Tripura

West Tripura

CC/95/2015

Mrs. Shibani Guha. - Complainant(s)

Versus

The Zonal Manager Eastern Zonal Office & others. - Opp.Party(s)

Mr. D.P. Ghosh.

29 Jul 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA :  AGARTALA

 

CASE   NO:   CC- 95 of 2015

Mrs. Shibani Guha,
W/O- Late Amalendu Guha,
Ramthakur Ashram, Banamalipur, 
Agartala, West Tripura.            -Complainant.
    

-VERSUS-

1. The Zonal Manager,
Eastern Zonal Office,
Life Insurance Corporation of India,
4, Chitta Ranjan Avenue, Kolkata- 72. 

2. The Manager(CR),
Life Insurance Corporation of India,
Silchar Divisional Office,
Maherpur, Silchar- 788015. 

3. The Senior Divisional Manager,
Life Insurance Corporation of India,
Silchar Divisional Office,
Maherpur, Silchar- 788015.

The Manager (Claims),
Life Insurance Corporation of India,
Hailakandi Road, PB No.54,
Silchar Divisional Office,
Meherpur, Silchar-788015.

5. The Head of Department(Claims),
Life Insurance Corporation of India,
Agartala Branch -2,

6. The Branch Manager,
Life Insurance Corporation of India,
Agartala Branch -2,
Agartala, Tripura West.        -Opposite parties.

 

 

      __________PRESENT__________

 SRI A. PAL,
PRESIDENT,
  DISTRICT CONSUMER  
DISPUTES REDRESSAL FORUM,
      WEST TRIPURA, AGARTALA. 

SMT. Dr. G. DEBNATH
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

C O U N S E L

For the Complainant        : Sri Dripta Pratim Ghosh,
                      Advocates.

For the O.Ps                 : Sri Prahlad Kr. Debnath,
                      Advocate.                    

 

        JUDGMENT  DELIVERED  ON:  29.07.2016

 

J U D G M E N T

        This case arises on the petition filed by one Shibani Guha U/S 12 of the consumer Protection Act alleging deficiency of service by the Zonal Manager and Manager of LICI. 

2.            The fact of the case in short  is that the husband of the petitioner, Amelendu Guha purchased Endowment Policy No-494053457 from LICI. Sum assured was Rs.3,25,000/-. Maturity of the policy was on 28.10.2018. Premium paid on yearly basis @ Rs.72,167/- paid. On 11.03.14 Amalendu Guha insured died due to ''Acute coronary insufficiency''. Complainant being the nominee of the policy Jeevan Vikash claimed the benefit of the policy but the O.P.LICI repudiated the claim on the ground that her husband, Amalendu Guha has given false declaration at the time of entering into the contract. Petitioner then filed an appeal before the insurance Ombudsmen but her appeal was not entertained. Finally she filed this petition before this Forum in the year 2015 claiming the sum assured Rs.3,25,000/- and compensation Rs.1 lakh for the deficiency of service of LICI.

3.            O.P. LICI appeared, filed W.S. denying the claim. It is contended by the Insurance company that the deceased had the history of consumption of Alcohol. He was a diabetic patient and suffering from various illness from the date of announcement of policy. He suppressed this fact and given false declaration. Therefore, he is not entitled to get any benefit.

4.            On the basis of rival contention as placed before us following points cropped up for determination;
            (I) Whether the deceased husband of the petitioner suppressed the material facts before purchasing the Endowment Policy and therefore repudiation of the claim was proper or not?
            (II) Whether the petitioner being nominee of the policy is entitled to get all the benefits of the policy certificate issued by LICI along with compensation ?

5.            Petitioner side produced the policy proposal, Policy Certificate, Death intimation letter, claim form, copies of medical prescription, forensic report, enquiry report, repudiation letter, letter of DM, LICI, Silchar.
         Petitioner Shibani Guha examined herself as P.W.1. Her statement on affidavit given before this Forum. 

6.            Respondent side on the other hand, produced Policy Proposal Certificate, death intimation, claim form, medical attendant's certificate, prescriptions, forensic report, claim enquiry report, repudiation letter, marked as Exhibit- A Series.
        O.P. also examined one witness, Nabarun Ghosh, Branch Manager of LICI, Agartala Branch No-II. 

