Dr. S.M. Kantikar, Presiding Member
1. The present Revision Petition is against the order dated 09.11.2017 of the Tripura State Consumer Disputes Redressal Commission, Agartala (for short the “State Commission”) whereby the appeal against the order of the District Consumer Disputes Redressal Forum, West Tripura, Agartala was dismissed.
2. To bring clarity, we refer the parties with the positions assigned to them in the complaint. Smt. Mampi Dhar (Ghosh) being the complainant; Tata AIG Life Insurance Co. Ltd. being the OP 1- Ins. Co. and Smt. Anjali Ghosh being the OP- 2.
3. Brief facts relevant for the disposal of the case are that one Mr. Bipul Kanti Ghosh had purchased an insurance policy (Policy No. U201069468) on 17.02.2011 from the OP- 1 Ins. Co. The value of the policy was Rs. 3,50,000/- and its time period was for 20 years. During the subsistence of the policy, the life assured, DLA died on 29.12.2011. The nominee Anjali Ghosh, mother of DLA filed death claim on 02.05.2012. Similarly on the same date, the DLA’s wife Mrs. Mampi Dhar sent letter to the insurance co. and requested not to release the claim payout in favour of the nominee Anjali Ghosh (mother). Thereafter, Mampi Dhar obtained a succession certificate on the strength of Order of Civil Judge, Sr. Division, West Tripura, Agartala and thereafter, she filed a claim of the insured amount from the insurance co. (OP-1) but the insurance co. did not pay the insurance amount, therefore, being aggrieved, she filed a complaint before the District Forum, West Tripura, Agartala. The nominee Anjali Ghosh i.e. the mother of DLA was proforma OP-2.
4. The complaint was resisted by the OP 1- Ins. Co. by filing a written statement. It was contended that the complainant was not a consumer as the nominee of the policy in question was the mother of the DLA i.e Smt. Anjali Ghosh. Proforma OP- 2 i.e the mother of the complainant also filed a written statement and asserted that the petition be allowed and the OP 1 – Ins. Co. be directed to deposit 1/3rd of the amount as per law.
5. After hearing the parties and appraisal of evidence, the District Forum vide order dated 19.01.2017 directed the OP 1- Ins. Co. to pay the insured amount of Rs. 3,50,000/- to the nominee , Anjali Ghosh after deducting Rs. 31,259/- which was paid earlier to her. OP 2 to pay 1/3rd of Rs. 3,50,000/- to the complainant and 1/3rd to her grandson , Bipradip Ghosh or to his natural guardian in proof of minority.
6. Being aggrieved by the order of the District Forum, the OP 1 - Ins. Co. appealed to the State Commission. The Appeal was dismissed being devoid of merit.
7. Being aggrieved by the order of the State Commission, the OP 1 – Ins. Co. has approached this Commission through this Revision Petition.
8. We have heard the learned counsel for the Ins. Co. and perused the material on record.
9. Learned counsel for the petitioner submitted that the claim of the nominee i.e. Mrs. Anjali Gosh being an early claim the Insurance Company decided to get the matter investigated and by virtue of that investigation a Bed Head Ticket dated 29.12.2011 issued by Tripura Medical College & Dr. B.R. Ambedkar Memorial Teaching Hospital was procured which clearly reflected that the DLA was addicted to drugs and substance abuse for the last 15 years including polysubstance abuse viz. benzodiazepine and syrups since the last 5 years. He was also an alcoholic since the last 4 years and suffering from Diabetes Mellitus or DM for the last the 2 years which was much prior to the issuance of the said policy dated 17.02.2011. The amount of Rs. 31529 (unit value) was credited to the account of the nominee Mrs. Anjali Gosh vide National Electronic Fund Transfer (NEFT). The insurance company repudiated the claim of the nominee Mrs. Anjali Gosh vide repudiation letter dated 09.10.2012 as the Contract of Insurance stands null and void, since the same was fraudulently obtained after having concealed material facts and making false representations. Vide the aforesaid letter she was informed that the amount of Rs. 31259/- (unit value) was credited to her account vide NEFT on 04.10.2017.
10. After thoughtful consideration, we note that both the fora below have not taken into account the policy’s terms and conditions. The medical record of Tripura medical college of the deceased clearly shows that he was drug abused for more than 15 years and alcoholic. He was diabetic also. It was concealed from the proposal form. We find it was a material concealment and the repudiation from insurance co. was justified. Thus, the claim of the nominee under the said policy i.e. Mrs. Anjali Ghosh, mother of the DLA already stood repudiated vide letter dated 09.10.2012 on the ground of material concealment and the unit value of Rs. 31,259 was also credited to her account. Hence the question of releasing the sum assured in favour of Mampi Dhar Ghosh does not arise as the contract of insurance stood cancelled.
11. In a nutshell, the claim was investigated by the Ins. Co. since it was an early claim; cogent evidence of drug and substance abuse and of being addicted to alcohol and of suffering from diabetes mellitus was well forthcoming; the said abuse and
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addiction and disease were prior to the filling up of the proposal form; no mention of the same was made in the proposal form, though specifically asked for (‘No’ had been written against the relevant entries in the proposal form); as such, this was clear concealment of material facts. Hence the Ins. Co. cannot be faulted on repudiating the claim. Both the fora below have erred in overlooking the afore. 12. Based on the above discussion, the Revision Petition is allowed. The impugned Order dated 09.11.2017 of the State Commission is set aside. The Complaint is dismissed.