Assam

Nagaon

CC/1/2015

Sri Madhabendra Bhuyan - Complainant(s)

Versus

Branch Manager, Nagaon Birla Sunlife Insurance Co. Ltd - Opp.Party(s)

PRASANTA BORA

16 Feb 2023

ORDER

1.        This is a petition filed by one Sri Madhabendra Bhuyan (hereinafter referred to as the petitioner) against the Branch Manager, Birla Sun Life Insurance Co. Limited, Nagaon Branch and two others (hereinafter referred to as the opposite parties) U/S  35 of the consumer Protection Act, 2019 praying for recovery of money, compensation and other relief.

 

1. The fact and circumstances for filing of the aforesaid petition as narrated by the petitioner are as follows:-

 

                  The father of the complainant, namely, deceased Mahim Chandra Bhuyan opened a policy for his life insurance  with Birla Sun Life Insurance Company Limited, Nagaon Branch on last 09/01/2013  vide  policy  number 005879637 for sum assured Rs.7,00,000.00 (Rupees Seven Lakhs)only and the present petitioner was made nominee for the said policy. Further case of the complainant is that policy holder Mahim Chandra Bhuyan died on last 03-09-2013 and thereafter, he intimated the Branch office of the opposite party  about the death of his father and placed his claim before opposite party No.1 along with all relevant documents to get the insurance benefit but the opposite parties did not settle his claim. He further stated that he had made approach many a time for settlement of his claim but the opposite parties did not response for which he served legal notice but the opposite party did not dispose his claim without any sufficient cause which amounts to deficiency of service on their part. Hence, this claim petition is before this Commission praying for the relief.

                The opposite party No.1 to 3 filed their written version denying all the allegation of the petitioner leveled against them. By their written version, the opposite parties pleaded inter- alia that there is no cause of action for the complainant to file the petition and that the petition is unsustainable in law and liable to be dismissed. The opposite parties further submitted that the law of insurance is governed by the legal doctrine Uberrima Fides meaning almost good faith (literally, most abundant faith) which means all the parties to an insurance contract must deal in good faith, making a full declaration of all material facts in the insurance proposal. The opposite parties further pleaded that in the instant case there are inherent misrepresentation and suppression of material facts and intentional false statement was made regarding health condition of the life assured in order to get the insurance coverage. The opposite parties further stated that since the claim being an early claim, the same was investigated by an independent investigating agency, namely, Sharp Eagle Investigation Private Limited and during investigation it was found that the deceased  policyholder at the time of obtaining the policy was suffering from Diabetes, an hypo-thyroism and underwent Appendectomy and LAP Cholecystectomy and the L.A. was diagnosed for bone cancer before 6 years prior to the date of application and he suppressed such material facts in the policy form and the insurance policy was obtained by fraud and misrepresentation and thus, the policy issued to the deceased policy holder should be treated as void at initio. The opposite parties also stated that the instant claim is barred by section 45 of the Insurance Act as because during investigation of the claim it was revealed the deceased policy holder intentionally suppressed the material facts in the proposal form regarding his health condition and hence, the act of opposite parties in repudiation of the claim on the ground of non-disclosure of material fact is squarely within the ambit of section 45 of the Insurance Act as the life assured died within two years from the date of commencement of the policy.   The opposite parties again submitted that the repudiation of the claim in the instant case is as per the terms and condition mentioned in the contract of insurance policy and the claim of the complainant is based on impermissible conjectures, inferences and surmise and the complainant is not entitled to any relief. Under the above premises, the opposite parties pray for dismissal of the complaint petition.

2.         Upon pleading of parties the following points are found for discussion and decision in the case.

1. Whether the opposite parties and illegally denied to extend the benefit to the complainant for the insured policy No. 005879637  for sum assured Rs.7,00,000.00 (Rupees Seven Lakh)only as nominee for the deceased policy holder Mahim Chandra Bhuyan without any justified cause and such act on the part of opposite parties amounts to deficiency in service?
2. Whether the claimant is entitled to any relief as prayed for?

 

 

4.              The complainant filed evidence in affidavit of one witness and also exhibited several documents in support of his claim. The opposite parties cross-examined the P.W. The Opposite filed evidence in chief of one witness but did not produce him for cross examination, hence, evidence in chief of D.W. has not considered to support of the written version of opposite party.

