lic of india

TanuTanu Senior Member
: O R D E R :

MR. S.COARI, LD. MEMBER

The present Appeal has been directed against the judgement and order dt. 5.11.07 passed by the Ld. Murshidabad District Consumer Forum in Con.Prot.Case No. 118/2005 wherein the Ld. District Forum allowed the complaint on contest against the LIC Of India thereby directing to pay a sum of Rs. 2,25,000/- assured for life of Bulu Roy Chowdhury, since deceased, to the complainants, without any order as to cost.

The case of the complainants before the Ld. District Forum, in brief, was that the wife of Complainant No. 3 was insured with the LIC Of India for her life under a valid and legal insurance policy from LIC Of India. After the life of the Complainant No. 3’s wife was duly insured, she was murdered by unknown miscreants. The complainants preferred a claim before the LIC Of India which was repudiated on the plea that the insured being murdered question of giving any relief does not arise and hence, the petition of complaint was filed.

The LIC Of India contested the case by filing written objection thereby denying all the material averments of the petition of complaint contending inter alia that as the deceased was murdered, no compensation was payable to the complainants. The case having been on false and fictitious grounds the same is liable to be dismissed with cost.

The Ld. District Forum while disposing of the petition of complaint has observed that the plea taken by the LIC Of India in the form of Clause 4(B) of the clause incorporated in the insurance policy that the complainants were not entitled to any relief is not tenable and accordingly, allowed the petition of complaint thereby awarding compensation as mentioned above.

The only moot question that revolves round the present Appeal is as to whether the Ld. District Forum was justified enough in disposing of the petition of complaint in the manner as discussed above.
DECISION WITH REASONS
At the time of hearing the Ld. Advocate for the LIC Of India has urged before us that in this case the Ld. District Forum did not appreciate the points/plea raised by the LIC Of India/Appellant before the Ld. District Forum. According to the Ld. Advocate, when the policy was issued under a special clause of 4(B), there was no point on the part of the District Forum in ignoring the special clause of 4(B) and allowing the petition of complaint in favour of the complainants. While elaborating on this point it has been submitted on behalf of the Appellant/LIC Of India that firstly, the deceased was murdered and secondly, the complainants/Respondents failed to substantiate that it was an accidental death or the same took place in a public place. According to the Ld. Advocate, a married female folk if murdered within three years of her marriage, her legal heirs are not entitled to get any insurance relief from LIC Of India as the same is barred under Clause 4(B) of the Insurance Policy of LIC Of India. According to the Ld. Advocate, at best the complainants/Respondents are entitled to the premiums that had been deposited by them in pursuance to the policy of LIC Of India in question. While concluding her submissions it has been emphatically submitted before us that when it is an admitted position that the policy was in force for less than one year during which time the lady met with her unfortunate end due to murder, question of allowing/granting any relief under the policy instrument does not arise at all. While criticizing the impugned judgement the Ld. Advocate for the Appellant has also submitted that the Ld. District Forum did not appreciate the actual legal position and as such, has arrived at an unjust and improper decision which is liable to be set aside.

We have duly considered the submissions put forward on behalf of the Appellant and have gone through the pleadings of the parties and the materials on record including the impugned judgement and find that it is an admitted position that the deceased met with her unfortunate end being murdered by some unknown miscreants. Now, as regards the plea taken by the Appellant that the deceased was murdered by her husband does not hold much water while it is an admitted position that the husband (Complainant No. 3) was acquitted from the charge of murder levelled against him. On perusal of Clause 4(B) we find that the exception clause as regards accident is when the same takes place in a public place. Now, from the materials on record it has become evident that the deceased lady when came out of her house for the purpose of easing herself was shot dead by some unknown miscreants. In such circumstances, we are of considered opinion that it is the Appellant/LIC Of India. to prove that the place where the deceased was shot dead was not a public place. Unfortunately, the Appellant has not done so. On the other hand, we can come to the conclusion that the unfortunate village lady met her death outside her residence which can be accepted as a public place. When it is an admitted position that the husband of the deceased has been acquitted of the murder charge, the ingredients of Clause 4(B) of the Insurance Policy of LIC Of India do not come of any help to the Appellant/LIC Of India at all. On the other hand, we find that the Ld. District Forum has appreciated the case of respective parties reasonably well and in the process has traversed the pleadings of the parties quite well and has also adjudicated the real controversy between the parties after giving due importance to the pros and cons of respective parties’ cases and as such, has arrived at a just and proper decision which, in our opinion, should not be interfered with.

Considering the present matter in the light of above observation we find no reason to disturb the impugned judgement which is accordingly affirmed. In the result, the Appeal fails.

Hence, ORDERED that the Appeal stands dismissed on contest without any order as to cost. The Appellant is directed to pay the insurance value of Rs. 2,25,000/- (Rupees two lacs twenty five thousand only) in respect of the life of the deceased lady with interest @ 10% (ten per cent) per annum from the date of filing of the complaint before the Forum below till the amount is paid in full, to the Respondents/Complainants within 30 (thirty) days from the date of communication of this order, failing which the decretal amounts will accrue further interest @ 12% (twelve per cent) per annum for the period of default.
«1345678

Comments

  • adminadmin Administrator
    edited September 2009
    DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
    BATHINDA (PUNJAB)

    CC. No. 220 of 21-08-2008 Decided on : 24-03-2009


    Harpreet Kaur aged about 45 years, widow of Sh. Hardeep Singh Toor, R/o Village Lelewala, Tehsil Talwandi Sabo, District Bathinda. ... Complainant
    Versus


    1. LIC Of India, Divisional Office, urban Estate, Phase 1, Dugri, Ludhiana through its Senior Divisional Mnager. LIC Of India
    2. LIC Of India, Divisional Office, Jeevan Parkash Building, Near Shopping Complex, Ranjit Avenue, Amritsar, through its Senior Divisional Manager.
    3. LIC Of India, Branch Office, Jeevan Jyoti Building, Bibi Wala Road, Bathinda, through its branch Manager
    4. LIC Of India, Branch Office, Jeevan Jyoti Building, Thana Road, Abohar, through its Branch Manager
    ... Opposite parties

    Complaint under Section 12 of the Consumer Protection
    1. Act, 1986.
    QUORUM


    Sh. Pritam Singh Dhanoa, President
    Dr.Phulinder Preet, Member
    Sh. Amarjeet Paul, Member

    Present : Sh. Ashok Gupta, Advocate, counsel for the complainant
    Sh. S.N. Baghla, Advocate, counsel for the opposite parties

    O R D E R


    SH. PRITAM SINGH DHANOA, PRESIDENT
    1. This complaint has been filed by Smt. Harpreet Kaur, widow of Sh. Hardeep Singh Toor, a resident of Village Lelewala, Tehsil Talwandi Sabo, District Bathinda, under Section 12 of the Consumer Protection Act, 1986 (in short called the 'Act') against LIC Of India through its Senior Divisional Managers at Ludhiana and Amritsar and Branch Managers at Bathinda and Abohar, for passing direction to them to make payment of Insurance claim in the sum of Rs. 8,00,000/-, alongwith bonus and interest at the rate of 12 percent per annum from the date of lodging of complaint till the date of payment or any other additional or alternative relief to which she may be found entitled by this Forum. Briefly stated the case of the complainant may be described as under :-
      That Hadeep Singh, husband of the complainant during his life time has secured Life Insurance Policy of LIC Of India No. 471491566 on 16-11-2005, for a sum of Rs. 8,00,000/- from opposite party No. 2 ( LIC Of India) through agent at his village who got the policy issued from Abohar office of the Insurance company (LIC Of India). The insured has appointed the complainant as his nominee to receive the amount of claim in case of his demise. The policy was valid from 16-11-2005 to 19-11-2026. It was issued after verifying the health of the insured who was subjected to medical examination by a doctor out of the penal of doctors appointed by the LIC Of India. The insured expired on 16-02-2007. He was hale and hearty. After the insured made complaint about minor pain suffered by him, he was shifted to the hospital of Dr. Harbhajan Singh at Talwandi Sabo and was accompanied by his co-villager viz Sukhminder Singh son of Sohan Singh. The opposite parties vide their letter dated 20-01-2008, asked the complainant to submit the original policy bond and her bank account number to enable them to consider her claim with further information that they will depute one of their field officers to help and guide her in case of need. They also intimated her that her claim is outstanding in their record, but vide letter dated 31-03-2008, they repudiated the same on the ground that deceased insured had withheld the state of his health at the time of filling proposal form and used to take alcohol and was a patient of sugar and blood pressure. The action of the LIC Of India in repudiating her claim is misconceived, illegal and arbitrary, violation of statutory provisions and terms and conditions of the Insurance policy.
    2. On being put to notice, LIC Of India filed written version resisting the complaint by taking preliminary objections; that it is not maintainable; that complainant is not consumer within the ambit of its definition given in the Act; that contract of Insurance is based on utmost good faith; that life assured has suppressed real facts about state of his health in the proposal form filled before issuance of Insurance policy although he was suffering from various ailments and was addicted to liquor although specific question were put to him in the proposal form which he denied in the negative, as such, complaint deserves to be dismissed; that complainant has not approached this Forum with clean hands and intricate questions of law and fact are involved which cannot be adjudicated in summary manner but after leading of elaborate evidence by the civil court; that this Forum has no jurisdiction to entertain and try the complaint which being false and vexatious, is liable to be dismissed with special costs. On merits, it is admitted that Insurance policy of LIC Of India in question was issued in the name of the complainant, but it is submitted that his claim has been repudiated after verifying state of health of her deceased husband. It is submitted that examination of life assured is conducted as per disclosure of diseases made by him but in the present case Hardeep Singh, has concealed consumption of liquor and diseases suffered by him. It is also contended that as per report of Dr. Harbhajan Singh, the life assured prior to his death was under influence of liquor. It is denied that complainant paid the premium of Insurance policy of LIC Of India to the agent of the at his village Lelewala or her husband hired his services. Rather it is averred that life assured himself deposited the amount of Insurance premium at branch office of the LIC Of India at Abohar, which is working under Divisional Office Amritsar. It is admitted that claim lodged by the complainant has been repudiated by the LIC Of India vide letter dated 31-03-2007 rightly on the ground that life assured has died within two years from the date of issuance of policy, as per terms and provisions of Section 45 of the Insurance Act. The insured had not been enjoying good health and was under influence of liquor at the time of his death. It is denied that the action of the LIC Of India in repudiating the claim of the complainant was arbitrary, illegal or malafide. Rest of the averments made in the complaint have been denied and prayer has been made for dismissal of the same with compensatory costs.
    3. On being called upon, by this Forum, to do so, the learned counsel for the complainant tendered affidavits of complainant Ex. C-1 & Ex. C-8 and affidavits of Sh.Sukhmander Singh and Sh. Jasveer Singh Ex. C-7 & Ex. C-9 respectively, and copies of documents Ex. C-2 to Ex. C-6, before he closed his evidence. On other hand, learned counsel for the LIC Of India tendered in evidence affidavit of Sh. J P Arya, Manager Ex. R-1, and photocopies of documents Ex. R-2 to Ex. R-5 before he closed their evidence.
    4. We have heard, learned counsel for the parties and perused the oral and documentary evidence adduced on record by them, carefully, with their kind assistance.
    5. At the outset, Sh. S N Baghla, learned counsel for the LIC Of India argued that Insurance policy, in question, had been purchased by the husband of the complainant and claim has been preferred by her at Abohar, as such no cause of action accrued in her favour within territorial jurisdiction of this Forum. Learned counsel argued that in view of the above said facts, this Forum lacks jurisdiction to entertain and try this complaint. In support of his contentions, he placed reliance on 2007(1) CLT 523 Life Insurance Corporation of India Vs. Kewal Krishan Kampani, wherein it has been held by the Hon'ble State Commission, Punjab, that a case can be filed by a person where the LIC Of India has a branch office.
    6. On the other hand, Sh. Ashok Gupta, Advocate, learned counsel for the complainant has submitted that cause of action for complainant to file the complaint has accrued within the territorial jurisdiction of this Forum because insured has expired at his Village Lelewala , which falls within the jurisdiction of this Forum and she has received letter of repudiation at the address of her village. Learned counsel has also submitted that the LIC Of India are also carrying on their business through their office situated at Bathinda, as such, this Forum has the territorial jurisdiction to entertain and try the complaint. In support of his contentions, he placed reliance on 2003 (IV) CPJ 26 (NC) Puran Chand Wadhwa Vs. Hamil Era Textiles limited, wherein debentures were issued from Bombay. They were to be redeemed at the same place on account of which, it was held by the Hon'ble National Commission that no action wholly or in part took place at Chandigarh, as such, Consumer Forum at Chandigarh, has no territorial jurisdiction to entertain and try the complaint. Learned counsel has further relied upon 2003 (III) CPJ 144 (NC) National Insurance Company Limited Vs. Sonic Surgical, wherein fire broke in godown in Ambala Cantt and the policy was obtained from Ambala and the claim was also lodged and compensation was paid at the same place. It was held that mere dealing with claim at some stage by Regional office at Chandigarh, would not furnish part of cause of action, as such, State Commission, Union Territory, Chandigarh, has no territorial jurisdiction and order passed by Consumer Forum was set aside.
    7. We find merit in the argument advanced by the learned counsel for the complainant. Section 11 (2)(a) of the Act provides that a complaint shall be instituted in a District Forum within the local limits of whose jurisdiction the LIC Of India, where there are more than one, at the time of the institution of the complaint, actually and voluntarily resides or carries on business or has a branch office or personally works for gain. In the instant case, it is not disputed that the LIC Of India are also carrying on business through their branch offices situated at Bathinda and village Lelewala of the complainant which falls in the District Bathinda. Moreover, complaint can be instituted in the District Forum, within local limits of whose jurisdiction the cause of action wholly or in part arises as envisaged in Section 2(1)(c) of the Act. The complainant has produced on record a copy of Death Certificate issued by Gram Panchayat showing that her husband died in his village Lelewala, District Bathinda, on 16-02-2007. She has also produced on record letter dated 31-03-2008 Ex. C-3, addressed to her by the Senior Divisional Manager of the opposite parties at her village Lelewala informing her about the repudiation of claim lodged by her after demise of her husband, as such, cause of action also accrued to the complainant to file the instant complaint within the territorial jurisdiction of this Forum. In these circumstances, we are escaped from holding that this Forum has territorial jurisdiction to entertain and try this complaint and no ground is made out to dismiss the complaint on this technical ground.
    8. Learned counsel for the complainant has submitted that complainant has been nominated by the insured who was her husband to receive the amount of claim in case of his death and she is also legal heir of her husband. Learned counsel has further submitted that the opposite parties have neither examined the doctor who treated her husband nor any person who may be conversant with his hand writing, as such, the reliance cannot be placed on the copies of documents tendered in evidence by the opposite parties. Learned counsel has argued with full vehemence that taking of liquor is no disease in itself and no oral and documentary evidence has been produced on record by the LIC Of India to establish that deceased insured was alcoholic or used to take any intoxicants, as such, the repudiation of claim merely on the information given by doctor, is not justified especially when consumption of alcohol in itself is no disease. In support of his contentions, learned counsel has placed reliance upon 2005(1) CPC 52 L.I.C. Of India Vs. Joginder Kaur and Another, wherein Insurance company repudiated the claim on the ground that insured has concealed actual disease suffered by him at the time of submitting proposal form and tried to justify that insured was a chronic alcoholic for the last 15 years and has also history of jaundice, but no evidence was adduced to prove that any doctor had treated the deceased for these diseases. It was held by the Hon'ble National Commission that simple allegation is not sufficient to prove the case of concealment of disease by the insured in the proposal form. Learned counsel has also relied upon 2008(3) CPC 472 Life Insurance Corporation of India Vs. Satinder Kaur, wherein claim of the insured was repudiated on the ground that insured deceased had concealed the fact that he was a habitual alcoholic and had a pre-existing heart disease. District Forum gave verdict that repudiation of claim was unjustified as it was proved on record that death of insured was proved, due to heart attack, from the certificate of hospital but nothing was brought on record to prove that death was due to drinking of alcohol or deceased had any pre-existing disease. It was held by our own Hon'ble State Commission, that mere medical opinion that “Acute Pancreatitis can cause sudden death and can occur to average one especially to an alcoholic” does not prove the case of appellant. Hence, the order passed by the District Forum is well reasoned. Learned counsel has further relied upon 2008(2) CPC 34 Life Insurance Corporation of India & Another Vs. Sukhpal Kaur , wherein claim was repudiated on the ground that insured has not disclosed the fact that he was habitual drunker for a period of six years and was suffering from hypertension for the last 10 years and the said fact was concealed from proposal form. After District Forum allowed the claim, opposite party preferred appeal in which it was held that taking of liquor is not a material fact which requires to be disclosed at the time of taking a policy and if liquor was a disease, he could not survive for such a long time. It was also held that order passed by the District Forum does not suffer any any illegality. Learned counsel has further relied upon 2008 (1) CPC 675 Life Insurance Corporation of India Vs. Smt. Sukhwinder Kaur, wherein reason for repudiation given by the Insurance company was that deceased was a chronic alcoholic for 20 years, but he concealed the said fact in the proposal form. It was held by our own Hon'ble State Commission that reason for repudiation of claim given by the Insurance Company is unjust and unrealistic as taking of liquor is not a disease. It was further held that deceased remained alive for a period of 20 years, then it cannot be treated as disease or he cannot be held to be guilty of suppression of material facts.
    9. On the other hand, learned counsel for the LIC Of India has submitted that as per provisions of Section 45 of Insurance Act, the insurer has liberty to repudiate the claim if the death of the insured takes place within a period of two years and it is established that he has concealed the pre-existing disease. Learned counsel has argued that in the proposal form Ex. R-5, furnished by the insured, he has claimed that he has good health and does not take liquor or any other drug , narcotics, tobacco etc., but as per documents tendered in evidence by the LIC Of India, he was under the influence of liquor at the time of admission in the hospital before his death and cause of his death was respiratory arrest and during last three years, he was treated by doctor for abdominal pain and vomiting, as such his claim has been rightly repudiated by the LIC Of India and there is no deficiency in service on their part for which liability may be fastened upon them. In support of his contentions, he placed reliance on 2008 (1) Civil Court Cases 206 (S.C.) P.C. Chacko & Another Vs. Chairman, Life Insurance Corporation of India & Others, wherein Insurance policy was repudiated by the Insurance company on the ground of mis-statement of facts on account of which it was held by the Hon'ble Apex court that Insurance company can repudiate the policy within a period of two years and on expiry thereof, it cannot be called in question, but mis-statement itself is no material for repudiation thereof unless the same is material in nature. Learned counsel has further relied upon 2004(I) CPJ 88 (NC) LIC of India & Another Vs. Naveen Dhingra, where deceased having ailment on day, filed policy revival form suppressing the said information. The complaint was dismissed by District Forum and was allowed by the State Commission in appeal filed by LIC. It was held by the Hon'ble National Commission that Insurance contract is a matter of good faith, as such deceased knowingly gave incorrect information on personal health in his statement made at the time of revival of lapsed policy form, then he is not protected by Section 45 of Insurance Act, as such, repudiation of claim was justified and the order passed by the District Form was restored. Learned counsel argued that material brought on record and proposition of law laid down in the authorities cited above, the complaint is bound to fail and is liable to be dismissed with costs.
    10. The argument advanced by the learned counsel for the LIC Of India has failed to sound well with us. The complainant in her affidavit Ex. C-1 has reiterated the averments made in the complaint on solemn affirmation that her husband died natural death after he was shifted to hospital of Dr. Harbhajan Singh on 16-02-2007 at Talwandi Sabo with complaint of minor pain. The contents of affidavit of the complainant are corroborated by the affdavits Ex. C-6 & Ex. C-7, of Sukhmander Singh, who accompanied the complainant and her husband from their village and Sh. Jasveer Singh. Learned counsel for the opposite parties have relied upon medical attendant certificate issued by Dr. Harbhajan Singh, who treated the deceased husband of the complainant. As per contents of the said document, the insured expired on 16-02-2007 in his hospital at Talwandi Sabo. The primary cause of the death of the insured has been mentioned by the said doctor in the certificate Ex. R-3, as “Respiratory arrest” and secondary cause mentioned as “effect of liquor”. It is further mentioned that he had been treated by the above named doctor for a period of ten years for abdominal pain and vomiting. The LIC Of India have neither examined the doctor who treated the insured before his death nor they examined any person who may be conversant with his hand writing and signatures. They have also not produced any other record of treatment of the insured by the said doctor, maintained in his hospital or any prescription slip issued by him. There is nothing on record indicating that inquiry was conducted regarding the disease suffered by the insured before he filled up the proposal form for issuance of Insurance policy. Therefore, on the basis of certificate Ex. R-3, we are unable to conclude that deceased has suppressed material facts concerning his health or disease was suffered by him while filling up proposal form Ex. R-5. Moreover, no question has been imposed to the complainant in the proposal form that as to if insured had ever suffered respiratory disease, abdominal pain or vomiting etc., On the basis of facts borne on record, we are unable to accept the plea of the LIC Of India that deceased insured had been suffering from chronic ailment and had intentionally suppressed the same while filling the proposal form.
    11. Being fortified by ratio judgements delivered in the authorities relied upon by the learned counsel for the complainant, we have no hesitation in holding that consumption of liquor itself is not a disease. As such, even if it be presumed for the sake of discussion that Insured has denied the factum of taking alcohol by him in the proposal form, even then, relief to the complainant cannot be denied on that score.
    12. We have carefully gone through the authorities relied upon by the learned counsel for the LIC Of India, but have come to the conclusion that facts and circumstances thereof, were quite distinguishable from those of the case in hand. In those cases it was established that insured had deliberately concealed the material facts regarding their health and diseases suffered by them whereas in the case in hand, this fact is not established by any positive evidence.
    13. In the light of our above discussion, we have come to the conclusion that repudiation of insurance claim lodged by the complainant of his deceased husband, upon the Insurance company on the ground of concealment of state of his health or any disease or chronic disease suffered by her husband or drinking habit, is not justified and there is deficiency in service on their part because of which complainant has faced mental agony and has to incur unavoidable expenses for filing of this complaint. Therefore, opposite parties have no option but to release the amount under the policy secured by her deceased husband and to pay her compensation and costs.
    14. For the reasons discussed above, we accept the complaint and set aside letter of repudiation dated 31-03-2008 and direct the LIC Of India to pay a sum of Rs. 8,00,000/- to the complainant in terms of policy secured by her deceased husband Hardeep Singh Toor son of Kartar Singh Toor, and any other benefit permissible therein, alongwith interest at the rate of 9 percent per annum with effect from 31-03-2008 till the date of actual payment. The LIC Of India are further directed to pay Rs. 1,000/- to the complainant on account of costs incurred by her for filing of instant complaint. The compliance of this order be made within a period of two months from the date of receipt of copy of its order. The copies of this order be sent to the parties, free of costs as permissible under the rules, on the subject.
    1. File be indexed and consigned.
    Pronounced :
    24-03-2009 (Pritam Singh Dhanoa)
    President
  • adminadmin Administrator
    edited September 2009
    DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
    BATHINDA (PUNJAB)

    CC. No. 139 of 8-05-2008Decided on : 17-03-2009
    1. Jatinder Kaur widow of Gurmej Singh S/o Sh. Mehtab Singh
    2. Parneet Kaur )
    3. Navdeep Singh )
      minor children of Gurmej Singh son of Sh. Mehtab Singh, through their natural mother and next friend Smt. Jatinder Kaur widow of Gurmej Singh
    4. Gurmit Kaur wife of Mehtab Singh (mother of Gurmej Singh)
      - all residents of Quarter No. 56, Police Colony, Lal Singh Basti, Bathinda. ... Complainants
    Versus


    1. LIC Of India, Urban Estate, Phase-I, Dugri Road, Ludhiana, through its Zonal Manager.
    2. Senior Divisional Manager, LIC Of India, Urban Estate, Phase -I, Dugri Road, Ludhiana.
    ... Opposite parties


    Complaint under Section 12 of the Consumer Protection
    1. Act, 1986.
    QUORUM


    Sh. Pritam Singh Dhanoa, President
    Dr.Phulinder Preet, Member
    Sh. Amarjeet Paul, Member

    Present : Sh. Abhey Singla, Advocate, counsel for the complainants
    Sh. Sanjay Goyal,Advocate, counsel for the opposite parties

