SARBANI CHATTERJEE R/O. C/O. CHANDRA SHEKHAR BARMAN Vs. BRANCH MANAGER, LIFE INSURANCE CORPORATION OF INDIA

JUDGEMENT

(1.) This Revision Petition has been filed by the Petitioner/ Complainant against the Respondents/Opposite Parties challenging the impugned Order dtd. 30/11/2016 passed by the State Consumer Disputes Redressal Commission, West Bengal, in First Appeal No. A/1416/2014. Vide such Order, the State Commission allowed the Appeal while setting aside the Order dtd. 31/10/2014 passed by the District Consumer Disputes Redressal Forum, North 24 Pgs, Barasat, in Consumer Complaint Case No. 665/2013.

(2.) The brief facts of the case are that the Complainant is the widow of deceased Late Prasanta Chatterjee. The deceased had purchased a Life Insurance Policy on 20/12/2011 bearing No. 429208659 during his lifetime by paying a substantial amount of premium for the sum assured at Rs.4,00,000.00. The Complainant's husband died on 29/2/2012 due to sudden Cardio-Respiratory failure. It was submitted by the Complainant that after the death of her husband, she vide letter dtd. 5/9/2012 was requested to submit certain documents which she duly submitted and which were received by the office of the Opposite Party on 18/9/2012. Thereafter, vide letter dtd. 12/3/2012, certain questions were put to the Complainants by Opposite Party No. 2 and the Complainant duly provided her version vide letter dtd. 8/4/2013. Further, vide letter dtd. 10/4/2013, the Complainant was advised to make representations for reconsideration of claim of the Complainant to the Zonal Office and vide letter dated 19/22/4/2013, the Complainant duly submitted her representation to Zonal Manager. Thereafter, vide letter dtd. 17/7/2013, she was informed that the Zonal Office Claims Review Committee had decided to uphold the repudiation decision of Divisional Office, and the Complainant was advised to appeal before the Opposite Party No. 4/Central Office Claims Review Committee, Mumbai. The Complainant filed an Appeal on 7/8/2013. However, till the filing of the instant complaint, no decision of the Opposite Party No.4 had been communicated to the Complainant. Hence, the Complaint was filed by her before the Ld. District Forum, being aggrieved by the acts of the Opposite Parties in not settling the claim in her favour, as the repudiation was based on no evidence or insufficient evidence. The Complainant therefore sought the following reliefs-

(3.) The Opposite Parties appeared before the Ld. District Forum and filed their reply to oppose the Complaint thereby denying deficiency in service on their part. The Opposite Parties denied the statements made in the Complaint except which were specifically admitted. It was contended by the Opposite Parties that the complaint was not maintainable, barred by limitation, barred by law of waiver, barred by non-disclosure of material facts and barred by non-availability of cause of action. It was submitted by the Opposite Parties that the deceased had purchased the Policy that was to run for 15 years and the premium that he paid was calculated on the supposition that the policy would run for a full term of 15 years. However, the policy ran for merely 2 months and 9 days. It is further submitted that vide letter dtd. 12/3/2012 no questions were asked, instead it was explained why the death claim had been repudiated, and how the deceased had misled the Corporation by answering the questions in the Proposal Form falsely. It was further contended that the decision of repudiation was upheld by Central Office Claims Disputes Redressal Committee on 30/1/2014 and the same was conveyed to the Complainant vide letter dtd. 30/1/2014. It was further contended that it was not mandatory to settle the claim in favour of the Complainant if the claim was shrouded by suppression of material facts to defraud the Corporation. It was further submitted that because the Policy had run for less than three years, it qualified as an early claim and the claim was referred to the Claim Review Committee of the Opposite Parties. During the claim review process, it was found that deceased life assured was a patient of morbid obesity, somnolence, obstructive sleep apnoea for about a year, as per prescription of Dr. N. B. Debnath dtd. 30/7/2008. However, in the Proposal Form dtd. 20/12/2011, the deceased life assured had answered the question No. 9 in the negative, thus misdirecting the Opposite Parties and suppressing material facts regarding his health. It was further contended that the contract of insurance is a contract of uberrimae fidei and therefore full disclosure must be made to the insurer of every material circumstance which is known to the assured. Hence, the Opposite Parties prayed for dismissal of the Complaint with exemplary costs.