Tripura

West Tripura

CC/14/90

Smt. Bina Ghosh & 3 others. - Complainant(s)

Versus

The Branch manager SBI Life Insurance Co. Ltd. & 1 another. - Opp.Party(s)

Mr.A.K.Pal.

30 Dec 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA

CASE NO:  CC-  90 of 2014

      1. Smt. Bina Ghosh,
W/O- Lt. Bimal Ghosh,
Camper Bazar, Hairmara,
P.O.- S.D. Mission, P.S. A.D. Nagar,
Agartala, Tripura West.

      2. Smt. Sushila Bala Ghosh,
W/O- Lt. Rasaraj Ghosh,
Camper Bazar, Hairmara,
P.O.- S.D. Mission, P.S. A.D. Nagar,
Agartala, Tripura West.

      3. Miss Mousumi Ghosh,
D/O- - Lt. Bimal Ghosh,
Camper Bazar, Hairmara,
P.O.- S.D. Mission, P.S. A.D. Nagar,
Agartala, Tripura West.

      4. Miss Puja Ghosh,
D/O- Lt. Bimal Ghosh,
Camper Bazar, Hairmara,
P.O.- S.D. Mission, P.S. A.D. Nagar,
Agartala, Tripura West.            .............Complainants.
    
         ______VERSUS______

1. The Branch Manager,
SBI Life Insurance Co. Ltd.,
Central Processing Centre,
Kapas Bhawan,
Plot No. 3A, Sector No.10,
CBD Belapur,
Navi Mumbai- 400614.

2. The Branch Manager,
SBI Life Insurance Co. Ltd.,
Joynagar, South Side of Fire Service Office,
Agartala, Tripura West.             ..........Opposite Parties.
            
                    __________PRESENT__________

 SRI A. PAL,
PRESIDENT,
  DISTRICT CONSUMER  DISPUTES REDRESSAL FORUM,
      WEST TRIPURA, AGARTALA. 

SMT. Dr. G. DEBNATH
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

SHR. B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

 

C O U N S E L

For the Complainant    : Mr. Anjan Kanti Pal,
                  Advocate.
                                                          
For the Opposite Party    : Mr. Arindam Ray,
                  Advocate.

JUDGMENT  DELIVERED  ON:  30.12.15

J U D G M E N T
        4 Petitioners Bina Ghosh and others filed a petition U/S 12 of the consumer Protection Act, 1986 alleging deficiency of service by the Branch Manager SBI, Life Insurance Co. Ltd. And Branch Manager, Joynagar, South side of Fire Service. Petitioner No.1 filed the prayer on behalf of all other petitioners as a attorney being legal heirs of deceased insurer late Bimal Ghosh.
2.        Petitioners case in short is that Bimal Ghosh insurer was the husband of petitioner No.1 who purchased the insurance policy from SBI Life Insurance Co. Ltd., Agartala. The date of commencement of the policy was 18.12.2009. Policy holder died on 26.02.12. Before making policy the medical officer given fitness certificate to the insurer Bimal Ghosh on 18.12.09. After death of the policy holder, his legal heirs i.e., petitioners claimed the benefits of the policy. Also filed petition before the insurance ombudsmen for settlement of claim. But the opposite party finally refused the claim of the petitioner, original insurance policy also not returned. Petitioner prayed for coverage of benefits and sum of Rs.3 lakhs and other death benefits. 
3.        O.P. No.1 and 2 Branch Manager, SBI Life Insurance Co. Ltd appeared and filed written statement & denied the claim. It is stated that the policy holder suppressed the material facts about his illness at the time of purchasing the policy. In the proposal form the insurer had given negative to the question that during last 10 years he had not undergone or advised to undergo  treatment or have no blood pressure or not ever suffered or treated or advised to undergo investigation for diabetes. He is not a diabetic patient. The proposal form is a primary document or assessment of risk and answer to each question is vital. From the investigation it is found that insurer Bimal Ghosh was a Hypertension diabetic patient on 30.07.2009 before purchasing policy. The existing illness was suppressed. For this petitioners are not entitled to get any compensation or benefit of the policy which is liable to be repudiated. 
4.        On the basis of rival contention as put forward by the petitioner and O.P.  the following points cropped up for determination;
        (i) Whether the petitioners  being legal heirs of deceased Bimal Ghosh are entitled to get benefits of the policy?
        (ii) Whether the O.P. is liable to pay the compensation to the petitioner having deficiency of service? 
5.        Petitioners side produced original Power of Attorney, Demand Notice, Reply of Legal Notice, original Repudiation letter, original Death Certificate, Survival Certificate, Death Claim, letters of Insurance Ombudsmen. Petitioner also produced the statement of affidavit of one witness i.e., Bina Ghosh. Documents are Exhibited and marked- 1 Series. 
6.        On the other hand O.P. produced copy of Proposal Form, Policy Documents, Investigation Report, Prescription slip dated 30.07.2009, 08.02.2011, Claim Repudiation letter, copy of letter conveying CRC decision, copy of Legal Notice, copy of Reply to the Legal Notice. Exhibited -A to I. 
7.        O.P. also produced statement on affidavit of Debjyoti Choudhury, DSM of Agartala Division, SBI Life Insurance Co. Ltd.
    