    O R D E R


    SH. PRITAM SINGH DHANOA, PRESIDENT
    1. This complaint has been filed Smt. Jatinder Kaur widow of Sh. Gurmej Singh and her minor children Parneet Kaur and Navdeep Singh and their grand mother Gurmit Kaur, under Section 12 of the Consumer Protection Act, 1986 (in short called the 'Act') against LIC Of India through its Zonal Manager and Senior Divisional Manager, Ludhiana, for giving them direction to pay double the amount payable under the Insurance Policy secured by deceased Gurmej Singh son of Sh. Mehtab Singh, covering risk of his life with further direction to pay a sum of Rs. 70,000/- on account of damages and compensation and any other additional or alternative relief deemed fit by this Forum.
    2. Briefly stated the case of the complainant is that the insured Gurmej Singh had been suffering from cough and cold for several days prior to his death on 26.10.05 and had been taking homeopathic medicine. The deceased insured confused the homeopathic medicines taken by him with tablet meant for killing rats and consumed the said poisonous substance by mistake on 26.10.2005. He died on the way to hospital and on account of his death, F.I.R. was registered and police officials in the course of investigation came to the conclusion that insured had died due to taking poisonous tablets presuming them to be homeopathic medicine taken by him. The deceased had purchase LIC policy bearing Account No. 300237616 from the LIC Of India. After his demise, complainant No. 1, lodged claim with the LIC Of India for seeking release of amount payable under the policy fo LIC Of India, but they repudiated her claim vide their letter dated 06-10-2006, on the ground that deceased has committed suicide within a period of one year from the date of issuance of policy of LIC Of India. On receipt of intimation, complainant No. 1, made representation on 27-02-2007 to the Zonal Manager of the LIC Of India, but he did not pay any heed. However, in terms of letter dated 11-10-2007, written by her, claim was referred by LIC Of India to Insurance Ombudsman, Chandigarh, but he too vide order dated 24-01-2008, rejected the same accepting version of the LIC Of India although the insured had expired accidental death and had not committed suicide. The complainants have suffered mental and physical agony due to repudiation of their claim by the LIC Of India, in arbitrary manner, hence this complaint.
    3. On being put to notice, LIC Of India filed written version resisting the complaint by taking preliminary objections that complainants have not approached this Forum with clean hands, as such, their complaint deserves to be dismissed; that complaint is not maintainable because earlier representations filed by the complainants before Zonal Level Committee chaired by retired judge of Hon'ble High Court and Insurance Ombudsman, Chandigarh, which is a statutory body, have been dismissed; that complaint is false, frivolous and baseless and there is no deficiency in service on the part of the LIC Of India, as such, it is liable to be dismissed. On merits, it is admitted that Insurance policy in question was purchased by the deceased insured in terms of which claim is not payable if insured committed suicide, within the period of one year from the date of issuance of policy. It is submitted that as the insured has committed suicide within a period stipulated in the policy, as such, claim has been rightly repudiated by the LIC Of India. It is submitted that representations were filed by the complainants before Zonal Level Committee, which is an independent body and before Insurance Ombudsman, a statutory body for the areas covered by States of Punjab, Haryana, Himachal Pardesh, J & K and Chandigarh. As such they have availed the remedy open to them before the Zonal Level Committee of the LIC Of India and orders passed by the said committee and Insurance Ombudsman have become final and are binding upon the parties. It is also contended that the said authorities have accepted the version of the LIC Of India and have passed the orders with independent mind without their influence after providing opportunity of being heard to the complainants. It is also submitted that complainants have no cause of action to file the present complaint and this Forum has no jurisdiction to readjudicate the controversy in view of the orders passed by the above said authorities. Rest of the averments made in the complaint have been denied and prayer has been made for dismissal of the complaint.
    4. On being called upon, by this Forum, to do so, the learned counsel for the complainants tendered affidavit of Jatinder Kaur, complainant and copies of documents Ex. C-2 to Ex. C-23, before he closed their evidence. On other hand, learned counsel for the LIC Of India tendered in evidence the affidavit of Sh. J P Arya, Manager Legal and copies of documents Ex. R-2 to Ex. R-5 and he closed their evidence.
    5. We have heard, the learned counsel for the parties and perused the oral and documentary evidence adduced on record by them, carefully, with their kind assistance.
    6. At the outset, learned counsel for the complainants Sh. Abhey Singla, Advocate, has submitted that factum of issuance of Insurance policy in the name of deceased insured is not disputed by the LIC Of India and cause of death is proved by the copies of documents produced on record by the complainants and affidavit of complainant No. 1 Smt. Jatinder Kaur, but no evidence to the contrary has been adduced on record by the LIC Of India, on the basis of which their plea may be accepted by this Forum that deceased insured has committed suicide within a period of one year from the date of issuance of Insurance policy. Learned counsel argued that even the Investigator appointed by the LIC Of India Sh. Vikas Aggarwal, has reported after recording the statements of the witnesses that claim of the complainants being genuine may be paid to them, but they preferred to reject the claim on the basis of no evidence. Learned counsel submitted that decisions given by Zonal Level Committee and Insurance Ombudsman on the representations made by the complainants are not binding upon them and complaint filed by them before this Forum, is maintainable. In support of his contentions, learned counsel has placed reliance on 2005(2) CLT 37 Kamleshwari Prasad Singh Vs. National Insurance Co. Ltd., wherein it has been held that decision of Ombudsman is not binding upon the complainant and action of Insurance Company of repudiating the claim is subject to adjudication by Consumer Forum constituted under the Act. Learned counsel has also relied upon 1997(2) CLT 43 Dev Dutt Dhiman and M.R. Dhiman Vs. State Bank of India, wherein it has been held that decision of Banking Ombudsman is only recommendatory in nature and there is no legal sanction for such a decision to get it implemented and thus cannot be a bar for a consumer to approach the authority under the Act. Learned counsel argued that in view of the material placed on record by the complainants and law laid in the authorities cited above, the LIC Of India cannot escape liability to release the amount payable under the policy alongwith compensation and costs, as demanded in the complaint.
    7. On the other hand, Sh. Sanjay Goyal, Advocate, learned counsel for the LIC Of India has submitted that as per documents placed on record by the complainants themselves, deceased has consumed poisonous substance and their plea about consuming of said substance due to confusion created in mind for medicine, which he has been taking earlier, is not supported by any positive evidence, as such, the LIC Of India have rightly repudiated their claim as per terms and conditions of the policy because insured had committed suicide within a period of one year after the date of issuance of Insurance policy. Learned counsel argued decisions given by Zonal Level Committee chaired by retired judge of High Court, which is independent body and Insurance Ombudsman, which is a statutory body, are binding upon the parties. Learned counsel argued that proper remedy for the complainants was to file appeal to avail further remedy against the decisions given by the above said authorities, but they have failed to do so and any conclusion drawn by the Investigator appointed by the LIC Of India, is not binding upon them as the same is subject to final decision which may be taken by them as per facts and circumstances of the case. In support of his contentions, learned counsel has placed reliance on 2005(2) CPC 440 Rural Postal Insurance through its Postmaster and Another Vs. Chandro Devi and others, wherein insured consumed poison which resulted in his death after which his legal heirs lodged claim for payment of the amount under the policy secured by him, which was repudiated by the petitioners on the plea that he committed suicide, within a period of one year from the date of issuance of policy in terms of decision by by the Hon'ble National Commission in revision petition No. 417 of 1997 titled as Branch Manager, LIC and Another Vs. Ramchander Singh dated 19-09-1994, to the effect that policy in question had become void and no claim could have been entertained by the District Forum, accepting the appeal of the insurer. Learned counsel has further relied upon 2001(1) CPC 633 National Insurance Co. Ltd., Vs. Dinesh (S.C.), wherein it has been held by the Hon'ble Apex court that Insurance company can dispute the correctness of report made by surveyor as his report is not always binding upon, with further observation that State Commission has wrongly ordered that entire amount as suggested by Surveyor should be paid to claimant, whereas Hon'ble National Commission has not considered the said question because of which impugned order was set aside accepting the appeal of the Insurance company. Lastly, learned counsel relied upon 2003(1) CPC 303 Punjab State Electricity Board Vs. M/s. Aneja Food Products, wherein dispute was referred to Dispute Settlement Authority, but complainant was not given the representation. District Forum accepted the complaint and set aside the impugned demand raised by the electricity board with direction to refund the amount paid by the complainant alongwith interest and costs. However, it came into evidence that complainant had acquiesced to the jurisdiction of Dispute Settlement Authority. It was held by the Hon'ble State Commission, Chandigarh, that once the matter was taken up by Dispute Settlement Committee, the District Forum could not sit over its decision as an appellate authority and order passed by District Forum was set aside by allowing appeal filed by Punjab State Electricity Board.
    8. There is no dispute regarding settled proposition of law that decision given by Insurance Ombudsman on the reference made at the instance of the complainants, does not debar them from availing remedy under the Act because the same is recommendatory in nature and remedy before Consumer Forum is additional remedy in terms of section 3 of the Act.
    9. However, the perusal of Ex. R-2 & Ex. R-3 reveals that appeal No. 4489 preferred by the complainants on account of death of Gurmej Singh, has been dismissed by ZOCRC and repudiation of claim by the LIC Of India has been upheld with the direction to inform them in case they are not satisfied with the decision of ZOCRC, then they can file further appeal to COCRC. The complainants have not denied the fact that they had availed remedy before Zonal Level Committee constituted by the opposite parties headed by High Court Judge, for adjudication of insurance claims. There is nothing on record that complainants have availed further remedy of appeal before COCRC or that they invoked the writ jurisdiction of the Hon'ble High Court under Article 226 of Constitution of India. After they have availed the remedy by filing appeal before Zonal Level Committee constituted by the LIC Of India and its order has become final binding upon the parties to the complaint, the complainants cannot invoke remedy under the Act.
    10. Even otherwise the plea of the complainants that deceased Insured had been suffering from cough and cold is not corroborated by any documentary proof like prescription slip or bill secured by the deceased after purchase of homeopathic medicine. They have also not examined any doctor who treated the deceased prior to the date of his death. They have produced on record copy of report of Investigator namely Sh. Vikas Aggarwal appointed by the opposite parties Ex. C-16 and copies of witnesses recorded by him Ex. C-21 to Ex. C-23 in the course of Enquiry. The report of surveyor or investigator appointed by the LIC Of India to verify the factum of cause of death of the insured is not binding on them. It is always subject to approval by competent authority and the insurer can always has liberty to differ with report of Surveyor or Investigator. The statements of witnesses recorded by him are no substitute for the statements made in the course of trial before the Consumer Forum. The complainants have not produced any of the person whose statement has been recorded in the course of Enquiry by the Investigator appointed by the opposite parties or the signatory of Panchyatnama Ex. C-15 relied upon them as to cause of death of insured. It may not be out of place to mention here that deceased insured was employed on the post of a Constable in Police and Investigator appointed by the LIC Of India arrived at a conclusion that Insured has not committed suicide on the basis of statements of his colleagues or their wives. Similarly Panchyatnama Ex. R-15 also bears the signatures of police officials alone. As mentioned in the Claimant's statement Ex. C-18, insured had expired after consuming Sulphas tablets. In the copy of postmortem report Ex. C-19, it has been mentioned that exact cause of death can be declared only after seeking report of chemical analyst. The complainants have themselves tendered in evidence the report of Chemical Examiner Ex. C-20, given after analysis of viscera as per which 'Aluminum Phosphate Insecticide' was detected in the Exhibits. In view of different size and shape of homeopathic tablets and Aluminum Phosphate tablets, the plea of the complainants that insured confused the above said insecticide and consumed them by mistake, does sound well to the conscience.
    11. The initial onus to prove the above said facts was upon the complainants, but they have failed to discharge the same by producing any reliable and convincing evidence. As such, they cannot succeed on the basis of any weakness in the case of the LIC Of India and liability cannot be fastened upon them merely because of non-production of any evidence to the contrary, especially when insured had been living in the police quarters prior to his death and none of his colleagues and their family member has come forward to reveal the truth before the Investigator appointed by the LIC Of India, who has given his report without recording evidence of any person having no departmental or personal dealing with the deceased insured.
    12. In the light of our above discussion, we have come to the conclusion that the LIC Of India were justified in repudiating the claim of the complainants as per terms and conditions of the Insurance policy, which provide that in case of death of insured within one year after the date of issuance thereof, claim can be repudiated if death of the insured has taken place due to suicide.
    13. For the aforesaid reasons, we dismiss the complaint and leave the parties to bear their own costs. The copies of this order be sent to the parties, free of costs as per rules, on the subject.
    1. File be indexed and consigned.
  • adminadmin Administrator
    edited September 2009
    BEFORE THE DISTRICT CONSUMER FORUM AT ADILABAD
    Date of filing : 26.05.2008.
    Date of disposal : 30.03.2009.

    C.C.No.64/08
    Between:-
    Vodnala Rayamallu, S/o.Late.Yellaiah,
    Age:35 years, R/o.Seetharampally village,
    Mandal Mancheiral,
    Dist.Adilabad. …Complainant.

    //AND//

    LIC Of India,
    Branch Mancherial. …Opp.Party.


    Counsel for Complainant : Mr.C.Sudhkar Reddy.


    Counsel for Opposite Party : Mr. P.Mohan Singh.

    QUORUM:-
    SRI.P.THIRUPATHI REDDY, M.A., L.L.B. : PRESIDENT.

    SRI.G.SRINIVAS, B.COM., L.L.B. : MEMBER.
    MONDAY THE 30th DAY OF MARCH 2009.
    -:ORDER:-
    Order Pronounced by President:-
    This complaint is filed under section 12 of C.P. Act 1986.
    The brief facts of complaint are as follows:

    1. The complainant is resident of Seetharampally village R/M. Mancherial. The brother of the complainant by name Vodnala Srinivas, S/o.Late.Yellaiah, R/o.Seetharampally insured his life with the LIC Of India for an amount of Rs.2 lakhs on 20.12.2005. Therefore, the LIC Of India issued Policy Bond bearing No,683991025 for Rs.2,00,000/- in favour of Vodnala Srinivas. Later, the brother of the complainant paid the premium installments regularly till his death. The maturity date is 20.12.2023 and in case of death of the insurer, the policy amount of Rs.2,00,000/- plus vested bonus is to be paid to the Nominee. At the time of issue of the policy, the complainant was nominated as Nominee by the Policy holder Vodnala Srinivas. The policy holder, i.e., the brother of the complainant died on 15.07.2007 leaving behind him the complainant as his nominee. The complainant filed an application before the LIC Of India on 30.08.2007 for payment of the policy amount and vested bonus to him. The complainant also got issued a legal notice on 07.04.2008 demanding the LIC Of India to pay the amount. But the LIC Of India failed to pay the amount to the complainant.
    Hence the complainant prayed this Forum to direct the LIC Of India as below:

    a). To pay an amount of Rs.2,00,000/- (Rupees Two Lakhs Only) with vested bonus and interest at the rate of 24% per annum from the date of death of insurer till the realization.

    b). To pay Rs.5,000/- (Rupees Five Thousand only) towards compensation on account of causing agony and pain both mentally, physically and monetarily and also on account of rendering deficient services.

    c). To pay costs of the complaint.

    d). To award any other relief or reliefs which this Hon’ble Forum deems fit and proper in the circumstances of the case.

    2. The LIC Of India contested the petition and filed counter. The contents of counter is as follows:
    It was found by the LIC Of India Corporation in the enquiries that the Life Assured was not a healthy person at the time of taking the said policy and suffering from cancer before issue of policy and taken treatment from Sai Orthopedic Clinic on 14.06.2004. That the life assured suppressed material facts about the status of his health, details of treatment taken for illness etc., in the proposal for insurance and fraudulently obtained the policy. That the proposal for Assurance dt:16.12.2005 the deceased Life Assured had answered the following questions as under noted:

    QUESTION
    ANSWER
    (a).
    During the past 5 years did you consult any Medical Practitioner for any ailment requiring treatment for more than a week.
    No.
    (b).
    Have you ever been admitted to any Hospital or Nursing Home for general check-up observation, treatment or operation?
    No
    (c ).
    Are you suffering from or have you ever suffered from any ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney Brain or Nervous System?
    No
    (d).
    Are you suffering from or have you ever suffered from any Diabetes, Tuberculosis, High Blood Pressure, Cancer Epilepsy, Hernia, Hydrocele, leprosy, or any other diseases?
    No
    (e).
    What has been your usual State of health?
    Good.

    That as per the Sai Orthopedic Clinic, Mancherial LA was admitted on 14.06.2004 and discharged on 21.06.2004 and was suffering from Fibromyxoid Sarcoma (cancer). This vital information was suppressed by the life assured in the Proposal dt:16.12.2005. Therefore, it is evident that the deceased life assured had made incorrect statements and withheld correct information from the Opp.Party regarding his health at the time of effecting the assurance. The LIC Of India prayed to dismiss the petition.

    3. Both parties filed Proof Affidavits.

    4. On behalf of complainant Ex.A1 to A7 are marked. Ex.B1 to B5 are marked on behalf of LIC Of India.

    5. Now the point for consideration is whether there are grounds to allow the petition?

    6. Heard both sides. The plea of the Ld. Advocate for complainant said that the deceased Srinivas was hale and healthy. He never suppressed that facts about his health and he never underwent any treatment prior to taking policy and he prayed to allow the claim. On the other hand the Ld. Advocate for LIC Of India in his counter and arguments constantly maintained that the Late.Srinivas underwent treatment from Sai Orthopaedic Clinic on 14.06.2004 and that he was patient and in support of the contention of LIC Of India they filed treatment particulars from Sai Orthopaedic Clinic Mancherial. A perusal of Ex.B3 shows:
    Soft tissues swelling

    (R ) Gluteal Region
    Size: 8” X 6” X 5”
    Excessive Burns

    SA by Dr.Murthy.
    By standard southern’s approach that sub gluteal region was exposed and found to be occupied by a cyst. The cyst wall was bluish, vascular and not adherent to surrounding tissues. The cyst wall was nearly ruptured and contents evacuated. Profuse, Ooze, was noted. Sciatic nerve was found extended in the sheath of the cyst wall. Haemostiasis was secured as much cyst as possible was excised.

    7. The LIC Of India further relied on the Affidavit of the Doctor Sai Orthopaedic Nursing home it is marked as Ex.B5. Ex.B5 reads as follows:
    I am the deponent herein and I know the deceased Vodnala Srinivas, S/o.Yellaiah, Age:22 years, R/o.Seetharampally, Post:CCC Naspur, Mdl:Mancherial, Dist.Adilabad. Who has taken treatment in my Nursing home for the disease Soft tissues swelling gluteal region as patient vide P.No.12/139 from 14.06.2004 to 21.06.2004. That earlier on the requisition of the LIC Of India I have given treatment Certificate on the basis of Records maintained by me in my Nursing Home.
    A perusal of Ex.B4 i.e., opinion of the Dr.Thirupathi Rao ( consultant Doctor of LIC of India Karimnagar) shows that this case was referred to him for opinion and he passed remarks as follows: Life assured was suffering from Fibromyxoid Sarcoma (Cancer). Doctor passed his remarks on information furnished by LIC Of India it is as follows:
    Please refer Case Sheet from Sai Orthopaedic Clinic dt:14.06.2004. Please ascertain 1). The disease suffered by the person. 2). The conformation of Histopathology report.

    A perusal of Ex.B2 application proposal for insurance the contents are as follows:
    Column 3 B.
    Q: Have you understood fully the terms and conditions of the plan you propose to take?
    Answer : Yes.
    8. Coming to in personal history in Page No.3 column No.11F
    Q: Do you have any bodily defects or deformity?
    Answer : Yes.
    In column No.11G Q: Did you ever have any accident or injury?
    Answer : Yes.
    In 4th page in column NB for Medical cases only
    “ I certify that the Proposer has signed/put this/her thumb impression in my presence after admitting that all the answers to Questions No.’s 10 and onwards of this form have been correctly recorded”.

    But where as column No.11 a to e
    PERSONAL HISTORY
    Answer Yes or No.
    a). During the last five years did you consult any Medical practitioner for any ailment requiring treatment for more than a week?
    No
    b). Have you ever been admitted to any Hospital or Nursing Home for general check-up observation, treatment or operation?
    No
    c). Have you remained absent from place or work on grounds of health during the last 5 years?
    No
    d). Are you suffering from or have you ever suffered from any ailments pertaining to Liver, Stomach, heart, Lungs, Kidney, Brain or Nervous system?
    No
    e). Are you suffering from or have you suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other diseases?
    No

    9. Ex.B4 is dated three years after issue of policy. It is obtained for repudiating the claim. Thus a perusal of Ex.B3 & B4 clearly reveals that late.Srinivas was suffering from Cancer disease and he underwent treatment prior from 14.06.2002 onwards. This policy was Ex.B2 application for obtaining policy was made on 16.12.2005 i.e., one year after treatment in the Sai Orthopaedic Nursing Home.

    10. Knowingly or unknowingly in column no.11 F & G Late.Srinivas admitted that he has bodily defects and injuries. But in column No.11 a to e the Late.Srinivas replied in negative, it amounts suppression of material facts about his status of health. Basing on this the Ld. Advocate for the LIC Of India relied on following Case Law.
    Re: Case Laws in support of suppression of material facts by the proposer/life assured.
    III (2002) CPJ 10 (NC)
    1. L.I.C. of India
    V/s.
    Minu Kalitha.
    Repudiation of claim – Insured suffering from cancer took treatment in hospital not disclosed. Incorrect information regarding health. Insurance contract invalid ab initio. No deficiency in service. Repudiation justified.
    It is settled that law that contract of insurance is based on good faith. It is for the respondent insured to give correct information on his health which he did not disclose at that time.
    This ground of incorrect information and false statements make the insurance contract null and void. We find there is no deficiency in service by LIC of India.
    We are convinced that LIC Of India rightly repudiated because the said policy had been rendered void and invalid ab initio in view of the false answers given by the life assured and the policy was unenforceable.
    III (2003) CPJ 15 (NC)
    2. Panni Devi
    V/s.
    LIC of India

    If a person with holds any information, Doctor would not know it unless it is visible. Life Assured violated the very good faith on which contract of Insurance Stands. Suppression of material facts at the time of policy proved. Repudiation of Claim justified.
    III (2002) CPJ 56 (NC)
    3. LIC of India
    V/s.
    Gangamma & ANR (Respondents)
    Repudiation of Claim – Suppression of material fact. Deceased had malignancy, obtained treatment, proved by documents on record. Suppression proved. Order of State Commission allowing claim is set aside. Suppression of information itself violates the terms of the contract, utmost good faith is a tenet of Insurance Policy which was not observed by the deceased.
    V (2003) CPJ 91 (NC)
    4. LIC of India
    V/s.
    Sashi Bala (Respondent)
    Repudiation of Claim – concealment of material information. Deceased suffering – Not disclosed. Repudiation Justified. Complaint dismissed. Insurance policy is issued on trust and good faith. Order passed by State Commission is set aside.
    II (2007) CPJ 51 (NC)
    5. LIC of India
    V/s.
    Krishan Chander Sharma … (Respondent)
    Repudiation of Claim – because of concealment of material facts regarding health. Insured is guilty of suppression of ailment. Repudiation justified. Complaint dismissed.
    I (2005) CPJ 77 (NC)
    6. Sree Devi Amma
    V/s.
    LIC of India … (Respondent)
    Repudiation of Claim – Suppression of material facts. Death within short period of taking policy. District Forum rightly dismissed the complaint on the ground of suppression of material facts by life assured at the time taking policy.
    Civil Appeal No.5322/2007 arising out of SLP (C ) No.23951/2005
    7. P.C.Chacko and another …Appellant.
    Vs.
    Chairman, LIC of India and others …Respondents.
    AIR 1962 SC 841
    8. Mithoolal Nayak …Appellant.
    Vs.
    LIC of India …Respondent.
    (Revision Petition No.3362 of 2004)
    L.I.C. of India …Petitioner.
    Vs.
    Smt.Ayesha. …Respondent.
    Head notes: Claim repudiated on the ground that the assured suppressed the material fact about his sickness and on being on medical leave before purchase of the policies. The cause of death had no relevance to the non disclosure of health at the time of purchase of policy.
    I (2009) CPJ 231 (NC)
    NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI.
    LIC Of India …Petitioner.
    Vs.
    M.Bhavani …Respondent.
    Revision Petition No.649 of 2005 from Order dated 28.10.2004 in Appeal No.421 of 2003 of A.P.State Consumer Disputes Redressal Commission, Hyderabad – Decided on 14.01.2009.
    Consumer Protection Act, 1986 – Section 21(b) – Life Insurance – Suppression of material facts – Deceased disclosed at time of revival of policy – False declaration given at time of revival of policy – Deceased guilty of suppression of fatal pre-existing disease, from which he was suffering at time of getting policy revived – Lower For a erred in allowing claim – Orders set aside in revision – No relief entitled. ( Paras 11,12 and 13.)

    11. On the other hand the Ld. Advocate for complainant submitted that the allegations raised by the LIC Of India are not established and it is an allegation for allegation sake. The Citation relied on by the LIC Of India has no application to the facts and circumstances of the case. In support of his contention he relied on the following citations.
    1993(2) CPR 427
    Padmaned Haribhai Parmar
    Vs.
    Divisional Manager LIC of India
    LIC – Suppression of material facts: not proved repudiation of claim un- justified.
    1998 (1) CPR 463.
    Narmada Devi.
    Vs.
    The LIC Of India.
    LIC Of India – Suppression of material facts – Plea that insured suffered from Sciatica but not disclosed in proposal. No such mention in confidential report of LIC Of India’s doctor – Repudiation of claim held improper.
    1996 (2) CPR 46.
    LIC of India.
    Vs.
    Smt.Laxmi Kumar.
    LIC Of India – Suppression of material facts – plea of – no evidence to substantiate it adduced before District Forum inspite of adequate Opportunity – Remand – Refused.
    1995 CPJ 388, 1995 (1) CPR 313.
    Smt. Gangamma.
    Vs.
    LIC Of India.
    LIC Of India – Suppression of material facts – failure of LIC Of India to prove that insured made false representation – Death of insured due to Myo Cardinal infraction – claimant held entitled to amount under the policy – LIC Of India has failed to prove that the life assured suppressed the material facts and made false representations regarding his health at the time of obtaining life insurance policies.
    II (1994) CPJ 55: 1994 (1) CPR 884.
    LIC of India.
    Vs.
    Smt.Chandrakanth.
    LIC Of India – Suppression of material facts – Evidence relating to not adduced by LIC Of India in spite of adequate opportunity – claim – Repudiation of – amount to deficiency.

    12. Coming to the background of this case the Date of Birth of complainant is 16.06.1987. 18 years 6 moths on the date of taking policy. V.Yellaiah the father of Srinivas was no more. Late.Srinivas admitted in First year Medical Course in Gandhi Medical College on 29.05.2005 (Ex.A5). He took this policy about 4 months. Prior to his death while studying 1st year Medical course.

    13. Admittedly Late.Srinivas has no recognize job of any type. As seen from Ex.B2 application source of income of his family or assets was not shown. As seen from column no.5 the Annual Income of Late.Srinivas by way tuitions was shown as at Rs.70,000/-. The Ld. Advocate for LIC Of India submitted that Medical student of the first year cannot spare single minute to towards tuitions for attending classes for others. As Medical study it is a intensive course of study. The Ld. Advocate for LIC Of India further submitted that another policy was taken on the name of Late.Srinivas (CC.No.70/08) and the premium p.a. is Rs.33,450/-. The premium in the case on hand is Rs.11,749/- and the total amount payable is Rs.45,199/-. Thus according to Ld. Advocate for LIC Of India said that the Financial capacity of the Late.Srinivas was doubt fully and it was the pre planned plot to take illegal advantage of the situation.

    14. Perused the citation relied on by both parties. There is no dispute on the principle laid in those citations. The facts and circumstances of the case on hand in a way a bit different from the cases in the citations except the oral submission that the insured was earning so much income per annum by way of tuitions, there is no reliable evidence to show that deceased Late.Srinivas was getting so much income. The Ld. Advocate for Opp.Parties submitted that generally tuitions are being given in Residential Schools and Colleges for 10th and Inter students by the experienced Post Graduates Lecturers and they will be likely to get reasonable fees. Where as Late.Srinivas was Inter student, and not expected to give tuitions for 10th class students. If Late.Srinivas gave tuitions for below 10th class students he may not get that much income as stated by complainant. That according to the Ld. Advocate for LIC Of India the contention of complainant that Late.Srinivas was getting Rs.75,000/- p.a. by way of tuitions is not believable and reliable. In this regard we agree the contention of the Ld. Advocate for LIC Of India.

    15. Admittedly Late.Srinivas died while he was doing his first year MBBS course. It is not an accidental death, it is pre matured death due to disease at young age. The Doctor who treated Late.Srinivas gave Proof Affidavit about the treatment given to Late.Srinivas that affidavit stands un rebutted. Thus a perusal of the application form and the nature of filing of the columns appears to be filled up without taking care.

    16. The facts and circumstances of this case coupled with Case Law. We feel that in a way Late.Srinivas suppressed previous treatment under gone by him. Any how he died about 2 years after commenced of the policy. So we feel it is a fit case to allow the claim.

    17. In the result complaint is allowed. The LIC Of India is directed to make a payment of Rs.2,00,000/- (Rupees Two Lakhs Only) with interest @ 9% p.a. from the date of filing of complaint i.e., Dt:26.05.2008 within a period of one month from the date of receipt of this order, failing which the complainant shall be at liberty to proceed against them U/S.25/27 of Consumer Protection Act 1986.
    Dictated to Steno, transcribed by her, corrected by us and pronounced in the Open Forum on the 30th day of March 2009.
  • adminadmin Administrator
    edited September 2009
    Complaint is filed on 29-08-2008
    Compliant disposed on 30-03-2009
    BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
    ::AT:: K A R I M N A G A R
    PRESENT: KUM. G.V.N.R. BHANUMATHI, M.A. B.L.,
    Ist ADDL. DIST. & SESSIONS JUDGE & PRESIDENT (F.A.C.)
    AND
    SMT. E. LAXMI, M.A.LL.B., MEMBER
    MONday, THE THIRTY DAY OF MARCH, TWO THOUSAND NINE
    CONSUMER complaint NO. 117 OF 2008
    Between:
    Chinthala Rajitha, W/o. Late Ch. Laxmaiah, age 35 years, Occ: Household, R/o. Mettupalli village of Mogullapalli mandal of Warangal district.
    …Complainant
    AND
    The LIC Of India, rep. by its Branch Manager, Branch Office, Huzurabad of Karimnagar district.
    …Opposite Party
    This complaint is coming up before us for final hearing on 18-03-2009, Sri G. Rajendra Prasad, Advocate for complainant being absent and in the presence of Sri P. Ashok, Advocate for LIC Of India, and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following:
    ::ORDER::
    1. This complaint is filed under Section 12 of C.P. Act, 1986 seeking direction to the LIC Of India to pay an amount of Rs.1,75,000/- towards sum assured, compensation, bonus, interest and costs.

