DATE OF FILING -2.1.2013
DATE OF DISPOSAL-24.6.2014
O R D E R
Mrs.Minati Pradhan,Member
The factual matrix leading to filing of the present consumer complaint by the complainant are that she is the legal heir as well as the nominee of her husband who had procured an insurance policy from the Opposite Party No.1 during his life time bearing Policy No.C-207020317 under basic plan viz. ‘Tata AIG Life Shubh Life’ on 11.10.l2010. The yearly premium was Rs.40,157.00 against sum insured of Rs.1,90,000/-. The policy was accepted after fulfilling all formalities about the state of health. But while the policy in force, the complainant was diagnosed of Lungs Cancer on 10.1.2011 and during his treatment he died on 11.05.2011. Thereafter, the complainant being the nominee applied in claim form on 17.11.2011. But the Opposite Parties repudiated the claim on 21.3.2012 without valid reason. Finding no other way out, the complainant has come up with this consumer complaint before this Forum seeking relief under Section 12 of the Consumer Protection Act,1986 praying therein for a direction to the Opposite Parties for payment of insured amount of Rs.1,90,000/- together with interest and compensation of Rs.30,000/- for the mental agony and harassment suffered by her .
2- The Opposite Parties have represented through learned counsel and filed the written version jointly wherein it has prima-facie raised objection regarding non-maintainability of the case on the ground that the complainant has made baseless and misconceived allegations. However, it is admitted that the husband of the complainant Late Bijaya Kumar Mohanty (hereinafter referred to as ‘the deceased’) during his life time having understanding the terms and conditions of the product ‘Tata AIG Shubh Life Plan’ had availed an Insurance Policy bearing No.C-207020317 on 11.10.2010. The complainant was the nominee of that policy. The policy was commenced from 25.10.2010 and the term was for 10 years and the premium was fixed at Rs.39,748/- for the sum assured Rs.1,90,000/-. While accepting the proposal form of the complainant, the complainant had given reply to certain questions put by the Opposite Parties regarding his health. The complainant had denied to have any disease like diabetes, thyroid disorders,cancer or any other hormonal disorder. The complainant informed the Opposite Parties about the death of the deceased on 11.5.2011 and the Death Claim was received by the Opposite Parties on 17.11.2011. It is further stated that the complainant on 6.2.2012 had given a statement to the Opposite Parties that the deceased was diagnosed of diabetes mellitus since 2008 and was on insulin regularly as per Doctor’s advice. The complainant has also provided with the certificate from Dr.Narusingha Charan Dash and Swasthya Bikash Sammittee, M.K.C.G.Medical College,Berhampur. While considering the death claim of the complainant the Opposite Parties came to know that the deceased had concealed the material facts regarding his treatment for diabetes. Since the procurement of insurance policy is based upon utmost good faith and the complainant knowingly availed the insurance policy without disclosing his status of health to the Opposite Parties. Since the deceased had procured the policy violating the basic terms and conditions of the policy, the death claim of the complainant was repudiated and informed to her vide letter dated 21.3.2012. Under such circumstances, the Opposite Parties have contended that there is no ground of the complainant to file this case for which it is prayed for dismissal with cost. In support of their case the Opposite Parties in their written version have cited voluminous decisions of the Apex Court, National Commissions and different State Commissions
3- In support of her case, the complainant has filed certain documents which are marked Annexure-I to Annexure-VIII. On the other hand, the Opposite Parties have filed a series of documents which are marked Annexure-1 to 5 respectively.
4- On the date of hearing, we heard the learned counsels appearing for both the parties at a length. We have also gone through the written notes of arguments filed by the respective parties. We have also minutely gone through the case along with relevant documents filed on record. It is not disputed that the deceased had availed a policy from the Opposite Parties bearing No.C-207020317 on payment of modal premium of Rs.39,748/-annually for the sum insured Rs.1,90,000/- for a period of 10 years. The date of commencement of the policy was 25.10.2010. It is also not disputed that during the policy in force the husband of the complainant died of lungs cancer on 11.5.2011. It is also not in dispute that the complainant is the nominee of the deceased and she had filed claim form on 17.11.2011. But the Opposite Parties have repudiated the claim of the complainant on the ground of mis-representation and non-disclosure of material fact of health of the deceased at the time of signing the proposal form.
Therefore, in the instant case only point remains for determination as to whether repudiation of claim made by the Opposite Party is justified or not and what relief the complainant is entitled to get?
5- It is averred by the learned counsel for the complainant that the Opposite Parties are to prove on the statement dt.6.2.2012 given by the complainant that the deceased was diagnosed of diabetes mellitus since 2008 and was on insulin regularly as per doctor’s advice. It is also argued that onus lies on the Opposite Parties to prove that on 14.3.2012 the Opposite Parties got another declaration from the complainant wherein she confirmed that the deceased was suffering from diabetes mellitus since 2008. On the other hand, it is contended and refuted the allegations made by the complainant as above. In this respect the Opposite Parties have filed copies of the letters, medical treatment reports of the deceased. While the proposal form the deceased had denied that he had any of the disease like diabetes, thyroid disorders or any other hormonal disorder. He had also denied that in the last 5 years he had never attended any doctor or any other medical facility for investigation or diagnostic tests such as x-ray, ultrasound, CT scan, biopsy, ECG blood or urine ,etc. The complainant in her letter dt.14.3.2012 addressed to the Manager, Claims department has informed to the Opposite Parties that the deceased was in diabetic condition since 2008 and taking insulin regularly as per doctor’s advice. It is also reported by the complainant( in Annexure-4 O.P series ) that the complainant was smoking earlier, attacked with PTB during 2004 and completed the full course of ATT, reported diabetes during 2008 and was regularly taking insulin as per doctor’s advice. The statement was submitted to Opposite Parties in presence of two witnesses. Moreover, the report of the Swasthya Bikash Samittee,M.K.C.G.Medical College,Berhampur reveals that the complainant was under treatment of diabetes. It is also clear from the report of Dr.Nrusingha Ch.Dash of dt.25.12.2010 as filed by O.Ps the deceased was adviced for CT Scan and other tests.
6- From the above documents it is clear that the complainant’s husband was under medical treatment while signing the proposal form and he had concealed such material facts and did not disclose it against the column meant for declaration. From the above admitted facts, it is beyond doubt that the deceased had violated the terms and conditions of the policy for which we opine that the repudiation of claim made by the Opposite Parties is justified. Therefore, the complainant is not entitled for any relief as prayed for in her petition of complaint.
7- To substantiate the case of the opposite parties, we have referred to the decision of the Hon’ble National Commission,New Delhi reported in 2002(3)CPR 79 in the case of The Senior Divisional Manager,LIC of India and others Vrs. Smt. J.Vinaya wherein it is held that if the policy holder withheld material information regarding health at the time of effecting insurance, the policy is deserved for repudiation.
8- In view of the above findings, we order that the present consumer complaint filed by the complainant have no merit for which we dismiss the case without any order as to cost.
Copy of the order be furnished to the parties free of cost.
Dictated and corrected by me on this 24th day of June,2014.
I AGREE(MEMBER) MEMBER
( Dr.N.Tuna Sahu) (Mrs.Minati Pradhan)
