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Smt Rekha Rani Dey Roy filed a consumer case on 05 Jan 2016 against The Branch Manager Tata life Insurance Corporation Ltd.And Other in the West Tripura Consumer Court. The case no is CC/14/79 and the judgment uploaded on 12 Jan 2016.
DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA
CASE NO: CC- 79 of 2014
Smt. Rekha Rani Dey(Roy),
W/O- Late Ajit Kumar Roy,
Devinagar, P.O. & P.S- Ranirbazar,
District- West Tripura. ............Complainant.
______VERSUS______
1. The Branch Manager,
Tata AIA Life Insurance Corporation Ltd.,
(Represented by its Authorized person),
Registered & Corporate Office
at 14th Floor, Tower, A-Peninsula Business Park,
Senapati Bapat Marg, Lower Parel,
Mumbai- 400013.
2. The Branch Manager,
Tata AIA Life Insurance Corporation Ltd.,
Agartala Branch, 1st Floor, 1 –Mantribari Road,
Agartala, West Tripura. ..........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 : Sri H. K. Bhowmik,
Sri Sanjib Majumdar and
Sri Amit Saha,
Advocates.
For the Opposite Party : Sri Swarup Pandit,
Advocate.
JUDGMENT DELIVERED ON: 05.01.16
J U D G M E N T
One Rekha Rani Dey filed the complaint U/S 12 of the Consumer protection Act alleging that Tata AIA Life Insurance Company did not pay the death benefits of her husband on the death of her husband Ajit Kr. Roy by cardiac arrest. It is stated that her husband purchased the policy from the O.P. for sum assured of Rs.1,06,000/- on 30.11.11. Premium of Rs.10,149/- was paid. Her husband died on 16.05.13 by cardiac arrest. She claimed the death benefit but the O.P. Insurance company refused to entertain her claim and said that the policy was repudiated for suppression of material fact by her husband at the time of purchasing the policy. Petitioner stated that her husband did not suppress any material fact as he was well and good at the time of purchasing the policy and died on sudden cardiac arrest. It is alleged that by refusing to pay the death benefit of her husband Insurance Company Opposite party failed to give proper service therefore she prayed before this Forum for appropriate relief for giving direction to give the death benefit and also compensation for harassment, deficiency of service.
2. Opposite party Insurance Company Tata AIA appeared and filed written objection through attorney, authorized signatory of the Tata AIA Life Insurance Company. It is contended that as per terms and conditions investigation was conducted on the claim of the petitioner. In the course of investigation it was established that deceased life assured suffered from Hypertension at the time of purchasing the policy. Dr Arindam Datta and others treated him and found the ailment but the life insured suppressed the material fact at the time of purchasing the policy. Company can repudiate any claim on disclosure of pre-exsisting disease or any material information. Therefore, the claim was repudiated properly. Petitioner therefore is not entitled to get any death benefit on the death of life assured.
3. On the basis of rival contention as put forward before us following points cropped up for decision.
(i) Whether the Petitioner being legal heir and nominee of the deceased insured is entitled to get death benefit of the policy?
(ii) Whether the O.P. Insurance Company is liable to pay compensation for deficiency of service?
Petitioner side produced;
Exhibit 1- Policy of Insurance,
Exhibit 2- Premium receipt,
Exhibit 3- Letter issued by Tata AIA,
Exhibit 4- Copy of Advocate Notice,
Exhibit 5- Death Certificate,
Exhibit 6- Medical Certificate as to cause of death,
Exhibit 7- Survival Certificate.
Petitioner side also examined one witness i.e., Rekha Rani Dey.
4. O.P., Tata AIA also produced photocopy of the Policy. Proposal form, Premium deposits, Policy information, other terms and conditions, prescriptions issued by different doctors in favour of deceased Ajit Kr. Roy in different time also pathology report, hematology report (all photocopies) are not exhibited.
Opposite party examined no witness in this case though sufficient time & opportunity given to produce evidence.