    2. The brief averments of the complaint are that the husband of the complainant by name Chintala Laxmaiah obtained Life Insurance Policy from the LIC Of India bearing no.684385920 Dt: 28.3.2006 for an assured sum of Rs.1,00,000/- and the complainant is nominated as nominee under the said policy. As per the terms and conditions of the said policy the LIC Of India undertook to pay an amount of Rs.1,00,000/- towards the sum assured with bonus in case of death of the policy holder. The husband of the complainant paid annual premium of Rs.5,873/-. After submission of the proposal the LIC Of India verified the age, occupation, health of the proposer and issued the policy. Unfortunately the policy holder died on 28.6.2006 on account of ill-health. After his death, the complainant being a nominee submitted claim form informing death of the policy holder by claiming assured sum of Rs.1,00,000/- with bonus and interest. Even after lapse of 2 years the LIC Of India did not settle her claim, therefore, the complainant got issued a Legal Notice Dt: 14.7.2008 to the LIC Of India to pay the claimed amount, inspite of service of Legal Notice the LIC Of India failed to settle the claim. The acts of the LIC Of India constitutes deficiency of service, therefore, the complainant sought direction for payment of assured sum of Rs.1,00,000/- with bonus, interest, compensation and costs.

    3. The LIC Of India filed counter admitting that the policy holder obtained Jeevan Anand policy on 28.3.2006 for an assured sum of Rs.1,00,000/- and the complainant is nominee under the said policy. After receiving death intimation from the complainant, the LIC Of India is causing enquiries to know the cause of death of the policy holder as he died within three months from the date of policy. As the investigation report is not received from its Parkal Branch the claim of the complainant could not be settled, as such there is no deficiency of service on their part. Therefore, the LIC Of India prayed for dismissal of the complaint.

    4. The complainant filed her Proof Affidavit reiterating the contents of the complaint and filed documents which are marked as Ex.A1 to A7. Ex.A1 is the original Premium Deposit Receipt in the name of deceased. Ex.A2 is the Xerox copy of Death Certificate Dt: 10.7.2006 of deceased issued by Panchayat Secretary, Mettupally Village, Mogullapally Mandal, Warangal District.Ex.A3 is the Legal Notice Dt: 14.7.2008 issued by counsel for the complainant addressed to LIC Of India. Ex.A4 & A5 are the Postal Acknowledgement Cards addressed to LIC Of India. Ex.A6 & A7 are the postal receipts.

    5. After filing Proof-Affidavit of the complainant, the LIC Of India deposited a sum of Rs.1,04,400/- in this Forum through a Demand Draft on 9.3.2009 towards the claim made by the complainant. Therefore, the present complaint is confined only for payment of interest and cost of the proceedings.

    6. The points for consideration are:
    (1) Whether the complainant is entitled to claim compensation, interest and costs?
    (2) To what relief?

    7. Admittedly the husband of the complainant obtained insurance policy for an assured sum of Rs.1,00,000/- by paying premium amount of Rs.5,873/- under Ex.A1. Subsequently the LIC Of India issued policy Bond undertaking to pay Rs.1,00,000/- with bonus in case of death of policy holder. The complainant informed the LIC Of India that her husband died on 28.6.2006 on account of ill-health and requested them to pay the assured sum with bonus by submitting Death Certificate of the policy holder under Ex.A2. Since the LIC Of India did not settle her claim she got issued a Legal Notice on 14.7.2008 under Ex.A3. Inspite of service of the same it was not settled, therefore, she filed the present complaint. In the counter filed by the LIC Of India it is stated that they are making enquiries regarding cause of death of the deceased and as the report is not received claim is not settled. However when this case is pending for enquiry, the LIC Of India deposited a sum of Rs.1,04,400/- towards the settlement of claim made by the complainant.

    8. As the LIC Of India deposited the assured sum with incidental bonus, the claim is confined regarding payment of interest, compensation and costs. After receiving the claim, the LIC Of India conducted investigation to know the cause of death of the policy holder as he died within 3 months from the date of issuance of policy and on account of delay in receiving the report from Parkal Branch the claim of the complainant could not be settled immediately. The delay in paying the amount is explained by the LIC Of India, therefore, the complainant is not entitled for compensation. However, the LIC Of India is liable to pay interest on the assured sum of Rs.1,00,000/- from the date of submission of claim by the complainant till the date on which the LIC Of India deposited amount in this Forum. In view of the above said reasons, we hold that the LIC Of India is liable to pay interest @ 7.5% per annum on assured sum of Rs.1,00,000/- from the date of submission of claim till 9.3.2009 on which date the LIC Of India deposited Rs.1,04,400/-. The complainant is entitled to withdraw the deposited amount of Rs.1,04,400/- from this FORUM. The LIC Of India is also liable to pay cost of Rs.500/- towards the expenses incurred in filing the complaint.

    9. In the result the complaint is partly allowed directing the LIC Of India to pay interest @ 7.5% per annum on Rs.1,00,000/- from the date of submission of claim till 9.3.2009 along with Rs.500/- towards costs of this case within one month from the date of receipt of this order.

    Typed to my dictation by Stenographer, after correction the orders pronounced by us in the open court this the 30th day of March, 2009.
  • adminadmin Administrator
    edited September 2009
    [FONT=&quot]Complaint is filed on 14-08-2008[/FONT]
    [FONT=&quot]Compliant disposed on 25-03-2009[/FONT]
    [FONT=&quot]BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM[/FONT]
    [FONT=&quot]::AT:: K A R I M N A G A R[/FONT]
    [FONT=&quot]PRESENT: KUM. G.V.N.R. BHANUMATHI, M.A. B.L.,[/FONT]
    [FONT=&quot]Ist ADDL. DIST. & SESSIONS JUDGE & PRESIDENT (F.A.C.)[/FONT]
    [FONT=&quot]AND[/FONT]
    [FONT=&quot]SMT. E. LAXMI, M.A.LL.B., MEMBER[/FONT]
    [FONT=&quot]MONday, THE TWENTYFIFTH DAY OF MARCH, TWO THOUSAND NINE[/FONT]
    [FONT=&quot]CONSUMER complaint NO. [FONT=&quot]114 OF 2008[/FONT][/FONT]
    [FONT=&quot]Between: [FONT=&quot]
    [/FONT][FONT=&quot]Nandagiri Sunitha, W/o. Late Srinivas, age 30 years, Occ: Household, R/o. Nizamabad, V/o. Konaraopet mandal in Karimnagr district. [/FONT][/FONT]
    [FONT=&quot]…Complainant[/FONT]
    [FONT=&quot]AND[/FONT]
    [FONT=&quot]The L.I.C. of India represented by it’s Senior Divisional Manager, Divisional Office, Karimnagar.[/FONT]
    [FONT=&quot]…LIC Of India[/FONT]
    [FONT=&quot]
    [FONT=&quot]This complaint is coming up before us for final hearing on18-03-2009, in the presence of Sri K. Shravan Kumar, Advocate for complainant, and Sri P. Ashok, Advocate for LIC Of India, and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following:[/FONT][/FONT]
    [FONT=&quot]::ORDER::[/FONT]
    [FONT=&quot]
    [FONT=&quot]1. This complaint is filed under Section 12 of C.P. Act, 1986 seeking direction to LIC Of India to pay a sum of Rs.1,00,000/- towards accident benefit together with interest, compensation and costs.[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]2. The brief averments of the complaint are that the husband of the complainant Nandagiri Srinivas obtained Jeevan Anand Policy from the LIC Of India with accident benefit coverage for a sum of Rs.1,00,000/-. As per the terms and conditions of the said policy in case the policy holder dies in an accident a sum of Rs.1,00,000/- will be paid towards accident benefit apart from assured sum of Rs.1,00,000/- with bonus. The complainant is the nominee under the said policy. On 3.12.2006 the policy holder met with an accident near Nizamabad village and died as he was hit by RTC bus when he was going on a motor cycle. After his death the complainant submitted claim for payment of the assured sum of Rs.2,00,000/- with bonus, but the LIC Of India allowed her claim for Rs.1,00,000/- and paid Rs.1,13,600/- consisting of Rs.1,00,000/- towards basic sum assured and Rs.13,600/- towards bonus and did not consider her claim for 1,00,000/- payable on account of accident benefit clause. Since the policy holder died in an accident the LIC Of India ought to have paid the said amount and failure to pay the same amounts to deficiency of service. Therefore, the complainant sought direction for payment of Rs.1,00,000/- together with interest @ 18% Per Annum, compensation and costs of the complaint.[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]3. The LIC Of India filed counter admitting the issuance of Jeevan Anand Policy with accident benefit to the husband of the complainant. It is also admitted that they received a claim from the complainant as she is the nominee under the policy and on receiving the same they considered it and paid Rs.1,13,600/- on 24.9.2007. The claim for Rs.1,00,000/- under accident benefit is not considered as the complainant failed to submit driving license of the deceased policy holder. It is submitted by the LIC Of India that if the policy holder does not hold driving license he is not entitled for the sum assured under accident benefit clause. Since the complainant failed to establish the driving license her claim for payment of Rs.1,00,000/- is not considered. Therefore, the LIC Of India prayed for dismissal of the complaint.[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]4. The complainant filed her affidavit reiterating the contents of the complaint and the documents filed by her are marked as Ex.A1 to A6. Ex.A1 is the Xerox copy of First Information Report in Crime No.68 of 2006 Dt: 3.12.2006 issued by Sub Inspector of Police, Police Station, Konaraopet (in 2 sheets). Ex.A2 is the Xerox copy of Inquest Report Dt: 3.12.2006 (in 2 sheets). Ex.A3 is the CC of Post Mortem Examination Report in Crime No.68/2006 of Police Station, Konaraopet Dt: 3.12.2006. Ex.A4 is the CC of Charge Sheet in Crime No.68/2006 of Police Station, Konaraopet. Ex.A5 is the copy of Jeevan Anand Policy (with accident benefit) bearing no.684154278. Ex.A6 is the Letter issued by LIC of India, Senior Divisional Manager, Divisional Office, Karimnagar Dt: 21.9.2007. [/FONT][FONT=&quot]

    [/FONT][FONT=&quot]5. When the matter is pending for filing of the Proof Affidavit of LIC Of India, a lodgment is filed by the LIC Of India enclosing a D.D. for Rs.1,00,000/- towards amount claimed by the complainant under accident benefit clause. In view of the payment of the said amount, now the claim of the complainant is confined regarding payment of interest, compensation and costs. In view of the same the following points are to be decided. [/FONT][FONT=&quot]

    [/FONT][FONT=&quot]6. The points for consideration are: [/FONT][FONT=&quot]
    [/FONT][FONT=&quot](1) Whether the complainant is entitled to claim interest, compensation and costs of the complaint?[/FONT][FONT=&quot]
    [/FONT][FONT=&quot](2) To what relief the complainant is entitled to under the circumstances of the case?[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]7. The claim of the complaint for payment of Rs.1,00,000/- payable under accident benefit clause is accepted by the LIC Of India by depositing the said amount in this FORUM through a Lodgment. Admittedly the husband of the complainant obtained Jeevan Anand Policy under Ex.A5 for an assured sum of Rs.1,00,000/- along with Personal Accident Benefit Scheme. As per the terms of the said policy in case if the policy holder dies in an accident the Nominee would be paid Rs.1,00,000/- apart from the basic sum assured. Admittedly the policy holder i.e. husband of the complainant died in an accident on 3.12.2006 at 2.00 P.M. when he was hit by RTC bus at the outskirts of Nizamabad village. The criminal case records under Ex.A1 to A4 (4) discloses that the driver of the RTC bus is charged for causing death of the policy holder on account of rash and negligent driving of the RTC bus. The said documents clearly established the death of policy holder in an accident. When the complainant submitted claim to the LIC Of India for payment of Rs.2,00,000/- with bonus, the LIC Of India considered her claim only to the extent of basic assured sum of Rs.1,00,000/- along with bonus of Rs.13,600/- and sent a letter under Ex.A6 stating that the claim for payment of amount under accident benefit is not payable in the absence of driving license.[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]8. Admittedly the deceased policy holder died in an accident and as per the terms and conditions of the policy the nominee is entitled to claim Rs.1,00,000/- under accident benefit clause. Without any valid and tenable reason the LIC Of India did not consider her claim, making her to approach this FORUM for payment of the said amount of Rs.1,00,000/-. However the same is considered after filing the case by depositing Rs.1,00,000/- in this FORUM Since non-payment of the said amount within in time is unjustified, the complainant is entitled to claim interest on the said amount. The LIC Of India deposited 1 lakh on 19.1.2009 with Lodgment. In view of the said payment the complainant is entitled to claim interest on 1 lakh @ 7.5% Per Annum from the date of payment of basis sum i.e. 21.9.2007. Since interest is awarded the complainant is not entitled for compensation. Therefore, we hold that non-payment of amount of 1 lakh under accident benefit clause within the stipulated time, there was deficiency of service on the part of the LIC Of India. Since the said amount is deposited the present order is passed with regard to payment of interest and costs only. The complainant is entitled to withdraw the amount of Rs.1,00,000/- already deposited by the LIC Of India.[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]9. In the result the complaint is partly allowed directing the LIC Of India to pay interest @ 7.5% Per Annum on Rs.1,00,000/- from 21.9.2007 (the date on which the basic assured sum was paid) to 19.1.2009 on which date the amount of Rs.1,00,000/- is deposited in this FORUM and Rs.500/- towards costs of the complaint within a period of one month from the date of receipt of this order.[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]Typed to my dictation by Stenographer, after correction the orders pronounced by us in the open court this the 25th day of March, 2009.[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]Sd/- Sd/-[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]MEMBER PRESIDENT[/FONT][/FONT]
  • adminadmin Administrator
    edited September 2009
    BEFORE THE DISTRICT FORUM CONSTITUTED UNDER THE CONSUMER PROTECTION ACT (ACT NO. 68 OF 86) AT SRIKAKULAM


    P R E S E N T

    01. Sri P.Gurunadha Rao,
    President, District Consumer Forum,
    Srikakulam
    02. Smt. D.Raj Kumari, B.A.(Hons.), B.L.,
    Lady Member.
    Dated this the 12th day of March, 2009

    C.C.No.51/2008


    BETWEEN:

    Kuna Lakshmi, W/o.Ravikumar, Aged about 30 years, Household
    duties D.No.14-90, Agraharam Street, Ponduru, Srikakulam Dist. ...Complainant.

    AND:

    01) Branch Manager, LIC of India, Branch Office,
    Women’s College Road, Srikakulam Town and District.

    02) The Divisional Manager, LIC of India, Divisional Office,
    Dabagardens, Visakhapatnam. …opposite parties.

    This complaint coming on 03-03-2009 for final hearing before us in the presence of Sri B.Rama Mohana Rao, Advocate for complainant and Sri K.N.B.V.Prasada Rao, Advocate for LIC Of India Nos. 1 and 2 and having stood over to this day for consideration, this Forum made the following:

    O R D E R

    (By Smt.D.Rajkumari, Lady Member)

    This is a complaint filed under Section 12 of the Consumer Protection Act, 1986 and facts of the case briefly are as follows:
    Complainant is nominee under a policy. Sister of the complainant by name Kancharapu Rangamma obtained policy for Rs.1,00,000/- with effect from 28-3-2006 and she died on 27-7-2006. Complainant claimed amount under the policy, but the LIC Of India refused the claim by letter dated 10-3-2008. Hence complaint is filed for a direction to the LIC Of India to pay the amount of Rs.1,00,000/- with interest at the rate of 24% p.a., from 1-11-2006 and compensation of Rs.30,000/- and costs of Rs.2,000/-.
    2) LIC Of India No.2 filed counter stating that the LIC Of India conducted investigation and found that the life assured was mentally ill since childhood.
    LIC Of India No.1 filed memo adopting the counter filed by LIC Of India NO.2.
    3) Exs.A1 to A8 are marked on behalf of the complainant. No documents are marked on behalf of the LIC Of India.

    Heard both parties.
    Point for consideration is:
    Whether there is deficiency in service on the part of the LIC Of India.
    4) Point: Complainant filed affidavit with the same facts contained in the complaint. LIC Of India filed affidavit with the same facts contained in the counter. LIC Of India refused the claim on the ground that the life assured was mentally ill since childhood and the agent had deliberately suppressed the material facts while getting the life assured insured. It is further stated that the agent is no other than the husband of the complainant. LIC Of India have not adduced any evidence to show that the life assured was mentally ill since childhood and there was suppression of material facts by the life assured. If the agent had played fraud for obtaining the policy, the LIC Of India may take action against him, but cannot repudiate the claim on that ground. There is no evidence on record to show that the life assured was suffering from mental illness since childhood. It cannot be presumed that there was suppression of material facts. We therefore hold that there is deficiency in service on the part of the LIC Of India in not paying the insurance amount to the complainant. Hence, we answer the point accordingly.
    In the result, complaint is allowed. LIC Of India are directed to pay Rs.1,00,000/- (Rupees one lakh only) to the complainant with interest at the rate of 12% per annum from the date of filing the complaint i.e., 28-4-2008 till the date of payment and costs of Rs.1,000/- (Rupees one thousand only). Advocate’s fee is fixed at Rs.1,000/- (Rupees one thousand only).
    Dictated to the Shorthand Writer, transcribed by him, corrected and pronounced by us in open Forum on this the 12th day of March, 2009.
  • adminadmin Administrator
    edited September 2009
    [FONT=&quot]1. Tirumalapudi Chittemma,[FONT=&quot]
    [/FONT][FONT=&quot]W/o Subba Rao, Housewife,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]R/o Vijaya Ashram,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Cherukupalli Mandal,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Guntur district.[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]2. Tirumalapudi Subba Rao,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]S/o Nagaiah,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]R/o Vijaya Ashram,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Cherukupalli Mandal,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Guntur district. … Complainants [/FONT]
    [/FONT]
    [FONT=&quot]AND[/FONT]
    [FONT=&quot]1. The Divisional Manager,[FONT=&quot]
    [/FONT][FONT=&quot]LIC of India, Machilipatnam Division,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Krishna District.[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]2. The Branch Manager,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]LIC of India, Gurazala,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Guntur district.[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]3. Tirumalapudi Lakshmi,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]W/o Kalidasu,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Durgapuram, [/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Near Durga Cement Factory,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Dachepalli Mandal,[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]Guntur district. … LIC Of India [/FONT][FONT=&quot]


    [/FONT][FONT=&quot]This complaint is coming up before us today for consideration, upon perusing the material on record, this Forum made the following:[/FONT][FONT=&quot]

    [/FONT]
    [/FONT]
    [FONT=&quot]O R D E R[/FONT]
    [FONT=&quot]Per Sri T. Anjaneyulu, President:-[FONT=&quot]
    [/FONT][FONT=&quot]Bothsides present. IAs 32, 33/09 are allowed. Affidavit of the complainant is received. Amendment of the complaint is also allowed. Neat copy of the complaint is also filed. Now the present claim is amounting to Rs.2,00,000/- instead of Rs.1,00,000/- under two policies. The learned counsels for the LIC Of India (1 and 2)/ insurance company has also deposited the DD for Rs.2,04,130/- in favour of the Forum to satisfy the claim of the complainant and as well as 3rd LIC Of India under two policies.[/FONT][FONT=&quot]
    [/FONT][FONT=&quot]The present complaint is filed by the parents of the deceased while making the wife of the deceased as 3rd LIC Of India. The complainants as well as 3rd LIC Of India being legal heirs of the deceased are entitled to receive the insured sum. It appears that the matter is amicably settled between the complainants and the 3rd LIC Of India. In this regard a compromise memo is also filed. Accordingly, the complainants and the 3rd LIC Of India would share the amount in deposit. Both the complainants 1 and 2 are entitled to Rs.70,000/- and the balance amount is entitled to be received by the 3rd LIC Of India as per the said compromise memo. As this dispute is settled in view of the deposit of the aforesaid DD by the LIC Of India and as there is amicable settlement between the complainants and the 3rd LIC Of India in respect of sharing the amount, the dispute is closed as settled.[/FONT][FONT=&quot]

    [/FONT][FONT=&quot]This the 19th day of March, 2009.[/FONT][/FONT]
  • adminadmin Administrator
    edited September 2009
    O R D E R
    SRI.K.T.SIDHIQ, PRESIDENT
    .

    Dr.Shri.K.S.Ganeshkumar the husband of the complainant Geetha had two Life Insurance Policies with Nos.791889296 and 791889450 for the sum assured Rs.50,000/- each. He was working as Asst. Surgeon, Medical Officer at Primary health Centre run by the government at various places. For the payment of monthly premium to the said policies he had availed salary savings scheme pertaining to Kerala Government employees. Thus the premium amounts were remitted as and when he drew the salary. While so the life assured who was then working at PHC Panathur was selected for PG course under the department. He was to report for the course on 27-3-04. Thus he was eligible for the salary up to 27-03-04. Thereafter he was entitled to get only stipend as PG student. Since the deceased was busy with his admission for the PG course he could draw the salary for the months of December 2003 to March 2004 only on 31-05-04. The premia for the month of December 2003, January 2004 and February 2004 were deducted on 31-5-04. Hence the premium for the month of March 2004 was paid on 3-6-04. Thereafter the premiums for the month of April 2004 and May 2004 were recovered by LIC Of India. Shri.K.G.Ganeshkumar expired on 13-6-04. When the complainant lodged claim for the policy benefits’ the first LIC Of India sent a reply dated 12-10-04 stating that the policies were lapsed as on the date of death of the deceased and sought some documents for considering the claim. The documents sought by LIC Of India were duly submitted. But the LIC Of India failed to settle the claim so far. Whenever the complainant approached the LIC Of India they sought time for settlement on one pretext or other. Hence alleging deficiency in service in the delay of settlement of the claim, this complaint is filed.


    2. According to LIC Of India the claim is barred by limitation. On facts LIC Of India admitted that the deceased Dr .K.S. Ganesh kumar has taken two life insurance policies. Both policies were issued under salary savings scheme to Kerala State Government Employees. While taking policy, deceased was working as Assistant Surgeon, a Gazetted Officer rank and hence he was a self drawing officer. So it is the duty of the life assured to recover the policy premiums from his salary and to remit to the concerned treasury for onward transmission to LIC Of India. The premium due from 12/03 to 2/04 was received by LIC Of India in April 2004 through sub treasury Hosdurg, like wise premium due for 3/04 was received in the month of May 2004. On the date of death i.e. on 13-06-04 the policies were in lapsed condition due to the non-payment of premium for 4/2004 and 5/2004. Though the complainant was asked by way of a letter dtd.12-10-04 to produce documents to show the receipts for the payment of premium for the subsequent month i.e. April 04 & May 04. It was not produced. Hence the claim was rejected and it was informed to the complainant on 12-11-04. Hence there is no deficiency in service on the part of LIC Of India.


    3. Complainant filed affidavit in support of her claim. Exts A1 to A3 marked on the side of the complainant For LIC Of India Shri.V.P.Gopalan, Manager, Legal Department, LIC Divisional Office, Kozhikode filed counter affidavit and Exts B1 to B4 marked. Both sides heard and the documents perused.


    4. The issues to be answered in this complaint are:
    i)Whether the complaint is barred by limitation?
    ii)Whether the complainant is entitled for the claim benefits as per the policies in dispute?
    iii)Relief and Cost.



    5. According to LIC Of India the claim of the complainant is rejected on 13-11-04 as per Ext.B4. Hence the complaint ought to have been filed on or before two years from 13-11-04 before the Forum. But the complaint is filed on 27-04-07 i.e. after 2 years 4 months and 14 days. But according to the complainant she has received the letter dated 12-10-04 demanding her to produce some more documents to consider the claim, that is otherwise not honourable since policies are in lapsed stated due to non-remittance of premium in due time. Even though by way of abundant caution an application to condone the delay if any caused is filed, in the said application also the complainant affirmed that the claim is pending before LIC Of India and they have not rejected the claim.



    6. The settled position of law is that limitation in respect of insurance claims runs only from the date of repudiation/rejection or refusal of the claims by the insurer. Since the complainant has no case that the claim is rejected, viewing that the complaint is within the period of limitation, the petition to condone the delay was not considered. But the LIC Of India in their version submitted that the claim was rejected and it was intimated to the complainant as per letter dated 13-11-04. Ext.B4 is only a copy of the letter. But no documents like postal receipt, acknowledgement card etc were produced by LIC Of India to prove that the said letter was consigned to complainant. Ext.B4 also did not show the mode of it’s despatch. In the absence of such supporting documents we are unable to accept that Ext.B4 was delivered to complainant. If so it can be regarded that the claim was subsisting with LIC Of India on the date of filing the complaint. Hence we hold that the complaint is not time barred. This issue is therefore found infavour of the complainant.



    7. Issue No.2: The learned counsel for the LIC Of India Shri.P.V.Jayarajan, relying on the decisions Jagadish Prasad Dagon V. Senior Divisional Manager, LIC reported in II (1993) CPJ 493 (NC) LIC of India & Anr V. Subbammal reported in II (2006) CPJ 512, LIC of India V. Ramesh Chandra reported in 1997 (2) CPR 8 (NC), Oriental Insurance Co.Ltd V. Sony cheriyan reported in AIR 1999 SC 3252, United India Insurance Co.Ltd V. Harchand Rai Chandanlal reported in (2004) 8 Supreme Court cases 644 argued with considerable vehemence that the terms of policy shall be strictly construed and once the claim is considered and rejected on due application of mind in good faith, it cannot be considered as deficiency in service.



    8. According to learned counsel for LIC Of India as evident from Ext.B4 the relevant pages of laper book, the policies were in lapsed condition on the date of death of the life issued for want of payment of premium for the month of April 2004 and May 2004. According to him the policy were lapsed on the date of death. Hence the claim is rejected considering all these aspects.





    9. The learned counsel for the complainant relying on the decisions Delhi Electric Supply Undertaking V. Basanti Devi & Anr reported in III (1999) CPJ 15 (SC), Rajani Patwari V. LIC of India & Anr reported in III (1997) CPJ 48 (NC), Branch Manager, LIC V. Smt.Mohawa Devi & Anr reported in 2002 (2) CPR 149, General Manager, Hotel Kanishka V. Saroj Attal & Another reported in III (1997) CPJ 72 (NC) LIC of India V. Pushpa Devi Yadav reported in I (2005) CPJ 593 has argued that under the salary savings scheme of the life assured, it is the duty of the employer to recover the premium from the salary of the employee and remit to the insurer and the non-payment of premium by the employer will no way absolve the insurer from the payment of policy benefits. But the said facts and circumstances of those cases are not applicable to the instant case since at the time of death, according to the complainant, the life assured was not a government servant since on 27-3-04 on the date on which the life assured was joined for his PG course. Hence the salary savings scheme ceased to operate as on 27-03-04. Even otherwise according to learned counsel for LIC Of India the life assured was a self drawing officer hence it was his duty to remit the premium from the salary.



    10. DW1 filed affidavit in lieu of oral evidence to support of the contention of the LIC Of India. He has been cross examined by the counsel for the complainant. DW1 in cross-examination has stated that the policies were lapsed as on 28-4-04 since there were no payment of premiums for the month of April. He further stated that a lapsed policy can be revived within 6 months if the premium arrears is paid with interest. But for revival after 6 months a letter is necessary. The mode of payment of premiums shows that 4 payments are made after the policy is lapsed. But the LIC Of India are accepted the same without charging any interest. That is repugnant to the deposition of DW1.


    11. According to DW1 the policies are lapsed as on 28-4-04 for non-payment of premium for the month of April 2004. But the question now arose before us is why the LIC Of India collected premium even on 31-5-04 and on 3-6-04. If it is lapsed on 28-4-04? The terms and condition of salary saving scheme is also not brought before us to ascertain the duties and liabilities of both the insurer and insured in case the employee leaves the service.



