Sri Shyamal Gupta, Member

This Appeal is directed against the Order dated 09-12-2016, passed by the Ld. District Forum, Purba Medinipur  in CC/183/2016, whereof the complaint case has been allowed.

The complaint case, in short, is that after the death of Complainant’s father, necessary death claim was lodged with the OP No. 2. As the said claim was not settled for long, the instant complaint case was filed.

The OP Nos. 1&2 did not contest the case.  Therefore, the case was decided ex parte against them.

Decision with reasons

Ld. Advocate for the Appellant submitted that the policyholder took the subject policy suppressing his previous medical condition.  As per available documents the policyholder was suffering from Myeloproliferative disorder  with myelofibrosis which have major bearing on the life span of a person.  Thus, it was material information that the policyholder, since deceased, ought to disclose while opting for the subject policy.  Such material information about the medical condition of the policyholder, since deceased, since been kept under the carpet while filling up the proposal form, the instant claim was not admissible.

Heard the other Ld. Advocates as well in the matter and gone through the documents on record.

Ld. Advocate for the Appellant furnished photocopy of a report, viz., Bone Marrow Trephine Biopsy dated 02-12-2013 in support of his contention.  On perusal of the said report, it transpires that it was the report of one Basudeb Roy, aged 62 years.  It does not contain any address of the patient. 

In this regard, it is noteworthy that as per the subject proposal form, the date of birth of the policyholder, since deceased, was 21-07-1955.  Accordingly, in the year 2013, the policyholder, since decased, was 58 years old; whereas, as per the medical report, the patient was 62 years old.

The age difference of 4 years is extremely crucial.  As the Biopsy report does not contain any address, it cannot be stated with certainty that the said report indeed belonged to the policyholder, since deceased.

Therefore, based on the said unproven report, I find no cogent reason to set aside the impugned order.

That apart, I have also noticed that the policyholder, since deceased, was not acquainted with English language which makes it crystal clear that the proposal form was not filled up by him.  Therefore, if the said proposal form was at all filled up as per his direction or not remains doubtful. 

Lastly, no authentic medical journal/write up is furnished on record from the side of the Appellant to establish any linkage between Myeloproliferative disorder and Cardio Vascular disease.  Thus, even if the policyholder was suffering from above disorder, in that case also it cannot be said that the same precipitated CVA. 

Above all, on going through the document namely, Proof of death (Physician’s Statement), I find that the same does not disclose any previous ailment of the policyholder, since deceased.

In appreciation of the above facts, I do not think that the impugned order suffers from any sort of incongruity and quite naturally, the same does not warrant intervention from this end in any manner whatsoever.

The Appeal, accordingly, fails.

Hence,

O R D E R E D

The Appeal stands dismissed against the Respondent No. 1.  The impugned order is hereby affirmed.  No order as to costs.