JUDGEMENT

          Complainant by filing this complaint has submitted that one Banku Behari Das, since deceased, during his lifetime was an employee of the Hooghly River Bridge Commissioners, a West Bengal Government Enterprise, having its office at Munshi Prem Chand Sarani, Kolkata-700021 in the post of Guard, Group-I, and till the date of his last hospitalization he was regular in his office.

          The said Banku Behari Das, since deceased, during his lifetime insured himself with Life Insurance Corporation of India (LICI) and purchased the policies which were issued by LICI from time to time, insuring the life of the said Banku Behari Das since deceased.  Practically he purchased 5 policies serial No.1) Policy No.41469172 and date of issuance 15.09.2001 and sum assured Rs.40,000/-, 2) Policy No.414691973, date of issuance 15.09.2001 and sum assured Rs.25,000/-, 3) Policy No.418785083, date of issuance-28.10.2006 and sum assured Rs.1,00,000/-, 4) Policy No.418785823, date of issuance-28.08.2009 and sum assured Rs.1,25,000/- and 5) Policy No.418786190, date of issuance-28.11.2010 and sum assured Rs.1,87,500/-.

          That on 02.12.2011 said Banku Behari Das died due to certain ailments like Septicemia and Abdominal Obstruction and was admitted at the Northland Nursing Home of 133, Bidhan Sarani, Kolkata-700004 and date of death he was aged about 43 years and his death was really unexpected to the members of his family and moreover before his penultimate hospitalization on 13.09.2011, he had never been admitted in any hospital for treatment of any disease whatsoever and as such on that particular date, for the first time in his life he was admitted in a nursing home namely, Northland Nursing Home of 133, Bidhan Sarani, Kolkata-4, for treatments of certain serious ailments, being advised by his consultant physician, Dr. Ashis Chatterjee and after admission in the said Nursing Home he was treated there for the ailments like intestinal obstruction and septicemia and as per Biochemistry Report he had his mild diabetes which has also detected, but the percentage of Random Sugar was not at all alarm and he was discharged on 22.09.2011 and after his discharge there from he was under supervision of the said consultant physician and ultimately the consultant physician issued a Fitness Certificate on 04.11.2011 after examining the patient thoroughly and thereby advised him to resume his normal work on and from 05.11.2011.

          After resuming his normal life step by step and joined his office also, but after few days of his joining at his office said Banku Behari Das, since deceased, suddenly became seriously ill and this time he was again admitted in ICU (Intensive Care Unit) of the said Northland Nursing Home under instructions of the said consultant physician, namely Dr. Ashis Chatterjee, but this time he could not recover from his ailments and ultimately died at the said Nursing Home on 02.12.2011and the cause of his death as recorded in the Death Certificate of the deceased was Septicemia.

          But during his lifetime he was physically fit and healthy person and he had never been hospitalized for treatment of any disease whatsoever and moreover he was not a patient of Blood Sugar/Diabetes and as such the immediate cause of death was for Cardio Respiratory Failure and antecedent of death was recorded therein as Septicemia.  On the date of death of said Banku Behari Das the present complainant his only sister Smt Anita Das and his brother Habu Das jointly inherited all the properties left by their deceased brother in equal share so they are jointly entitled to the benefits and proceeds of the above referred Life Policies and Banku Behari Das since deceased nominated his only sister Kumari Anita Das, as his nominee to collect the proceeds of the said policies from the insurer in case of his death before maturity of the said policies.

          Accordingly complainant submitted claim in respect of the said policies, the LICI had disbursed the sum assured against LICI Policy No.418785823, dated 28.08.2009 and 418786190 dated 28.11.2010 respectively.  But refused to make payment against the LICI policy No.418785823 dated 28.08.2009 and 418786190 dated 29.11.2010 respectively.

