DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

CASE   NO:   CC- 37 of 2019

 

Smt. Gayetri Biswas (Sarkar),

W/O. Lt. Tapan Sarkar,

Resident of Village & P.O.-Lankamura,

P.S. -West Agartala,

Dist.-West Tripura, 799009….......................................................................Complainant.

 

 

-VERSUS-

 

 

1. The Branch Manager,

SBI Life Insurance, Orient Chowmuhani, Agartala

West Tripura. 

 

 

2. The Manager, SBI, 

TLA House Branch, Colonel Chowmuhani,

Agartala, West Tripura, Pin-799001......................................................... Opposite Parties.

 

 

 

   __________PRESENT__________

 

 SRI RUHIDAS  PAL

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

      WEST TRIPURA, AGARTALA. 

 

DR (SMT) BINDU PAL

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION, 

  WEST TRIPURA,  AGARTALA.

 

SRI SAMIR  GUPTA

MEMBER,

  DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA. 

 

C O U N S E L

 

 

For the Complainant : Sri Kousik Nath,

  Smt. Aradhita Debbarma,

  Advocates.

 

For the O.P. No.1    : Sri Arindam Ray,

  Advocate. 

 

For the O.P. No.2 : Sri Prabir Saha,

  Advocate. 

 

JUDGMENT  DELIVERED  ON : 03 /06/2022.

J U D G M E N T

          The Complainant Smt. Gayetri Biswas (Sarkar), set the law in motion by presenting the complaint petition U/S 12 of the Consumer Protection Act, 1986  complaining against the O.Ps. for deficiency of service. 

The Complainant's case, in brief, is that the Husband of the Complainant died on 15/08/2018.  After the admissible benefit as per law and with such financial benefits, Lt. Tapan Sarkar took a Life Insurance Policy from the O.Ps. i.e. SBI Life Insurance Policy vide Policy No.35700892008 and customer ID No.28387776 the policy ought to have settled in favour of the Complainant i.e. wife of the Policy Holder Lt. Tapan Sarkar. Unfortunately without settling the policy, by giving the assured sum under the said policy to the Complainant i.e. wife of the insured, the O.Ps. refunded an amount of Rs.19,062/- It has been made in violation of the terms and condition of the aforesaid policy of Lt. Tapan Sarkar. Thereafter, the Complainant submitted representation to the Branch Manager, SBI, TLA House Branch, Agartala on 12/04/2019. The Complainant after giving entire factual matrix requested the Branch Manager, to settle the claim arising out of the Policy No.35700892008 due to the death of the Policy Holder but no response has been made by the O.Ps. The O.Ps. has failed to discharge the contractual obligation arising out of the aforesaid policy. The O.Ps. have failed to render the assured service to the Complainant on the basis of the Policy which was purchased by deceased Tapan Sarkar.  Thereafter, the Complainant filed a petition before the appropriate authority expressing her desire to discontinue the said Insurance Policy and also prayed for refund of the money of the premium. Now, she is seeking the refund of her premium money along with interest and compensation. 

Hence, the Complainant filed her complaint. 

2. On the other hand O.P. No.1 & 2 contested the case by filling written statements. 

        In the written statement of the O.P. No.1, SBI Life Insurance stated that there is no cause of action for filing the complaint. O.P. No.1 offers individual insurance scheme, wherein each individual to be insured relying on the information so furnished. The Company grants insurance cover on the principle of UTMOST GOOD FAITH. Any suppression of material facts in the proposal form will render the insurance cover invalid.  In the instant case, the Deceased Life Assured Tapan Sarkar committed a breach of the principle of Utmost Good faith by suppressing the material fact that he was suffering from Diabetes, Mellitus, Chronic Kidney disease and Liver disease and was under treatment for the same prior to the date of commencement of risk. At the time of signing the proposal form on 14/05/2018, he replied in negative to the relevant questions. O.P. No.1 did not disclose in the proposal form and procured the insurance policy fraudulently. 

        In the written statement of the O.P. No.2 submitted para-wise reply to the complaint in seritem. Mostly, O.P. No.2 denied the dispute and averred that the instant complaint is false and concocted and it is liable to be dismissed. Moreover, it is averred that the Commission does not have jurisdiction to entertain the instant complaint as there is hopelessly barred by law of limitation nor any deficiency in service on their part. The SBI, Life Insurance was direct connection between State Bank of India as well as SBI, Life Insurance, though the said SBI, Life Insurance are the separate wings of the SBI. The Husband of the Complainant took a Personal Loan for amounting to Rs.6,20,000/- vide Loan Account No.37696529958 and though, the husband of the Complainant namely Tapan Sarkar(Now Deceased) during the pendency of the said loan, made a policy under the SBI, Life Insurance Annually premium was Rs.19,062/- and said Tapan Sarkar gave only one premium. O.P. No.2 stated that Deceased of Tapan Sarkar, though was suffering various ailments specially in Kidney Disease and by concealing the said fact, though made the said insurance policy by giving a single premium for the said policy and within after 3 months said Tapan Sarkar expired due to the said decease and according to the SBI, Life Insurance Policy rules, if in the subsequent even, if the surveyor report reveals that person concerned who make the policy by concealing his actual disease the SBI, Life Insurance wings reject the said policy and handed over the premium only and the Complainant also received the said policy premium which was given by said Tapan Sarkar.   

