Tripura

West Tripura

CC/21/2015

Smti Anjali Bhattacharjee. - Complainant(s)

Versus

The Zonal Manager, Life Insurance Corporation of India & 3 Others. - Opp.Party(s)

Mr.R.Datta, Mr.R.Das.

16 Mar 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA : AGARTALA

CASE NO:  CC-   21  of   2015

Smt. Anjali Bhattacharjee,
W/o- Late Dr. Ashim Chowdhury,
C/o- Sishu Bihar Higher Secondary School,
P.O.- Agartala, P.S. -West Agartala,
District- West Tripura.            ........Complainant.
    
                 ___VERSUS___

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

     2. Sr. Divisional Manager, Life Insurance Corporation of India,
     Silchar Divisional Office, Jeevan Prakash, Silchar- 15.
    
     3. Divisional Manager, Life Insurance Corporation of India,
      Silchar Divisional Office, Jeevan Prakash, Silchar-15.

             4. Branch Manager, LIC Branch Office,- II,
                Agartala, P.O- Agartala, P.S.- West Agartala,
                District- West Tripura.            ........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.

SHR. B. BHATTACHARYA,
MEMBER,
  DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

C O U N S E L

For the Complainant        : Sri Rupak Das, 
                      Sri Ratan Debnath,
                      Advocates.           

For the Opposite Parties        : Sri P.K. Debnath,
                      Advocate.                                           
          

        JUDGMENT  DELIVERED  ON:  16.03.2016

J U D G M E N T
        This case arises on the petition filed by Anjali Bhattacharjee u/s 12 of the Consumer Protection Act, 1986 alleging the deficiency of Life Insurance Corporation of India. It is alleged that her husband, Ashim Chowdhury during his life time insured his life with Endowment Assurance Policy commenced from 03.11.10 for sum assured of Rs.2,15,000/-. Premium amount was Rs.25,000/-. After payment of one premium her husband Ashim Chowdhury died on 20.08.11. Petitioner being the nominee of the insurer placed her demand before the O.P. Insurance company. But the O.P. Insurance company repudiated the claim on the ground of suppression of material facts by her husband. Petitioner then approached the ombudsman of the Insurance company but there she did not get any positive result. So, she filed this case for reddress.

2.        Insurance company, LIC appeared, filed W/S denying the claim. It is stated that the assured is under obligation to make full disclosure of material facts which is relevant for the insurer to  take into account while deciding whether the proposal should be accepted or not. Petitioner placed the medical documents of her husband and on scrutiny of all those documents Insurance company rightly repudiated the claim and it was informed to her on 04.12.13. Therefore, she is not entitled to get any  compensation from the Insurance company.

3.        On the basis of assertion denial made by the parties following points cropped for determination.
        (I) Whether there was any suppression of material fact by the insurer?
        (II) Whether the petitioner is entitled to get all the benefits of the policy and any compensation for deficiency of service by the O.Ps.? 

4.        Petitioner produced original copy of repudiation letter, application to Zonal Manager, copy of repudiation letter,2014, copy of letter, report, original copy of report which are marked and exhibited as Exhibit 1, 2, 3, 4, 5 and 6. Petitioner also produced statement on affidavit of one witness i.e., the petitioner herself.

O.P. Insurance company on the other hand produced the Proposal Form, Medical examination report, Policy certificate, Death intimation, Claim Form, Leave Records, Medical Records, Reply Letter, Repudiation Letter, Exhibit- A series.
         O.P. Insurance company also examined one witness, Nabarun Ghosh, Branch Manager of LICI of Agartala Branch.

On the basis of all these evidence and after hearing advocate for both side and the written argument placed before us, we shall now decide the above points.

