West Bengal

Paschim Midnapore

CC/178/2017

Smt. CH. Shanti - Complainant(s)

Versus

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

Bidyut Kr. Pratihar

10 Jul 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

   Bibekananda Pramanik, President,

                                                                                      Pulak Kumar Singha,Member,

                                                                                                              and

                                                                                                 Sagarika Sarkar,Member.

 

 

Complaint Case No.178/2017.

 

Smt.Ch. Shanti, W/o-Late Ch. Raja Rao,Quarter No.G-69, I.I.T.Campus,P.O.Kharagpur Technology , P.S.Kharagpur Town, Dist.Paschim Medinipur,Pin-721302.                                                                                                                                                  …………..Complainant.                    

                                                  -Vs-                                                                                                                       

1)  The Zonal Manager, Life  Insurance Corporation of India, Eastern Zonal Office,  

      4,C.R.Avenue , Hindustan Building, Kolkata-700072.

2)  The Manager(Claims),Life Insurance Corporation  of India,Claims Department,    

      Kharagpur Divisional Office,Near Lal Bunglow,P.O.Nimpura,P.S.Kharagpur Town,            

      District-Paschim Medinipur,Pin-721304.                                                                                                                                                                                                                                                                     

                                                                                                       …….….Opp.Parties.

                                                  

              For the Complainant: Mr.Bidyut Kumar Pratihar, Advocate.

            For the O.P.            : Mr.Diptendu Ghosh, Advocate.

                                                         

                                                                                Date of filing: 16/11/2017                                                                                                                                                                           

                                                                                     Decided on   : 10/07/2018

                               

ORDER

                          Bibekananda Pramanik,President:–This consumer complaint u/s 12 of the C.P. Act has been filed by the complainant Smt.Ch.Shanti against the above named O.Ps. alleging deficiency in service on their part.

                                                                                                                                                             Contd………P/2                                                             

                                                                                                                 (2)

                        Complainant’s case, in brief, is as follows:-

               Ch.Raja Rao,since deceased, the husband of the complainant, obtained three policies bearing nos.(i) 498759447, (ii) 499433008 and (iii) 499432413 from the O.P-LICI,Kharagpur Branch. Thereafter on 9.2.2014, Ch.Raja Rao while in service at Hall       

Management Centre, IIT, Kharagpur died on 9.2.2014. After his death,the complainant being the wife and nominee of those policies, applied before the LICI for payment of insurance amount of those policies and she also submitted all relevant  papers in support of her claim. Unfortunately ,the Divisional office of the O.P. vide their letter dated-31.3.2017 repudiated the claim of those policies on the ground of suppressing of material information regarding alleged suffering from cirrhosis of liver of the policy holder. It is stated by the complainant that the answers given in the questioners while filling up proposal form was actually filled up by the agent of the O.P. and the deceased-insured only signed  on blank form at the instance of the agent of the O.P. Besides that,such policies were issued after proper medical test and verification by the O.P. through its own doctor and after being  satisfied with such medical examination, O.P. issued those policies. By sending a legal notice on 27.6.2017 the complainant approached the O.P. for payment but in vain. Hence the complaint, praying for directing the O.P. to effect payment of all policies and for compensation and other reliefs.

         Both the O.Ps.have contested this case by filing a joint w/v.

           Denying and disputing the case of the complainant, it is the specific case of the O.Ps. that on 26.7.2011, 21.6.2012 & 2.1.2013 the deceased insured Ch.Raja Rao obtained those policies and at the time of obtaining those policies and during filling up the proposal form he suppressed material facts regarding his health condition although he was suffering from several ailments since long as a patient of cirrhosis of liver and Ischaemic cerebral stroke, acute myo-cardiak infraction in a case of chronic alcoholism. He was admitted in B.C.Roy Technology Hospitlal of IIT, Kharagpur since the year 2011 till his death on 9.2.2014 on several occasions but he suppressed such fact during filling up the proposal form in column no.11 of those three policies. Due to such illness, he was on medical leave from his duty on several times prior to obtaining those policies. It is also stated that Dr.Sumit Roy, who issued death certificate on 9.2.2014, opined that the cause of death of said Ch.Raja Rao is ‘cardio respiratory failure in a case of acute Myo-cardiak Infraction in a case of chronic alcoholism with cirrhosis of liver and Ischemic cerebral stroke(old)’. If the deceased- proposer disclosed his such illness and treatment etc., the LICI might have not issued those policies in his favour. After such repudiation, the complainant through her Advocate filed a written representation before the Zonal Manager                                                                                                                                       

                                                                                                                                                                      Contd…….P/3.

 

                                                                                                 (3)

of LICI, who uphold the decision of repudiation by the Divisional Authority and therefore the matter has been finally decided and the complainant has no scope to seek relief before this Forum as the matter is barred by principle of Resjudicata. O.Ps.claimed that there is no deficiency in      service on their part and they pray for dismissal of the complaint with cost.