    12. From the character and conduct of the life assured it is evident that the life assured was never wished to oust the insurance coverage, since he had remitted 3 consecutive monthly premiums on 31-5-04 and the subsequent one after three days i.e on 3-6-04 just 10 days prior to his death. Had he been made aware about the sate of his insurance policies that it was in lapsed condition, of course he could have get a chance to revive it. The LIC Of India were go on with the acceptance of premiums paid irrespective of the state of policies and without giving a hint about it to the life assured. That means the premium were accepted without any uberrimae fide to honour the claims. It is nothing but an unjust enrichment at the expense of the policy holder and an unscrupulous exploitation of consumer. As stated by the LIC Of India if the life assured was a self drawing officer and there is no employer over him to recover the premium from his salary and to pay it to the L.I.C. then of course it was the duty of the LIC Of India to inform the life assured about the dues pending payment to revive the policy that was lapsed. But the LIC Of India have no case that they have informed about the lapse of policy at any point of time particularly when the life assured’s monthly premiums those were pending from December 2003 onwards till the life assured remitted it on 31-5-04. On that day the life assured had remitted 3 monthly premiums together. If any policy had lapsed then the subsequent premiums should not have been accepted by the LIC. Even if the version of DW1 is taken in to account then ofcourse at least Interest should have been collected from the life assured when premiums were accepted on a lapsed policy. If so the life assured would have been aware about the condition of his policy. But no such interest is seen collected. No communication is also seen sent to the life assured in this regard. All this would goes to show that the LIC Of India have no consistent and clear rules regarding the acceptance of premium and the revival of policies. Hence the non-settlement of claim according to the whims and caprices of the LIC Of India warrants interference and we find deficiency in service on the part of LIC Of India.


    13. Reliefs and Costs:
    In the light of the above discussions we allow the complaint and direct the LIC Of India to honour the claim of the complainant arising out of the two policies Nos. 791889296 and 7918894501 of the life assured Shri.K.S.Ganeshkumar and pay the assured amount Rs.50,000/- each as per both parties. LIC Of India further directed to pay interest @ 9% for the said amount of Rs.1,00,000/- from the date of death of the life assured till payment by way of compensation. LIC Of India also directed to pay Rs.3000/- towards the cost of these proceedings.
  • adminadmin Administrator
    edited September 2009
    O R D E R
    Paul Gomez, Member.


    1. Shortly, the facts of the complainants' case are as follows:-
    The 1st complainant's husband had taken a policy of assurance from the L.I.C. of India for sum assured Rs. 3,00,000/- with policy No. 774864202 and date of commencement of the policy was 19-02-2005. T.M. Abdul Salam, the husband died on 27-04-2005 within a very short span of 2 months and 8 days from the date of policy. He had remitted only the first premium under the policy. The death claim lodged by the first claimant who is the nominee under the policy was repudiated on the ground of suppression of material facts, rendering the contract of insurance null and void.

    2. According to the version filed by LIC Of India company, on enquiry, it was revealed beyond doubt that the deceased Abdul Salam was an alcoholic and due to his heavy drinking habit he did not enjoy sound health and that he had undergone treatment for alcohol dependence syndrome.

    3. Both parties were represented by their respective counsel. The complainant produced documents that were marked as Exts. A1 to A16 on their side. The complainant was examined as PW1, whereas witness on complainant's side was examined as PW2. On closing the evidence of the complainant, the LIC Of India adduced evidence on their side by getting Exts. B1 to B12 marked as well as by examining DW1 as their witness. After closing the evidence on both sides, the parties' counsel were heard.
    4. The points of law that crop up for our consideration :-

    i) Whether the complainant's deceased husband had

    suppressed material facts to defraud the LIC Of India?

    ii) Whether the complainants are entitled for compensation

    and other reliefs?


    5. Point No. i) :- In this background, let us begin with analysis of documentary evidence produced by both the parties. The certificates issued by doctors underlines the fact of his having undergone treatment for the alleged alcohol dependence syndrome. Here, we have to keep in mind the fact he had of his own, chose to undergo treatment for the alcohol dependence syndrome. Incidentally, alcohol dependence syndrome cannot be classified as a disease or ailment. This is amply brought out by the dictionary meaning of the word syndrome. “Syndrome : 1. “a set of physical conditions that show you have a particular disease or medical problem. For example; PMS or premenstrual syndrome.” 2. A set of opinions or a way of behaving that is typical of a particular type of person, attitude or social problem.” - New Oxford Advanced Learner's Dictionary. In the second sense, those who suffer from a particular syndrome is prone to a particular attitude. A person having alcohol dependence syndrome will have an exceptional liking for alcohol. Hence it cannot be characterised as a disease; it indicates only an attitude of mind towards something. The doctor had stated in Ext. A11 certificate at the end of the treatment, that at the time of discharge he was perfectly healthy and was fit to join the duty. Similarly in Ext. B1 certificate of hospital treatment the doctor had remarked against the question, “What was his condition when he was discharged,” as “improved and recovered”. In this context, the statement made by one M. Sirajuddin .


    6. Ext. B8 outpatient record goes to show that he was undergoing treatment as an out patient. As the doctor has not noted anything against “Provisional diagnosis”, the presumption that can be drawn is that he had been there due to some simple ailment. The columns on personal history on Alcohol consumption also is left blank is note worthy. By putting all the above pieces of materials together, we get to know the reason why the policy holder, while filling up the proposal form has answered the questions referred in Ext. B11 in the negative. He was thinking that he had never been undergoing treatment in hospital for any ailment as according to him it was a clinical exercise to liberate himself completely from alcoholism. According to Islam alcoholism of any degree is anti-religious. Moreover, he was not under treatment at any time in relation to alcohol related diseases affecting vital organs like liver kidney etc. If we look at his disclosures made in proposal form in this background, we cannot rush to the conclusion that it was made with an intention to defraud the proposee namely Life Insurance Corporation.


    7. Several rulings of higher courts and National tribunal have been cited at the bar. But we think for the present purpose, one need turn to the Hon'ble Apex Court decision in Mithoolal Nayak Vs. L.I.C. Of India (AIR 1962 SC 814) where in an identical issue of suppression of material facts was the central issue involved. An illuminating exposition of law has been made by the learned judges where it has been stated with reference to Section 45 of L.I.C. Act as follows:
    “The three conditions, the application of the second part of Section 45 are;
    a) the statement must be on a material matter or must suppress facts which it was material to disclose.
    b) the suppression must be fraudulently made by the policy holder and
    c) the policy holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose.”


    8. It may be noted that the operative part of Section 45 corresponds with the factors to be established to show that the contract of insurance was null and void for suppression of material facts. In short, to impugn the legality on this score, the LIC Of India has to prove that
    i) there was suppression of fact
    ii) the fact suppressed was material one
    iii) the suppression was effected to defraud the other party.


    9. In the light of analysis of facts of the complaint we have earlier made, one cannot come to the conclusion that the suppression of facts made in the proposal form satisfied all the legal requirements specified in the pronouncement of Apex Court earlier referred. Eventhough, it can be admitted without any difficulty that he had suppressed facts, but one cannot conclude with certainty that he was knowing that the facts suppressed were material to the contract of insurance. The possibility cannot be ruled out as the complainant claimed, that her deceased husband was emboldened by the agent, who personally filled up the form, gave him the impression that those questions he answered in the negative were not of much significance or consequence. Moreover, he might have been under the bonafide impression that the treatment he had undergone was not for any disease but to get himself rid of drinking habit. In this perspective, one cannot say that the statements were made by the proposer to defraud the other party. Moreover, these are things of the past one would like to forget. Contract of insurance is a contract of uberrima fides. Of course, good faith forms the corner stone of such contracts. Eventhen, no body would like to reveal everything openly. Take the case of marriage, another instance where utmost good faith is called for. Generally, relatives will be slow in revealing everything regarding their girls. One cannot expect that relatives will announce every blemish of their bride from house top. Nevertheless, facts which are material to marriage have to be scrupulously disclosed to the other party. The same rule is applicable in the contract of insurance also. The facts alleged to have been suppressed in the present case, appears to our mind, not of much significance especially in the backdrop of facts peculiar to the the complaint. Hence, we hesitate to conclude that the complainant's deceased husband had suppressed material facts to defraud the LIC Of India. With due respect to the chairman of the Review Committee, we make it clear that we have been left with no option but to defer with the finding of the Review Committee and we hold that repudiation of the claim preferred by complainant is not well founded.


    10. Point No. ii) :- The complainants are the wife and children of the insured person. When the claim for the assured sum was made, it was repudiated by authorities of the LIC Of India in different rungs of the hierarchy. In such an occasion, mental agony, humiliation depression and dejection undergone by a helpless widow and her children is quite conceivable. Therefore they deserve some consolation in the form of compensation. We quantify it as Rs. 50,000/-. In the same way, the complainants have been striving very hard, knocking at the doors of different bodies to get her legitimate monetary relief for which they have incurred money. Therefore, we think they are entitled for costs of proceedings in the Forum.


    11. Accordingly, we allow the complaint as follows :-
    i) The LIC Of India shall pay the insured amount of Rs. 3,00,000/- (Rupees three lakhs only) to the complainants with interest at the rate of 12% p.a. from 27-04-2005, the date of death of the insured, till realisation.
    ii) The LIC Of India shall pay Rs. 50,000/- (Rupees fifty thousand only) as compensation for mental agony, suffered by the complainants in repudiation of their claim.
    iii) Pay Rs. 1,000/- towards cost of the proceedings to the complainant.
    The order shall be complied with, within a period of one month from the date of receipt of a copy of this order.

  • adminadmin Administrator
    edited September 2009
    C.D.R.F. KOLLAM : CIVIL STATION - 691013

    CONSUMER DISPUTES REDRESSAL FORUM ::: KOLLAM

    consumer case(CC) No. CC/03/360

    Uthaman.L, Thoppil Veedu,Thazhamel Muri
    ...........Appellant(s)
    Vs.

    Regional Manager, LIC of India and Another

    The Branch Manager,LIC of India,Punalur
    ...........Respondent(s)

    BEFORE:
    1. K. VIJAYAKUMARAN : President
    2. RAVI SUSHA : Member


    ORDER ADV. RAVI SUSHA, MEMBER

    The complainant had availed Ashadeep policy from the LIC Of India bearing No.781547082 and other policy bearing No.781084865 and 78073302. The Ashadeep Policy bearing No.781547082 was proposed on 25.2.1998 and the policy was granted on 28.7.2008 for a sum of Rs.50,000/- to be matured on 28.7.2013. The premiuym was fixed at Rs.2,714/- half yearly. The complainant had undergone renal transplantation on 7.4.2003 as he happened to be directed as a chronic patient of ‘Renal failure”. Expenses for the surgery and treatment and continued use of medicine exceeded Rs.4 Lakhs and the complainant is entitled to medical benefits to the tune of double the sum of insurance and accordingly he placed a claim before the LIC Of India. The LIC Of India changed the Asheep claim benefit policy one of endorsement type plan 14-15 from 28.7.2003 onwards and demanded the certificate for further endorsement. The change was without the knowledge and consent of the complainant and the rate of premium was also changed accordingly The change was advised to the benefit of the complainant suggesting disability of policy conditions, against his demands for medical imbursement on 25.3.2003. The complainant had suffered mental agony which is estimated to Rs.25,000/- which is to be compensated by the LIC Of India. Hence the complaint.

    The LIC Of India filed a version contending, interalia, that the complaint is not maintainable either in law on or facts. The LIC Of India issued Life Insurance Policy No.781547082 [Asha Deep Policy] to the complainant viz. L. Uthaman. Uner this plan [121-15] either of the two benefits mentioned A & B below are payable.
    AThe sum assured with vested bonuses is payable either on the date of maturity
    Or on earlier death
    B.However if the Life assured, during the term of the policy
    a.Undergone cornary Artory By-ass surgery
    b.Undergoes regular Heemo –Dialysis of Kidney Transplant.
    c.Is afflicated with cancer [Malignant
    d.Suffers a paralytic stroke causing total permanent disability of two or more limbs persisting for 3 months after suffering the stroke and produces evidence there to satisfactory to the Corporation, then the following payments will be made.
    1.Immediate payment of 50% of the sum assured
    2.Payment of the balance 50% of the sum assured along with vested bonus on full
    Sum assured payable either on the date of maturity or on earlier death
    3.An amount equal to 10% of the sum assured will be paid every year commencing
    From the policy anniversary falling on or after the date of eligibility till maturity
    Or death whichever is earlier.
    4. The premiums [including accident premium] will be waived, subject to recovery of
    unpaid premiums till the next anniversary after the date of eligibility.
    A lien in respect of the benefits mentioned in para 2 above will be operative commencing from the date of risk and ending one year from the date of the policy. These benefits are not payable if contingency occurs during the lien period and in such event, the policy will be altered to a corresponding Endowment Assurance with profit plan
    from the first policy anniversary The life assured underwent Kidney Transplantation on 7.4.2003 and put forth a claim for benefits B mentioned above. But the life assured is not eligible for benefit B since the contingency occurred within one year from the date of revival of the policy. In this caselien is operative for a period of one year from the date of revival and since the occurrence of the contingency is within this lien period, the plan of assurance has been altered from Asha Deep to Endowment Assurance Plan with consequent change in instalment premium. There is no illegality or impropriety in altering the plan and denying benefit ‘B’ of the policy. The life assured becomes eligible for benefit B of the policy only when the conditions given under 11 [A] is satisfied. In this particular case the lapsed policy was revived on 27.2.2003 and the contingency occurred which is within on year from the date of revival. Hence benefit B is not payable in this case. The medical claim of the complainant cannot be entertained as the policy conditions are not satisfied as mentioned above. There is no lack of service or deficiency of service on the part of the LIC Of India vide letter dt. 30.7.2003 the 2nd LIC Of India informed the complainant that his claim under benefit B is disallowed for reasons stated thereunder and vide letter dt. 6.8.2003 the original policy was returned to the complainant after changing the Asha Deep Policy to Endowment Assurance Plan with profits. Hence no relief is admissible against the LIC Of India.

    Points that would arise for consideration are:
    1.Whether there is deficiency in service or unfair trade practice on the part of the LIC Of India
    2.Reliefs and costs.
    For the complainant PW.1 is examined. Ext.P1 to P5 are marked.
    For the LIC Of India DW.1 is examined. Ext. D1 is marked.
    Points 1 and 2
    The complainant filed this complaint against the repudiation of his claim in connection with the policy taken by him. The contention of the LIC Of India is that the renal transplantation was done within one year of the revival of policy. LIC Of India has also then converted the said policy into an ordinary Endowment Assurance Policy with effect from 28.7.2003. According to them the complainant has revived his lapsed policy on 27.2.2003 and the contingency occurred within one year from the date of revival. Hence 11 B benefit is not payable to the complainant and therefore the policy claim was repudiated and as per Administrative condition LIC Of India has converted the policy into an ordinary Endowment Assurance Policy.
    The definite contention of the complaint is that the complainant had paid premium of Rs.2174/- from 28.7.1998 upto 2002. On 28.1.2003 the LIC Of India has asked the complainant to pay the entire arrear with interest and late fee through Ext.P2 letter for Renewing the policy. On the basis of Ext.P2, the complainant paid the entire arrears including the interest and late fee and LIC Of India issued Ext.P3 Renewal Premium Receipt. According to the complainant after collecting the arrears, with interest and late fee, the LIC Of India cannot contend that the policy is starting a fresh on revival. On verifying Ext.P3, it can be seen that the LIC Of India had received the entire arrears with interest and also late fee and issued Renewal Premium Receipt and also it is seen that Ext.P2 letter was issued by LIC Of India themselves and not on the request of the complainant asked to pay the entire dues with interest and with late fee for renewing the policy. The complainant had paid the amount on the basis of Ext.P2. After P3 renewal of policy, the denial of Benefits B of Edt.P1 Policy on the ground of contingency occurred within one year from the date of revival is not legal. In these circumstances were of the view that the repudiation of the complainant’s claim is not proper and there is deficiency in service on the side of the LIC Of India. Point found accordingly. The complainant is entitled to get 11 B benefit in the policy

    The next point to be decided is that whether the conversion of policy from Ashadeep to an Endowment Assurance Policy is legal and proper. According to the complainant, the said conversion was done without issuing any letters to the complainant or without his knowledge. LIC Of India contend that they have power to convert such policy as per Administrative condition. By converting into ordinary Endowment Assurance Policy the features of the medical reimbursement was taken away. In this case the complainant has paid the outstands arrears with late fee on 27..2.2003. The renal transplantation was done on 7.4.2003. The opp..party has no case that the complainant has suppressed his existing renal diseases at the time of revival of policy. In these circumstances without giving the above said conditions to the complainant along with Ext.P1, the LIC Of India cannot convert the policy unilaterally by which the features of the medical reimbursement was taken away. Hence the act of LIC Of India of converting the policy amount to unfair trade practice.
    In the result the complaint is allowed, directing the LIC Of India to pay the complainant Rs.25,000/-[50% of the assured amount] with interest at the rate of 12% per annum from12..9..2003 till payment and also 10% of the assured amount on every succeeding year along with waiver of future premiums. LIC Of India 1 to 3 are also to pay Rs.25,000/- towards compensation for unfair trade practice. The order is to be complied with within one month from the date of this order.

  • adminadmin Administrator
    edited September 2009

    Complaint filed on 08.12.2008
    and Decided on 17.03.2009
    BEFORE THE UDUPI DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
    AT UDUPI (KARNATAKA)

    PRESENT: 1. Sri P.C.Gopal, President,
    2. Sri Bekal Lakshmana Nayak, Member.

    Consumer Complaint No. 145/2008
    Clubbed with
    Consumer Complaint No. 146/2008
    Order Dated 17.03.2009
    Between:

    Smt.Vijayalakshmi
    Aged about 58 years,
    W/o Vittal Hegde,
    Darkhas House, Seethanadi Post,
    Karkala – 576 112, Udupi District.

    (Sri Mohandas Shetty, Advocate for the Complainant)
    ……. Complainant
    Versus

    Life Insurance Corporation of India,
    Divisional Office,
    “Jeevan Krishna”,
    P.B.No.8,
    Ajjarkad, Udupi – 576 101.

    (Sri Dayananda K., Advocate for the LIC Of India)
    …………..LIC Of India
    WRITTEN BY SRI P.C.GOPAL, PRESIDENT.

    1. In both the above complaints bearing CC No.145/08 and CC 146/08, the Complainant is the same, filed against the same LIC Of India i.e. LIC Of Indiain respect of two different policy certificates, arising out of same cause of action. Hence these two complaints are clubbed together and common order is passed.

    2. The Complainant Smt.Vijayalakshmi is the mother of Late Vijaykuamr Hegde. During his life time, he had obtained the insurance policies coverage on his life as detailed below:
    Complaint No.
    Policy Certificate No.
    Date
    Sum Assured
    145/2008
    624353904
    26.12.2005
    Rs.2,00,000/-
    146/2008
    624156395
    15.12.2004
    Rs. 50,000/-
    Contd……..2
    Vijaykumar Hegde died on 20.01.2007 due to heart failure. The Complainant filed claims documents with the LIC Of India furnishing all the details. But the LIC Of India did not respond to the claim.

    3. The Complainant got issued lawyer’s notice dated 15.12.2007 to the LIC Of India and the LIC Of India replied the same by letter dated 23.3.2008 intimating the repudiation of the claim alleging that deceased Vijaykumar has suppressed the truth with respect to the pre existing ailment which is false. The reason assigned for the repudiation is wholly false and baseless and imaginary. The cause of death of Vijaykumar Hedge is nothing to do with the ailment stated in the letter dated 23.3.2008. Hence the above complaints.

    4. After service of notice of complaint, LIC Of India appeared through the counsel and filed the versions contending that the complaints are false, frivolous and not maintainable under law or on merits and the same are filed with a view to have unlawful gain for herself.

    5. On issuance of notices in both the C.C.Nos.145/08 and 146/08 LIC Of India represented by advocate and filed a memo for clubbing the matter and the same was considered since Complainant has no objection.

    7. LIC Of India admits having issued policy Nos. referred in the Complaints for sums of Rs.2,00,000/- under table and term 091-30 30 commencing risk from 26.12.2005 and for Rs.50,000/- under table and term 91-30 commencing risk from 15.12.2004 to the son of the Complainant Vijayakumar Shetty hereinafter refereed to as the life assured, denies that the life assured had undergone all the medical tests conducted by the medical practitioner/s belonging to the LIC Of India. The captioned policies are issued under non medical general case for which no medical check up/s were insisted/conducted by the LIC Of India.

    8. The LIC Of India admits the date of death as 20.01.2007 and the lawyer’s regd. notice dated 15.12.2007 and states that it is not correct to say that the LIC Of India did not respond to the claim of the Complainant despite the fact that the Complainant had submitted all the details and that the claims were repudiated on false and imaginary reasons as contended. The claims were repudiated for valid reason of non disclosure of material facts by the life assured
    Contd……..3
    regarding his health and it was conveyed to the Complainant on 23.03.2008. The Complainant’s appeals before Zonal claims Review committee of LIC Of India had upheld the decision of repudiations on 17.9.2008 and same has been communicated to the Complainant on 6.10.2008.

    9. The LIC Of India submits that on investigation it was revealed that the life assured had been suffering from Synovial Sarcoma for about 2 years at the time of proposing for the policies. The final diagnosis was left Popliteal Fossa Swelling (Pigmented Villonodular Synovitis). The life assured was admitted to the hospital with the history of inability to straighten and bend left knee since 5 years. Open biopsy of left knee was done. He was again admitted to the same hospital on 21.5.2004 and discharged on 11.06.2004. The final diagnosis was old operated case of Synovial Sarcoma left knee with fixed Flexion deformity. He was put on skin traction and discharge with advice to continue the skin tractions at home. The life assured did not however disclose these facts in his proposal for the subject policies as he was expected to do in terms of the declaration signed by him in the proposal form with a view to defraud the LIC Of India and to make unlawful gains if possible. Thereby the life assured made mis-statements and with held material information from LIC Of India. This LIC Of India has repudiated the claims under condition 6 of policy under heading forfeiture in certain events’ accordingly the LIC Of India is not liable for any payment under the policies and all moneys that have been paid inconsequence thereof belong to the LIC Of India.

    10. The LIC Of India submits that the ultimate cause of death given in medical attendance certificate (claim form B) given by Doctor Satyanarayan B of Muniyal Ayurvedic Hospital and Research Centre, Muniyal the primary cause of death of life assured was a cardiac arrest due to metastasis of sarcoma. The life insurance contract is based on the doctrine of uberrima fides (utmost good faith) between the parties in so far as acceptance of risk under the life insurance policies. It is also submitted that had the life assured disclosed the facts the LIC Of India would not have accepted his proposal or refunded the initial premium received. Therefore the contention that cause of death of the life assured has nothing to do with the ailment that he suffered is not correct and no relevance.
    Contd…………4
    11. LIC Of India denies that the life assured had availed the services of LIC Of India against payment and the Complainant being the beneficiary of such service and repudiations are deficiency in service, since there was breach of contract on the part of life assured in suppressing material information at the time of submitting the proposal for insurance.

    12. The LIC Of India submits that this Forum has no jurisdiction to entertain the complaint on the grounds under Sec.2(c)(iii) of Consumer Protection Act and denies there is indulgence of unfair trade practice. The LIC Of India submits that the Complainant be directed to approach civil courts as laid down in R.P. 435/95 and 874/95 by Hon’ble National Commission.

    13. The LIC Of India admits that the Complainant is a nominee in the policies but not admitting her as legal heir or only legal heir of deceased. The Complainant is put to strict proof of the same and prays for dismissal of the Complaints with compensatory costs U/s 35A of CPC.

    14. The Complainant filed 3 documents each in both the complaints which are marked as Exs.C-1 to Exs.C-3 and LIC Of India filed 11 documents in C.C.No.145/08 and relied them in both the Complaints, marked as Ex.R-1 to Ex.R-11. Parties filed affidavits, interrogatories and reply affidavits. LIC Of India filed written arguments and prayed to taken as heard. We heard the oral arguments of Complainant. These are the materials placed before the Forum to decide the Complaints.

    The issues that arise out of the above two complaints are that:
    1) Whether the Complainant is consumer? If so.
    2) Whether this Forum has jurisdiction to entertain the complaint? If so.
    3) Whether the LIC Of India is justified in repudiating the claims of the Complainant? If so.
    4) Whether the Complainant is entitled to reliefs? If so.
    5) What order?

    Point No.1 & 2:
    15. The LIC Of India’s contention is that the Complainant is not a consumer, since the life assured while taking life insurance policy had suppressed material
    Contd…………5
    facts of his health conditions. Therefore, he has breached the terms and conditions and the policy was obtained in breach of utmost good faith, uberrima fides. Since there is breach of good faith, the contract ends once it is found out therefore, there is no contract between the life assured and the LIC Of India. Since there is no contract, the Complainant nominee of life assured is not a consumer.

    16. The Complainant’s case is that she is the nominee of the life assured and there was a valid contract of insurance between life assured and the LIC Of India. Therefore, she is a consumer.

    17. We have gone through the merits of the case and find that the LIC Of India could not prove the breach of contract of insurance is of uberrima fides. Therefore, the Complainant is the nominee of the deceased life assured is a ‘consumer’.

    18. The LIC Of India’s argument is that this Forum has no jurisdiction to entertain the complaint and referred to rulings in R.P. 435/95 and 874/95 delivered by Hon’ble National Commission and sought direction to Complainant to approach competent Civil Court. The Complainant’s argument is that she being a consumer and in exercise of power conferred under Section 3 of CPA this Forum has jurisdiction. We are of the opinion that this Forum has jurisdiction to entertain the complaint since point No.1, it is held that the Complainant is a consumer and CPA is applicable to her. Therefore point No.1 and 2 are answered in affirmative.

    Point No.3:
    19. The LIC Of India’s argument is that the repudiation is justified on the grounds of non disclosure of material facts, since the deceased life assured has undergone treatment for ‘left popliteal Fossa Swelling (Pigmented Villonodular Synovitis) during 3.2.2003 to 8.2.2003 prior to obtention of 1st policy and also subsequent to this he was undergoing treatment for Synovial Sarcoma. Hence he has breached the contract of utmost good faith and relied on Ex.R-1 and Ex.R-2 proposal Forms, Ex.R-3 to Ex.R-10. which are medical hospital records, discharge summary and medical attendants certificate (Ex.R-10) and submitted that in proposal forms at column 11(a) to (d) the Complainant has given negative answer
    Contd……6
    on his health condition during the last 5 years and at J, he has answered “good” on his usual states of health. Had the life assured disclosed his ailment particulars the LIC Of India would not have issued policies to him or would have issued with altered terms/with extra special reports called for. The life assured had made deliberate mis-statements and withheld correct information from the LIC Of India. Hence the terms of the policies of the contract becomes void-ab-initio.

