Jharkhand

Bokaro

CC/44/2022

Chetani Devi - Complainant(s)

Versus

The Compentent Authority of SBI Life Insruance Co. Ltd. - Opp.Party(s)

Prasant Kumar Roy

23 Jun 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-21-03-2022

Date of final hearing-23-06-2023

 Date of Order-23-06-2023

Case No. 44/2022

Chetani Devi W/o Late Puran Mandal

R/o 83 Jarandih, Double Stori, Bermo

P.S.- Bokaro Thermal District- Bokaro

Jharkhand Pin 829113

 Premanent Resident Village and Post- Chunglo,

 P.S. Jamua, District- Giridih 825318

Vs.

1. The Compentent Authority of SBI Life Insruance Co. Ltd.

    Regd. Office- SBI Life Insrance Company Ltd. Central Processing Centre 7^th Level D Wing and 8^th Level Seawoods Grand Central Tower 2, Plot No. R-1, Sector-40, Seawoods Nerul Node, District- Thane Navi Mumbai 400706

2. The Compenteant Authority of SBI Life Insurance co. Ltd.

       Branch Office at- 1^st Floor, Commerce House 1,

       Shashtri Nagar, Bank More, Dhanbad Jharkhand 826001

 

 Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-:Order:-

1. None turned up on behalf of both the parties on repeated call. It reveals from the record that this case is pending at the stage of argument in which complainant is absent since long, therefore, in the given facts as per provision of Section 38 (3) (c) Consumer Protection Act. 2019 case has been taken up for decision on merit on the basis of materials available on record.

 

2. Complainant has filed this case with prayer for direction to O.Ps. for payment of Rs. 10,50,000/- as death claim and to pay Rs. 50,000/-  as compensation and Rs. 20,000/-  as litigation cost to the complainant.
3. Complainant’s case in brief is that her husband late Puran Mandal purchased SBI Life Smart Swadhan Plus Policy No. IZ637872908 on 07.08.2020 after payment of premium Rs. 50,365/- to the O.P. SBI Life Insurance Co. Ltd.  and sum assured was Rs. 10,50,000/- but unfortunately her husband died on 01.11.2020 in Bhagwan Mahavir Medica Superspeciality Hospital, Ranchi due to SUBACUTE MENINGOENCEPHALITIS/SEPTIC SHOCK/MULTI ORGAN FAILURE/ADRS/AKI/SECONDARY OLD CVA/CHOLECYSTITIS/CHOLETHIASIS/DM.  Further case is that complainant being wife of the insured has filed death claim before the O.Ps. but there was no payment hence legal notice dt. 19.02.2022 was served which has been replied by the O.Ps. vide reply dt. 26.02.2022 by repudiation of the claim on the basis that the deceased was suffering from brain disease and mental disorder and was taking treatment for same prior to the date of proposal form which was suppressed by the insured, however the premium amount has been refunded on 01.12.2021. Further ground is that the husband of the complainant was examined by the doctor of the O.Ps. and he has disclosed all the facts which were within his knowledge and it is not expected that he will remember all past treatments for its disclosure. Hence this case has been filed.
4. O.Ps. appeared and have filed W.S. mentioning therein that all allegations are not true. Further reply is that each individual to be insured is required to furnish all information about his personal and family history, his heath and habits etc. and relying on the information furnished, the policy is being issued under good faith. Further reply is that late Puran Mandal committed a breach of the principle of utmost good faith by suppressing the material fact that he was suffering from brain disease and mental disorder and was taking treatment for the same prior to the date of proposal for insurance policy. Further reply is that  the deceased has given declaration regarding truthfulness of the statements given but it appears that it was against the insurance norms. Further reply is that as per death certificate of Bhagwan Mahavir Medica Superspeciality Hospital, Ranchi due to SUBACUTE MENINGOENCEPHALITIS/SEPTIC SHOCK/MULTI ORGAN FAILURE/ADRS/AKI/SECONDARY OLD CVA/CHOLECYSTITIS/CHOLETHIASIS/DM. Hence it is replied that due to suppression of material fact as per settled principle of law claim has been repudiated. Hence it is prayed to dismiss the case with cost.
5. Point for consideration is whether complainant is entitled to get relief as claimed ?
6. On perusal of the papers annexed with the complaint petition it appears that complainant has filed photo copy of Identity Card, Adhar Card, first premium receipt, death certificate issued by Municipal Corporation, Ranchi, death certificate issued by Medica Hospital, Ranchi, treatment summary of the patient, USG report, OPD prescription & discharge summary of the deceased of Deo Kamal Hospital, Ranchi, CT Scan Report of the deceased, legal notice and its reply in support of her case.
7. It is very much clear from the death certificate issued by Bhagwan Mahavir Medica Superspeciality Hospital, Ranchi  in which cause of death has been mentioned that death was due to SUBACUTE MENINGOENCEPHALITIS/SEPTIC SHOCK/MUTLI ORGAN FAILURE/ADRS/AKI/SECONDARY OLD CVA/CHOLECYSTITIS/CHOLETHIASIS/DM. This opinion finds  support with the prescription of Dev Kamal Hospital, Ranchi in which it is mentioned that CVA( Lt. sided) four years, DM2. Therefore, these papers are sufficient to show that at the time of treatment at Devkamal Hospital, Ranchi deceased has disclosed the fact that he was suffering with above mentioned deceased since four years. But there was no such disclosure by the deceased before the O.Ps. at the time of taking insurance policy as it is apparent from annexures  of the W.S. From Annexure-D, E, F, G,H of the W.S. it is apparent that on the basis of medical papers claim has been repudiated by the O.Ps. on the ground related to suppression of material facts.
8. In light of above discussion we are of the view that complainant has not proved her case for grant of any relief as prayed rather repudiation of the claim is based on material evidence hence there is no any deficiency on the part of the O.Ps. Accordingly this point is being decided against the complainant.
9.  In light of above discussion case is dismissed on merit and parties shall bear their own costs.

                                                                                                                                                                                                              S/d

(J.P.N. Pandey)

                                                                                      President

 

         S/d               

                                                                               (Baby Kumari)

                                                                                       Member