 

5.                   Written argument filed by both the contesting parties and perused the same.

 

 

6.                               Decision and reasons thereof:-

 

7.                     For the sake of brevity both the Point (i) & (ii) are taken jointly for discussion and decision:-

 

                          The claim of the complainant is that his father deceased Mahim Chandra Bhuyan during his life time opened a policy with the opposite parties, namely, Birla Sun Life Insurance Company Limited and on his death, the complainant being his son and nominee filed his claim for insurance benefit of the policy of his father but the opposite parties without any justified cause hold that  his father suppressed the material facts regarding his health condition at the time of opening the policy and thereby, refused to provide him with the insurance benefit. In support of his claim, he as P.W.1 adduced evidence to the effect that his father, namely, deceased Mahim Chandra Bhuyan opened a policy for his life insurance with Birla Sun Life Insurance Company Limited, Nagaon Branch on last 09/01/2013  vide  policy  number 005879637 for sum assured Rs.7,00,000.00 (Rupees Seven Lakhs)only and P.W.1 was made nominee for the said policy. Further evidence of P.W.1 is that policy holder Mahim Chandra Bhuyan died on last 03-09-2013 and thereafter, this P.W. intimated the Branch office of the opposite party  about the death of his father and placed his claim before opposite party along with all relevant documents to get the insurance benefit but the opposite parties did not settle his claim. In his evidence this P.W. further stated that he had made approach many a time for settlement of his claim but the opposite parties did not response for which he served legal notice but the opposite parties did not dispose his claim without any sufficient cause which amounts to deficiency of service on their part and thus, the opposite parties violated the term of the contract between the policyholder and  the insurer company and such act on the part of the opposite parties amount to deficiency in service. P.W.2 Nripendra Kr. Deka in his evidence as P.W.2 deposed that death certificate was issued in connection with death of Mahim Chandra Bhuyan and the date of death was last 03/09/2023. He is cross examination deposed that as per official record death of Mahim Chandra Bhuyan was due to old age.   

             The opposite parties while filing their written version submitted that the policy was obtained by fraud and at the time of opening the policy, the policy holder had suppressed the material facts regarding his health condition and he was diagnosed with Diabetes, Hypothyroidism and treated for bone cancer prior to the date of his application for his policy and thus he having concealed the material facts at the time of application, the act of opposite parties in repudiation of the claim on the ground of non-disclosure of material fact is squarely within the ambit of section 45 of the Insurance Act as the life assured died within two years from the date of commencement of the policy  and such act on their part does not amount to deficiency in service. Opposite parties though cross-examined the P.W.1 but nothing revealed from his cross examination that his father was suffering Diabetes, Hypothyroidism and treated for bone cancer prior to the date of his application for his policy. The opposite parties though filed evidence in affidavit of one witness but did not offered him for cross examination by the other side, hence, evidence in chief cannot be considered in support of the written version of opposite parties. Hon’ble Apex Court in many judicial pronouncement specifically stated that mere filing of written statement is not sufficient unless supported by evidence. The same Court further in Life Insurance Corporation of India-Vs-Komalavalli Kamba & Ors. Reported in (1984) AIR, 1014, 1984 SCR (3) 350 has held that the general rule is that the contract of Insurance will be complete only when the party to whom an offer has been made accepts unconditionally and communicates the acceptance to the person making the offer. The duty of the insurer is to verify the correctness of the information supplied by the person whose life is assured regarding his health condition. In the instant case the opposite parties failed to adduce any evidence in support of their written version that they verified about the information supplied by the policy holder regarding his health condition and that he was suffering from Diabetes, Hypothyroidism and treated for bone cancer prior to the date of his application for his policy  for reasons best known to them while from cross examination of P.W.1 also reveals nothing that policy bearing number 005879637 was obtained by fraud and misrepresentation by the deceased policy holder Mahim Chandra Bhuyan. In view of above observation we are of the opinion that the complainant has successfully established that there is a deficiency of service on the part of the opposite parties.

                  In result both the points for discussion and decision are answered in affirmative and go in favour of the complainant.

 

                                            O   R  D   E  R

 

8.                        In view of the above discussion, it is found that the petitioner has succeeded to prove that there was a deficiency of service on the part of opposite parties.

                                     

                       Accordingly, the prayer made by the petitioner U/S 12 of the Consumer protection is allowed on contest. Issue direction to the opposite parties to pay the complainant the insurance benefit for the insured policy No.005879637 of deceased Mahim Chandra Bhuyan as per terms and condition of the policy with interest @ 12 per annum from today till realization. 

 

                      Inform all the parties concern.

 

                      Given under the hand and seal of this Commission, we signed and delivered this Judgment on this 16^th Day of February 2023.