          In the repudiation letter of LICI signified the cause of repudiation to the effect “ we have sufficient evidence and reasons to believe that before taking the policies he had not in a state of good health as he availed leaves frequently on sickness ground as certified by the employer which he did not reveal in the proposal form while taking these policies and moreover the op no.3 has also stated that the deceased insured made regarding his health at the time of effecting the assurance on the grounds the authority has repudiated the claim raised by the undersigned and denied its liability under the aforesaid policies”.  In the said repudiation letter it is also noted “ in case you disagree and feel, we have not considered any particular fact or facts and circumstances, you may send your representation within a month from reconsideration of your claim tour Zonal Office at the following address and on receipt of the said letter of repudiation, complainant made a representation for reconsidering the same in respect of the said two policies and after that on receipt of the same by the LICI, the said authority vide its letter and from the statement of the said letter till date LICI Zonal Manager did not take any step or decide the same.  But ultimately they confirmed the repudiation on the ground before taking the policy, the health condition of the deceased was very poor and suppressing material facts and insured purchased the policies.  But anyhow op did not disclose what the causes are and in the above circumstances, complainant being aggrieved about their decision filed this case for released of the said policy amount with interest etc.

          Whereas op nos.1 to 4 by filing written statement submitted that the life assured expired on 02.12.2011 due to Septicemia and Type 2 Diabetes and prior to policy of deceased in the hospital on 13.09.2011 but the deceased life assured suffered from diseases which is evident from Claim Form B and (Medical Attendant’s Certificate dated 10.02.2012) and the treating Dr. D. D. Dey stated that the deceased life assured had taken treatment for Diabetes and Hypertension and it was observed long back and at Northland Nursing Home, the deceased life assured was treated for Sepsis and Diabetes.

          Further it is evident from Claim Form E that certificate by the Employer Hooghly River Bridge Commission supports that deceased life assured did not resume his duties on 05.11.2011 and deceased life assured attended his duty on 12.09.2011 and moreover on 12.09.2011 deceased did not join his duty as per certificate issued by his employer.  But Medical Attendant’s Certificate From B has declared that deceased life assured was the patient of Diabetes and Hypertension and history of such illness was for long back and that claim Form-B is submitted by the complainant and complainant relied upon the said document for lodging claim with LICI and in claim form B (B1) reveals that prior to admission of deceased to Northland Nursing Home on 26.11.2011, the deceased life assured had taken treatment in the said hospital for treatment of Septicemia with Diabetes.

          Moreover from the certificate issued by the Employer, it is found that complainant was on – 1) Commuted Leave from 18.08.2006 to 27.09.2006 – 41 days, 2) from 17.04.2008 to 26.04.2008 – 10 days Commuted Leave due to his illness, 3) from 27.04.2008 to 01.05.2008 – 5 days earned leave due to his illness, 4) from 04.07.2008 to 18.07.2008 – 15 days commuted leave due to his illness, 5) from 18.05.2009 to 23.05.2009 – 6 days commuted leave due to his illness and 6) from 24.05.2009 to 05.06.2009 – 13 days earned leave due to his illness.  Further from the certificate granted by doctor J.M. Hinger dated 28.09.2006 it is found that deceased life assured was patient of Psychosomatic Disorder and took leave on this ground from 18.08.2006 to 27.09.2006, the deceased life assured did not disclose all these diseases in the Proposal Form intentionally at the time of taking the policies in order to defraud the ops, though the deceased in the above facts.

          So, by practicising fraud upon the op, deceased life assured took the said policy and in the declaration deceased life assured again if any untrue or false statement is made in the Proposal Form, the contract shall stand null and void and all moneys which shall have been paid in respect of the said policy shall stand forfeited to the Corporation.  In the above situation, the claim under the present two policies were rightly repudiated for suppressing and material fact the other policies claim were released when same were prior to such illness and considering all the above fact and materials the claim was repudiated and there was no laches on the part of the op and for which the present complaint should be dismissed.

