State Consumer Disputes Redressal Commission
The Branch Manager, , Lici, Raiganj ... vs Maharani Baidya on 4 December, 2014
State Consumer Disputes Redressal Commission West Bengal 11A, MIRZA GHALIB STREET, KOLKATA 700 087 S.C. CASE NO FA/1265/2013 (Arisen out of Order dated 29-08-2013 in Case No 92/2012 of District Consumer Disputes Redressal Forum, Uttar Dinajpur) DATE OF FILING : 26-11-2013 DATE OF ORDER: 04-12-2014 APPELLANT : 1.The Branch Manager, Life Insurance Corporation of India, Raiganj branch, Kshudiram Bose Sarani, PO & PS. Raigunj, Dist. Uttar Dinajpur 2.Life Insurance Corporation of India Rep. by the Divisional manager, Jalpaiguri Division, Jeevan Prakash, Shantipara P.O. Dist. Jalpaiguri RESPONDENT :
Maharani Baidya W/o Nirmal Baidya, Malanpally, PO & PS. Islampur, Dist. Uttar Dinajpur BEFORE HONBLE MEMBER : Sri Debasis Bhattacharya.
FOR THE APPELLANT :
Mr. Saptarshi Dutta, Ld. Advocate FOR THE RESPONDENTS :
Date:
04-12-2014 Sri Debasis Bhattacharya This appeal is directed against the order dt. 29-08-2013 in Case No. 92/2012, passed by the Ld. District Forum, Uttar Dinajpur, whereby the complaint case has been allowed on contest. Being aggrieved by and dissatisfied with the same, the OPs thereof has preferred this appeal.
In a nutshell, case of the Complainant is that took a life insurance policy, namely, New Bima Gold Policy, bearing no. 454129121 for a sum assured of Rs. 1,00,000/- on 28-05-2007. OP No. 1 arranged for medical examination and the M.O. of the LICI examined her husband. At the time of taking the policy, her husband was not suffering from any disease and the insured never defaulted in making timely payment of premiums during his lifetime. Complainants husband, i.e., the insured suddenly died due to liver jaundice on 29-07-2009. After his death, the Complainant lodged her claim with the insurance company. The insurer vide its letter dated 16-05-2011 repudiated her claim alleging withholding of material information by the deceased insured regarding his health at the time of effecting the assurance with the insurer. Hence, the case.
Case of the OPs, on the other hand, is that the DLA had been suffering from Hepatitis B virus prior to signing the proposal form and they have clinching evidence to prove that. As per Claim Form E submitted by the employer of the insured, the DLA availed of 124 days earned leave from 26-05-2007 to 27-07-2009 i.e. 124. He was also on leave from 04-02-2008 to 24-02-2008 (28 days) and from 10-02-2009 to 01-06-2009 (72 days), which he suppressed while applying for the insurance claim. As per claim form B received from Dr. Soumyarup Mondal, Medical Practitioner, Islampur, DLA was a patient of Cirrhosis of liver and jaundice and this was the primary cause of death of said insured. So, the LIC rightly repudiated the claim on the basis of leave applications along with medical certificate produced.
Point to be considered in this appeal is if the impugned order suffers from any factual/legal incongruity, or not.
Decision with reasons The appeal is heard exparte as the Appellant, though appeared initially to contest the case, but withdrew herself at the time of final hearing of the appeal.
Ld. Advocate for the Appellant has submitted that the death claim of the Complainant has been repudiated by the insurance company on the ground of non-disclosure of proper information about the health of the deceased insured at the time of taking the policy. It was a non-medical policy for the police personnel which had been effected on the basis of statements provided by the proposal-makers. However, the deceased insured deliberately suppressed material information about his past ailments at the time of applying for the policy for the sole purpose of immoral and illegal gain.
While filling up the columns under Sl. No. 11, especially under the heads, (a), (d), (i) and (j), containing personal history of past/existing diseases of the proposer, the deceased insured not only concealed his illness by stating No in the respective columns, but also declared his state of health as Good. He filled up the proposal form on 31-05-2007, and on 10-05-2007, he was treated by Dr. S. K. Dutta, who diagnosed him with Viral Hepatitis B. Thereafter, again on 16-05-2007, the same doctor because of Hepatitis B, advised him rest for 30 days. There is another prescription of Dr. Sudeb Saha dated 20-05-2007, who referred the deceased insured to a Gastroenterologist when he was suffering from abdomen pain. Besides, there are also bunch of pathological reports in respect of the deceased insured predated 31-05-2007 i.e. when he filled up the proposal form. It further reveals from the information provided by his employer in Claim Form No. E No. 3787(Rev.), issued by the Inspector of Police, C.I.D., West Bengal, Bhabani Bhavan (3rd floor), Kolkata 700 027 that the deceased insured was on long leave for 124 days during the period from 26-05-2007 to 27-09-2007 due to his illness, which also supports the advice of rest on medical ground for 30 days as per the prescription of Dr. S. K. Dutta dated 16-05-2007 during which period of leave, he made and filled up the proposal form.
The Death Certificate issued by Dr. B. L. Mitra dated 29-07-2009 attributes the cause of death to decompensated liver cirrhosis with Jaundice and ascites and pedal edema.
Accordingly, the claim was rightly repudiated by the insurance company by a letter dated 16-05-2011 on the ground of pre-existing disease. The Ld. Advocate has relied upon the decisions of the Honble National Commission reported in II (2014) CPJ 53 (NC), II (2014) CPJ 190 (NC) and I (2014) CPJ 3 (NC).
The materials on record clearly indicates that the deceased insured did not give correct information about his actual state of health in the proposal form. Just before opting for the insurance policy, he was treated by a doctor who diagnosed him of suffering from Hepatitis B and also advised him rest on medical ground. But, suppressing such fact, he declared that he was not suffering from any ailment. Ultimately, he died due to liver cirrhosis with jaundice, etc. Accordingly, there is a co-relation between his disease just before taking the policy and his death about two years after. Therefore, the insurance company is fully justified in repudiating the Complainants claim on account of material suppression of fact i.e. pre-existing disease of the policyholder. Thus, the claim of the Complainant cannot stand at all. In the light of foregoing discussion, it is clear that the impugned order suffers from severe incongruity insofar as legal and factual proposition of the case is concerned.
In the result, the appeal succeeds.
Hence, ORDERED that the appeal be and the same is allowed exparte against the Respondent, however, there shall be no order as to costs. The impugned order is, accordingly, set aside.
Debasis Bhattacharya MEMBER