West Bengal

Bankura

CC/4/2015

Dipankar Dey - Complainant(s)

Versus

Branch Manager Tata AIG life Insurance Co. Ltd. - Opp.Party(s)

Jayanta Kr. Mukherjee

17 Jan 2023

ORDER

IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION BANKURA

Consumer  Complaint  No. 04/2015

Date of Filing : 21.01.2015

Before:

1. Samiran Dutta                              Ld. President.      

2. Rina Mukherjee                          Ld. Member. 

3. Siddhartha Sankar Bhui            Ld. Member.

For the Complainant: Jayanta Kr. Mukhopadhyay

For the O.P. None  

Complainant    

Dipankar Dey, Vill + P.O. Ranibandh, Dist. Bankura

 Opposite Party 

1. Branch Manager, Tata AIA Life Insurance Co. Ltd., Nutanchati, Bankura
2. Tata AIA Life Insurance Co. Ltd., Peninsula Business Park, Senapati Bapat Marg, Lower Parel, Mumbai- 400 013

DELIVERY OF JUDGEMENT

Date: 17-01-2023

This is an application under Section 12 of Consumer Protction Act, 1986 filed by the Complainant against the O.P. claiming Rs.14,40,000/- as the death benefit claim together with compensation and litigation cost.

            The Complainant’s case is that the deceased Dibyendu Dey brother of the Complainant purchased two Life Insurance Policies from the O.P., Proposal Forms No. being C066320847, dt.24-03-2014 and C066305998, dt.20-03-2014 respectively for basic sum assured of Rs.4,80,000/- each for a term of 15 years with an Yearly premium of Rs.49,483/-, Rs.25,236/- respectively. After payment of first premium the Insured expired on 08-05-2014 as a bachelor in young age leaving behind the Complainant as his sole legal heir and nominee. The death of the Insured was duly intimated to the O.P. authority along with claim application in due time but the same was refused by the O.P. authority by letter dated: 25-08-2014 on the ground of suppression of pre-existing disease.

            Hence this case for appropriate relief.

            The O.P. contested the case by filing a written version contending inter alia that the Complainant is not entitled to get any relief in this case because of suppression of pre-existing disease of the Insured which is a ground for repudiation of claim application.           

                                                                                                                                                                                       Contd…….p/2

Page: 2

An Affidavit in chief is on record in support of the O.P.’s defence case. The Complainant has however relied upon the material documents in support of the complaint case.

            Having gone through the entire facts and circumstances of the case and the documentary evidence on record it transpires that the Insured expired on 08-05-2014 and prior to his death he had medical history of cancer which is evident from Tata Memorial Hospital’s electronic medical records referred to as Annexure O.P.6 in the written version but at the time of submitting proposal forms on 20-03-2014 and 24-03-2014 said information was not disclosed therein in reply to the specific questions in the proposal form. Be it mentioned here that Annexure O.P.6 is not on record but it is evident from the copy of written version supplied to the Complainant.

The Ld. Advocate for the Complainant has contended that as per death certificate issued on 15-05-2014 by Dr. M. Ghosh that the death of the Insured was due to Sun-stroke which has no nexus with the disease of cancer. In support of his contention he has referred to a decision reported in (2022) CPJ 142. Taking judicial notice of the copy of Annexure O.P.6 as produced by the Complainant the Commission finds that there is no medical proof that at the relevant time the Insured was suffering from any disease of cancer and no findings could be found to that effect from that electronic medical record. It is no doubt true that the claim may be repudiated whenever pre-existing disease is suppressed in the Proposal form but the exception is that there must be proximity and nexus between the actual cause of death and the suppressed disease. In this case the actual cause of death as is evident from the death certificate is Sun-stroke but the disease of Insured is alleged to have been suppressed on behalf of the claimant is of the category of cancer which has no bearing upon on the cause of death.

            In this connection it is apposite to refer to a decision of the Apex Court dated: 05-10-2015 in Sulbha Prakash Motegaonkar Vs. LIC Civil Appeal No.8245/2015 wherein it has been held that death benefit claim cannot be refused merely on the ground of suppression of pre-existing disease if the cause of death cannot be linked to the pre-existing disease. In that case the Insured was suffering from Lumber Spondilitis which was not disclosed in the Proposal form but the death of the Insured occurred due to Ischemic heart disease and so death benefit claim was allowed by the Hon’ble Supreme Court as there was no proximity and nexus between the disease which caused the death and the pre-existing disease suppressed by the Insured.           

                                                                                                                                                                                  Contd…….p/3

Page: 3

Considering the entire facts and circumstances of the case and the material on record and legal position relating to the death benefit claim the Commission is of the view that the Complainant is entitled to get the reliefs as prayed for.

                                                                   Hence it is ordered……..

That the case be and same is allowed on contest.

The O.P.s are directed to pay to the Complainant Rs.14,40,000/- as the death benefit claim of the Insured with Compensation of Rs.50,000/- and Litigation Cost of Rs.10,000/- within two months time from this date in default the Decretal amount may be realized in due process of law.

Both parties be supplied copy of this judgement free of cost.

 

                    ____________________                           _________________                                  _________________

                   HON’BLE   PRESIDENT                     HON’BLE MEMBER                               HON’BLE MEMBER