Jagannath Bag, Member:
The present appeal is directed against the order dated 22.05.2013 passed by the Ld. District Consumer Disputes Redressal Forum, Malda, in DF Case No. 35/2011, whereby the complaint was dismissed on contest without any order as to costs.
The complaint case, in brief, was as follows:
The Complainant’s wife Keka Das @ Datta opened a Postal Life Insurance Policy (No. WB/151400-CS) by depositing Rs.1350/- as premium on 04.01.2008. The sum assured was Rs. 2,00,000/- . The Complainant was made nominee of the insured in respect of the policy. The insured died on 22.08.2008. The Complainant submitted a claim in prescribed form on 15.09.2008. Though the Complainant was informed by the OP No. 4 vide their letter dated 10.09.2009 that his claim was being processed and the same would be settled as early as possible, by their letter dated 22.04.2010, the claim was repudiated on the ground of non-disclosure of the fact of prolonged treatment of the insured at CMC Vellore prior to taking the policy. A letter was sent by the Complainant on 10.01.2011 with prayer for reconsideration of the decision of the OP No.4. But nothing materialized. In the said situation, a consumer complaint was filed before the Ld. Forum below with prayer for direction upon the OPs to pay the sum assured of Rs.2,00,000/- with interest and bonus along with litigation cost of Rs. 25,000/- and compensation of Rs. 25,000/- for mental agony etc.
OP Nos.1-5 contested the case by filing a W.V., wherein the allegations made out in the complaint petition were denied. It was contended that the insured had been under the treatment of CMC Vellore in the year 2007 as evident from the Discharge Summary issued by CMC Vellore cardiology unit, which fact was not disclosed at the time of filiing up the proposal form. It was a suppression of material fact about her pre-existing disease at the time of procuring the policy. It was also denied that there was any deficiency in service or unfair trade practice on their part. Accordingly, the complaint was liable to be rejected.
OP No.6 in his W.V. submitted that though the insured Keka Das @ Datta underwent treatment at CMC, Vellore, on 21.06.2007, she tendered her proposal form for PLI on 04.01.2008 with suppression of the fact of her being admitted in the hospital during the last 3 years as noted in column No.16(c )of proposal form. Suppression of material information on the part of the insured made the policy void and the payment of premium stood forfeited because of incorrect and untrue declaration by the insured. The claim was repudiated as per rule of policy.
Ld. Forum below after having heard all concerned including the Complainant who deposed as PW-1 and also the OP No.6 and having perused the W.Vs filed by the parties together with evidence adduced, observed that the Complainant had actually undergone heart treatment in the form of PCI/Angioplasty in the year 2007. It was a major disease of heart and PCI was done on 21.06.2007. Ld. Forum also observed that in a contract of insurance a material fact should be disclosed at the time of taking an insurance policy and any incorrect answer would entitle the insurer to repudiate his liability because there is a clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance. Having relied upon the principle of law as laid down by the Apex Court in the case of Satwant Kumar Sandhu -vs- New India Assurance Co. Ltd., Ld. Forum below dismissed the complaint on the ground of material suppression of fact by the insured.
Being aggrieved by and dissatisfied with the order of the Ld. Forum below, the Complainant-turned-Appellant has come up before this commission for setting aside the impugned order.
Ld. Advocate appearing for the Appellant submitted that at the time of filling up the proposal form, there was no suppression of any material fact. The Respondent No.6 being the Field Officer of the other OPs was present when the proposal form was being filled up. Actually it was under his guidance and supervision that the proposal form was filled up. Further, Dr. Santi Kumar Mondal, being the Panel Doctor of OP No.1, examined the insured and recommended acceptance of the proposal for the policy in question. Ld. Forum below did not take into consideration the recommendation part of the Medical Officer who on behalf of the OP/Respondents examined the proposer and certified that the proposer was medically fit for obtaining a Postal Life Insurance Policy It was also argued that the cause of death of the insured was not related to any pre-existing disease. Again, Ld. Advocate appearing for the Appellant mentioned that the policy paper was not given to the insured and the repudiation letter was sent after about 1 and years’ time which was a deficiency in service. That caused mental agony and harassment for which necessary compensation must be paid by the Respondent. In citing a copy of the judgment of the Hon’ble Supreme Court as reported in III (1996) CPJ 8 (SC), Ld. Advocate emphasized that the Respondents should have settled the complaint within a period of two months from the date of submission of the claim. In not doing so, the Respondents committed serious deficiency in service. Ld. Forum below failed to appreciate the fact and the impugned order should be set aside on that score.