    20. The LIC Of India further argued that the life assured was admitted to KMC Hospital Manipal on 3.2.2003 with a complaint that he was unable to straighten and bend knees for the last 5 years. He was discharged on 8.2.2003 and he was readmitted as inpatient on 21.5.2004 and discharged on 11.6.2004 with a complaint of pain left, knee with deformity and with a history of Synovial sarcoma left knee on radio and chemotherapy. Past history of surgery swelling left knee. Physical findings of examination revealed that surgical scar was found on posterior part of left knee and other serious problem. He was further operated and skin traction was put. He was admitted to Muniyal Ayurvedic Hospital and Research Centre, Muniyal on 2.12.2006 and discharged on 10.12.2006. The diagnosis was Synovial Sarcoma (Asthyarbuda). For the 3rd time he was admitted to KMC Hospital, Manipal as an inpatient on 10.12.2006 and was discharged on 10.01.2007. Hence when he purchased the said policies, he had the said problems. It is further submitted that as per medical investigation the ultimate cause of death will be cardiac arrest only under all ailments. As per Ex.R-10 the primary cause of death of life assured was cardiac arrest due to metastasis of sarcoma. Under these circumstances, had he disclosed his ailments the LIC Of India would not have accepted the proposal for assurance at all or have cancelled his proposal and refunded the initial premium. The 11 documents produced by the LIC Of India disproves the case of the Complainant and relied upon rulings in
    RP 1835/1999 LIC of India before Hon’ble National Commission.
    RP 3362/2004 LIC of India before Hon’ble National Commission.
    Appeal (Civil) No.5322/2007 S.C.
    and prayed for dismissal of the complaints.

    21. The Complainant argued that the LIC Of India admits the death by cardiac arrest. The LIC Of India also admits the policies, and also admits that the Complainant is nominee. The Opposite Parties main argument is that non
    Contd….7
    disclosure of material facts. The non disclosure of material facts does not arise in this case because, the reason for death “cardiac arrest” has no nexus with the Synovial Sarcoma. LIC Of India had canvassed that the ultimate reason of death will be cardiac arrest. But LIC Of India did not prove it that the material facts as contended by LIC Of India has lead to the death and relied upon IV CPJ (2008) 458 where the synopsis reads:
    “Consumer Protection Act, 1986 – Section 15 – Insurance – Suppression of pre-existing disease – Reimbursement claim repudiated – complaint dismissed by Forum. Hence Appeal – Disparity found in hospital reports – Evidence of treating doctor not given – Onus to prove pre existing disease not discharged by insurer – mere mention of pain during urination for last two years, without positive finding of disease and treatment record; not amount to pre existing disease – Repudiation unjustified – order of Forum set aside – Insurer held liable under policy

    And prayed for allowing the complaints. We observe that Ex.R-1 is dated 5.12.2004, Ex.R-2 is dated 26.12.2005. The nominee is the Complainant. The LIC Of India admits the issuance of policies, date of death, and Complainant as nominee. This dispute is as regards the cause of death which according to LIC Of India is on account of non disclosure of material fact in this case. The Complainant’s case is that the cause of death and non disclosure of alleged material fact has no nexus. There is nothing to prove that the cardiac arrest, the reason admitted by both the parties other than the Ex.R-10. The Complainant submitted during the course of argument that the deceased life assured was taken to hospital for admission but before admission he died because of cardiac arrest, hence the body was taken back home without any treatment in the hospital. The Ex.R-10 medical attendants certificate at “4(a) what was the exact cause of death” is answered “a) Primary cause: cardiac arrest, Secondary cause : Metastasis of Sarcoma”
    at “(b) was it ascertained by examination after death or inferred from symptoms and appearance while alive”
    “inferred from symptoms and appearance while alive (about 2 months)”

    22. The last discharge summary is available for the period 2.12.2006 to 10.12.2006 from Muniyal Ayurvedic Hospital and Research Centre, Muniyal. The date of death is 20.01.2007 place of death is the life assured house. The LIC Of India had fair opportunities to prove the cause of death by producing the treating doctors but did not opt for proving the documents and cause of death. In the circumstances, the LIC Of India has failed to prove that the cardiac arrest, the primary reason for death is a consequence to Synovial Sarcoma.
    Contd……8
    23. The LIC Of India in its arguments relied on Sec. 45 of Insurance Act. In the case of policy No.624156395 dated 25.12.2004 on expiry of 2 years from the date of issuance policy, the policy was not capable of being called in question interalia on the ground that certain facts have been suppressed which were material to disclose or that it was fraudulently been made by the policy holder or that the policy holder knew at the time of making it that the statement was false. Therefore, we hold that the repudiation of policy No.624156395 dated 15.12.2004 is deficiency in service in complaint No.146/08 and repudiation is not justified.

    24. In the case of CC No.145/08 policy No.624353904 dated 26.12.2005 for Rs.2,00,000/- was taken and the life assured died on 20.1.2007. According to the Ex.R-10 the place of death is at deceased life assured house. The reason given in “medical attendant’s certificate (Ex.R-10). Primary cause of death is “cardiac arrest”. and secondary cause of death is metastasis of sarcoma”. The LIC Of India had failed to prove the cause of death and nexus to the non disclosed material fact. The Complainant relied on ruling in IV (2008) CPJ 458. Since the nexus is not proved and cardiac arrest is not disproved, the repudiation by the LIC Of India on the ground of non disclosure of material facts is deficiency in service and repudiation is not justified in the case of C.C.No.145/08. In the result, we answer point No.3 in Negative.

    Point No.4:
    25. In view of affirmative answers to point No.1 & 2, and Negative answer to point No.3 the Complainant is entitled for reliefs. The Complainant has claimed 12% interest on the policy amounts from the date of death. The parties have failed to mention or produce the document with date of claim. Therefore, the Complainant is entitled for the interest on insured amount and vested bonus from the date of death of life assured. The Complainant had further claimed Rs.25,000/- and Rs.1,00,000/- as compensation for mental agony.. No doubt there is agony till the policy amounts are realized and received. We allow Rs.5,000/- each in both the Complaints towards mental agony and harassment alongwith the cost of the proceedings. In view of the above, we answer point No.4 in affirmative and pass the following:
    Contd……9

    ORDER
    The complaints are allowed. LIC Of India is directed to pay to the Complainant Rs.50,000/- and Rs.2,00,000/- alongwith vested bonuses in both cases alongwith 12% interest on the amounts from 20.01.2007 till payment. The LIC Of India also directed to pay Rs.5,000/- in each case (Total Rs.10,000/-) as compensation and Rs.5,000/- as cost of proceeding (consolidated) for both cases. The LIC Of India shall pay the above amounts within a month from the date of receipts of the order. Original order is kept in C.C.No.145/08 and copy in C.C.No.146/08.

    (Order dictated to the Stenographer, after the same is typed, corrected and pronounced in the open court on this the 17th day of March 2009)


    (BEKAL LAKSHMANA NAYAK) (P.C.GOPAL)
    MEMBER PRESIDENT
  • adminadmin Administrator
    edited September 2009
    ::: O R D E R ::: -


    1. The complainant has filed this complaint u/s 12 of the Consumer Protection Act against the LIC Of India for the deficiency of service in repudiating the claim of the complainant and prays for a direction to pay compensation along with the court costs as detailed in the complaint.


    2. The facts of the case in brief are as follows:-
    The complainant No.1 is the wife of the deceased insured and the 2nd and 3rd complainants are the children of the said deceased husband of the complainant No.1. The said deceased husband of the complainant No.1 had taken the insurance of Jeevan Anand With Profits for a sum of Rs.1,00,000/- in the year 2004 and the premium is Rs.3,406/- payable half yearly and the policy was in force. Such being the case, he died on 13.09.2007 and the death was natural and the policy was in force at the time of his death. As she is the nominee to the said policy, claimed for compensation under the policy by providing all the documents to the LIC Of India. But the LIC Of India have repudiated the claim of the complainant stating that the deceased husband was suffering from Chronic Pancreatitis. But the deceased husband died naturally at home and the LIC Of India have repudiated the claim without any valid reasons. Hence, the complainant issued a legal notice dtd.14.08.2008. Inspite of the receipt of the said legal notice also, the LIC Of India have failed to provide the compensation to the complainant. Hence, they are at deficiency of service and prays for the above referred reliefs.



    3. After the service of the notice, the LIC Of India have appeared through their counsel and filed version contending that subsequent to the death of the deceased husband of the complainant, they have conducted an investigation and revealed that the said deceased was suffering from Chronic Pancreatitis for about 1 year 10 months before giving proposal and he has taken the treatment for the above said disease during 30.01.2003 to 06.02.2003 and he was a known alcoholic for about two years before taking the policy. The said deceased husband of the complainant No.1 was also hospitalized from 01.03.2003 to 19.03.2003 and underwent Pancreatectomy and Spleenectomy on 06.03.2003. As such the said deceased husband of the complainant had not disclosed these facts to the opponent Corporation at the time of giving the policy proposal.



    4. The LIC Of India have further contended that the contract of insurance is of “Uberrima Fides (Utmost Good Faith), wherein the proposer is required to disclose correct status of his/her health to enable the insurer to assess the risk and to protect the interest of the other policy holders by avoiding bad selection of lives. The deceased husband of the complainant with ulterior motive of cheating the corporation did not disclose his ailments, which was material for the opponent for assessing the risk. If the assured disclosed his ailments particulars, the opponent would not have issued a policy to him or would have issued with altered terms with extra after called for various special reports. Hence, as the deceased life assured had made the deliberate mis-statements and withheld correct information from the opponent regarding his health. Therefore, they have repudiated the claim and there is no deficiency of service. Hence, prays for the dismissal of the complaint.




    5. The complainant has filed his affidavit evidence as PW.1 along with documents and the same have been marked as Exs.P1 to P17.


    6. One Sri Niranjan Murthy, Asst. Administrative Officer of the opponent Insurance Company has also filed his affidavit evidence as RW.1 along with documents and the same have been marked as Exs.R1 to R5.


    7. Heard the arguments on both the sides.



    8. Now, the points that arise for consideration of this Forum are as follows:-

    i) Whether there is any deficiency in service on the part of
    the LIC Of India?
    ii) If so, whether the complainant is entitled to the
    reliefs as sought?
    iii) What Order?


    9. Our findings on the above points are as follows:-

    i) Point No.1: In the Affirmative

    ii) Point No.2: In the Affirmative

    iii) Point No.3: See, as per order below
    - ::: R E A S O N S ::: -


    10. Point No.1 & 2: There is no dispute with respect to the policy taken by the deceased husband of the complainant No.1 and there is also no dispute with respect to the policy is in force at the time of death of the deceased husband of the complainant. The only dispute raised by the opponent in settling the claim is that the deceased husband of the complainant No.1 had suppressed the material facts at the time of proposal of the policy and he has suppressed the material facts with respect to the health condition. Hence, they repudiated the claim.


    11. Whereas, the complainant had filed affidavit stating that her husband died naturally on 13.09.2007 at home and the LIC Of India have repudiated the claim without any valid reasons. Therefore, she prays for the direction of payment of claim along with the compensation.


    12. The opponent has produced a proposal form, which is marked as Ex.R3, which was duly signed by the deceased husband of the complainant No.1 and a discharge summary is marked as Ex.R4 and another discharge summary is produced to show that the deceased husband was admitted to the hospital on 31.07.2007 and discharged on 07.08.2007, which is marked as Ex.R5.


    13. The complainant has also produced a death certificate, which is marked as Ex.P3. The claim application is marked as Ex.P4 and the repudiation letter is marked as Ex.P5.



    14. The complainant No.1 in her affidavit has sworn that her husband died at home naturally, whereas the opponent has taken a contention that the assured was hospitalized before taking policy with the history of abdominal pain and chronic alcoholic since 2002 and has produced discharge summaries, which are marked as Exs.R4 and R5. Ex.R5 is a discharge summary, which shows that the assured was hospitalized after taking the policy with a history of Chronic Pancreatitis. In the said Ex.R5 nowhere it is mentioned that the complainant’s husband was an alcoholic and we noticed in the column of history of present illness the patient was apparently normal 15 days back, when he noticed distension of the abdomen with on & off vague abdominal discomfort, no H/o of vomiting / constipation, no aggravating / relieving factors, h/o of jaundice for 3 days and it is also noticed in the said Ex.R5 all other conditions of the assured were normal. Such being the case, we cannot believe that the deceased husband of the complainant died due to the said disease as shown in Ex.R4 and R5 and the opponent has failed to prove that alcoholic and Chronic Pancreatitis is the cause of the death of the assured husband of the complainant. Therefore, the repudiation made by the opponent is not justifiable on the ground of suppression of material facts.



    15. In this regard here we quote, the decision of Hon’ble Rajasthan State Consumer Disputes Redressal Commission, Jaipur in the case of Life Insurance Corporation & Others V/s Shanta Mali, wherein it is held that:
    Consumer Protection Act, 1986 – Section 2(1)(g) – Life Insurance – Suppression of material facts – Claim repudiated – Contention, deceased undergone operation of syndrome, not disclosed – Disease of syndrome very minor disease, if not mentioned in proposal form, not amounts to suppression of material facts – Alleged suppression had no nexus with cause of death – Mere incorrect/wrong answer to questions having no connection with cause of death, not absolves insurer from liability – Repudiation unjustified – Insurer liable under policy.
    (Vide I (2009) C.P.J. Page 476)


    16. Following the principles laid down in the above cited decision, here also the LIC Of India have failed to prove that the deceased husband was died due to the chronic pancreatitis as narrated in the Exs.R4 and R5 and it is pertinent to note that he died at home and the death was natural one. Therefore, the repudiation made by the complainant amounts to deficiency of service. Hence, the complainants 1 to 3 are entitled to get the assured amount of Rs.1,00,000/- with the benefits from the LIC Of India. The complainants are also entitled to get Rs.3,000/- compensation towards the deficiency of service along with the costs of Rs.1,000/- towards the litigation expenses. For the above said reasons, we answer the point Nos.1 and 2 in the affirmative.


    17. Point No.3: In view of our findings on the above points the complaint filed by the complainant has to be allowed. In the result we pass the following order.
    - :::O R D E R::: -
    1. The complaint filed by the complainants against the LIC Of India is partly allowed.
    2. The LIC Of India are hereby directed to pay a sum assured amount of Rs.1,00,000/- with benefits covered under the policy in question to the complainant No.1.
    3. The LIC Of India are also hereby directed to pay compensation of Rs.3,000/- towards the deficiency of service along with costs of Rs.1,000/- towards the litigation expenses to the complainant, within one month from the date of this order, failing which the amount shall carry interest at the rate of 9% P.A. from the date of default till realisation.
  • adminadmin Administrator
    edited September 2009
    ORDER

    This is a complaint filed Under Section 12 of the Consumer Protection Act, 1986 (hereinafter called as Act for short)

    2. Through this compliant the complainant prays for an award to recovery a sum of Rs.39,479/- with interest at at24% from 14-11-2006 till recovery, for cost and for such other reliefs.

    3. The facts given rise to institute the complaint may be summarized as thus:
    It is his case that, he had insured his life under the policy bearing No.610814713 dated 13-2-1991 with half yearly premiums at Rs.1756/- . It is alleged that, he had paid premiums regularly from 13-2-1991 to 14-11-2006. That on 14-11-2006, he surrendered the policy to the LIC Of India. He was informed by the LIC Of India that, the surrender value of the policy was Rs.39,427/- and cheque bearing No.0021031 had been drawn in his favour and sent for approval to the Hyderabad. But, inspite of lapse of 2 years the LIC Of India has not paid the surrender value. Hence, this complaint.

    4. The LIC Of India who has notified of the complaint entered appearance to his counsel and resisted the same by filing his objection

    5. In his objection, this LIC Of India while admitting the insurance policy taken by the complainant, certain payments of premiums however, contended that, the complainant had stLIC Of Indiaped paying the premiums from August 2004. It is also admitted by this LIC Of India that, the complainant had surrendered the policy and requested for paying the surrender value. It is further contended that, the LIC Of India on calculation worked out the surrender value at Rs.39,427/- and has issued an account payee cheque bearing No.21031 for said sum on 14-11-2006 drawn at State Bank of Mysore, Madhugiri branch in favour of the life assured towards the full settlement of the surrender value of the policy. It is contended that, as per the records available of the office of the LIC Of India, the cheque was presented through Madhu Patina Sahakara Sangha Niyamitha, Madhugiri on 14-11-2006 in S.B. Account No.3205 and it was encashed on the same day in the name of the complainant A.S.Parthsarathy. It is further contended that, on receipt of legal notice of the complainant, this LIC Of India has initiated an investigated into the matter and though the investigation is pending, a decision was taken to settle the surrender value of the complainant on the basis of taking an indemnity bond. This decision was communicated to the complainant on 26-12-2008 through courier, but it was returned with an endorsement “Address is not sufficient”. It is further contended that, pending investigation, this LIC Of India is prepared to pay a sum of Rs.46,737/- on a condition of executing an indemnity bond by the complainant. Accordingly, he prays for rejection of the complaint.

    6. Both the parties have filed their affidavits.

    7. On hearing both parties this forum has passed an order on 24-2-2009 as here under:
    “Affidavit of the LIC Of India filed. Sri.KCN submits that, the complainant is ready to execute that bond as demanded by the LIC Of India subjected to the result of the investigation to receive this amount. Accordingly, this complainant is permitted approach the LIC Of India, Madhugiri branch for needful. This LIC Of India shall take apprLIC Of Indiariate steps to release this amount in favour of the complainant subject that result of investigation pending after taking the bond and call on for complainace 4-3-2009”.

    8. In pursuance of the said order, on 4-3-2009 the complainant filed a memo reporting receipt of Rs.46,737/-. The LIC Of India has also filed a similar memo regarding the payment of the said amount.


    9. Learned counsel appearing for the complainant insisted for cost and future interest. However, other side has LIC Of Indiaposed this move.

    10. Heard.

    11. From the nature of pleading, it is seen that, the surrender value of the policy amounting to Rs.39,427/- sent on 14-11-2006 drawn at State Bank of Mysore, Madhugiri branch in favour of the complainant has been drawn on that day vide S.B Account No.2305. The complainant claims that, he has not LIC Of Indiaened that account nor realized it. In this regard, an investigation was initiated by the LIC Of India and it is pending. However, without prejudice to his right, pending investigation, the LIC Of India has offered to pay Rs.46,737/- being the surrender value as on that date on a condition of executing an indemnity bond by the complainant. Though, the complainant had worked out, the claim at Rs.39,427/- as on the date of filing the complaint, a sum of Rs.46,737/- has been paid to the complainant after taking the indemnity bond. Therefore, having regarding to the facts and circumstances of the case, we are of the LIC Of Indiainion that, it is not just and prLIC Of Indiaer to impose cost and future interest on the LIC Of India. Thus, we hold that, it is a fit case to close the complaint by recording the payment of Rs.46,737/- by the LIC Of India to the complainant. Accordingly the complaint is disposed off.

    Dictated to the stenographer, typed by him, corrected and pronounced on LIC Of Indiaen forum this 5th day of March 2009.



    (Smt.Girija) (Sri.D.Shivamahadevaiah) (Sri.K.M.Thammaiah)
    Lady member Member President
  • adminadmin Administrator
    edited September 2009
    Date of Filing:23.10.2008
    Date of Order : 06.03.2009
    BEFORE THE I ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SESHADRIPURAM BANGALORE - 20
    Dated: 6th DAY OF MARCH 2009
    PRESENT
    Sri. Bajentri H.M, B.A, LL.B., President
    Smt.C.V. Rajamma, B.Sc., LL.B., PGDPR, Member


    COMPLAINT NO. 2270 OF 2008

    Mr.Sunder Raj V.
    A/a 55 yrs, R/at No.526,
    A.T.ST.A.N.K. Road Cross,
    V.V.Puram, Bangalore
    …. Complainant.
    V/s

    01. LIC of India,
    KG Road Branch,
    PrithviBuildings, 2nd Floor,
    P.O.Box No.9930, K.G.Road,
    Bangalore.

    02. LIC of India,
    Residency Road Branch,
    CanaraMutualBuilding,
    Residency Road, Bangalore.
    …. Opposite Parties
    -: ORDER:-
    This complaint is for a direction to the LIC Of India to refund the loan amount of Rs.15,000/- raised by the LIC Of India under the insurance policy and to pay compensation of Rs.30,000/-.


    2. The case of the complainant is as under:-
    He has obtained LIC policy No.610877940 from LIC Of India No.1 and policy No.612627760 from LIC Of India No.2. He received letter dated 13.11.2006 from LIC Of India No.2 stating that LIC Of India No.1 had made excess payment of Rs.25,000/- and he (complainant) has remitted the amount of Rs.7,000/- towards excess payment and the outstanding balance of Rs.18,000/- is to be repaid by him to LIC Of India No.2 as the same is required to be shown to Audit Department about the recovery. The LIC Of India requested the complainant to give authorization to raise loan for adjusting the excess payment of Rs.25,000/- and also provided blank loan application to be filled and submitted by the complainant. LIC Of India No.1 sent the letter dated:15.11.2006 stating that on receipt of the completed loan papers they have settled the loan and have sent cheque for Rs.14,999/-. The complainant has neither raised any loan nor sent any loan papers nor received any excess payment as alleged by the LIC Of India. LIC Of India No.2 endorsed that the cheque is adjusted towards the excess payment made in policy No.610877940 by LIC Of India No.2. The complainant never received any excess payment but received only the surrender value of the policy. He issued legal notice dated:11.08.2008 and in spite of it, the LIC Of India neither adjusted any payment nor gave reply. Hence, the complaint.


    3.In the version, the contention of the LIC Of India is as under:-
    The complaint is misconceived. The dispute raised is not a consumer dispute. The complainant has obtained one insurance policy from LIC Of India No.1 and another insurance policy from LIC Of India No.2. LIC Of India No.1 came to know from LIC Of India No.2 that a sum of Rs.15,000/- was due from the complainant to LIC Of India No.2 under policy No.61627760. In order to clear the dues, LIC Of India No.1 paid Rs.15,000/- to LIC Of India No.2 on behalf of the complainant treating the same as loan under policy No.610877940 and wrote a letter to the complainant to give consent for the same. Since the complainant did not consent for the transaction, LIC Of India No.1 brought back the sum of Rs.15,000/- from LIC Of India No.2 and cancelled the loan transaction. As such there is no loan transaction between the LIC Of India and complainant and deficiency in service on the part of the LIC Of India. The action of LIC Of India No.1 was to help the complainant to clear his dues as a matter of courtesy. It is the practice of the LIC Of India that if a Customer is due any amount, they will raise loan and then seek consent of the Customer. Accordingly the transaction of raising loan and then sending loan amount to LIC Of India No.2 was a courtesy service rendered in good faith that the complainant would give his consent. But when he did not consent for the same, the loan was cancelled. Thus, there is no deficiency in service on the part of the LIC Of India and as such the complaint is liable to be dismissed.


    4.In support of the respective contentions both parties have filed affidavits. We have heard arguments on both side.


    5. The points for consideration:-
    1.Whether the complainant has proved deficiency in service on the part of the Opposite Parties?

    2.Whether the complainant entitled to the relief prayed for in the complaint?




    6.
    Our findings are:-
    Point No.1 : In the Affirmative
    Point No.2 : As per final order
    For the following:-
    -:REASONS:-


    7.
    Though in the version it is contended that the complainant was due certain amount to LIC Of India No.2 – The Residential Road Branch of LIC, the details of the dues is not disclosed. In the letter dated:13.11.2006 addressed to the complainant it is stated by the LIC Of India that the complainant has remitted Rs.7,000/- towards excess payment of Rs.25,000/- made to him and requested the complainant to authorize them to raise loan on the policy held by him with LIC Of India No.1 and to adjust the loan amount towards excess payment. Along with the said letter, the LIC Of India also sent the copy of the loan application requiring the complainant to submit the same duly filled up. About two days thereafter namely 15.11.2008, the LIC Of India addressed a letter to the complainant that on receipt of loan papers a loan of Rs.15,000/- has been sanctioned and the same is adjusted towards excess payment. The complainant has denied that any excess payment was made to him or that he had consented for raising the loan on the policy held with LIC Of India No.1 and to adjust the loan amount towards excess payment alleged to have been made by LIC Of India No.2. In spite of this contention of the complainant, the LIC Of India have not bothered to furnish the details of the excess payment alleged to have been made to the complainant. From the statements in the version, it is clear that before the complainant gave consent by submitting loan application for raising loan and to adjust the loan amount towards alleged excess payment, the LIC Of India raised loan and adjusted the amount towards the alleged excess payment. It appears after the complainant issued legal notice, the LIC Of India cancelled the loan transaction and restored the policy to the original condition. But the fact remains that the LIC Of India had raised loan on the insurance policy of the complainant without his consent. This clearly amounts deficiency in service and also to unfair trade practice. We are unable to appreciate the contention of the LIC Of India that as a matter of courtesy they will raise loan on the insurance policy of a Customer and thereafter seek his consent for the same. No service provider is expected to raise loan without the consent of the Customer. In view of the fact that the LIC Of India have cancelled the loan transaction, the complainant is not entitled to claim payment of the loan amount. But for the deficiency in service on the part of the LIC Of India, the complainant is entitled to claim compensation. In our opinion, the compensation of Rs.30,000/- claimed by the complainant is on the higher side. Considering the facts and circumstances, we hold that it is just and proper to award compensation of Rs.5,000/-. In the result we pass the following:-

    -:ORDER:-

    * The complaint is ALLOWED IN PART.
    * The LIC Of India are directed to pay compensation of Rs.5,000/- to the complainant inclusive of the cost of the proceedings. Compliance of this order shall be made within eight weeks from the date of communication.
    * Send a copy of this order to both parties free of costs immediately.
    * Pronounced in the Open Forum on this the 6th DAY OF MARCH 2009.

  • adminadmin Administrator
    edited September 2009
    BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President, 2. M.N.MANOHARA, B.A., LLB., Member, 3. A.P.MAHADEVAMMA, B.Sc., LLB., Member,

    ORDER

    Complaint No.MDF/C.C.No.132/2008 Order dated this the 26th day of March 2009

    COMPLAINANT/S Sri.Anand Sericulture Extension Officer, Department of Sericulture, Doddagarudanahalli, Mandya Taluk & District. (By Sri.H.S.Lokapal Rao., Advocate)

    -Vs-

    LIC Of India/S

    1. The Divisional Manager, L.I.C. of India, Near Tippu Circle, Mysore.

    2. The Branch Manager, L.I.C. of India, Bandigowda Layout, Mandya. (By Sri.S.Sudarshan., Advocate)
    Date of complaint 11.12.2008
    Date of service of notice to LIC Of India 22.12.2008

    Date of order 26.03.2009 Total Period 3 Months 4 Days Result

    The complaint is allowed, directing the LIC Of India to pay compensation of Rs.5,000/- to the complainant within 2 months with cost of Rs.500/-. Sri.Siddegowda, President 1. This complaint is filed under section 12 of the Consumer Protection Act 1986, to direct the LIC Of India to waive off the interest and penal interest on loan amount subsequent to August 1996 and for payment of compensation of Rs.50,000/- with costs.

    2. The case of the complainant is that he availed loan on four L.I.C. polices in the month of March 1995, when he was working at Ramanagar. For the repayment of the said loan in the month of August 1996, he approached the LIC Of India Branch Office at K.R.Pet as he was transferred to that place. But, the officials of K.R.Pet Branch Office informed the complainant that there was no loan existing on the said policies and refused to receive the payment from him. Subsequently, at periodic intervals of time the complainant made sincere attempts for repayment of the loan by enquiring at different branches of the LIC Of India as in general, the policy profiles and loan dockets were being transferred to the places where the policy holder would be transferred. In the month of June 2005 again the complainant approached the LIC Of India Branch Office at K.R.Pet and requested to provide him the status report of all the said policies. The branch Manager orally informed that they have sent a letter to branch office at Mandya regarding the status report and directed the complainant to approach Mandya Branch Office and accordingly, he approached on 2nd LIC Of India and requested for status report of the said policies and 2nd LIC Of India issued 4 computer copies of the status report of the said policies which clearly state that there was no previous loan existing on all the 4 policies. But, to his surprise a loan repayment quotation slip dated 24.01.2008 was sent to the complainant by 2nd LIC Of India with a calculation of interest. As per the calculation made by the 2nd LIC Of India, the complainant required to repay a sum of Rs.52,507/-.

