State Consumer Disputes Redressal Commission
Smt. Kanan Ghosh. vs Life Insurance Corporation Of India. on 2 June, 2016
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION WEST BENGAL 11A, Mirza Ghalib Street, Kolkata - 700087 First Appeal No. FA/327/2011 (Arisen out of Order Dated 09/06/2011 in Case No. 66/2007 of District Burdwan) 1. Smt. Kanan Ghosh. W/o Late Kanailal Ghosh, Vill. & P.O. - Satgachia, P.S. Memari, Dist. Burdwan. ...........Appellant(s) Versus 1. Life Insurance Corporation of India. Asansol Div. Office, Jeevan Prakash, G.T. Road(West end)Asansol, Dist. Burdwan. 2. Life Insurance Corporation of India Memari Br. Office, G.T. Road (West end) Asansol, Dist. Burdwan, P.O. & P.S. Memari, Pin - 713 146. ...........Respondent(s) BEFORE: HON'BLE MR. DEBASIS BHATTACHARYA PRESIDING MEMBER HON'BLE MR. JAGANNATH BAG MEMBER For the Appellant: Mr. Ramesh Kr. Choumal., Advocate For the Respondent: Ms. S. Roy Chowdhury., Advocate ORDER DEBASIS BHATTACHARYA, PRESIDING MEMBER
Date : 02.6.2016 This appeal has arisen out of order dated 09.06.2011 in Case No. 66/ 2007 passed by the Ld. District Consumer Disputes Redressal Forum, Burdwan (in short, District Forum). By the impugned order, the complaint has been dismissed.
The case of the Complainant is that her husband, Kanailal Ghosh got a policy issued by the OP No. 2, bearing no. 465308393 for a sum of Rs. 3,00,000/- for which the OP No. 2 received the first premium for a sum of Rs.24,493/-. This is an Endowment Policy commenced with effect from 07.08.2003. He deposited yearly premiums for the years 2004 and 2005 together with interest with the OP No. 2 on 09.09.2005. Unfortunately, he suddenly fell ill with cardiac complaint along with respiratory distress and admitted to the Chittaranjan Advanced Medical Research Institute on 31.07.2006 and expired on 01.08.2006. Accordingly, the Complainant as nominee approached the OPs to get benefit under the insurance policy and submitted a claim form duly filled in to the OPs on 28.09.2006. Ultimately, the OPs, in particular, the OP No. 1 by a registered letter dated 31.03.2007 repudiated the claim on the ground that the insured at the time of taking the policy made deliberate misstatements and withheld material informations regarding his health, which is completely illegal, arbitrary and unjustified and constitutes gross deficiency and negligence in rendering the service. Accordingly, the case.
On the other hand, the case of the OPs is that the complaint petition is wholly misconceived, groundless and unsustainable in law and is liable to be dismissed as such. It is also frivolous and vexatious and is liable to be dismissed under Section 26 of the Consumer Protection Act. The deceased Life, Assured, Kanailal Ghosh submitted a proposal for a sum assured of Rs.3,00,000/- for his own life, which was accepted by the OPs, resulting in an insurance policy bearing no. 465308393, issued on the basis of information furnished by him in the proposal form. But, the death claim made by Complainant was repudiated by the OPs on the ground of suppression of material facts. It is mentioned that he had another policy bearing no. 460588203, which is a policy for medical benefits, and an application was received with his LTI stating that he fell seriously ill on 03.08.2001 late night and was admitted to National Neuro-Sciences Centre, Kolkata and he was unable to make signature and put his LTI and made a claim for sickness benefit under Asha Deep and produced some documents in support of the claim, which was declined by the Divisional Office, LICI vide letter no. ADO/Claim/CC dated 13.06.2002, as the ailments did not come under the purview of the policy conditions under Asha Deep. Later, he surrendered the Asha Deep policy at the Branch Office on 26.03.2014 and got Rs. 25,999/- by a cheque. At the time of proposal of the instant insurance dated 31.07.2003, he did not mention his aforesaid Asha Deep policy or his illness in the proposal form and made deliberate misstatements and withheld material information that would have effected the underwriting decision. So, the claim of the Complainant has been rightly repudiated by the OPs for valid ground and proper application of mind and knowledge. Thus, the Life Assured Kanailal Ghosh obtained the policy in question by way of suppression of material facts. By such misdeclaration and concealment of facts by the Life Assured in the proposal form, the policy of insurance is vitiated and there is no deficiency in service. The said Life Assured Kanailal Ghosh was suffering from ailments pertaining to nervous system etc., and he lost total control of his limbs and was confined to bed and the treatment was continuing for a few years before he proposed for the instant policy. Thus, the OPs duly repudiated the claim of the Complainant. Accordingly, the Complaint petition be dismissed/rejected.
It is to be considered if there is any irregularity and /or illegality in the findings of the Ld. District Forum concerned, or not.
Decision with reasons Ld. Advocate for the Appellant has submitted that the death occurred to said Kanailal Ghosh for Cardio-Respiratory failure. The claim was disallowed on the plea that the previous policy was surrendered and such facts were not disclosed and there has been suppression of facts, although he was found fit by the empanelled Doctor of the OPs. Furthermore, any misstatements found after two years from the date of policy can not be taken into consideration by the Insurance Company.
Ld. Advocate for the Respondents has submitted that it was an Endowment Policy, with effect from 07.08.2003, whereas the Life Assured died on 01.08.2006. Previously, he took one Asha Deep Policy, which is in the nature of mediclaim, and the claim was repudiated, as he was suffering from paralytic stroke and the Life Assured surrendered it. Thereafter, he took this policy. The fact of Asha Deep policy was not disclosed. So, also his diseases. He intentionally and deliberately did not disclose such facts. There has been repudiation for suppression of material facts at the time of taking the policy. The contract of insurance is based on good faith, which the Insurance Company is to take into account for a proper decision to accept the proposal and premium. There has been discharge certificate from National Neuro-Sciences Centre, Kolkata. He was also treated at Peerless, R.N.Tagore Hospitals. He was suffering from severe diseases. There is no deficiency in service of the Insurance Company and the claim had been rightly repudiated for suppression of material facts. These are all material informations, and riders for acceptance of the policy or not. In fact, the treatment papers upon which the repudiation has been made were given by the Complainant. She has referred to certain decisions, namely, of the Hon'ble Supreme Court in Civil Appeal no.5322/2007 reported in (2008) 1 SCC, 321, four decisions of the Hon'ble National Commission, i) reported in III (2011) CPJ 143 (NC),in Appeal No. 242/2006, one reported in I (2012) CPJ 223 (NC) and RP Nos. 50/2011 and 51(2011) and one decision of the Hon'ble Kerala High Court reported in AIR 1986 Kerala 201.
It is true that the facts of Asha Deep Policy taken by Life Assured and his diseases as such were not reported in the proposal form for taking out the instant policy, which is surely an intentional and deliberate choice of the Appellant/Complainant. In the given facts and circumstances, there is no reason to interfere in the observation and finding of the Ld. District Forum made out in the impugned order, by which the complaint was dismissed. The repudiation is a rightful one. The impugned order is affirmed. Consequently, the appeal is dismissed.
Let a copy of the order along with the LCR be forwarded to the Ld. District Forum, Burdwan forthwith. [HON'BLE MR. DEBASIS BHATTACHARYA] PRESIDING MEMBER [HON'BLE MR. JAGANNATH BAG] MEMBER