DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

 

CASE   NO:   CC- 39  of  2022

 

Sri Nani Gopal Biswas,

S/O- Late Murari Mohan Biswas,

Nimbark, Bank Chowmuhani,

P.O. - O.N.G.C., P.S. - Amtali, 

District- West Tripura- 799014. ...........Complainant.

 

 

-VERSUS-

 

 

1. The Divisional Manager,

 

2. The Branch Manager,

 

3. Sri Khokan Chandra Sarkar,

 

4. Smt. Puja Das, Agent,

  District- West Tripura- 799035. .........Opposite Parties.

 

 

 

 

 

 

 

    __________PRESENT__________

 

  SRI GOUTAM DEBNATH

  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 O.Ps     :  Sri Niranjan Bal,

 

 

 

 

 

 

F I N A L    O R D E R

1. This case is filed U/s 35 of the Consumer Protection Act, 2019 by Sri Nani Gopal Biswas(here-in-after called “the Complainant”) against the (1)The Divisional Manager, Life Insurance Corporation of India Ltd., Silchar Division Office, Silchar, Assam(here-in-after called “the O.P. No.1”), (2) The Branch Manager, Life Insurance Corporation of India Ltd., Branch No.2, Krishnanagar, Agartala, West Tripura(here-in-after called  “the O.P. No.2”) and (3) Sri Khokan Chandra Sarkar, Administrative Officer, Life Insurance Corporation of India Ltd., Ranir Bazar, West Tripura(here-in-after called as the “the O.P. No.3”) and Smt. Puja Das, Agent, Life Insurance Corporation of India Ltd. (here-in-after called as the “O.P. No.4”) alleging deficiency in service on the part of the O.Ps. However, the name of the O.P. No.4 is deleted vide order dated 27.05.2022.

 

1.1 The case of the complainant in short is that the son of the complainant Sri Tridip Biswas had taken a policy on 13.01.2016 under Jivan Arogya Scheme and the date of expiry of the said policy is on 13.01.2035. The said policy is under coverage name of the father of the policy holder, Sri Nani Gopal Biswas and Mother of the policy holder, Smt. Manju Biswas.

1.2 During the existence of the policy in the month of July, 2017 and July, 2018 the complainant was treated his disease at Medica Super Speciality Hospital, Kolkata. And in the month of July, 2019 the complainant was treated at Peerless Hospitex Hospital and Research Centre Ltd., Kolkata for heart disease of spinal cord. 

1.3 All the relevant documents including the prescriptions, cash bills etc. were submitted before the O.P. No.3 for reimbursement of the treatment cost but the O.P. No.3 did not contact with the complainant.

On 18.11.2018 complainant submitted reimbursement bill for Rs.3,00,000/- and also for treatment cost of Rs.2,24,000/- to the O.P. No.1 and 2 through O.P. No.3 and 4 but the O.Ps did not settle the claim of the complainant.

 

1.5 Demand notice was also sent on 21.09.2020 claiming Rs.5,24,000/-. In reply to the demand notice the O.Ps No.1 and 2 sent a letter on 05.10.2020 that the bill is under examination.

1.6 By their letter dated 05.03.2021 and 09.03.2021 the O.P. repudiated the claim filed by the complainant. 

1.7 Hence, the complainant filed this complaint before this Commission for getting redress claiming Rs.5,24,000/-, cost of his treatment and Rs.1,00,000/- for mental agony, pain and harassment and also Rs.20,000/- as litigation cost. 

2. The O.P. resisted the claim of the complainant stating that the claim of the complainant  is not maintainable. It is also pleaded in the written statement that the insured was suffering from Pre-existing disease before purchasing the policy. However, this fact was not divulged in the proposal form. The claim of the complainant was repudiated on the ground of suppression of pre-existing disease.

3. Complainant submitted evidence on affidavit.

3.1 O.P. also submitted their evidence on affidavit.

 

4. Hearing argument the following points are taken up for discussion and decision:-

 

Decision  and  Reasons:-

5. The O.P. submitted medical certificate dated 09.06.2019 issued by Dr. Satyendra Saha wherein Dr. Saha opined that Nani Gopal Biswas had pre-existing disease like TDM as CKD i.e., Chronic Kidney Disease with C.A.D i.e., Corronary Artery Disease. This medical Certificate was allegedly forwarded to the O.P. by the claimant himself.

 

5.1 It is argued that at the time of taking the policy of insurance Nani Gopal Biswas did not divulge his pre-existing disease and meaning thereby the Insurance company had failed to exercise the option of choosing whether to enter into an agreement with Nani Gopal Biswas i.e., whether to issue such policy or not. It is no more Res-intigra that the policy of insurance is a contract of utmost good faith wherein the insured is liable to divulge the material facts with in his knowledge.

5.2 But the alleged forwarding letter although was written in the name of the complainant but it does not bear signature of the complainant. Similarly, the Medical Certificate allegedly issued by Dr. Saha in the name of the complainant also does not bear signature of the complainant. Hence, these papers are summarily rejected. As such, we do not find reason to reject the claim.

6. Both the points are decided accordingly against the O.P.

 

7. In the result, it is directed that the O.P. shall reimburse Rs.5,24,000/- to the complainant with a further sum of Rs.30,000/- as compensation including litigation cost within 30 days from today, otherwise this amount shall carry interest @ 7.5% P.A. from today till the date of actual payment.

8. The case stands disposed off. Supply copy of this Final Order free of cost to both the parties.     

Announced.

 

 

 

SRI  GOUTAM DEBNATH

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.