7.        On the basis of all these evidence we shall now determine the above points.

        Findings and decision on point No-1 and 2;

We have gone through the repudiation letter issued by LICI authority. In the letter dated 16.12.14 addressed to the petitioner it is written that 5 answers to the questions were given by deceased, Amalendu Guha Life assured as false. 1st question is about consult with medical practitioner requiring treatment for more than a week, 2nd question is about ailment to liver, stomach, heart, lung, 3rd question is on suffering from diabetes, TV, High Blood Pressure, 4th question is about taking alcohol, narcotics. Deceased given reply as 'No'. He also declared that the state of his health was good. Senior Divisional Manager informed that the life assured Amalendu Guha had given deliberately misstatement, withheld material information regarding his health at the time of effecting the insurance so, the claim was repudiated. How the insurance authority determined that false statement was given by life assured? No specific evidence given by Insurance company to support their contention. They relied on the prescription and medical reports, forensic report submitted by petitioner to them. We have gone through the prescription issued by Dr. Dibyendu Roy on 15.07.13, 20.07.13. No where it is found that Amalendu Guha required treatment for more than 7 days. His blood pressure was 70 to 110. Nothing written to support that he was diabetic. Another prescription was issued by Dr.Mridul Das on 10.08.13. In that prescription nothing written about his addiction to alcohol. His blood pressure was found 70-104/118. Blood report of diagnostic laboratory, Agartala is produced. There his blood sugar on random shown 161 on 10.08.2013. On 13.08.13. it was shown 136. On 24.12.13 his plasma glucose on PP was 133. normal accepted range is up to 140. So from the report it is found that he was not diabetic. From the prescription and another report on 21.08.13, it is found that Amalendu Guha had some disturbance and blood pressure was normal and nothing is there to support that he was diabetic. From the report of the laboratory it is found on plasma glucose the PP was 140 on 01.12.13. We have gone through the prescription issued by Dr. Swapan Kumar Das, MD(Medicine). Nothing found in those prescriptions in our naked eyes that he required treatment for more than a week or had been suffering from liver, stomach, heart, lung ailment or had been suffering from diabetes, TV, High Blood Pressure. Nothing found from those medical prescriptions that he was alcohol addicted. Concerned doctors were not produced to support the views taken by Insurance company. Postmortem report, forensic report also produced. From those report is is not possible to come to a clear finding that the deceased, Amalendu Guha was alcoholic or had been suffering from diabetes or high blood pressure. It is found that without consulting any medical officer only by going through naked eyes on the prescriptions the insurance company authority had to come to the conclusion that the deceased, Amalendu Guha was Diabetic, Alcoholic and had been suffering from heart, lung disease before purchasing the policy certificate. Policy certificate was purchased on 28.10.13. O.P. LICI failed to produce any cogent evidence to support that before 28.10.13 Amalendu Guha life assured was suffering from high blood pressure, diabetes and also suffering from heart, lung disease. When the contention is raised by the Insurance company it is their duty and burden to prove the same. Otherwise whims or any inferences can not be drawn to come to the conclusion that the deceased had made false declaration.

9.            Learned advocate for the O.P. placed reliance on the decision of State Consumer Forum, Tripura in appeal No. FA- 64/2013 and the National Forum Revision Petition No. 3340/2014. In those decisions it is clearly stated that when false declaration is made then the policy should be repudiated. But the obligation to disclose the answers/information depends upon the knowledge one posses. When the deceased have no knowledge about the disease while entering into the contract then he can not be blamed for giving false declaration. In this case deceased was not diagnosed with any such disease by doctors. So, he did not make any false declaration knowing fully that he had been suffering from those diseases. So we can clearly come to definite findings that deceased Amalendu Guha had given false declaration and the repudiation of claim by LICI therefore, improper without application of mind.

10.            From the evidence as produced by the parties it is found that the petitioner on the death of her husband become helpless and she made the claim before the LICI authority for getting the benefits in right time. LICI repudiated the claim without application of mind. She then made appeal and thereafter before the Insurance Ombudsmen. But she did not get any redress. Due to the deficiency of service of LICI petitioner suffered a lot. Therefore, she is definitely entitled to get compensation of Rs.50,000/- for this deficiency of service of Insurance company. Petitioner is entitled to get sum assured Rs.3,25,000/- and all other benefits from the endowment policy as purchased by her husband, Amalendu Guha. Petitioner is also entitled to get cost of litigation Rs.10,000/- also interest for the amount from the date of filing the application 09.11.15 @ 9% P.A. Points No.1 and 2 is decided accordingly.

11.            In view of our above findings over the two points this petition is allowed. We direct the Insurance company LICI to satisfy the claim of the petitioner by giving the sum assured and other all benefits to the petitioner within one month along with interest @9% P.A. from the date of filing the petitioner 09.11.15. We also direct the O.P. Insurance company to pay compensation amounting to Rs.50,000/- to Shibani Guha. In addition to the benefits of the policy Rs.10,000/- for the cost of litigation.    
 

                     Announced.

SRI A. PAL
PRESIDENT,
DISTRICT CONSUMER  DISPUTES 
REDRESSAL FORUM,
WEST TRIPURA,  AGARTALA.

 

 

SMT. DR. G. DEBNATH,
MEMBER,
 DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM, 
WEST TRIPURA, AGARTALA    SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.