        So, the complaint is liable to be dismissed.                                                                                 

EVIDENCE ADDUCED BY THE PARTIES:-

Complainant has examined herself as PW-I and she has submitted her examination-in-Chief by way of Affidavit. In this case the complainant produced 5 documents comprising 9 sheets under a Firisti dated 22/05/2019. The documents are namely copy of the Insurance Policy, Copy of the Statement of Account, Copy of the Death Certificate, Copy of the Survival Certificate & Copy of the Representation dated 12/04/2019 and 16/04/2019. The complainant was cross examined by the O.P. side. 

    On behalf of the O.Ps. one witness namely Sri Shirshendu Das, Works as Pvt. Employee of SBI Life Insurance Co. Ltd, was examined. The said witness has produced 1 documents comprising 03 sheets under a Firisti dated 21/03/2022. The documents are namely Copy of Medical Certificate of cause of Death No.3898 dated 15/08/2018. On identification the documents have been  marked  as Exhibit A Series. The witness of the O.P. was not cross examined by the Complainant side as it is a summary trial.              

POINTS TO BE DETERMINED:-

    On perusal of the pleadings of both parties and having regard to the evidence adduced by the parties, the following points are to be determined:

     (i). Whether there is deficiency of service on the part of the O.Ps. towards the Complainant?

     (ii) Whether the complainant is entitled to get any compensation/ relief as prayed for?

ARGUMENTS OF BOTH SIDES 

            At the time of argument Complainant was absent even Counsel of the Complainant also absent. 

          On the other hand Learned Counsel Mr. Arindam Ray was present on behalf of the O.P. No.1 and Mr. Prabir Saha was present for the O.P. No.2. We heard both the Counsels. They submitted that there is no negligence or deficiency in service on the part of the O.P. No.1 & O.P. No.2. The Policy was taken suppressing the real facts that the insured was suffering from Diabetes, Mellitus, Chronic Kidney disease and Liver disease and was under treatment for the same. Since there was a suppression of facts and the terms and condition was violated, the death claim benefit was repudiated as per terms and conditions of the Policy and the premium amount of Rs.19,062/- was refunded to the Complainant's account in the TLA House Branch on 26/02/2019 and the decision repudiation was communicated to the Complainant vide letter dated 06/03/2019 and the repudiation decision was upheld by the review committee. Both Counsels further submitted that the DLA failed in his duties towards full disclosure of material facts that he was suffering from Diabetes Mellitus, Chronic Kidney Disease and Liver disease. He also committed the breach of the doctrine of UTMOST GOOD FAITH. There was no harassment as well as deficiency in service. 

        So claim petition is liable to be dismissed with cost.                                                  

6. DECISION AND REASONS FOR DECISION:                                     

         Both the points are taken up together for convenience. 

           We have carefully gone through the pleadings submitted by both parties. We have carefully gone through the examination-in-chief on affidavit submitted by both parties as well as cross examination of the Complainant. 

  On perusal of the pleadings we find that there is no dispute in respect of issuance of Policy. The dispute only that the insured suppressed the material facts at the time of purchasing the Policy. On perusal of the examination-in-chief on affidavit submitted by the Complainant we found that nowhere in her examination-in-chief on affidavit stated about the illness of her husband. In her cross examination she admitted that she has received Rs.19,062/- from the O.P. No.1 without any protest. She denied the suggestion that in the year, 2016 her husband's health condition was not good and he used to take leave for medical treatment. 

          From the evidence of Sri Shirshendu Das (OPW) we found that the SBI Life (O.P. No.1) offers an individual insurance scheme, wherein each individual has to insured furnish full information or his/her personal and family history, health and habits, income, date of birth, and details of existing insurance cover with all information. Relying on the information so furnished, the company grants insurance cover on the principle of UTMOST GOOD FAITH. Any suppression of material facts in the proposal will render the insurance cover invalid in respect of individual insured member. At Para-14 of Examination-in-Chief of OPW he stated that as per the medical records of Medica Super Speciality Hospital, Kolkata, it is clear that DLA had a known case of DM and CKD(Chronic Kidney Disease) and as per the medical record dated 12/08/2018, it clearly mentioned that DLA was diagnosed with Chronic Kidney Disease prior to purchase of policy. O.P. No.1 submitted the copy of medical certificate in respect of cause of death which is collected by them and the documents are marked as Exhibit-A series. In the medical certificate of cause of death, it is specifically mentioned that there was Septic Shock with Multiorgan faillure, Pulmonary Tuberculosis, CKD & Diabetes. 

        It is crystal clear from the evidence discussed above that the insured purchased the Policy suppressing his disease. He has violated the terms and condition of the proposal. The said intentional non-disclosure of material facts goes to the root of the matter vitiating the subject policy and rendered it invalid, void-ab-initio and unenforceable. There is settled principles of law that intentional suppression of past medical history indicates breach of contract of insurance policy.

7.    After over all appreciation of pleadings as well evidence adduced by the parties, we are in the opinion that the Complainant suppressed material facts at the time of entering into the insurance contract. So, we do not find any deficiency in service on the part of the O.Ps. Hence, complaint is dismissed as devoid of merit. No costs. 

Supply a certified copy of the judgment to both the parties  free of cost. 

 

Announced.

 

 

 

SRI  RUHIDAS  PAL

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA

 

 

 

 

 

DR (SMT)  BINDU  PAL

MEMBER, 

DISTRICT CONSUMER DISPUTES 

REDRESSAL COMMISSION, 

WEST TRIPURA, AGARTALA

 

 

SRI SAMIR  GUPTA

MEMBER,

  DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA.