai-400055, State- Maharastra. O.P.No.3.
4. Avanish Singh
Head-Under writing and claims
Reliance Nippon Life Insurance, Reliance Centre, 5th Floor
Off Western Express Highway, Santacruz East
Mumbai- 400055, State- Maharastra O.P.No.4
Present: - Sri Bishnu Debnath, President,
District Consumer Forum,
Cachar, Silchar.
Shri Kamal Kumar Sarda, Member,
District Consumer Forum,
Cachar, Silchar.
Appeared: - Mr. Imdadul Hussain Borbhuiya, Advocate for the complainant.
Mr. Rahul Nath, Advocate for the O.Ps.
Date of Evidence 21-02-2018,
Date of written argument 30-06-2017, 10-08-2018
Date of oral argument 07-09-2018
Date of judgment 06-10-2018
JUDGMENT AND ORDER
Sri Bishnu Debnath,
- The Complaint has been brought by Ms. Missma Begum against the Reliance Insurance Co. Ltd. including the Branch Manager, Silchar for award of making payment of sum insured of Insurance Policy No.52636858 and compensation for disservice etc.
- Late Lutful Rahman purchase Insurance Policy No.52636858 for his life on 22/04/2016 but he expired on 04/06/2016 due to Cardio Pulmonary Failure (CPF). Accordingly, his wife being nominee submitted claim but O.Ps repudiated the claim on the plea that the deceased life insured concealed material facts of ailment in the proposal form that he was suffering from Chronic Liver Disease, Hypertension and Esophageal Varices. The O.Ps in their joint W/S did not challenge the fact of death of Life Insured due to CPF but took plea that the claim has been repudiated due to concealment of ailment mentioned here in above.
- During hearing both the Complainant and O.Ps submitted deposition and exhibited documents and also submitted written argument.
- Perused the evidence on record and written argument. I have also heard oral argument of the Ld. Advocate of the Complainant but none has appeared for oral argument on behalf of the O.Ps.
- In this case in view of the proposal form vide Ext.1, & policy documents the deceased life insured answer the question regarding his High blood pressure, liver disease etc. are negative. Accordingly, the O.P. by adducing evidence tried to establish the fact that deceased suppressed those facts. As such adduced further that prior to execute the proposal form the deceased life insured was suffering from above mention disease and got treatment under Dr. Devesh Kr. Singh. To prove that fact the O.P. exhibited the prescription of Doctor vide Ext.2. In that prescription it is written that the patient was suffering from Chronic Liver disease, Hypertension etc. The O.P. further stated that the said prescription was collected during investigation by their investigator and got it verified with said document. The said doctor was examine as P.W.1. The said witness stated that in the prescription vide Ext.2 medicine prescribed by him and the note of ailment also noted by him but name of patient, age etc. are not written by him and cannot say who wrote the same. He also denied the verification report.
- As such the Ext.2 is not sufficient to prove this ailment of the deceased life insured. To establish the aforesaid ailment, other reliable and material evidence are needed. Nothing found in the record. So, it is not confidently said that the deceased life insured died due to the cause of aforementioned ailment. Of course, the Complainant stated that deceased life insured died due to Cardio Pulmonary Failure. In support, the Complainant exhibited death certificate, a prescription of attending doctor of Algapur PHC vide Ext.1 and Ext.9 respectively. The Complainant also produced medical certificate of last attending doctor (Annexure 1).
- From the above documents it is presumed that the deceased life insured died due to cardio pulmonary failure. Whether the chronic liver disease, portal hypertension etc. are responsible for heart attack is not clear from the evidence on record. Moreover from forgoing discussion it is not established beyond doubt that the deceased life insured was suffering from Chronic Liver, Hypertension etc. mentioned in the prescription produced by the O.Ps.
- Therefore, in this case I do not find any cogent ground for repudiating the claim. As such O.Ps are asked to make payment of sum insured to the complainant and also to pay cost of the proceeding of Rs.2,000/-
- The O.Ps are jointly and severally liable to pay the aforesaid awarded amount within 45 days from today. In default, interest at the rate of 10% per annum to be added with the total awarded amount.
- With the above, this case is disposed of on contest. Supply free certified copy of Judgment to the parties. Given under my hand and seal of this District Forum on this the 6th day of October, 2018.