5. On the basis of documents and evidence on record before us we shall now determine the points.
FINDINGS AND DECISION & REASONS FOR DECISION;
6. In this instant case it is admitted that predecessor of the petitioner Ajit Kr. Roy purchased the policy from Tata AIA. It is also admitted that the sum assured was Rs.1,06,000/- and premium was Rs.10,149/-. Premium also paid as supported by the premium receipts. We have gone through the Exhibit 1, Policy of Insurance and premium deposit receipt and it is established that Ajit Kr. Roy, the predecessor of petitioner Rekha Rani Dey was the policy holder. Ajit Kr. Roy was survived by the petitioner and her minor son Joy Krishna Roy who is 13 years old. The cause of death Ajit Kr Roy as per Exhibit-6 is cardiac respiratory failure. The claim of the petitioner was repudiated by the company by letter dated 6th September, 2013 vide Exhibit- 3. It is informed that on the investigation it was established that life assured was suffering from Hypertension, Hyperthyroidism prior to applying for Insurance. Such information was not given in reply to the specific question in the application dated 28th November, 2011. So, it is clear that before us that the claim was repudiated on the basis of investigation report. From the photocopy of documents before us it is clear that Ajit kr. Roy attended some doctors before purchasing the policy from Tata AIA. Prescription of Dr. Arindam Datta (photocopy) is dated 26.07.2009 another X-Ray report is dated 09.02.2009. Another report of diagnostic Centre is of 2009. The prescription of Sailesh Bhattacharjee is 20.12.2011 after purchasing of policy. No doctors or chemical examiner produced. Lal Path report dated 18.04.12 after purchasing policy. Opposite party produced no evidence to support this photocopy. Even the person who investigated also not appeared. Investigation report is not produced before us. By producing photocopies of some prescriptions and also investigation report of a investigator the Insurance company by the letter dated 6th September (Exhibit- 3) concluded that the life assured, Ajit Kr. Roy suppressed the material fact about his illness. It is true that within 2 years of purchase of the policy Ajit Kr. Roy died. But before death no question raised by the insurance company about any false declaration made by life assured or about any medical certificate wrongly furnished about the state of health. Insurance company raised about the question of suppression of material fact about illness. So, burden lies with them that insured fraudulently made false statement about his state of health. Only photocopy of prescription issued by Dr. Arindam Datta is not sufficient to support that life assured Ajit Kr. Roy had been suffering from Hypertension or heart ailment at the time of purchasing the policy. No evidence given by the Insurance company to support such contention. Non-disclosure of material fact about illness is definitely right cause of repudiation of the claim. But that nondisclosure is to be proved by the Insurance company before this Forum. In Nalini Vrs. LIC of India (2008) CPJ 144 it is held that suppression of serious ailment pertaining to heart, brain or kidney make the repudiated claim justified. In this case opposite party miserably failed to prove that the life assured Ajir Kr. Roy had been suffering from serious ailment pertaining to heart, brain, kidney at the time of purchasing the policy. Repudiation therefore, in our considered view, is illegal. The representation made by the complainant was not taken into consideration by the Insurance company. This Forum can not support it. Therefore, we are of considered view that petitioner being nominee, legal heir along with her minor son are entitled to get death benefit as reflected in the policy. Petitioners are also entitled to get Rs.20,000/- for harassment, deficiency of service by the opposite party Insurance company.
7. We therefore, direct that the O.P. Insurance Company is under liability to pay the death benefits to the petitioner being legal heir and custodian of her minor. Insurance company is also directed to pay Rs.20,000/-(rupees twenty thousand) to the petitioner for deficiency of service and harassment.
8. In view of our above findings the petition filed U/S 12 of the Consumer Protection Act is allowed. The O.P. Insurance Company is directed to pay death benefit to the petitioner being legal heirs long with her minor son and also pay Rs.20,000/-(Rupees twenty thousand) for deficiency of service. The amount is to be paid within 2(two) months, if not paid it will carry interest @9%. Supply copy to the parties.
A N N O U N C E D
SRI A. PAL
PRESIDENT,
DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM,
WEST TRIPURA, AGARTALA.
SMT. DR. G. DEBNATH,
MEMBER,
DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM,
AGARTALA, WEST TRIPURA. SHRI. B. BHATTACHARYA,
MEMBER,
DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM,
AGARTALA, WEST TRIPURA.
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