Judgment On 29.12.2006
Present: Sri B.K. Samanta, President
Sri Kumar Mukhopadhyay, Member
Smt. Jyotsna Sarkar, Member
This is a case for claim and compensation.
The Complaint’s case in short is that the Complainant’s son dipak Kr. Giri made a policy being No. 433066216 on 29.02.2000 for Rs.31,000/- under the OP. The Complainant is the nominee of the policy. The said policy was lapsed due to non-payment of premium and subsequently renewed on 06.07.20012. The said Dipak Kr. Giri died on 23.10.2003. The complainant being nominee prayed for sum assured in February 2004. But the OP repudiated the claim on 15.10.2004 stating that at the time of renewal of the policy Sri Dipak Kr. Giri suppressed the truth about his health. The statement of the OP is false.
So the Complainant prays for sum assured i.e. Rs. 31,000/- along with 20% interest over the amount and compensation Rs. 20,000/-.
The OPs contested the case by filing a written statement wherein they stated that the case is not maintainable. They denied the material allegation of the case and stated that one dipak Kr. Giri made a policy being no. 433066216 on 28.02.2000 for Rs. 31,000/- and the said policy was lapsed due to non payment of premium of the policy. The said policy was revived on 19.09.2003 by paying premium and on the basis of declaration of good health. The life assured died on 23.10.2003 due to Cardio respiratory Failure in a case of Multi drug resistance tuberculosis as per Medical Officer, Bhagawanpur Rural Hospital, Bhagawanpur-I, Purba Medinipur in claim form “b”. The doctor also stated that the life assured had been suffering from the disease for two years. The life assured had been suffering from the disease for two years. The life assured had suppressed the treatment of tuberculosis form April 2000 as it is evident from the prescription dt. 16.05.2001 of S.S.K.M Hospital. He was also treated at Apex General Hospital from August 2000. The said policy was revived suppressing the material information regarding treatment and ill health. The claim was repudiated on 15.10.2004 on the ground of deliberate and mis-statement and withholding material information regarding his health, at the time of getting the policy revived.
Under the circumstances, the OPs pray for accepting the written objection.
Points for decision
On the basis of above pleading of the parties, the following points are taken up for consideration.
- Is the case maintainable?
- Is there any deficiency in service on the part of the OPs?
- Is the complainant entitled to any relief as prayed for?
Points No.1 It Is admitted by both the parties that Sri dipak KIr. Giri was the policy ho0lder being no. 433066216 under the OP in which the complainant is the nominee. It is also admitted by the OPs that the said Dipak Kr. Giri died on 23.10.2003 and the complainant made a claim before the OP for the sum assured. So we can say that the complainant is the consumer under the OP according to consumer protection Act. Thus the case is maintainable.
Points No.2 It is admitted by both the parties that the policy was revived on 19.09.2003 after due payment for premium for the lapsed policy of Sri dipak Kr. Giri being no. 433066216. The complainant filed the letter of repudiation dt. 15.10.2004. It is a fact that at the time of revival of the policy the complainant submitted declaration of good health. The said Sri Dipak Kr. Giri died on 23.10.2003. It is the case of the OP that as per declaration made by the complaint he was in good health at the time of revival of the policy. It is a fact that he was suffering from tuberculosis which can be seen from the Medical Attendants Certificate (Ext. A) and subsequently cause of death was Cardio Respiratory failure in a case of multi drug resistance tuberculosis. The medical paper submitted by the OPs support this aspect. It is no doubt in the declaration form the Complainant did not mention this aspect. As per decision reported in 2006(2) CPR-195, it has been clearly expressed in the judgement that “chest disease is not a permanent disease but a recurring one. Chest disease can never be the cause of death itself. Moreover, the immediate cause of death of the deceased was Heart Attack and there is no nexus between the cause of death of the deceased and the chest disease. Considering this it can not be said that there was suppression of material fact and therefore, liability of the insurance company arose under the policy. Thus, repudiation of claim is not justified. Further in the said judgement it is also stated that even for the sake of argument that the deceased might have been suffering from disease TB. Now TB is 100% curable disease and patients of that disease can survive for a longer period. Besides this the immediate cause of death of the deceased in the instant case was heart attack and not TB and there is no nexus between the cause of the death of the deceased and TB. The death of the deceased having not been connected with TB, it can not be considered to be material so far death of the deceased is concerned. Thus, it can not be said that there was suppression of material fact by the deceased. The repudiation of insurance claim can not be made merely on ground of non mentioning of chest disease in declaration form, specially when death occurred due to heart attack. In the instant case, the OP filed documents(Ext. A) in order to show that Sri Dipak Kr. Girir died due to cardio respiratory failure in a case of multi drug resistance tuberculosis. However, as per decision cited above we can say that non mentioning of TB in the declaration form can not be considered as suppression of material fact. As such, non-payment of insurance claim is no doubt deficiency of service on the part of the OP.
Point No.3. Based on the foregoing discussions and materials on record we are of opinion that the complainant is entitled to have insurance claim of Rs.30.000/- along with compensation.
Hence,
Ordered
That the case be and the same is allowed on contest against the OP. The Complainant is entitled to have insured sum Rs. 31.000/- along with compensation Rs.5.000/- from the OPs. The OPs are directed to pay the same by one month from this date failing which the complainant is entitled to have the same by way of execution through this Forum after expiry of the period mentioned above along with interest @8% p.a. from the date of filing this case till the date of payment.
