STATE CONSUMER DISPUTE REDRESSAL COMMISSION
BIHAR, PATNA
Appeal No. 63 of 2020
PNB MetLife India Life Insurance Co. Ltd. through Managing Director, Brigade Seshamahal, 5 Van Vilash Road, Basavangudi, Bangalore-560004
…. Appellant
Versus
Udha Devi, W/o- Late Bhola Raoy, Resident of Village- Bhagwanpur Ratti, PO- Balukaram, PS- Vaishali, District- Vaishali at present Moh- Anandpuri, PS- Brahmpura, District- Muzaffarpur, Bihar
… Respondents
Counsel for the appellant: Adv. Satyendra Prasad
Counsel for the respondent: Adv. Nikhil Agarwal
Before,
Hon’ble Mr. Justice Sanjay Kumar, President
Mr. Ram Prawesh Das, Member
Dated: 23.02.2023
As per Sanjay Kumar, President.
O r d e r
Present appeal has been filed on behalf of PNB MetLife India Life Insurance Company Ltd. for setting aside the order dated 18.07.2019 passed by District Consumer Forum, Muzaffarpur in Complainant Case No. 240 of 2016 whereby and whereunder the learned District Consumer Forum has allowed the complaint case and directed the appellant to pay Rs. 18,20,000/- sum assured to the complainant with interest @7% p.a from the date of death of insured i. e. 15.06.2015 and Rs. 20, 000/- as compensation for mental and physical harassment and Rs. 10,000/- as cost of litigation within two months from the date of receipt of order failing which interest @9% p.a shall become payable.
Briefly stated that the facts of the case is that the complainant is nominee and widow of Late Bhola Ray who had purchased two policies bearing no. 21494215 & 21484320 for sum assured amount of Rs. 18,20,000/- against which premium amount was paid and accepted by the insurance company.
Proposal form were filled up by the agent of insurance company in presence of its officials and insured had put his signature on the proposal form and after accepting the premium amount with respect to said policies, receipts for premium paid and insurance policy bonds were issued in the name of insured.
On 15.06.2015 while insured Bhola Ray was going to meet his friend in Repora under Muzaffarpur district, he met an accident as a result of which he fell down and become unconscious. He was brought before a doctor in Muzaffarpur for treatment and the doctor referred him to PMCH but before reaching PMCH he died on the way.
A Sakra PS Case no. 271 of 2015 was lodged and after investigation police submitted charge sheet against the guilty persons.
Complainant filed death claim being nominee and widow of deceased before the insurance company with all relevant documents but the insurance company repudiated the claim of the complainant by letter dated 12.02.2016 on the ground that insured had consulted a doctor on 01.07.2013 for the treatment of Tuberculosis and had also taken other insurance policies which he did not disclose in his proposal form.
Aggrieved by which complainant filed her complaint case for payment of sum assured along with interest before the District Consumer Forum, Muzaffarpur.
In support of her claim case claimant produced all relevant documents required to establish her case however, on notice although, insurance company appeared but did not file written statement nor produced any evidence either oral or documentary to controvert the claim of complainant.
The complainant in her deposition has denied that neither her deceased husband suffered from T.B. nor consulted any doctor for his treatment. It is now settled proposition of law that if repudiation has been done on ground of pre existing disease which insured did not disclose in the proposal form then onus lies upon the insurance company to establish it but in present case neither written statement has been filed by the insurance company nor any evidence has been adduced to support reasons as stated in the repudiation letter.
The District Consumer Forum has rightly allowed the complaint case filed by complainant and directed insurance company to pay the insured amount with interest and Rs. 20,000/- as compensation for mental and physical harassment and Rs. 10,000/- as cost of litigation failing which interest @9% p.a shall become payable.
Even otherwise the claim of complainant could not have been repudiated as the insured died in an accident and not on account of any pre existing disease. There is no nexus with cause of death with any preexisting disease.
The case of complainant also finds support in case decided by NCDRC, Exide Life Insurance Co. Ltd. Vs Durgesh Kumar Agarwal of para 9 of which reads as under:
“ The burden to prove this fact is upon the petitioner. He did not raise any defence before the District Forum. Even before the State Commission where he filed the additional evidence he did not file any admission record or treatment record of the insured prior to the date of taking policy. Mere mention of this fact by the doctor is not sufficient unless it is so prove by either examining the witness or producing the document showing such treatment by the insured. Even otherwise there was no defence of the petitioner before the District Forum and hence the complainant did not have any chance to rebut the same before the District Forum. State Commission has rightly concluded that this was not sufficient to prove any concealment of fact.
Also it is a fact that the insured had not died due to any illness but he suffered injuries in an accident (fall from stairs) for which he was admitted in the hospital and subsequently expired. His death summary which has been produced before the District Forum in evidence clearly states the events relating to his death and it is due to injuries. Bleeding from his nose or ears was found to be due to be due to the injuries he received in the accident. Therefore there is no nexus between the disease for which the insured was allegedly suffering and the cause of death.”
There is no merit in this appeal and is accordingly, dismissed.
(Ram Prawesh Das) (Sanjay Kumar,J)
Member President
Md. Fariduzzama