Ld. Advocate appearing for the Respondents,1to5, submitted that it was incumbent upon the insured to furnish material information as asked for vide the proposal form , but she avoided providing such information as it is evident from the reply she furnished in proposal form, particularly under Column No. 16 while she put in necessary information by way of her reply against the column 16 i.e., Personal History According to her information, she was not admitted to any hospital/nursing home for general checkup , observation , treatment or operation against the question put in this regard vide column 16 ( c ) . Her reply was ‘No’ in regard to the question No. 16 ( c ) through which she was asked if during the last three years prior to the taking of her policy , she contacted any medical practitioner for any ailment regarding treatment for a week or more or was admitted to any hospital/nursing home for general checkup , observation , treatment or operation . This was a willful suppression on the part of the insured, as she underwent a PCI/Angioplasty in connection with descending aorta and suprarenal abdominal aorta stenting done on 21.06.2007. This fact was not disclosed by the insured at the time of taking the policy. This was a material suppression of fact and as per policy condition, the statement contained in the proposal and declaration made therein was found to be untrue. The policy was rendered void as per clause 10 of the terms of contract. That being the position, the policy was rejected. There was no deficiency in service on the part of the Respondents.
Ld. Advocate appearing for the Respondent No.6 supported the submission made by the Ld. Advocate appearing for Respondent Nos. 1 to 5 and added that he acted as an agent of Respondent Nos. 1 to 5 in regard to the sale of the Insurance Policy, terms of which were very much known to the insured as she had another policy taken in 1996. There was no case against him and he is in no way responsible for making any payment to the Appellant.
Decision with Reasons
The point for consideration before us is as to whether the impugned order suffers from any material irregularity/legal infirmity or jurisdictional error.
We have gone through the memorandum of appeal together with copies of the impugned order, the petition of complaint with annexure thereto and other documents including the W.Vs. filed by OP Nos. 1 to 5 before the Ld. Forum below and the W.V. filed by OP No.6 . BNAs submitted by the Appellant and Respondent No.6 have also been perused. The judgment of the Hon’ble Supreme Court as reported in III (1996) CPJ 8 (SC) submitted on behalf of the Appellant has also been gone through.
There is no dispute that the Complainant’s wife Keka Das alias Datta took a PLI from the OPs on payment of premium due and the last premium was deposited on 18.08.2008. There is also no dispute that the insured died on 20.08.2008.
The claim of the Complainant, being the nominee and beneficiary in respect of the policy, was repudiated on ground of non-disclosure of material information at the time of taking the policy.
Ld. Forum below appears to have dealt with all aspects of the matter in detail. Ld. Forum below examined all material evidence adduced before them by both the parties. Non-disclosure of the material fact of prolonged treatment of the deceased insured at CMC Vellore was found to have been established as the Discharge Summary of the deceased insured showed that she was a patient of Aortoarteritis, Type -III and she had treatment of Descending Aorta and Suprarenal Abdominal Aorta stenting done on 21.06.2007. Ld. Forum below also observed as follows:
‘It is mentioned in the history para of document that the said patient complained of having uncontrolled hypertension and she had undergone PCI/Angeoplasty in the year 2007. Thus it is very clear that she suffered from major disease of heart in the year 2007 when the PCI was done on 21.06.2007 and the same was never a disease like fever or flue which is a minor one’.
Ld. Forum further observed that suppression of such serious disease in the proposal form was suppression of a material fact and the same rendered the policy void. As suc
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h, the OP rightly repudiated the same. Interestingly, it is an admitted fact, as put under paragraph 6 of the complaint petition, ‘that in her life time the said Keka Das had been undergone treatment in CMC Vellore in Cardiology Unit.’ Such treatment was taken just about 6 months before taking the policy in question and it is hardly believable that the insured could not recollect or remember the fact of her treatment in the CMC Vellore in cardiology unit. That is utterly a willful suppression on the part of the insured who took the insurance policy but did not disclose the material fact. Such non-disclosure of material fact by the insured rendered the policy void and accordingly, the insurance claim was repudiated. Ld. Forum below adjudicated the matter in a reasoned manner and we find no reason to interfere with the impugned order. We are inclined to hold that the appeal does not succeed. Hence, ORDERED That the appeal be and the same is dismissed on contest. The impugned order is confirmed. There shall be no order as to costs.