    Then, the complainant sent a letter on 22.05.2008 to 2nd LIC Of India to waive off the interest levied on the loan amount and copy to 1st LIC Of India, but the LIC Of India did not oblige the report. Then, the legal notice was sent to 1st & 2nd LIC Of India and they have not sent any reply. Due to the negligence and dereliction of duty on the part of the LIC Of India an interest of Rs.38,107/- is accumulated on principle amount of Rs.14,400/- which is almost 3 times the principle amount for which LIC Of India are responsible. The LIC Of India have committed deficiency in service in not rendering proper information and have caused mental agony and inconvenience. Therefore, the present complaint is filed.


    3. The LIC Of India have filed common version, admitting that the complainant has obtained loans on 4 policies on 07.03.1995and the total loan amount is Rs.18,600/- and the loan was sanctioned at Channapatna Branch Office. The Complainant has not approached any of the Branch Offices for repayment of the loan and interest, all the loan dockets were transferred from Channapatna to K.R.Pet Branch Office on 21.11.1995 itself. Had the complainant approached the branch, LIC Of India would have accepted the amount. The allegation that the LIC Of India refused to receive the payment is utterly false. As per the condition No.3of the policy loan application, the complainant has to pay half yearly compounded interest at 10.5%. The life assured should inform the LIC Of India in writing as to the actual place of his work and his intention to get the policy and loan records transferred. The averment that generally the records will be transferred to place to place of transfer of the life assured and the complainant made sincere attempt to repay the loan are all false.

    The complainant was not deligent in paying the half yearly loan interest and kept quiet for a long time. The complainant is bound to repay the loan amount demanded by the LIC Of India as per the conditions. Though the complainant requested to waive the interest, but reply was sent expressing the inability to waive the loan interest. All the policies are due to maturity within a short period. The complainant in order to make unlawful gain, but not paying the loan and interest, has approached this Hon’ble Forum with unclean hands, selfish motives. The question of waiver of loan interest is not possible. There is no cause of action and there is no deficiency in service and hence, the LIC Of India are not liable to pay any compensation and complaint is liable to be dismissed with costs.


    4. During trial, the complainant & 2nd LIC Of India are examined and produced documents Ex.C.1 to C.7. On behalf of the LIC Of India one witness is examined and documents Ex.R.1 to R.12 are marked.


    5. We have heard both sides.

    6. Now the points that arise for our considerations are:- 1. Whether the LIC Of India has committed deficiency in service by giving misleading information with regard to the loan? 2. Whether the complainant is entitled to waiver of the interest on the loan? 3. Whether the complainant is entitled to compensation?


    7. Our findings and reasons are as here under:-


    8. The undisputed facts are that the complainant being a Government Servant had obtained 4 L.I.C. policies from the LIC Of India as per Ex.R.1 to R.4 and he has availed the loan of Rs.5,500/- on Ex.R.1, Rs.6,000/- on Ex.R.2, Rs.2,000/- on Ex.R.3 and Rs.4,200/- on Ex.R.4 on 02.03.1995. The loan applications Ex.R.6 & R.8 are not disputed. Under this application, the condition is that the complainant has agreed to pay interest at compounding half yearly to the Corporation and the policies are assigned in favour of the LIC Of India and these documents revealed that the loan was disbursed at Channapatna Branch when the complainant was working in Ramanagar.

    The grievance of the complainant is that when he was transferred to K.R.Pet during 1996, he enquired in the Branch Office of the LIC Of India to pay the interest, but the Branch Office informed that there was no loan existing on the said policies and refused to receive the payment from him and at periodic intervals of time, he made sincere attempts for repayment of the loan by enquiring at different branches of the LIC Of India, but there is no material. It is admitted by him that he has not paid any amount towards the loan, though his duty is as to pay the loan with interest.

    According to him, loan amount was being deducted in his salary. But, no documents are produced at all. He has not sought for in writing about the loan particulars till 2005 and he kept quiet for 10 years. But the evidence of the complainant that he approached K.R.Pet branch in June 2005 requesting for status report of the policies and they directed him to approach the branch office at Mandya and then he approached the 2nd LIC Of India Branch and 2nd LIC Of India Branch issued 4 computer copies of the status report of the said policies. The complainant has produced Ex.C.3, C.4, C.5 and C.6 wherein policy particulars are mentioned, but with regard to the loan details, it is mentioned as “no previous loan exists”. 2nd LIC Of India has admitted that Ex.C.3 to C.6 have been issued from his branch office and except L.I.C. Office, those documents cannot be issued from anywhere.

    The contention of the advocate for the LIC Of India is that Ex.C.3 to C.6 though computerized they are not bearing the seal of the branch office and signature of the officer who issued, therefore they cannot be considered at all as evidence. Admittedly, Ex.C.3 to C.6 are computerized copies issued from the 2nd LIC Of India Branch Office on 09.03.2006 and hence they do not require the signature and seal of the officer who issued.

    The evidence of the complainant that he had obtained Ex.C.3 to C.6 from 2nd LIC Of India Office cannot be doubted at all, since they are generated by the computer. Nobody except, the official of L.I.C. can issue such documents and hence they are relevant for consideration. Of course, it is admitted fact that the complainant has not paid the interest and loan on the policy and he was aware that he was due of the loan and interest. But, when the complainant approached to know the details of the loan and interest, the LIC Of India should have furnished the proper information, but surprisingly they have issued wrong information in Ex.C.3 to C.6 stating no previous loan exists.

    Therefore, the 2nd LIC Of India Branch has committed deficiency in service in giving wrong information about the loan status to the complainant, because if the proper information had been given, the complainant would have made efforts to deposit the interest to the loan. Therefore, we hold that 2nd LIC Of India has committed deficiency in service by giving wrong information about the loan status.



    9. The complainant has sought for waiver of interest and penal interest charged on the loan, on the ground that would have paid the loan and interest if the information had been given. But, merely because the LIC Of India has not furnished the information the complainant cannot escape the liability of payment of interest and loan amount obtained on the policies admittedly. In fact, he has assigned the policies in favour of the LIC Of India for the loan security and the condition is that he is liable to pay interest 10.5% compounded half yearly. In spite of it, he has not made efforts to deposit the loan. Nothing prevented the complainant to deposit the interest or principle mentioning the policy number on which he has obtained the loan. Therefore, in view of the conditions of the loan sanctioned, the complainant is liable to pay interest as agreed upon as per the contract and the complainant is not entitled to waiver of the interest or compound interest.


    10. The complainant has sought for compensation of Rs.50,000/- for deficiency in service and mental agony. It cannot be said that all the policies are going to mature shortly and hence, the present complaint is filed, because only one policy i.e., Ex.R.2 is going to mature on 28.02.2009. It is expected that LIC Of India Branches should furnish proper information to the policy holder whenever they seek information. The LIC Of India Branch Offices should not furnish wrong information by dereliction of duty and it leads to loose good faith earned by the LIC Of India Corporation. Therefore, in the circumstances of the case for mental agony and deficiency in service, it is reasonable to award compensation of Rs.5,000/-, so that LIC Of India Corporation would issue instructions to all the branches to furnish correct information about the policy particulars and loan particulars.



    11. In the result, we proceed to pass the following order; ORDER The complaint is allowed, directing the LIC Of India to pay compensation of Rs.5,000/- to the complainant within 2 months with cost of Rs.500/-.
  • adminadmin Administrator
    edited September 2009
    BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President, 2. A.P.MAHADEVAMMA, B.Sc., LLB., Member, ORDER Complaint No.MDF/C.C.2/2009 Order dated this the 20th day of March 2009

    COMPLAINANT/S Smt.B.R.Vinutha W/o Late Ravikumar, R/at Bharathinagara, C.A.Kere Hobli, Maddur Taluk. (By Sri.B.Ramakrishne Gowda., Advocate)

    -Vs-

    LIC Of India/S 1. Senior Divisional Manager, LIC Of India, Divisional Office, Jeevan Prakash, P.b.No.37, Mysore – Bangalore Road, Bannimantap, Mysore.

    2. The Manager, LIC Of India, Maddur Branch, Maddur, Mandya District. (By Sri.B.A.Vijay., Advocate) Date of complaint 03.01.2009 Date of service of notice to LIC Of India 22.01.2009 Date of order 20.03.2009 Total Period 1 Month 28 Days Result


    The complaint is dismissed. However, there is no order as to costs. Sri.Siddegowda, President 1. This complaint is filed under section 12 of the Consumer Protection Act 1986, for settlement of insurance claim of Rs.3,00,000/-.


    2. The case of the complainant is that her husband Sri.Ravikumar S/o Boregowda had obtained Life Insurance from the LIC Of India for a sum of Rs.3,00,000/- vide Policy No.721196368 dated 15.10.2000. That policy had been lapsed for non-payment of premium from April 2001 and same has been revived on 19.05.2005 and when policy was in force death took place. The complainant filed claimant’s statement and other documents as a nominee. The LIC Of India Company repudiated the claim vide letter dated 28.05.2008 stating that deceased assured withheld material information with regard to his health at the time of getting the policy and the assured had suffered from T.B. since 2004 and took treatment in Asha Kiran Hospital. But, the ground of the LIC Of India has no basis at all. In spite of legal notice, the LIC Of India have failed to comply with the claim. Therefore, the present complaint is filed, for the insurance amount of Rs.3,00,000/- with interest and compensation of Rs.50,000/- for mental agony.


    3. The LIC Of India have filed version. Admitting that the policy was taken for Rs.3,00,000/- and also revival of the policy on 28.05.2005 and the complainant is the nominee, but pleaded that at the time of revival of the policy, the assured has submitted personal statement regarding his health dated 24.05.2005. Death was occurred within 5 months and 14 days from the date of revival. As it is early claim, investigation was conducted and it revealed that the life assured was a patient of Crypto Vollal Meningitis, Pulmonary T.B. and AIDS and had availed treatment from 2004 at Asha Kiran Hospital, Mysore and further, treated from 18.09.2005 to 11.11.2005. The fact of ill-health was not disclosed by the deceased while reviving the policy.

    The assured has given false statement and suppressed the material facts and hence, the LIC Of India repudiated the claim of the complainant. The revival policy is a new contract. Therefore, the LIC Of India has right to repudiate the claim and LIC Of India have not committed any deficiency in service and the complaint is liable to be dismissed with costs.


    4. The complainant has filed affidavit and is examined and produced the documents Ex.C.1 & C.2. On behalf of the LIC Of India one witness is examined and Ex.R.1 to R.12 are produced.


    5. We have heard both sides.

    6. Now the points that arise for our considerations are:- 1. Whether the deceased assured had suppressed the material facts at the time of revival of the police regarding health? 2. Whether the LIC Of India have committed deficiency in service by repudiating the claim? 3. Whether the complainant is entitled to the insurance amount with interest?


    7. Our findings and reasons are as here under:-


    8. The undisputed facts are that Ravikumar S/o Boregowda, the husband of the complainant had obtained L.I.C. policy on 15.10.2000 for Rs.3,00,000/- as per Ex.R.1 and the complainant is the nominee. It is also admitted fact that the policy was lapsed due to non-payment of premiums from April 2001 to April 2005 and the policy was revived on 19.05.2005 on paying the arrears of premiums, by giving personal statement regarding his health as per Ex.R.2. The complainant reported the death of her husband on 12.11.2005 due to heart-attack as per her letter dated 06.02.2006 as per Ex.R.5 and then submitted claim application Ex.R.7 with death certificate Ex.R.6. Then LIC Of India repudiated the claim, on the ground that deceased assured had suffered from T.B. since 2004 and took treatment from 18.09.2005 to 11.11.2005 at Asha Kiran Hospital, but he did not disclose these facts in his personal statement and hence withheld material information regarding health at the time of revival of the policy.



    9. So, the burden is on the LIC Of India to prove that the deceased assured had suppressed material facts with regard to his health at the time of revival of the policy. Admittedly, the policy had lapsed for nearly 4 years from April 2001 to April 2005 and on payment of arrears of premium, it was revived. At that time, the LIC Of India has taken personal statement regarding health of the deceased as per Ex.R.2 and it is not in dispute. He answered ‘No’ about the illness, treatment, operation or any test reporting good health. But according to the LIC Of India, the deceased had suppressed the material facts about his illness and treatment at the time of revival of the policy, though he was suffering from Crypto Vollal Meningitis, Pulmonary T.B. and AIDS and took treatment in Asha Kiran Hospital, Mysore from 2004.


    10. According to the complainant, the assured died due to heart-attack, but no document is produced. Though the complainant has denied that her husband Ravikumar was suffering from Pulmonary T.B., AIDS and Crypto Vollal Meningitis and took treatment at Asha Kiran Hospital, Mysore, but LIC Of India has examined R.W.2 Dr.Swamy, who is R.M.O. of Asha Kiran Hospital and he has produced the case sheet records Ex.R.12. In fact, the LIC Of India had written letter Ex.R.8 to Asha Kiran Hospital to furnish the documents and R.W.2 has sent reply Ex.R.9 stating that Ravikumar S/o Boregowda, residing at K.M.Doddi, Mandya got admitted to hospital on 18.09.2005 and discharged on 11.11.2005, he had taken treatment for Crypto Vollal Meningitis, Pulmonary T.B. and AIDS, he had taken out patient treatment since 2004. R.W.2 is the R.M.O. of this Asha Kiran Hospital has sent reply Ex.R.9. The evidence of R.W.2 Dr.Swamy is that Ravikumar S/o Boregowda, K.M.Doddi was referred by Dr.Poornima at Mandya for further treatment as he was diagnosed of having H.I.V. positive on 14.05.2004 and at every month he was treated as out patient and he was admitted on 18.09.2005 to 11.11.2005 with H.I.V. positive and he was also treated for Crypto Vollal Meningitis and Pulmonary T.B. (Brain infection).

    In fact, he was admitted on 04.07.2005 and discharged on request on 11.07.2005 and has produced the case sheet Ex.R.12, the case sheet records proves that Mandya Diagnostic Centre has diagnosed on reference by Dr.Poornima that Ravikumar is reactive for H.I.V I & II test and this report is dated 13.05.2004. On 14.05.2004 at Ashakiran Hospital, the complainant was examined and counseling was done and investigation revealed that he was H.I.V. positive and he was treated again on 17.05.2005, 17.06.2005 as a out-patient and he was admitted on 04.07.2005 and suspected tuberculosis and meningitis and discharged on request on 11.07.2005. Again he was admitted on 18.09.2005 and discharged on 11.11.2005 diagnosis was Crypto Vollal Meningitis, Pulmonary T.B.

    There is no reason to suspect this documents and the evidence of the doctor R.W.2. So, though he was positive to H.I.V. as on 13.05.2004 and diagnosed at Asha Kiran Hospital of having H.I.V. positive and took treatment as an out-patient, he did not disclose in his personal statement of regarding health on 24.05.2005 in Ex.R.2, but stated no hospitalization, no disease, but having good health at the time of revival of the policy. Of course, he was admitted to Asha Kiran Hospital on 04.07.2005 and suspected tubercular meningitis and C.T. Scan of the Brain was conducted and there was Meningitis with Diffuse Cerebral Oedema, and was in hospital up to 11.07.2005, but this treatment was before the giving declaration of health at the time of revival of the policy.


    Even though, the LIC Of India have produced the documents and evidence of the doctor he was suffering from Pulmonary T.B. and Crypto Vollal Meningitis, it is subsequent to the revival of the policy and it was not within the knowledge of the deceased assured, but it is proved that at the time of revival of the policy, he was positive H.I.V. and taking treatment.


    11. After the claim made by the complainant, investigation has been conducted and the LIC Of India have sent repudiation letter, stating that the assured had suffering from T.B. since 2004 for which he took medical treatment at Asha Kiran Hospital from 18.09.2005 to 11.11.2005 and he suppressed the material information deliberately in his personal statement. Admittedly, for the revived policy, personal statement of the assured was taken on 24th May 2005 as per Ex.R.2, thereafter he was admitted to hospital on 04.07.2005 and discharged on 11.07.2005 with diagnoses of tubercular meningitis. So, this disease was subsequent to the revival letter, but there is no evidence that he was suffering from T.B. at the time of revival of the letter. Of course, the LIC Of India has proved that the assured was positive to H.I.V. at the time of revival of the policy i.e., in May 2005 up to 24th May 2005 (date of personal statement) and had taken treatment visiting every month.


    12. The contention of the complainant side is that death is due to heart-attack and not for pulmonary tuberculosis or brain illness and there is no connection between the disease suppressed and the cause of death and hence, the repudiation is improper. The learned counsel for the complainant has relied upon the decision reported in 2006 (2) CPR page 195 of Rajasthan State Commission in the case of Mangej Kanwar –Vs- L.I.C. of India and 2008 (1) CPR page 299 of Punjab Chandigarh State Commission in the case of L.I.C. –Vs- Sukhpal Kaur. On the other hand, the learned counsel for the LIC Of India has relied upon the decision of the Hon’ble National Commission in Revision Petition No.2142/1999 in the case of L.I.C. of India –Vs- Smt.Savitri Devi and I (2009) CPJ page 231 of Hon’ble National Commission in the case of L.I.C. of India –Vs- M.Bhavani, we have perused those decisions.


    13. The decision cited by the learned counsel for the complainant which were rendered by the Hon’ble State Commissions are not applicable to the facts of the case and they are overruled by the Hon’ble National Commission decisions.


    14. It is settled law that revival of policy is a fresh contract. The Hon’ble National Commission in the case of L.I.C. of India –Vs- Bhavani referred above, has held that false declaration given at the time of revival of the policy leads to repudiation of the claim. Further, in the decision reported in II (2007) CPJ page 51 in the case of L.I.C. of India –Vs- Krishan Chandar Sharma, the Hon’ble National Commission has held that nexus between cause of death and illness with treatment is not material. So, applying the above position of law to the facts of the case, the evidence clearly proves that at the time of revival of the policy, the insured Ravikumar had given fresh declaration as per Ex.R.2, but he has failed to disclose the disease namely H.I.V. Positive, though he had the knowledge and he had taken treatment at Asha Kiran Hospital, Mysore. So, there is suppression of the disease H.I.V. by the insured and it is a material information, because H.I.B. Positive is a serious disease. So, it is established that the insured had given false declaration suppressing the fact of H.I.V. positive disease and treatment before the revival of the policy. Though in the repudiation letter, the LIC Of India have stated that assured had suffered from T.B. since 2004 and took treatment in Asha Kiran Hospital, but further pleaded that he had made deliberate mis-statements and withheld material information regarding his health at the time of getting the policy revival. The LIC Of India have taken specific contention in the version about the AIDS apart from pulmonary T.B. and Crypto Vollal Meningitis from 2004.

    Therefore, it is open to the LIC Of India to take the defence that the insured was suffering from H.I.V. Positive (AIDS) before the revival of the policy and he had the knowledge, but suppressed the same at the time of revival of the policy. Therefore, the repudiation of the claim of the insurance preferred by the complainant is justified.



    15. Hence, the complainant is not entitled to the insurance claim of Rs.3,00,000/- with benefits.

    16. In the result, we proceed to pass the following order; ORDER The complaint is dismissed. However, there is no order as to costs.
  • adminadmin Administrator
    edited September 2009
    Smt.V.Porkodi,
    W/o.Late Varadarajan,
    96/157-Z/1, Rajapuram,
    Palaniappa Nagar, Salem 636 005 and two minors. --- Complainants
    Vs.
    1. The Senior Divisional Manager,
    Life Insurance Corporation of India,
    Trichy Road, Coimbatore – 641 018. 1st LIC Of India

    2. Tmt.R.Jayalakshmi,
    W/o.Ramkumar Nachimuthu,
    2/421, Teacher's colony,
    Senniampalayam,Coimbatore. ---
    (CMP 24/09 in CC 381/08 order dt.2.3.09) 2nd LIC Of India

    ---

    This case coming on for final hearing before us today in the presence of Mr.J.V.George, Authorised representative for complainant and the Senior Divisional Manager appeared for the LIC Of India No.1 and the 2nd LIC Of India appeared in person and upon perusing the case records and hearing the arguments and the case having stood over to this day for consideration, this Forum passed the following:
    ORDER
    Complaint under Section 12 of the Consumer Protection Act, 1986 seeking direction against the LIC Of India No.1 to disburse the terminal benefits and policy amount as per the accounts maintained by the LIC Of India, Rs.10,500/- towards compensation and Rs.2000 towards costs.
    The case of the complaint are as follows:
    1.The Complainant is the wife late Varadarajan who was employed as a Higher Grade Asst. in the LIC Of India's company. The deceased while he was a bachelor joined in the service, at the time he nominated his mother as a nominee. The nomination was changed immediately after marriage. But the LIC Of India has failed to record the nomination. The dispute arises as to whom the death benefit to be paid. The complainant with her minor children namely R.V.Kavin and R.V.Chathurbalu approached District Munsif's Court, Perundurai and filed O.S.595/04 and got an order on 28.8.06 as per the decree all the four claimants namely the mother of the deceased, the wife of the deceased, and two minor children should get the death benefits equally at the rate of 25% . The dispute is clear but the LIC Of India refused to settle the claim. There is no necessity to prolong the issue the LIC Of India also admitted the fact of dues to be paid to the legal heirs and a sum of Rs.9,72,574 as on 31.10.04. Even after nearly two years after the decree the LIC Of India has not sent any letter to the complainant. Hence this complaint.




    The case of the LIC Of India is as follows:

    2.The complainant is not a consumer as per the Consumer Protection
    Act, 1986. Late R.Varadarajan was employed with the oLIC Of India as a Higher Grade Asst. , while in service he met with an accident and died on 31.10.04. An amount of Rs.13,68,695 was due for settlement as terminal benefits. Late Varadarajan had nominated his mother as a nominee to receive the terminal benefits. But the complainants rights objection. Hence the LIC Of India was forced to withhold settlement. Complainants had filed a suit in O.S.No.595/04 before the District Munsif Court, Perundurai and got an order on 28.8.06. Since minors rights involved a specific order was asked for, but there was no reply from the complainant. Hence the settlement had to be kept in abeyance Smt.Jayalakshmi has later filed a Writ Petition claimed a ¼ settlement and is still pending.

    3. The LIC Of India was and is always ready to disburse the amount to the rightful claimants without getting entangled into another litigation. The dispute between the complainants and the nominee Smt.Jayalakshmi has disabled this LIC Of India from discharging their duties. Without prejudice to the defense raised, this LIC Of India is willing to deposit the entire amount of Rs.13,68,695 payable as a terminal benefit of late Varadarajan before this Forum and this Forum may kindly decide on terms of settlement and dispose of the matter. The settlement had to be postponed only because of the ongoing dispute between the claimants and not because of any deficiency in service on the part of this LIC Of India. Hence this complaint may be dismissed with costs.

    4. The complainant has filed Ex.A1 and A2 was marked on the side of the complainant and the opposite parties has not filed the proof affidavit and not filed documents.

    The point for consideration is
    1.Whether the opposite parties have committed deficiency in service?
    If so to what relief the complainant is entitled to?

    ISSUE 1:

    5. The only dispute is who are all the rightful claimants to receive the terminal benefits of Rs.13,68,695 of late Varadarajan. The present complainant V.Porkodi is the wife of Late Varadarajan and minor R.V.Kavin and R.V.Chathurbalu are the children and the 2nd LIC Of India Mrs.Jayalakshmi is a mother of deceased Varadarajan. As per Ex.A2 all the four legal heirs are entitled to get 25% each. Ex.A2 is the District Munsif Court order dated 28.8.06. As per counter the 2nd LIC Of India has filed a Writ Petition claiming 1/4th share. The above said facts are admitted by both parties.

    6. A joint memo is filed by the parties accepting 25% share each. Parties have also agreed to deposit minors share in Fixed Deposit in Canara Bank, Saramangalam branch, Salem till the minors attained majority. They also agreed for taking the interest by the mother of the minors once in 3 months. A memo was recorded.


    7. In the result, a) Smt.V.Porkodi, wife of Late Varadarajan, minor R.V.Kavin, minor R.V.Charthubalu children of late Varadarajan, and Mrs.R.Jayalakshmi, mother of late Varadarajan are entitled to get 25% of the amount out of Rs.13,68,695/- , b) the share of minor R.V. .V.Kavin, minor R.V.Charthubalu children of late Varadarajan, shall be deposited in Fixed Deposit at Canara Bank, Saramangalam branch, Salem till the minors attained the majority, c) the interest accrued in minors fixed deposit account can be taken by the mother namely Porkodi once in three months, d) the fixed deposit receipt will be given to the mother of the minors. With this direction the complaint is disposed of.
  • adminadmin Administrator
    edited September 2009
    [FONT=&quot]Smt[/FONT][FONT=&quot]. Sulochana Kamalakant Gaonkar,[/FONT]
    [FONT=&quot]House No.603, Thorlem Bhat,[/FONT]
    [FONT=&quot]Dongrim[/FONT][FONT=&quot], Tiswadi, [/FONT][FONT=&quot]Goa[/FONT][FONT=&quot]. ……………….Complainant[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT][FONT=&quot]V [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]Life Insurance Corporation of [/FONT][FONT=&quot]India[/FONT][FONT=&quot],[/FONT]
    [FONT=&quot]91F, Mapusa Branch Office,[/FONT]
    [FONT=&quot]Rastroli[/FONT][FONT=&quot] Sadan, Near Cine Alankar,[/FONT]
    [FONT=&quot]Mapusa[/FONT][FONT=&quot], Bardez, [/FONT][FONT=&quot]Goa[/FONT][FONT=&quot] ......………...…..Opposite Party -1[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]The Zonal Manager, Life Insurance [/FONT]
    [FONT=&quot]Corporation of [/FONT][FONT=&quot]India[/FONT][FONT=&quot],[/FONT]
    [FONT=&quot]Western Zonal Office,[/FONT]
    [FONT=&quot]“Yogakshema” Jeevan Bima Marg,[/FONT]
    [FONT=&quot]Mumbai 400 021.[/FONT][FONT=&quot] ......………...…..Opposite Party -2[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]Date: - 05 /03/2009[/FONT]



    [FONT=&quot]O R D E R[/FONT]
    [FONT=&quot] (Per Smt. Shanti Maria Fonseca, Sr. Member)[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]Brief facts of the Complaint:-[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]1.[FONT=&quot] [/FONT][/FONT][FONT=&quot]The case of the Complainant is that her husband Shri Kamlakant Gaonkar who expired on 8.3.06 at Goa Medical College & Hospital was insured with the Life Insurance Corporation of India under policy no.930783137 for Rs.30,000/- (Rupees thirty thousand only) for double accident benefit along with two other policies.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]2.[FONT=&quot] [/FONT][/FONT][FONT=&quot]It is her case that out of 3 policies held by her husband with the Life Insurance Corporation of [/FONT][FONT=&quot]India[/FONT][FONT=&quot] 2 have been honoured and that policy bearing No.9300000783137 for Rs.30,000/- (thirty thousand only) was repudiated by the Life Insurance Corporation on grounds of non-disclosure of material facts by the deceased pertaining to his health.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]3.[FONT=&quot] [/FONT][/FONT][FONT=&quot]According to the Complainant there is no basis for the Insurance Company to conclude that vomiting of blood by the deceased was solely due to the consumption of alcohol and that the said conclusions arrived at by them are hypothetical without any proof. In the light of the above, the Complainant has alleged that there has been a deficiency in service on the part of the Opposite Parties as they have failed to honour the 3rd policy No. 9300000783137 of the deceased.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]Case of the Opposite Parties:[/FONT][FONT=&quot][/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot](i)[FONT=&quot] [/FONT][/FONT][FONT=&quot]The deceased policy holder had taken up the policy on [/FONT][FONT=&quot]2-2-06[/FONT][FONT=&quot] while he expired on [/FONT][FONT=&quot]8-3-06[/FONT][FONT=&quot] i.e. within a very short period of about 1 month & 5 days after taking up the policy.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot](ii)[FONT=&quot] [/FONT][/FONT][FONT=&quot]In the light of letter No:RHTC/GMC/2006-07, dated [/FONT][FONT=&quot]13/10/06[/FONT][FONT=&quot] from Dr. Seema Natekar it is on record that the deceased was a chronic alcoholic. There has also been an affidavit dated [/FONT][FONT=&quot]18/4/08[/FONT][FONT=&quot] filed by the said doctor in support of her letter dated [/FONT][FONT=&quot]13-10-06[/FONT][FONT=&quot].[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot](iii)[FONT=&quot] [/FONT][/FONT][FONT=&quot]Letter dated [/FONT][FONT=&quot]9/1/07[/FONT][FONT=&quot] from Doctor Anant Halarnekar who was the regular doctor of the deceased for 20 years has been placed on record before this Court. The contents of the said letter states that the Complainant was a consumer of both alcohol and tobacco till March 2006.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]On perusal of all documents and evidence that has been placed before us we make the following [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]OBSERVATIONS[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]1.[FONT=&quot] [/FONT][/FONT][FONT=&quot]The Opposite Party has brought no specific medical record to show the connection between “hypovolemic shock due to upper G-I blood with hepatic Encepalopathy” and the alleged alcoholism addiction which the deceased suffered from.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]2.[FONT=&quot] [/FONT][/FONT][FONT=&quot]The regular doctor who treated the deceased has very clearly stated in his letter dated [/FONT][FONT=&quot]9/1/07[/FONT][FONT=&quot] to the Opposite Parties that in the 20 years prior to his death the deceased was never referred to by him to any consultant nor admitted to any hospital as he had no major illness.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]3.[FONT=&quot] [/FONT][/FONT][FONT=&quot]The defense taken up by the Opposite Parties in para 11 pag. 6 of their Written Arguments is not acceptable as `occasional’ gastritis is suffered by all normal human beings at some point of time or the other. The fact that the policy was accepted by the Opposite Parties is what makes them liable for payment. [/FONT]
    [FONT=&quot]In the aforesaid circumstances we pass the following:[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT][FONT=&quot]ORDER[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]1.[FONT=&quot] [/FONT][/FONT][FONT=&quot]Opposite Parties jointly and severally to pay to the Complainant a sum of Rs.30,000/- (Rupees thirty thousand) @ 12% p.a. from the date when Complainant made a claim to the Opposite Parties until the date of payment.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]2.[FONT=&quot] [/FONT][/FONT][FONT=&quot]Cost of Rs.15,000 (Rupees fifteen thousand) awarded to the Complainant towards mental torture and harassment and also the cost of legal expenses towards the filing of this suit.[/FONT]
    [FONT=&quot][/FONT]
  • adminadmin Administrator
    edited September 2009
    (Super Market Complex, Block – 1, 1st Floor.)