           To prove her case, the complainant Smt. Ch.Shanti has examined herself as PW-1 by tendering a written examination in chief supported by affidavit and during her examination on oath, few documents were marked as exhibit-1 to 3 respectively. At the time of her cross examination by the O.P. few other documents were marked as exhibit A to F respectively on admission. On the other hand, O.P.-LICI has examined one Provat Chakraborty as OPW-1 and during his evidence, one document was marked as exhibit-G.

                                                            

                                      Points for decision

1.     Is the case maintainable in its present form and prayer ?
2.     Is there any  deficiency in service on the part of the O.P.-LICI in repudiating   

   the claim of insurance ?

3.    Is the complainant entitled to get the reliefs, as prayed for ?

                                              

     Decision with reasons

               Point no.1:-

                                  Maintainability of this case has not been questioned at the time of  final      

               hearing of  this case. On perusal of the pleadings of the parties and the evidence on record  

             we do not find anything adverse regarding maintainability of this case.

            This point no.1 is accordingly decided in favour of the complainant.

                                              

             Point no.2:-

             Admittedly Ch. Raja Rao, since deceased, the husband of the complainant obtained three LIC policies bearing nos. (i) 498759447, (ii) 499432413 and (iii) 499433008 on 26.7.2011, 21.6.2012 and 2.1.2013 respectively. Admittedly the present complainant Smt. Ch.Santi is the nominee of those three policies. Fact remains undisputed that on 9.2.2014 said Ch. Raja Rao died while he was in service and after his death the complainant being the nominee of those policies submitted claim of insurance before the O.P.-LICI for payment of insurance amount and she also submitted all relevant papers and documents in support of her claim. It is also admitted by the parties that the Divisional Office of O.P.-LICI vide their letter dt.-31.3.2017 repudiated the claim of insurance of those policies on the ground of withholding material information regarding his health condition at the time of filling up proposal form. Now the question arises as to whether the

                                                                                                                                                                 Contd…….P/4.

                                                  

                                                                                         (4)

OP-LICI was justified in repudiating the claim of insurance. According to the complainant those policies were issued by the O.P.-LICI after proper medical test done by their own doctors. Complainant produced no scrap of paper to show that her husband was medically examined by the doctors of LICI before issuance of such policies. In her cross-examination, the complainant has also admitted that she has no such medical papers. Further according to the complainant the answers given in the questionnaires of proposal form were filled up by the agent of the LICI and her husband signed on blank proposal form. The deceased insured was an employee of Hall Management Centre, Kharagpur IIT and it is not at all believable that a literate person would sign on blank proposal form. Regarding withholding of material information in respect of health condition of the deceased insured we find from the proposal form(exhibit-B) that the deceased insured answered all questions regarding his health history in the negative while filling up such proposal form. In her cross-examination, it is none but the complainant has admitted that before obtaining such policies her husband was suffered from mild heart attack and he was a patient  of hypertension. She has further admitted that her husband used to take alcohol on certain occasions. Exhibit-C goes to show that the husband of the complainant died due to “cardio respiratory failure  in a case of acute Myocardiak Information in a case of chronic alcoholism with cirrhosis of liver and Ischemic cerebral stroke(old)”. The series of documents(exhibit –E series) go to show that the deceased insured was suffering from various ailments and he was treated in B.C.Roy Technology Hospital, IIT, Kharagpur before his death as well as before obtaining such policies. From the certificate (exhibit-D) issued by the employer of the deceased insured we find that prior to obtaining such policies he was on medical leave on and from 2.9.2008 to 15.9.2008 and from 19.9.2008 to 11.10.2008. Inspite of that, suppressing all such ailments the deceased insured answered all questions regarding his health history in the negative while filling up the proposal form. It is well settled that if any such information about medical condition of a person which could influence mind of a prudent insurer is not disclosed to him, it amounts to suppression of material facts and the insurer is very much within his rights to repudiate such claim of insurance.

             In the above facts and circumstances ,we are of  the view that the O.P.-LICI was quite justified in repudiating the claim of insurance in question and they have caused no deficiency in service as alleged by the complainant.

             This point is accordingly answered in the negative and against the

             complainant.

                                                                                                                                                                      Contd……..P/5.                                              

                                                                       

 

                                                                                                             ( 5 )

 

Point No.3:-

                In view of our above findings in point no.2,  the complainant is not entitled to get any reliefs.       

             All the points are accordingly disposed of.            

             In the result, the complaint case fails.

                   Hence, it is,

                                               oRdered

                          that the complaint case no.178 /2017  is dismissed on contest but in the circumstances without cost.                              

Let plain copy of this order be given to the parties free of cost.

 

           Dictated and Corrected by me

                          Sd/-B. Pramanik.             Sd/-P.K. Singha        Sd/- S. Sarkar           Sd/-B. Pramanik. 

                                  President                      Member                    Member                        President

                                                                                                                                         District Forum

                                                                                                                                     Paschim Medinipur