8.        We have gone through all the evidence and documents as produced & now we shall decide the above points.

    FINDINGS AND DECISION AND REASONS FOR DECISION:
9.        From the copy of the policy certificate and proposal form as produced by O.P. it is established fact that Bimal Ch. Ghosh was the insurer of SBI Life. Deputy Chief Operating Officer by writing a letter admitted it. Sum assured was Rs.3 lakhs. Premium payable was Rs.6526/- as per proposal form. Premium also paid. All these are admitted facts. Death of Bimal Ch. Ghosh during the policy coverage period is also admitted fact. It is also admitted that petitioner No.1 along with others are the legal heirs of Bimal Ch. Ghosh. Only contention in this case for which the claim is repudiated is that the insurer suppressed the material facts about his illness while purchasing the policy. O.P. employed investigation team and from the investigation it is revealed that the insurer was a diabetic and hypertension patient. In the claim investigation report it is stated that life assured consulted many doctors. Life assured's family members stated that though he had many diseases he looked active and continued office normally. For  one year his health condition improved. But on 26th February, 2012 at 6.30pm after few hours suddenly he fell down in the ground became speechless. Subsequently he died. Investigation report also revealed that life assured consulted Dr. Ashok Sinha and Dr. Chinmoy Datta. The prescription of the life assured issued by Chinmoy Datta (photocopy) is taken. In that prescription blood  pressure is shown 160/106. It is also written that he had diabetic. But this Dr. Chinmoy Datta, Dr.  Amitava Ghosh was not produced before us to support the prescription issued by them. Prescription dated 30.07.09 issued by Dr. Chinmoy Datta was before purchasing policy. Another prescription by Dr. Amitava Ghosh dated 18.02.11 is after policy  therefore  have no  relevency. SBI heavily relied on the prescription of Dr. Chinmoy Datta (photocopy) to come to their conclusion that the life assured was Diabetic and patient of Hypertension. But  in reply to   the question No.8(xii)  Do you have high blood pressure? 8(xiii) Do you have ever suffered or treated or advised to undergo investigation for Diabetes? The answer was no. The policy purchased before 2 years of the death of life assured after 2 years one month 18 days life assured died. Refering to the decision of the Supreme Court, Sealark   Vrs. United India Insurance Co. Ltd. it is pointed out that if a customer  fails to furnish his necessary particulars while applying for the policy the company can not be held liable for non payment of money. Life assured definitely is bound to disclose truthfully to all the question in the proposal form. Learned advocate for the petitioner referred the Section 45 of the Insurance Act, 1938. In that section it is clearly stated that after the expiry of 2 years from the date of which it was effected be called in question by insurer on the ground that the statement made in the proposal for insurance or any report of a medical officer or referring or any  other documents leading to the issue of the policy was inaccurate or false unless the insurer shows such statement was on material matter or suppressed facts which it was material to disclose and it was fraudulently made by the policy holder and policy holder knew that it was a false statement while making. In this case, admittedly 2 years period expired. Insurance Company raised the question that the insurer suppressed the material facts about his illness. So, burden lies on the insurance company to prove that the insurer fraudulently made false statements about his state of health. Only a photocopy of prescription issued by Dr. Chinmoy Datta is not sufficient to prove it. On this it can not be said that insurer made false declaration in the application for policy. Fitness certificate was issued by the doctors which was not questioned by the insurance company in the last 2 years. There is no evidence to support that the question in English was fully explained to the insurer and was understood by the insurer who was a Constable. We consider that the insurance company miserably failed to establish that the insurer made false statements about his health condition while purchasing the policy. So, on this plea the O.P. insurance company should not repudiate the policy. But the policy was repudiated and petitioners and legal heirs were deprived from the benefits of the policy. This repudiation is therefore, we consider is illegal. Representation made by the petitioner was not taken into consideration by the insurance company. This we can not support. Therefore, we are of the opinion that the petitioners being legal heirs are entitled to get the death benefits as enshined in the policy. We therefore, direct the insurance company to pay the death benefits to the petitioner being the legal heir and attorney of other legal heirs immediately within a period of one month. We also consider the harassment by the petitioner because of the deficiency of the service by the O.P. insurance company. Petitioner was supposed to get the benefit in the year 2012 In last 3 years petitioner had to wait and they suffered a lot. Therefore, for this deficiency of service harassment of the petitioners O.P. insurance company is directed to pay Rs.50,000/- to the petitioners and also cost of the petition. Petitioners also entitled to get the death benefit of the policy along with it. Both the points are decided accordingly. 

10.        In view of our over and above points this petition filed u/s 12 of the Consumer Protection Act is allowed.
        O.P. Insurance company is directed to pay  death benefit to the petitioner being legal heirs and attorney of other legal heirs of the other petitioners. O.P. is also directed to pay Rs.50,000/-(Rupees fifty thousand) for the deficiency of service and also for cost of the petition immediately. The amount is to be paid within one month,  if not paid will carry interest @ 9% P.A.  Supply copy to the parties.        
        
10.                      A N N O U N C E D

SRI A. PAL
PRESIDENT,
DISTRICT CONSUMER  DISPUTES 
REDRESSAL FORUM,
WEST TRIPURA,  AGARTALA.

    SHRI. B. BHATTACHARYA,
MEMBER,
    DISTRICT CONSUMER DISPUTES     
REDRESSAL FORUM, 
     AGARTALA, WEST TRIPURA.