    Consumer Case No.: 52 / 2006.
    Date of filing : 08.11.2006.
    Date of final order : 24.04.2009.
    Present:
    A) Sri Saurish Chakraborty President.

    B) Smt.Swapna Kar Member.

    C) Sri Swaraj Kumar Biswas Member.


    Subho Debnath,
    Son of Gopal Debnath,
    Milanpara, Raiganj, Uttar Dinajpur. Complainant.

    versus

    1. The Branch Manager,
    Life Insurance Corporation of India,
    Raiganj Branch, Uttar Dinajpur.

    2. The Manager (Claim),
    Jalpaiguri Divisional Office,
    Life Insurance Corporation of India,
    Jeevan Prakash, Jalpaiguri – 735 101. Opposite Parties.
    Judgment
    Date: 24.04.2009.

    Petitioner Sri Subho Debnath on 08.11.2006 by filing a petition of complaint Under Section 12 of the Consumer Protection Act, 1986 has prayed for an order for payment i) The double amount of sum assured that is Rs.40,000/- x 2 = 80,000/- along with 12% interest till payment, ii) For getting the cost of the complaint, iii) For paying Rs.10,000/- towards harassment, iv) Moreover the petitioner also prays to relinquish the untenable plea of denying payment of sum assured.

    The background facts in a nutshell are as follows: -

    The wife of the complainant Smt. Tagari Debnath, aged 18 executed a L.I.C. policy bearing No. 453321037 on 10.12.2003 as per table No. 93-25 and the sum assured is Rs.40,000/-. The premium is to be paid on 10th in quarterly basis and the amount of L.I.P. is Rs.555/-.

    The complainant paid quarterly premium of Rs.555/- to the O.P. 10.12.2003. However, the policy holder, Tagari Debnath inflected severe Burn Injury 100% on 19.01.2004 at her father’s residence and she was admitted in the Raiganj District Hospital forthwith.

    Immediately the attending doctor examined her and considering the serious condition of the patient referred the case to the North Bengal Medical College and Hospital, Siliguri. But she had succumbed to death on the way to Siliguri and as such her dead body taken back to Raiganj District Hospital. Co-incidentally the Hospital Authorities informed the Police and accordingly ‘Surathal’ was performed and they arranged post mortem of the dead body. Incidentally it is fit to be mentioned here that the cause of death as incorporated in the Post Mortem Report is “extensive Burn Injury about 95%”.

    Of late the petitioner furnished Death Certificate/ Surathal Report and FIR.

    Moreover, being the absolute claimant (husband of the deceased) the petitioner claimed the sum assured to the L.I.C. Authority.

    Never the less the L.I.C. Authorities vide their reference No. J.D.O./ Claims/ Mgr./ 53, dated 26.08.2006; refused to entertain the claim stating untenable plea, that the deceased had committed suicide and as the life assured committed suicide well within one year from the date of commencement of risk, nothing is payable under the policy.

    On the contrary O.P. L.I.C.I., contested the case and filed W.V. denying inter alia all the material allegations against them contending therein that the case is time barred by limitation as the complainant filed the case after period of limitation, because the cause of action arose form the date of death of the policy holder i.e. 19.01.2004 but the instant petition had been filed on 08.11.2006.

    They also contended that 100% Burn Injury can only possibly be sustained in case of suicide as she periled herself in some inflammable substance and kept herself in a confined place.

    In view of the above fact and circumstances O.P. prayed before the Forum to dismiss the case with cost.
    Decisions with reasons:

    The case has arisen out of a rejection of insurance claim of the petitioner by the O.P.

    Nevertheless the main question which arose for determination is whether Tagari Debnath committed suicide? OR expired due to accidental extensive Burn Injury (95%).

    However, we have carefully perused the records i.e. Post Mortem Report/ Inquest Report/ Surathal Report/ Deposition of the Witnesses/ Cross Examination thereof in view of the aforesaid complaints in the petition.


    The relevant reports i.e. Post Mortem Report/ Surathal Report could not confirmed that Tagari Debnath expired due to Accidental Burn Injury (95%). On the other hand such type of Burn Injury might have caused by suicide as opined by Dr. Guchait in his witness. So, there is every reason to believe due to that the death caused due to suicide.

    We have carefully considered the arguments advanced by the Ld. Counsels for the parties, we are of the view that the complainant is unable to prove his case that the death caused due to accident.

    Fees paid are correct.

    Hence it is ordered,

    That the complaint could not be entertained as the Policy Holder committed suicide within one year from the date of commencement of risk under the policy.

    The Complaint is dismissed on contest without cost against O.P.

    Let true photo copies of this final order be supplied to the parties free of cost.
  • adminadmin Administrator
    edited September 2009
    [FONT=&quot]CONSUMER COMPLAINT No. 75 OF 2004[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]Date of filing: 18th October 2004[/FONT][FONT=&quot] [/FONT]
    [FONT=&quot]Date of Order: 8th April 2009[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] Complainant (s) Opposite Party (s)[/FONT]
    [FONT=&quot]1.[FONT=&quot] [/FONT][/FONT][FONT=&quot]Rekharani[/FONT][FONT=&quot] Mahato, 1. Zonal Manager,LICI,[/FONT]
    [FONT=&quot]W/o. Late Jagadish Chandra Mahato.[/FONT][FONT=&quot] Eastern Zonal Office,[/FONT]
    [FONT=&quot]2.[FONT=&quot] [/FONT][/FONT][FONT=&quot]Tapati[/FONT][FONT=&quot] Mahato. Hindusthan Building,[/FONT]
    [FONT=&quot]3.[FONT=&quot] [/FONT][/FONT][FONT=&quot]Usha[/FONT][FONT=&quot] Mahato. 4,Chittaranjan Avenue,[/FONT]
    [FONT=&quot]4.[FONT=&quot] [/FONT][/FONT][FONT=&quot]Anupama[/FONT][FONT=&quot] Mahato. Calcutta.[/FONT]
    [FONT=&quot]5.[FONT=&quot] [/FONT][/FONT][FONT=&quot]Banashree[/FONT][FONT=&quot] Mahato. 2.Branch Manager,LICI,[/FONT]
    [FONT=&quot]All daughters of Late Jagadish Ch. Mahato, Jhalda Branch,[/FONT]
    [FONT=&quot]6.[FONT=&quot] [/FONT][/FONT][FONT=&quot]Sandip[/FONT][FONT=&quot] Mahato, P.O. & P.S. Jhalda,[/FONT]
    [FONT=&quot]S/o. Late Jagadish Ch. Mahato.[/FONT][FONT=&quot] District: Purulia.[/FONT]
    [FONT=&quot]Resident of : Neemtar, Purulia,[/FONT]
    [FONT=&quot]P.O., P.S. & Dist: Purulia[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT][FONT=&quot][/FONT]
    [FONT=&quot]Present[/FONT][FONT=&quot]: 1. Shri A.K.Sinha, President-in-Charge.[/FONT]
    [FONT=&quot] 2. Smt. S. Sengupta (Santra), Member.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]For the Complainant (s) : Sri S.K.Sarkar, Adv.[/FONT][FONT=&quot][/FONT]
    [FONT=&quot]For the O.P. No. 1 & 2 : Sri S. Patra, Adv.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]Order No. 59 dated 08.04.2009/C.C.No. 75of 2004[/FONT]

    The fact of the case in brief is that Smt. Rekha Rani Mahato and on behalf of her three minor daughters and one son alleged that her husband was a teacher who died on 16.9.2001 following an unnatural death. Over such death Purulia (T) P.S. UD Case No. 178/2001 was started and P.M. was done at Purulia Sadar Hospital on 16.9.2001 The deceased during his life

    time subscribed LIC Policy Nos. 462067340, 462067378, 461027948, 461029198, 463551935, 463551467 and 463552623, 7 nos. in all. After the
    death of the insured the petitioner approached O.Ps. for payment of the claim covered in the aforesaid policies. The O.P. promptly considered and paid the claim amount in respect of four of the policies and repudiated the claim against Policy No. 463551935, 463551467 & 463552623 by a letter dt. 27.12.2006 on the ground that the deceased had been suffering from Epilepsy since long and had died due to fall in a well following a sudden attack by Epilepsy.

    The petitioner subsequently tendered her representation to the O.Ps. but till the date of filing the complaint the O.Ps. did not settle the claim on three of the policies noted above. This gives rise to the instant case for the reliefs as have been prayed for.

    The O.Ps. have filed joint Written Version admitting therein, that, the deceased insured purchased policy no. 461027948 on 28.10.2001, No. 461029198 on 28.2.1995, No. 462067740 on 27.12.1997 and No. 462067378 on 28.10.1996 and they have allowed the basic sum assured with Bonus against the aforesaid four policies as non-early death claim taking lenient view without conducting investigation as per usual Rules & Regulations and claim in respect of three policies in question was repudiated as per contractual obligation on the ground of suppression of material facts. The O.Ps. have however referred to death claim guide line in the policy servicing manual no. II Chapter 2 Clause 2 wherein it was explain “ (1) Claims arriving within two years of the date of risk……. as early claims/premature claims and (2) Claims arising more than two years after the death of such risk or revival/reinstatement termed as other/ordinary claims”. The O.Ps. subsequently decided to repudiate all liability under the three policies in question on account of the deceased having withheld material information regarding health of insured at the time of effecting assurance with the company.

    From the pleadings of both parties of above the following points are required to be scrutinize for effective disposal of the case.
    1)[FONT=&quot] [/FONT]Whether the service of the O.Ps suffers from deficiency?
    2)[FONT=&quot] [/FONT]Whether the petitioner is entitled to the reliefs as prayed for?
    -:Decision with reasons:-
    Point No. 1 & 2:

    Both the points are taken together as these are interlinked.

    The petitioner has filed photocopies of (1) Legal heir certificate issued by Pradhan of Uparkahan G.P. dt. 03.12.2002, (2) Receipts dt. 08.12.2001 issued by O.P. against surrender of eight nos. of policies, (3) Certificate of death issued by SDMO, Purulia, (4) Intimation to O.P. dt. 08.12.2001 about the death of deceased with prayer to release claim amounts against seven no. of policies and (5) Status report of policy nos. 463551935, 462551467 & 462552623.

    The petitioner has filed affidavit-in-chief and has been cross-examined by the O.P. The PW has identified the signature of her husband in the proposal form of the above three policies in question when shown to her and the documents have been marked Exbt. A, B & C respectively. She stated that her husband died on 16.9.2001 at about 11.30 a.m. at her residence due to fall in the well, she got senseless and afterwards she came to know that fire brigade rescued the dead body of her husband. She further stated that she made no statement before police, police did not interrogate her and only on the date of incident police came to spot and thereafter did not turn up. She also admitted that the prescription of her husband were made over to LIC when asked for. The PW denied the suggestions that her husband was a patient of Epilepsy and made statement before police regarding such disease of her husband.

    O.P.W 1 who has filed his examination-in-chief has identified letter dt. 19.11.2002 to O.P. by the petitioner along with the prescription received by O.P. on 22.11.2002 which have been marked Exbt. G and X respectively. He denied the suggestion of Ld. Counsel of complainant that all proposal forms were rooted through the agent and stated that suffering from Epilepsy is considered to be a bar for opening of a policy which is bar in under writing manual of LICI. OPW1 also admitted that they did not hold any enquiry as to whether the insured had been suffering from any ailment and their opinion as to the suffering of Epilepsy of insured was formed on the basis of final report of police in the U.D.Case. They never asked the beneficiary in respect of the policies of deceased insured against which the insured amount have already been paid and further stated that they had got paid up the amount of those policies by adopting fraudulent means.

    On scrutiny of records it appears that the O.Ps in the W/V as well as in the Written argument claimed that the deceased insured purchased the following policies from the O.Ps during his lifetime.
    1)[FONT=&quot] [/FONT]Policy No. 461027948, sum assured – Rs. 30,000=00 dt. Of commencement 28.10.91.
    2)[FONT=&quot] [/FONT]Policy No. 461029198, sum assured – Rs. 50,000=00 dt. Of commencement 28.2.95.
    3)[FONT=&quot] [/FONT]Policy No. 462067740, sum assured – Rs. 1,00,000=00 dt. Of commencement 27.12.97.
    4)[FONT=&quot] [/FONT]Policy No. 462067378, sum assured – Rs. 50,000=00 dt. of commencement 28.10.96.
    5)[FONT=&quot] [/FONT]Policy No. 673551467, sum assured – Rs. 1,00,000=00 dt. Of commencement 28.6.99.
    6)[FONT=&quot] [/FONT]Policy No. 463551935, sum assured – Rs. 50,000=00 dt. of commencement 28.2.2000.
    7)[FONT=&quot] [/FONT]Policy No. 463552623, sum assured – Rs. 40,000=00 dt. of commencement 21.2.01.

    But the petition of the complainant clearly manifest that the deceased insured purchased eight policies in all including policy no. 460802314 besides the policy no. referred to by the O.Ps. Such statement of the complainant is also confirmed when we securitized Exbt C series being the proposal form of policy no. 463552623 wherein in column 9 specified for mentioning previous insurance policy no. 460802314, sum assured Rs. 10,000=00 year of issue 1988 is reflected. The complainant also claimed that claim form with relevant documents were submitted to the O.Ps after the death of her deceased husband and the O.Ps have paid the sum assured with bonus in respect of Policy No. 460802314, No. 461027948, No. 461029198, No. 462067740 and No. 462067378 but repudiated the claim against Policy No. 463551467, No. 463551935 and No. 463552623.

    Thus it appears that the O.Ps. have settled 5 policies of the deceased insured purchased during 1988 to 1996, out of eight nos. of policies referred to hereinabove considering non early death claim and without conducting investigation as per the usual Rules and Regulation of the corporation through strictly as per the contractual obligations all the claim for the policies were repudiated on the ground of suppression of material fact as referred in Para 7 of the written argument of the O.Ps.

    Now the O.Ps. by repudiating the claim against policy bearing no. 463551467 dt. 28.6.99, sum assured Rs. 1 lack, No. 463551935 dt. 28.2.06 with sum assured Rs. 50 thousand and No. 463552623 dt. 21.2.01 with sum assured of Rs. Forty thousand being early claims under norms and made detail enquiry which established that the deceased assured willfully suppress his illness and there was suppression of material facts at the time of submitting proposal forms. The O.Ps. have cited Sec 45 of Insurance Act 1938 Clause 4.1 and 13.1 of Policy Servicing manual No. 11 as sufficient ground to consider the claim application and repudiation of same.

    From the above discussion of evidence and material on record it has been evident that the O.P. had repudiated the claim of the complainant in respect of 3 policies being nos. 463551467, No. 463551935 and No. 463552623 purchased during the period from 28.6.99 to 21.2.01 on the ground of suppression of material fact in respect of health declared in the relevant column of the proposal form. It is also apparent that the ground of repudiation of the O.Ps based on 4 prescription of Dr. K.K.Sinha of Ranch, Bihar dt. 11.5.88, 23.11.88, 13.2.88, and 27.2.90 (marked Exbt. X), 3
    proposal form (marked Exbt. A,B,C), letter of the petitioner to O.P. dt. 19.11.02 regarding sending of prescription of Dr. K.K.Sinha (Exbt.G) and copy of final report of Police in C/W U.D.Case No. 178/2001 (Exbt. D).

    On scrutiny of Exbt. X series it appears that no where in the prescription the history of the patient nor the diagnosis has been noted by Dr. K.K.Sinha excepting advice of medicine. The doctor was not even examine in the witness dock to substantiate the contention of the O.P. that the insured got treatment of Epilepsy. On perusal of Exbt. D we find that the I.O. stated that “ in course of investigation it transpired that the deceased was a patient under Doctor K.K.Sinha, MD, FRCP, Ranchi since long and the diease was apparently one “Mrigi”. It appears from cross examination of PW1 that she clearly stated that police visited her house only on the date of incident, she was not even examined by the Police. Exbt. D is also not supported by any documents statement of witness and therefore, it is not substantiated that the deceased insured got treatment of Epilepsy by Dr. K.K.Sinha since long and apparently it was “Mrigi” . The evidence of OPW 1 clearly manifest that the O.P. did not hold any enquiry as to whether the deceased insured had been suffering from ant ailment of Epilepsy and the opinion to repudiate the claim was formed on the basis of Police Report in the U.D.Case. It is also stated that they never asked the beneficiary in respect of the policies against which the insured amount have already been paid.

    The O.Ps have referred Sec 45 of the Insurance Act 1938 which is on fair reading it is clear that it is restrictive in nature. It lays down 3 condition for applicability of the second part of sec namely a) the mis- statement must be on a material matter or must suppress facts which it was material to disclose, b) the suppression must be fraudulently made by the policy holder and c) the policy holder must have known at the time of making statement that it was false or that it suppressed facts which it was material to disclose. Mere inaccuracy of (or) falsity in respect of some recital or item in the proposal is not sufficient. The burden of proof is on the insurer to establishe the circumstances unless the insurer is able to do so there is no question of the policy being avoided on the ground of mis-statement of facts (LIC vs. Asha Goel AIR 2001 SC 549).

    In view of above observation of Hon’ble S.C. and the facts and circumstances discussed herein above it can safely be said that the insurer O.P. have failed to establish that deceased insured was suffering from epilepsy and there was misstatement and suppression of material facts in the proposal form in respect of three policies in question. Further it appears that all eight policies were purchased by the deceased insured during the period from 1988 to 2001 and the O.Ps. have considered the claim in respect of five policies amounting to Rs. 2,50,000=00 when Exbt. D and Exbt. X series were at hand and in repudiating the claim in respect of three other policies they have considered those two exhibits as vital documents for repudiation of the claim. Such plea of the O.Ps. appears arbitrary and does not find leg to stand on. In our opinion that the O.Ps. have scrutinized the above exhibits and other documents submitted to them by the complainant for her claim and the O.Ps. disburse the insured amount to his beneficiaries on application of mind about contractual obligation and the O.Ps. disbursed the insured amount to its beneficiaries.

    Having given anxious thought over the matter this Forum has come to the conclusion that the O.P. have failed to establish the fact of mis-statement and suppression of material facts in respect of health of the deceased insured at the time of purchase of policy No. 463551935, 463552623 & 463551467. From the facts and circumstances which came to light from the evidences of both sides it can also safely be said that neither the disease of epilepsy could be proved nor its nexus with the cause of death could be substantiated. Therefore, the case of the O.Ps. is patently misconceived, far-fletched and wrong amounting to delay in settlement thereof and denial of the claim which is determined to be a deficiency in service as enumerated in the provisions of C.P.Act. This Forum has gone through the rulings appearing in 1996 CCJ 1368, 1995 CCJ 963, 1995 CCJ 35, 2003 CCJ 295 & 1994 CCJ 276 filed by the Ld. Counsel for the O.Ps. and this Forum has considered and found that these are not similar to the facts and circumstances of the case.
    Both the points are thus disposed of in the affirmative.

    Proper fees have been paid. Accordingly, it is
    O r d e r e d

    That Purulia Consumer Complaint Case NO. 75 of 2004 is allowed on contest against O.P.No.1 (Zonal Manager, LICI, Eastern Zonal Office, Hindustan Building, 4 C.R. Avenue, Kolkata) and O.P.No.2 (Branch Manager, LICI, Jhalda Branch, P.O. & P.S. Jhalda, District Purulia). Both the O.P.No.1 & 2 jointly and severally do pay the sum assured of Rs. 50,000=00 + Rs. 1,00,000=00 + Rs. 40,000=00 against Policy No. 463551935, 463551467 & 463552623, a total of Rs. 1,90,000=00 (Rs. One lack Ninety Thousand) only, of which the complainant No. 1 do get Rs. 60,000=00 (Rs. Sixty Thousand) only and all five minors namely, (2) Tapati Mahato, (3) Usha Mahato, (4) Anupama Mahato, (5) Banashree Mahato and (6) Sandip Mahato do get Rs. 26,000=00 (Rs. Twenty Six Thousand) only each within thirty (30) days from date failing which the entire decreetal amount shall carry interest @9% per annum till its final realization.

    The complainant No. 1 do deposit the amount of each minor in the nearest Post Office/Nationalized Bank. Minor daughters may withdraw the amount in deposit in their respective names at the time of attainment of majority /marriage whichever is earlier, similarly, complainant No. 6 will withdraw the amount in deposit on attainment of majority.
  • adminadmin Administrator
    edited September 2009
    Consumer complaint No 122/07
    Date of presentation: 27.4.2007
    Date of decision: 2.4.2009

    Raj Kaur wife of late Sh. Tilak Singh resident of village Raju Bela, Post Office Chak Sharif, Tehsil and District Gurdaspur (Pb) at present resident of C/O Sh. Harnam Singh, village Bakan, Post Office Deol, Tehsil Jawali, District Kangra (HP)

    Complainant Versus

    1. Life Insurance Corporation of India, Amritsar Division, “Jeevan Jyoti” Building, G.T. Road, Gurdaspur (Pb) through its Branch Manager
    2. Life Insurance Corporation of India, Amritsar Division, Jeevan Prakash, 4-5 District Shopping Complex, Ranjit Avenue, Amritsar (Pb) through its Divisional Manager


    Opposite parties
    Complaint under section 12 of the Consumer
    Protection Act, 1986

    PRESIDENT: A.S.JASWAL
    MEMBERS: PABNA SHARMA & PARDEEP DOGRA

    For the complainant: Sh. Gaggan Guleria, Advocate.
    For O.Ps: Sh.Rajeshwar Sapeya, Advocate.

    ORDER
    A.S.JASWAL, PRESIDENT (ORAL)

    In nut-shell, the case of the complainant is that her husband, during his life time, had taken New Janaraksha Insurance Policy bearing 471216052 in the sum of Rs.50,000/- on dated 13.3.2003 from the opposite parties. The date of maturity was 15.3.2019. It is asserted that during the subsistence of the Policy, her husband expired and that she, being his nominee, had filed her claim before the opposite parties, but they repudiated the same in illegal manner and thus committed deficiency in service.
    2. The claim of the complainant has been resisted and contested by the opposite parties by taking various preliminary objections, including that the deceased, while filling in the proposal form, had suppressed material facts regarding his health. On merits, it is asserted that the claim of the complainant was duly investigated and that during investigation, it was revealed that the life assured had made false statements in the proposal form and got the policy issued in his favour on false statements. It is asserted that the life assured was a chronic alcoholic and this fact has been concealed by the life assured at the time of proposal. Therefore, the opposite parties are not liable to indemnify the complainant.
    3. This Forum on 5.10.2007 framed the following points for determination:-
    1. Whether O.Ps committed deficiency in service, as alleged? OPC
    2. Whether the complaint is not maintainable, as alleged? OPOPs
    3. Relief

    4. For the reasons to be recorded hereinafter while discussing points for determination, our findings on the aforesaid points are as under:-
    Point no.1: Yes
    Point no.2: No
    Relief: The complaint is partly allowed as per operative part of the order

    REASONS FOR FINDINGS
    POINTS No.1 & 2

    5. Both these points are inter connected and inter linked, hence are taken up together for determination, in order to avoid repetition in discussion. The learned counsel for the complainant has argued that the action of the opposite parties in not paying the insured amount to the complainant is nothing but deficiency in service.
    6. On the other hand, the learned counsel for the opposite parties has argued that the deceased, life assured, had suppressed material facts regarding her ailment prior to obtaining the Policy and the claim of the complainant has been rightly repudiated by the opposite parties and that there is no deficiency in service on their part.
    7. To appreciate the arguments of the learned counsel for the parties, the entire record available on the file was gone into in detail. From the record it stands proved that the deceased/life assured had obtained Janaraksha Insurance Policy from the opposite parties and that he had also paid the premium amount to them. There is no dispute regarding these facts. The death of the deceased has also been admitted.
    8. The only basis for the rejection of the claim of the complainant is that the deceased, life assured, had suppressed material facts regarding his ailment as during investigation, it was found that the life assured was a chronic alcoholic. This plea of the opposite parties has no force and is rejected being devoid of any force. The onus to prove their such defence was upon the opposite party, but they have failed to bring on record, medical expert opinion to prove that the life assured was a chronic alcoholic. Further more taking of liquor is not a material fact and that it is also not a disease. We would like to observe that almost every body takes liquor with few exceptions Furthermore; the opposite parties have failed to prove, by way of expert evidence that the life assured had died due to taking of excessive liquor by him. We are of the view that consumption of liquor by the life assured is not a material fact, the suppression of which will entitle the opposite parties to repudiate the claim of the complainant. Thus, the action of the opposite parties in repudiating the genuine claim of the complainant is nothing but great deficiency in service.
    09. In view of the discussion made hereinabove, we hold that the opposite parties have not applied their mind to the facts of the present case, and illegally and arbitrarily repudiated the genuine claim of the complainant.
    10. Now, how this deficiency can be cured. We are of the view that the ends of justice will be met in case the opposite parties are directed to pay the insured amount alongwith all accrued policy benefits to the complainant. Due to deficiency in service, the complainant has suffered mental pain, agony and inconvenience and the ends of justice will be met in case the opposite parties are directed to pay compensation, which is quantified at Rs.5000/-. Hence, point No.1 is answered in affirmative and point no.2 in negative.
    11. No other point argued or urge before us.
    Relief
    12. In view of our findings on points No.1 and 2 above, the complaint is partly allowed and we order the opposite parties jointly and severally to pay the insured amount alongwith all accrued policy benefits to the complainant within 30 days after the receipt of copy of this order, failing which it will carry interest @ 9% per annum from the date of complaint, till its realization. The opposite parties are also directed to pay compensation to the complainants to the tune of Rs.5000/-. The complaint is allowed alongwith litigation costs of Rs.2000/-.
  • adminadmin Administrator
    edited September 2009
    C.C.No: 251/2008
    BETWEEN:
    Daruvuri Surendra Babu,
    S/o. Nageswara Rao, Hindu,
    Aged about 30 years, Unemployee,
    R/o Punur Village,
    Yaddanapudi Mandal,
    Prakasam District. ... Complainant.
    Vs.
    Life Insurance Corporation of India,
    Chirala Branch represented by its
    Manager …Opposite party.