                                                   Decision with reasons

          In the present case after meticulous study of the complaint and written version and also relying upon the argument as advanced by the Ld. Lawyers both the parties and further considering the health condition of life assured Banku Behari Das because during his life time as an employee of Hooghly River Bridge Commissioners and its certificate dated 27.08.2011 issued by the employer of the said deceased it is undisputed fact that deceased 1) Commuted Leave from 18.08.2006 to 27.09.2006 – 41 days, 2) from 17.04.2008 to 26.04.2008 – 10 days Commuted Leave due to his illness, 3) from 27.04.2008 to 01.05.2008 – 5 days earned leave due to his illness, 4) from 04.07.2008 to 18.07.2008 – 15 days commuted leave due to his illness, 5) from 18.05.2009 to 23.05.2009 – 6 days commuted leave due to his illness and 6) from 24.05.2009 to 05.06.2009 – 13 days earned leave due to his illness and it is undisputed fact.  Further it is found from the certificate issued by Dr. Hinger dated 28.09.2006 which was submitted by the complainant wherefrom it is found that said insured Banku Behari Das had been suffering from Psychosomatic disorder time to time.  Moreover from 13.09.2011 to 22.09.2011 he was in the Northland Nursing Home with history of subject acute intestinal obstruction with Septicemia.  Further it is found from other documents that prior to 28.09.2009 and since 2006 deceased insured had been suffering from Hypertension and high Blood Sugar.  But in the proposal form in respect of the policy No.418785823 dated 28.08.2009 and 418786190 dated 28.11.2010, it is found that complainant knowing fully well about his pre-existing disease did not disclose that he had been suffering from such ailment from time to time.  Rather he mentioned that his health condition is good.  But considering the above ailments and leave of the deceased from 18.08.2006 to 14.07.2010 we have gathered that complainant was aware of his health condition that he had been suffering from sugar and blood pressure and also he time to time suffered from Psychosomatic disorder.  But he did not disclose it and no doubt it is suppression and non-disclosure of the material fact.

          But anyhow in the complaint, complainant has stated that his brother never suffered from any illness prior to his admission of Northland Nursing Home and he also stated in the application form that his brother physically condition prior to admission of the hospital was good.  But her all documents produced from employer of the deceased supports that he had been suffering from several diseases like High Blood Pressure, Blood Sugar, Septicemia, Psychosomatic diseases since 2006.  But all pre-existing diseases were not disclosed in respect of aforesaid two disputed policies proposal form which is no doubt as per contract is suppression of material fact and in this regard op’s Ld. Lawyer relied upon one ruling passed in R.P. No.2958/2008 passed on 21.01.2014 wherefrom we have gathered that it was obligatory on the part of the insured to give correct answer time of obtaining insurance policy and as insured the complainant in this case suppressed material facts regarding disease, regarding of leave and gave all false answers.

          So, deficiency was on the part of the deceased insured.  But in this case op’s doctor did not examine the insured at the time of purchasing the policy on the ground that insured did not disclose his any previous ailments regarding his health and moreover life assured was under obligation to give correct answers pertaining to health at the time of issuance of any policy and op has also not placed any record to ascertain that he had been suffering from Psychosomatic disorder, Septicemia and Hypertension and Blood Sugar including Diabetes.

          In this regard Ld. Lawyer for the complainant submitted that psychosomatic disorder is not at all disease but it is mental stress and anxiety.  So, it is not a disease at all and Psychosomatic disorder cannot be the cause of death.  In this regard Ld. Lawyer for the op produced one part of literature about Psychosomatic disorder and after considering that definition we have gathered that Psychosomatic disorder is a disease which involves both mind and body and it is specifically mentioned in the said literature that it is one kind of disease due to worse mental factors and it is one kind of mental illness and moreover such sore of diseases are jointly found in case of Blood Pressure with stress and anxiety and Blood Sugar and also for stomachs related diseases and such a disease is made worse for mental factors which causes stomach failures also.

