S. S. ALI, Member

                                  The complainant’s case in brief is that the complainants husband Basudev Guria, since deceased took a house building loan of Rs 800000 /- from the Bank the opposite party no2. As per bank there was a loan condition for which the complainant’s husband took a life insurance policy from the Tata AIG (AIA) Life insurance being no UGML 000001,through the opposite party no1, by paying premium thereto from 27-08-11. Unfortunately the said Basudev Guria died on 14-03-12 due to acute cerebral hemorrhage leaving behind him his wife, the complainant as the nominee. The complainant as nominee claimed the insured amount from the op no1.but the same had been repudiated by the op no 1 by a letter dated 30-06-14 for which this case has been filed for relief.

                                    Both the opposite parties entered appearance and filed their WV as well as their WNA. The opposite party no 1, filed his affidavit in chief but the witness has not been cross-examined by any of the contesting parties nor tendered before the forum, hence the same can not be considered while delivery of judgement.

                                    The opposite party no2 stated in its WV that the borrower ie Basudev Guria since deceased took a HBL A/C covered under Group Insurance scheme for the benefit of HBL borrower of op no2 under tie-up Arrangement with op no1. (GRIHA MANGAL) scheme. In consideration of Application for enrolment and premium paid the said borrower is insured under subject to the terms and condition of TATA AIG Life Total Suraksha being policy no. UGML 000001. issued to Allahabad Bank by the op no 1. on Sept 14,2011. Further more the op no2 states that it is the prime liability of the Insurance company to verify the details of the insured before issuance of any policy by its panel of doctors. The opposite party no1in his WV stated that the said policy was taken by concealing  and suppression of material facts. The opposite party no1 also stated that the contract of insurance including Contract for life insurance are contract UBERRIMA FIDES ie every material fact must be disclosed. It further states that as per IRDA 2002 a form is to be filled up by the proposer of insurance by furnishing all material details required by the insurer to decide whether to accept or decline the risk of insurance. If the proposer had  knowledge of such fact ,he is obliged to disclose its particular while answering questions in the proposal form, which has not been done by the insured in this case and as such the case is liable to be dismissed.

                                    We have gone through the petition of complaint, w/v and w/n/a and the documents filed the parties.

                                    The proposal form filed on behalf of the op no1, goes to show that the insured had answered all the questions regarding the HEALTH DETAILS OF THE PROPOSED INSURED. a physicians statement issued by Dr Pradip Bhattacharya on behalf of Tata AIA LIfe Insurance Company Limited dated 17-12-12  which was  issued after 9 months after the death of the insured. The registered Doctor stated in his statement that he had been treating the patient for5/6 years whereas his first and last day of visit was on 14-3-12,which is self contradictory.,as he has issued the death cerficate of the insured. Everywhere it is seen that cause of death was Acute Cerebral Haemorrage and not due to Diabetese Mellitus or Hypertension. It cannot be said that Diabetese or Hypertension is the only cause of Cerebral Haemorrage, as such cerebral haemorrage can lead to death even to persons not suffering from diabetes or hypertrnsion. So it cannot be said that the insured suppressed material facts at the time of taking insurance. Moreover, it is the duty of the insurance company to check the medical history of the insured  by their panel of doctors before issuing the policy, but in this case the op no 1  was only interested to receive the premium without following any duty.

                                    The insurance company wrongly repudiated the claim of the complainant. The Ld Advocate on behalf of the complainant argued that the op no1 had not given any evidence of any expert, in support to that he filed a finding of the Hon’ble National Commission wherein Oriental insurance vs Baby Simran Kaur 2014(2)CPR 504(NC) wherein it has been held that pre-existing disease must be proved by expert opinion.

                                    Moreover the insured was never hospitalised for the diseases he suffered as stated by the op no1. The op no1 failed to prove his case as observed by the Punjab State commission in appeal 2009(9)CPR 423 that Hypertension could not be said to be a material disease and  the insurance company would not be justified in repudiating the claim on the ground of suppression of material facts. As such we are of the opinion that the op no1 is not  justified in repudiating the claim of the complainant ,ie the nominee of the insured Basudev Guria and there is deficiency in service on the part of the op no1 since the insurance company wrongly repudiated the claim of the complainant. As such the complainant is entitled to claim.

                                    Hence, it is,

Ordered

            that the instant C.C. case 55 be and the same is allowed on contest against the OP no 1 and dismissed against OP no 2.  The opposite party no 1 shall make payment of RS 800000/- to the nominee (complainant) of Basudev Guria since deceased, along with compensation of Rs 20000/- and litigation cost of Rs 2000/- within 40 days from the date of this order, failing which the complainant is at liberty to execute the case as per law, in which case the op no1 Insurance company have to pay interest @ 8% p.a. from the date of order to the complainant till compliance of this order in toto.