Decided on June 30,2009

Tripti Kana Sadhu Respondents


- (1.)THE appeal arises out of the order/judgment dated 30.12.08 passed by the Dist Forum. Birbhum in Case No. CC/23 of 2008 wherein the complaint was allowed in part on contest. Complainant was awarded the policy amount of the policy in question with interest @ 10% p.a from the date of claim till payment along with a litigation cost of Rs. 5,000. The OP was directed to pay the awarded amount within 30 days from the date of the impugned order failing which the amount would carry interest @ 12% p.a after expiry of 30 days till payment.
(2.)BEING aggrieved by and dissatisfied with the aforesaid order the Appellant has preferred the instant appeal for setting aside the same mainly on the grounds that the life assured expired on 29.10.2006, i.e. within one year from the date of commencement of the policy on 3.11.2005 and it was a case of early death claim. The deceased life assured was under treatment and medication since the year 2000 and it was within his knowledge but he intentionally did not disclose it in the proposal form. The deceased assured was a known patient of diabetes and other ailments. The Forum below ought to have considered the claim form issued by SSKM Hospital, Kolkata and relied upon by the Respondent. The primary cause of death was Cardio Respiratory Failure and the secondary cause was COPD in a case of diabetes mellitus and hypertension. This factor was overlooked by the Forum below. The Dist Forum also erred in not holding that the diseased life assured was a patient of diabetes type (ii) and hypertension which was stated in the certificate of the SSKM Hospital in claim form B and Bi . The prescriptions of Dr. S. Dasgupta also clearly indicated the same. The deceased life assured was aware of his disease but intentionally withheld the same in the proposal form to get the benefits under the policy. The claim was repudiated on 11.8.2007 by the insurer.
(3.)THE Complainant s story in short was that one Upananda Sadhu had taken one life insurance policy for the sum assured Rs. 50,000 from the OP/Appellant. The date of commencement of the policy was 3.11.2005. The life assured died on 29.10.2006 at SSKM Hospital. The Complainant/sole Respondent herein being his wife and nominee preferred the death claim of the policy holder. But the Appellant Insurance Company repudiated the claim on 11.8.2007 on the grounds of suppression of material facts in the proposal form regarding his health status. Hence the case.
The case was heard ex parte as the Respondent did not turn up to contest this case in spite of receiving the notice. As a result we have to depend on the copy of complaint petition and other written materials which were available with the records.

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