          So considering the above definition and the previous treatment sheet of the deceased we have confirmed that complainant had been suffering from Psychosomatic disorder, Hypertension and Diabetes since 2006 and time to time he suffered from Psychosomatic disorder and deceased took leave on several occasions.  When that is the fact then there is no other alternative but to hold that insured deceased suppressed the fact of taking continuous leave time to time due to his illness and invariably ailment pertaining to his stomach are causes of Psychosomatic disorder, Blood Pressure and Blood Sugar and it is proved that he had been suffering from several ailments since 2006 and prior to taking this two disputed insurance policies on 28.08.2009 and 28.11.2010.  so according to the documents of the complainant, it is proved that deceased was suffering from acute diabetes and hypertension including Psychosomatic disorder which insured was fully aware at the time of taking out of those two policies.  But as per contract assured is at his under solemn obligation to make full disclosure and material fact which may be subject for insurer to take into account while deciding whether the proposal form should be accepted or not.  While making disclosure of the relevant fact it is the duty of the insured to state that they correctly furnished all the above fact.

          Now the Ld. Lawyer for the complainant submitted that prior knowledge about his ailments has not proved by evidence and no doubt in this case no other evidence is adduced by the op to show that insured had prior knowledge about his ailment which he had suppressed.  But in this regard we have also relied upon one ruling reported in AIR 1962 SC 814 wherefrom we found that repudiation of insured claim the insurer must satisfy the following conditions- 1) statement must be on material matter or must suppress fact which was material to disclose, 2) suppression must be fraudulently made by the policy holder and 3) the policy must have to know at the time of making the statement that it was false or he has suppressed facts which are material to disclose and considering that 3 conditions and the present materials it is found that evident is produced by the op from the Employer of the deceased and certificate materials are produced by the complainant in respect of medical certificate of their employer regarding the taking of leave after leave by the employer the deceased insured and certificate of suffering from Psychosomatic disorder from 2006 as produced by the complainant along with claim application and further report of the doctors of the employer are in record wherefrom it is found that insured has its  and produced sufficient material that insured had prior knowledge about his ailment what he had suppressed and in fact the op has repudiated the claim being satisfied about the material and non-disclosure of the health condition by the insured at the time of leave and it was suppressed fraudulently made by the policy holder and it was known to the policy holder that his statement was false.

           But he was aware that if the status of health would be disclosed in that case the policy could not be accepted.  So, he adopted such path and suppressed the material fact.  Another factor is that complainant is the sister of the deceased and fact remains that she was not aware of the fact that at the time of filing the application form for policy, the complainant submitted one answer sheet on 05.04.2013 and in that question answer complainant also suppressed all the material facts giving answer – No against 6 questions.  But there is no answer about the complainant regarding that.  So, it is clear that the complainant was also aware as sister of her brother’s health condition and practically her brother was suffering from several diseases since 2006 for which ultimately due effect of Hypertension, Blood Sugar, Psychosomatic disorder and ultimately he died due to intestinal disorder and there is nexus with such disorder and particularly the Psychosomatic patient are not given any insurance policy by the Insurance company.  If that would be disclosed in that case complainant’s brother must not get those two policies.  So, in the present case it is proved that there was continuous history of suffering from Hypertension, Blood Sugar, Psychosomatic disorder by the insured so, past diseases were within knowledge of the insured and so the entire declaration made by the complainant is false and fabricated and with due knowledge he suppressed the said fact and for which we are convinced to hold that op repudiated the insurance policy claim of the complainant after satisfying itself about the condition as laid down in AIR 1962 SC 8 (already discussed above), so, in view of the above fact we are inclined to hold that op insurance company has proved the allegation of suppression of material fact in the proposal form and their convenient evidence.  So, we are not in a position to interfere with the repudiation order made by the op.

          In the result, the complaint fails.

          Hence, it is

                                                         ORDERED

          That the complaint be and the same is dismissed on contest against op with cost of Rs.5,000/-.