 

        FINDINGS AND DECISION:
7.        It is admitted fact that deceased, Ashim Chowdhury, husband of the petitioner purchased the Endowment Policy Certificate for Sum of Rs. 2,15,000/-. The policy  documents is admitted and there is no dispute over the matter of acceptance of proposal by the Insurance company. It is also admitted position that one premium was only paid and thereafter life assured Ashim Chowdhury died due to NON HODGKINS LYMPHOMA. In the proposal form as per guideline of the LICI, Ashim Chowdhury  made some declaration. The contention of the Insurance company is that those declaration was made by the deceased falsely. In Exhibit- 1, letter of the Divisional Manager clearly wrote that the 1st question that whether in last 5 years he has consulted any medical practitioner requiring treatment for more than a week then he answered 'No'. In response to another question whether he was suffering from ailments pertaining to liver, stomach, heart, lungs, kidney, brain or nervous system, he answered 'No'. On 3rd question whether suffering from diabetes, TB, high BP, low BP, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease, he answered 'No'. According to Insurance company those answers are false. In such a case Insurance company is to prove that during 5 years i.e., from  2005 to 2010, Ashim Chowdhury consulted any doctor for ailment requiring treatment for more than one week or he had been suffering from disease pertaining to Liver, stomach, heart, kidney, diabetes, TB, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydorcele or leprosy or any other disease. Insurance company produced no doctor to support that Dr. Ashim Chowdhury suffered from all these diseases in between the year 2005 to 2010. They relied on the documents placed before them by the complainant, Anjali Bhattacharjee. We have gone through the photocopy of those medical documents. Treatment summary of Health Care Global Enterprise. It is written there that patient and history of multiple joint pain since one year. But whether from that multiple joint pain he was treated for a duration for more than 7 days not clear. On the treatment report discharge summary of Manipal Hospital it is written that Dr. Ashim Chowdhury, life assured presented to them with history of joint pain since 2 months associated with fever for last one week. Such statement was made on 02.04.11. So, it is not between in the year 2005 to 2010. How relying on this medical documents Insurance company came to the conclusion that the life assured made false statement not clear before us. In the oral evidence it is stated that Dr. Ashim Chowdhury was on 'Commuted Leave' during this period. If so Insurance company is to prove the period of leave, actual ailment supported by medical certificate or not. But those medical certificates to support the commuted leave not produced before us. The commuted leave is not reimbursible. So, employees in Tripura take even on casual leave which requires no longer ailment at all.

8.        When the Insurance company came to conclusion that there was suppression of material fact in that case Insurance company is to enquire through the agency to find out the documents to support their views. Hon'ble Apex Court in 2009 Vol. 8 Sec. 316 held that '' fact that goes to the root of the contract of Insurance has a bearing on the risk involved  can be material fact. All essential relevant information are material. When the Insurance company repudiated the claim on the basis of suppression of material fact then Insurance company is to prove that actually the fact was suppressed. Here in this case Insurance company totally failed. It appears that without application of mind without proper enquiry and even without scrutinizing the medical documents through the medical person they came to a wrong conclusion and repudiated the claim of the petitioner. This act of the Insurance company in our view appears to be deficiency of service. It is not proper service at all. The Insurance company failed to render proper service to the petitioner who is the nominee of the life assured. On the death of her husband she placed her claim with all necessary documents with the Insurance company. Insurance company without any proper enquiry came to a wrong conclusion that her husband made suppression of material fact and repudiated the claim. This was improper. Therefore it appears there was no suppression of material fact by the life assured, Ashim Chowdhury. He was diagnosed with the dreaded disease after 6 months of purchasing the policy and he was not aware about such a dreaded disease when he purchased the policy certificate. There is no suppression of material fact at all. So, repudiation of claim was not proper. Petitioner is entitled to get compensation and all benefits of the policy, purchased by her husband. Both the points are decided accordingly.

9.        In view of our above findings over the 2 points this petition is allowed. We direct the Insurance company to give all benefits of the policy to the petitioner. We also direct to pay the petitioner an amount of Rs.25,000/- for the deficiency of service and Rs.5000/- for cost of litigation. We direct the Insurance company to pay within 2 months if it is not paid it will carry interest @ 9% P.A. Supply copy of the judgment to both the parties.   
               
Announced.

 

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

 

 
SMT. DR. G. DEBNATH,
MEMBER,
 DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM,  AGARTALA, 
WEST TRIPURA.    SHRI. B. BHATTACHARYA,
MEMBER,
 DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM,  AGARTALA,
 WEST TRIPURA.