    COUNSEL FOR COMPLAINANT: SRI B.L. NARAYANA RAO,
    ADVOCATE, ONGOLE.

    COUNSEL FOR OPPOSITE PARTY: SRI O.N. SASTRY,
    ADVOCATE, ONGOLE.

    This complaint is coming on 17.04.2009 for final hearing before us and having stood over this day for consideration this Forum delivered the following:
    ORDER:
    1. This is a complaint filed by the complainant under Section 12 of Consumer Protection Act, 1986 against the opposite party.

    2. The averments in the complaint are as fallows: The complainant has obtained Asha Deep Insurance Policy bearing No.841158003 for an assured sum of Rs.1,50,000/- commencing from June’2003 ending by June 2028. The policy was renewed in the year 2005 by charging late fee of Rs.1055/-. Subsequently, the complainant is paying premiums regularly. Unfortunately, the complainant fell ill in November’2006 and after diagnosis, it was revealed that his kidneys are not functioning properly. He was treated at Aswini Hospital, Guntur with medicines and also with dialysis. As there was no improvement in the health of the complainant he went to Mahaveer Hospital at Hyderabad for treatment. Finally in the month of October’2007 the doctors came to conclusion that both the kidneys totally failed. Since, October’2007 the complainant was on dialysis regularly for survival. On 10.11.2007 both the kidneys are transplanted with a kidney donated by his mother. Since then, the complainant is surviving with One kidney. He incurred Rs.4,00,000/- for transplantation of kidneys and after that he is incurring Rs.25,000/- every month for medicines. The complainant submitted claim forms before the opposite party by submitting of original documents pertaining to his treatment. Unfortunately, his claim was rejected by the opposite party in October’2008. The claim was repudiated on the ground that the complainant was undergoing dialysis since March’2006. The complainant never had dialysis in March’2006 and it was for the first time in November’2006 he had dialysis. The repudiation of the claim is totally illegal. The complainant is entitled to 50% of the policy amount immediately after transplantation of kidney. Thereafter, after surgery is entitled for 10% of the total policy amount deliver the maturity date. Because of the attitude of the opposite party the complainant was put to serious mental agony and physical sufferance. Hence, the complaint.

    3. The opposite party filed his counter contending as fallows: It is true that the complainant had taken Asha Deep Policy on 26.06.2003 for a sum assured of Rs.1,50,000/-. The policy was under lapsed condition for non-payment of premiums from June’2004 to June’2005. Later, the policy was survived on 30th January’2006. As per the terms and conditions of the policy the sickness benefits under the policy will not be entertained up to the expiry of One year period from the date of revival of the policy i.e., lien clause is applicable as per condition No.11 of the policy bond. The date of revival was 31.01.2006 and the date of 1st admission for treatment was during the lien period of One year i.e., in March 2006. The same is admitted by the complainant and hence nothing is payable under the sickness benefits and the same was communicated to the complainant on 13.10.2008. As per the terms and conditions of the policy the complainant is not entitled to any amount and the complainant is liable to be dismissed with costs.

    4. On behalf of the complainant Exs.A1 to Ex.A5 were marked. The Ex.A1 is the Bunch of medical bills. Ex.A2 is the Premium Receipt. Ex.A3 is the Premium Receipt. Ex.A4 is the Patients Hand Book. Ex.A5 is the Medical Certificate dated 14.01.2009.

    5. On behalf of the opposite party Exs.B1 to Ex.B6 were marked. The Ex.B1 is the Letter of the opposite party addressed to the complainant dated 13.10.2008 and acknowledgement of receipt of the letter by the complainant. Ex.B2 is the Claim Form AD (KF) – 3 submitted by the complainant dated 10.11.2007. Ex.B3 is the Claim Form AD (KF) – 1 submitted by the complainant. Ex.B4 is the Policy Bond dated 04.07.2003. Ex.B5 is the Proposal Form dated 26.06.2003. Ex.B6 is the Addendum to Proposal under Asha Deep Plan.

    6. The point for consideration is whether the complainant is entitled for the reliefs in the complaint.

    7. It is not in dispute that the complainant has obtained Asha Deep Insurance Policy for an assured sum of Rs.1,50,000/- commencing from June’2003. For non-payment of premium from June’2004 to June’2005 the policy was under lapsed condition and it was revived on 30th January, 2006.

    8. The case of the complainant is he fell sick in November’2006 and the doctors diagnosed that his kidneys are not functioning properly and he took treatment in Aswini Hospital, Guntur and Mahaveer Hospital, Hyderabad. It is further case that since October’2007 he was undergoing dialysis and on 10.11.2006 kidneys are transplanted with the kidney donated by his mother it is his further case that when he submitted claim form for claiming sick benefits under the policy his claim was repudiated on the ground that he was undergoing dialysis since March, 2006 in the lien period from revival of the policy. It is his further case that he never had dialysis in March’2006 and for the 1st time he had dialysis in November’2006 and the repudiated of his claim is illegal.

    9. On the other hand the opposite party contended that in the present case the policy was revived on 30th January, 2006 and he was undergoing dialysis since March’2006 within lien period from revival and as per policy condition he is not entitled for sick benefits and his claim is rightly repudiated.

    10. Policy condition 11 reads as fallows: a) “Benefit (B) of the Policy Schedule is not applicable if any of the contingencies mentioned in Para 11. b) occurs (i) at any time on or after the date of which the risk under this Poicy is commenced but before the expiry of one year reckoned from the date of this Policy or (ii) one year from the date of revival”.

    11. As per Ex.B2, Hospital report date of 1st Renal dialysis was in March’2006. In the claim form Ex.B3 submitted by the complainant himself he stated that he was undergoing dialysis since March’2006. It falsifies his case that he was undergoing dialysis since November’2006 and he never had dialysis in March’2006. The documents Ex.B2 and Ex.B3 shown that, he was undergoing dialysis since March’2006 i.e., within one year from the date of revival of the policy. As per condition No.11 of the policy he is not entitled to claim the sick benefits and his claim was rightly repudiated by the opposite party.
  • adminadmin Administrator
    edited September 2009
    CC.No:209/2008
    BETWEEN:
    1. Khatiza Begum,
    W/o Mahaboob Khan, aged 42 years.

    2. P. Mahasin Idad Alikhan,
    S/o Mahaboob khan, aged 6 years,
    2nd complainant being minor represented
    by his mother 1st complainant

    Both are residents of Akaveedu village,
    Racharla Mandal, prakasam District. ... Complainants.
    Vs.
    1. The Branch Manager,
    L.I.C. of India, Khammam,
    Khammam District.

    2. The Regional Manager,
    L.I.C. of India, Dargamitta,
    Bhakthavatchala Nagar,
    Nellore.

    3. The Branch Manager,
    L.I.C. of India,
    Ramnagar 1st line, Ongole. …Opposite parties.


    COUNSEL FOR COMPLAINANT: SRI M. MALLIKHARJUNA REDDY,
    ADVOCATE, ONGOLE.

    COUNSEL FOR OPPOSITE PARTY: SRI Y. RAMESH,
    ADVOCATE, ONGOLE.

    This complaint is coming on 08.04.2009 for final hearing before us and having stood over this day for consideration this Forum delivered the following:
    ORDER:
    1. This is a complaint filed by the complainant under Section 12 of Consumer Protection Act, 1986 against the opposite parties.

    2. The averments in the complaint are as fallows: The 1st complainant is the wife and the 2nd complainant is the son of the deceased policy holder P. Mahaboob Khan. Said P. Mahaboob Khan worked as a mechanic in Telephone Department. He obtained insurance policy on 15.12.2004 and authorized his drawing officer to deduct the premium amount from his salary and remit the same to the L.I.C of India. The L.I.C. also accepted this proposal and issued endowment assurance with profit and with double accident benefits. Accordingly, premium was paid up to 14.05.2007. The deceased went to Akaveedu which is his native place on leave. while he was in Akaveedu he fell ill and died on 19.05.2007. Immediately, after the death of the deceased the complainant informed the same to the department people as well as to L.I.C. people to settle the insurance claim. The L.I.C received the documents and kept silent without settling the claim. There after she issued legal notice through her counsel on 14.05.2008. The L.I.C. gave reply on 23.05.2008 with false averments. In the above circumstances there is no other go for the complainant except to file the present complaint. Hence, the complaint.

    3. The 2nd opposite party filed his counter and the opposite parties 1 and 3 filed Memo adopting the counter filed by the 2nd opposite party. In their counter the opposite parties are contending as fallows: It is true that husband of the 1st complainant took a policy for the sum assured of Rs.2,00,000/- showing the 2nd complainant as his nominee. The policy is an endowment policy and it covers with profit and with double accident benefit. Double accident benefit applies when the death caused is due to physical injury i.e., accidental injury to the policy holder. In the present case the policy holder did not die due to any physical injury and therefore, the complainants are not entitled for double accident benefit. The deceased paid the premium through his employer by attaching the salary every month. The employer did not pay 2nd, 3rd, 4th, 5th premiums of the year 2005 and 2nd and 3rd premiums of the year 2007 during his life time. After the death of the deceased the complainant sent claim application along with some documents and the L.I.C. requested the complainant to fulfill the requirements mentioned in the letter dated 26.05.2008. The L.I.C issued reply notice dated 23.05.2008 stating that the policy was in lapsed condition on the date of death without acquiring paid up values, dues of non receipt of premiums for 2,3,4,5 for the year 2005 and 2,3 of 2007. However, the claim is under consideration on exgretia basis and as it is an early claim the opposite parties are arranging for claim enquiry. There is no deficiency in service on the part of the opposite parties. Any how, the opposite parties are ready to pay Rs.1,89,949/- as per the terms and conditions of the policy, requirements of the corporation and insurance act. For the foregoing reasons the opposite parties prays the forum to dismiss the complaint.

    4. On behalf of the complainant Exs.A1 to Ex.A5 were marked. The Ex.A1 is the Xerox copy of the Endowment assurance dated 29.01.2005. Ex.A2 is the Death Certificate. Ex.A3 is the Legal Notice to the Chief Branch Manager, L.i.C of India, Khammam, Khammam District. Ex.A4 is the Letter dated 23.05.2008. Ex.A5 is the Letter dated 26.05.2008 to the Smt. Katiza Begum, Akaveedu Village, Prakasam District. No documents are marked on behalf of the opposite parties.

    5. The point for consideration is whether the complainant is entitled for the reliefs in the complaint.

    6. It is an admitted case that the husband of the 1st complainant P. Mahaboob Khan had taken endowment policy and it covers with profit and double accident benefit. The case of the complainant is that the death of the insured was accidental death and that she is entitled to receive the amount under double accident benefit. Whereas the opposite parties contented that the death of the insured was natural death and it is not an accidental death and therefore the complainants are not entitled to claim amount under double accident benefit.

    7. Now, the point for consideration is whether the death of the policy holder was accidental or natural.

    8. No evidence is produced by the complainant to show that the death of the policy holder was an accidental death. The averments in the complaint goes to show that the policy holder went to his native place on leave and died due to illness on 19.05.2007. From the reading of the complaint it is clear that the death was not due to any bodily injury solely or directly caused by external, violent and visible means and the death is natural death due to illness. Therefore, the complainants are not entitled to claim amount under double accidental policy.

    9. It is not in dispute that the deceased had taken insurance policy for Rs.2,00,000/- under salary saving scheme. An authorization was given to the employer to deduct premium every month from his salary and remit the same to the LIC.

    10. In the instant case the L.I.C contented that the employer did not remit the premium to the L.I.C for 4 months in the year 2005 and 2 months in the year 2007 and the policy was in lapsed condition and however they are considering the claim on exgretia basis and arranged for claim enquiry. The L.I.C further contented that after deducting 6 months premium which was not paid from the sum assured of Rs.2,00,000/- ready to pay the balance with bonus which works out to Rs.1,89,949/- to the complainants. Complainants did not agree for it and filed the present complaint for the policy amount.

    11. It is not in dispute that the deceased has taken policy under salary savings scheme. As per salary savings scheme the amount of premium was to be deducted every month from the salary of the policy holder. If premium was not deducted for any particular month it is the duty of the employer to inform the L.I.C. regarding non-payment of premium giving reason as to why premium was not remitted. Then a duty is caste on the LIC to inform the insured that his premium had not been remitted. In the present case no notice was issued to the insured about non deduction or non remittance of premium. Insured may not be aware of the fact that the premium was not paid. Therefore, unless a notice is issued the insured could not be held responsible for the consequence of non payment of premium under the policy.

    12. In a case reported in 1999 (3) CPR at page 91 (Supreme Court) in Delhi Electric Supply Undertaking Vs. Basanti Devi & Another. It was held that “Insurance – Life Insurance – LIC Agent – Authority of LIC agent to collect premium from policy holders – Liability of LIC – Salary Savings Scheme Policy – Employer collecting premium by deducting from salary and paying it to LIC – So for as employee was concerned employer was agent of LIC to collect premium on its behalf – Employers had implied authority as an agent of LIC to collect premium – General principles of agency attracted – LIC liable for default of employer’s failure to deduct premium from salary of employee resulting in lapse of policy – LIC bound to pay assured sum”.

    13. In another case reported in 1(2009) CPJ, Page 266 (National Commission) in LIC of India Vs. Gousabi it was held that “Consumer Protection Act, 1986 – Section 2(1) (g) – Life Insurance – Salary Saving Scheme – Policy lapsed due to non-payment of premium – Payment of premium after deducting from salary, between employer and LIC – Non-remittance of premium not to be intimated to LIC by employee – Deceased employee proceeded on leave without pay – Duty caste on employer to inform LIC that premium from deceased’s salary not being deducted and remitted – Deceased kept ignorant about non-deduction of premium from salary, not responsible for consequence of non-payment of premium – LIC held liable to pay sum assured to wife of deceased”.

    14. In view of the decisions sited above I am of the opinion that the LIC is liable to pay the insurance amount of Rs.2,00,000/- to the complainants.

    15. In the result, petition is allowed and the opposite parties are directed to pay policy amount of Rs.2,00,000/- to the complainants together with interest @ 9% p.a., from the date of the petition till realization and also to pay Rs.1,000/- towards costs of litigation. The complainants are entitled to receive the amount in equal shares. The share of the minor 2nd complainant shall be kept in fixed deposit in any Nationalized Bank till he attains majority.
  • adminadmin Administrator
    edited September 2009
    C.C. No. 20 /2009


    Between


    D.C.Geethanjali W/o Late J.B.Jayasankara Raju,
    Hindu, aged 34 years, residing at Raja Street,
    Bangarupalyam Town & Mandal, Chittoor Dist.,
    … Complainant.

    And

    1.[FONT=&quot] [/FONT]The Life Insurance Corporation of India,
    Divisional Office, rep., by its Divisional
    Manager, office at Dharga Mitta, Nellore
    Town & District.

    2.[FONT=&quot] [/FONT]The Life Insurance Corporation of India,
    Rep., by its Branch Manager, Puttur,
    Puttur Mandal, Chittoor District.
    … Opposite Parties.

    This complaint coming on before us for final hearing on 20.04.2009 and upon perusing the complaint, written versions, affidavits, material documents and on hearing Smt P. Madhusudhan, counsel for the complainant, and Sri P.Dayasekhar counsel for opposite parties 1 & 2 and having stood over till this day for consideration, the Forum made the following:-

    ORDER

    DELIVERED BY Sri.K.Subramanyam Reddy, B.A., B.L., Male Member
    ON BEHALF OF THE BENCH


    1) This is a complaint filed by the complainant U/Sec. 12 of C.P.Act, 1986 for directing the opposite parties to pay Rs. 50,000/- with interest at 18% p.a being policy amount; Rs. 30,000/- towards compensation and Rs. 10,000/- towards litigation expenses to the complainant.

    2) The material averments in the complaint dt. 31.01.2009 in brief are as follows :-
    The complainant is the legally wedded wife of J.B.Jayasankara Raju, The husband of the complainant died on 03.02.2004 due to Heart Attack. During the life time of deceased had taken L.I.C policies in his name by mentioning the complainant as nominee in one policy and remaining two policies nominee was his mother J.Thulasamma. The deceased was paid the premium amounts regularly till his death without any default. The complainant obtained policy No. 840157274 for a sum of Rs. 50,000/- payable on quarterly rests of Rs.460/- through the 2nd opposite party. After death of the deceased J.B.Yasankara Raju the complainant has submitted claim form to the 2nd opposite party for settlement of the claim. Later the complainant submitted requisitions and made several requests personally, but the opposite parties have not choosen to settle the claim of the complainant. Due to the acts of the opposite parties the complainant suffered a lot both mentally, physically and financially for non settlement of the policy amount. Hence there is clear deficiency of service on the part of opposite parties.
    Hence the complainant approached this Forum for redressal of her grievances. Under the above said circumstances the complainant prayed this forum to
    a) Direct the opposite parties 1 & 2 to pay Rs. 50,000/- with interest at 18% p.a from the date of complaint till the date of realization to the complainant towards policy amount;
    b) direct the opposite parties 1 & 2 to pay Rs. 30,000/- towards compensation for mental agony; and
    c) to pay an amount of Rs. 10,000/- as costs of litigation.

    3) The 1st opposite party filed his Written Version on 24.03.2009 and admitted that on 28.03.1996 the husband of the complainant obtained JEEVAN MITRA DOUBLE COVER ENDOWMENT PLAN with Profits policy No.840157274 for Rs.50,000/-. The deceased/ life assured has nominated the complainant as his nominee in the said policy. This opposite party further submits that the said policy was lapsed due to non-payment of premiums from 3/1997. The said policy was revived on 26.02.2001 by paying 16 quarterly premiums due from 3/1997 to 12/2000. At the time of reviving the policy the deceased/ life assured has given self declaration by mentioning that he was hale and healthy.

    This opposite party further submits that after death of the deceased/ life assured this opposite party conducted investigation and found that the deceased was not in a good condition of his health, at the time of revival of the policy the deceased/ life assured withhold material information regarding to his health in the declaration give by him had given false answers.

    This opposite party further submits that the deceased/ life assured has suppressed his ailment at the time of reviving policy. The death of the deceased is 03.02.2004 and the claim of the complainant is repudiated by the complainant on 03.01.2005. The complaint filed by the complainant on 10.02.2009. Hence the complaint is barred by limitation. The SVIMS Hospital Tirupathi has issued Medical attendants certificate, which shows that the deceased/ life assured is a known smoker and alcoholic patient and he had taken treatment since 3 to 4 years for hyper tension. Hence there is no deficiency of service on the part of this opposite party. Hence the complaint may be dismissed with costs.

    The 2nd opposite party filed Memo adopting the Written Version filed by the 1st opposite party.

    4) On behalf of complainant the complainant filed his Chief Affidavit in support of pleas raised in the complaint and same is marked as deposition of PW-1 and he also relied upon 3 documents and same are marked as Ex.A1 to A3. Ex.A1 is Xerox copy of first premium receipt issued by 2nd opposite party in favour of complainant’s husband. Ex.A2 is the Copies of requisitions dt. 24.08.2005, 14.11.2006 & 13.04.2007 issued by the complainant to the 2nd opposite party. Ex.A3 is the office copy of legal notice dt. 26.06.2008 with postal receipts and acknowledgements issued to the opposite parties.

    On behalf of opposite parties the 1st opposite party filed his Chief Affidavit in support of pleas raised in the Written Version and same is marked as deposition of RW-1 and he also relied upon 5 documents and same are marked as Ex.B1 to B5. Ex.B1 is the Xerox copy of policy of the deceased/ life assured. Ex.B2 is the original personal statement regarding health of the deceased/ life assured. Ex.B3 is the certificate issued by Cardiology, SVIMS, Hospital relating to the deceased/ life assured. Ex.B4 is the Xerox copy of repudiation of claim dt. 03.01.2005 issued by the opposite party. Ex.B5 is the Medical attendant certificate of deceased/ life assured issued by SVIMS, Hospital, Tirupathi.

    5) On the pleadings and on consideration of the material available and upon hearing the parties, the points that arise for consideration are :
    1) Whether the complaint is barred by limitation U/Sec. 24(a) of C.P.Act?

    2) Whether the insured suppressed his pre-existing disease at the time of revival of his policy?

    3) whether the complainant is entitled for the policy amount ? If so, whether there is any deficiency of service on the part of opposite parties in settling the claim of the complainant?

    4) Whether the complainant is entitled for Rs. 30,000/- towards compensation for deficiency of service on the part of opposite parties ?
    And
    5) to what result ?

    6) Both sides filed Written Arguments.

    7) Point No. 1 :-
    It is the case of the complainant that the insured/ deceased J.B.Jayasankara Raju is the husband of the complainant. During his life time the insured obtained JEEVAN MITRA DOUBLE COVER ENDOWMENT PLAN with Profits policy for Rs. 50,000/- from the 2nd opposite parties. In that policy the insured nominated his wife i.e complainant as nominee. The said policy was lapsed due to non payment of premiums from March-1997 to December-2000. But the said policy was revived on 26.02.2001 by paying 16 quarterly payments due from March-1997 to December-2000. The insured died on 03.02.2004 due to Heart Attack. The policy was in force at the time of death of the insured. After death of the insured the complainant submitted the claim form to the 2nd opposite party for settlement of the claim. But the opposite parties have not settled the claim in spite of her representations and legal notice.
    8) It is the case of the opposite parties that the insured has suppressed his health condition at the time of revival of policy, though he was taken treatment for his ailment. The opposite parties further stated that the insured was not in a good condition of his health at the time of revival of his policy and insured suppressed pre-existing disease and given false answers for Question No. 2, a, b & c and for question No. 4. Hence the opposite parties repudiated the policy on 03.01.2005 stating that the insured had made deliberate mis-statement and withhold material information regarding his health condition at the time of getting policy revived and hence in terms of policy of contract the revival policy is void.
    9) Further the opposite parties stated in their Written Version that the complaint is barred by limitation U/Sec. 24(a) of C.P.Act, since the life assured died on 03.02.2004 and the claim of the complainant is repudiated by the opposite parties on 03.01.2005. The complaint filed by the complainant in this Forum on 31.01.2009, after lapse of 4 years i.e from the date of repudiation of the claim.
    10) Sec. 24(a) of C.P.Act deals with the period of limitation. For the convenience sake and for ready reference Sec. 24(a) of C.P.Act is here under incorporate:-
    “[24-A. Limitation Period] :--(1) The District Forum, the Station Commission or the National Commission shall not admit a complaint unless it is filed within two years from the date of which the cause of action has arisen.

    (2) Notwithstanding anything contained in sub-section(1), a complaint may be entertained after the period specified in sub-section(1), If the complainant satisfies the District Forum, the State Commission, as the case may be, that he had sufficient cause for not filing the complaint within such period:

    Provided that no such complaint shall be entertained unless the National Commission or the District Forum, as the case may be, records its reasons for condoning such delay.”

    In the Insurance cases the limitation in filing of the complaint before Consumer Fora will start from the date when the insured’s claim was repudiated by the insurer. In this case the insurance claim was repudiated by the opposite parties on 31.01.2005 whereas the complaint filed by the complainant in this Forum on 31.01.2009 i.e after more than 4 years. In view of the above discussion I am of the view that the complaint filed by the complainant is barred by limitation U/Sec. 24(a) of C.P.Act.
    The Point is answered accordingly.
    11) Points No. 2 to 4 :-
    In view of my finding on Point No.1 the question of discussion of the points 2 to 4 does not arise.
    12) Point No. 5:-
    In the result the complaint is dismissed as barred by limitation. In the circumstances of the case each party will bare its own costs.
  • adminadmin Administrator
    edited September 2009
    [FONT=&quot]CONSUMER complaint NO. [/FONT][FONT=&quot] 96 OF 2008[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]Between:[/FONT]
    [FONT=&quot]Mattepaly Laxmi, W/o. Late Sambaiah, age 42 years, Occ: Vegetable Vendor, R/o. Pothkapally (v), Odela (m), Karimnagar district. [/FONT]
    [FONT=&quot] …Complainant[/FONT]
    [FONT=&quot]AND[/FONT]
    [FONT=&quot]The Branch Manager, LIC of India, Karimnagar division, Near Ambedkar Stadium, Karimnagar.[/FONT]
    [FONT=&quot] …Opposite Party[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] This complaint is coming up before us for final hearing on8-4-2009, in the presence of Sri A. Venkateshwar Rao and A. Niranjan and G. Venkat Rao and SK. A. Nabi Advocates for complainant and Sri P. Ashok, Advocate for opposite party, and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following:[/FONT]
    [FONT=&quot]::ORDER::[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]1. This complaint is filed under Section 12 of C.P. Act, 1986 seeking direction to the opposite party to pay a sum of Rs.50,000/- towards sum assured along with Rs.30,000/- towards damages and expenses.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]2. The brief averments of the complaint are that the husband of the complainant by name Mattepally Sambaiah obtained Endowment Insurance Policy for a sum of Rs.50,000/- from the opposite party bearing policy no.683928047 commencing from 15.12.2004. Under the said policy the complainant is named as the nominee of the policy holder. As per the terms of the policy the opposite party undertook to pay an assured sum of Rs.50,000/- with bonus in case of death of the policy holder and further undertook to pay Rs.50,000/- in case of policy holder dies accidentally, As per the terms of the policy the policy holder has to pay yearly premium of Rs.1,824/-. It is submitted that the policy holder died on 26.6.2006 in a train accident at Bijjigiri Sharief when he was crossing the railway track. On his death the Railway Police, Bellampally registered a case in Crime No.131/2006 U/s. 174 of Cr.P.C. After the death of her husband the complainant filed claim to the opposite party requesting him to pay an amount of Rs.1,00,000/- towards the sum assured as the policy holder died accidentally. But the opposite party paid an amount of Rs.50,000/- towards sum assured with bonus treating the death of the deceased as suicide. Along with the said claim form the complainant submitted copies of FIR, Panchanama, Postmortem Report, Death Certificate and other documents. In the Final Report it is mentioned that the deceased died in an accident but the opposite party relied on the typographical mistake that the death of deceased is a case of suicide and closed the investigation and on that ground the accident benefit coverage was not given by the opposite party. It is further submitted that when the complainant came to know about the mistake she requested the Railway Police to correct the mistake as her husband died in an accident and the same was corrected by the Police in the Final Report. The complainant requested the opposite party to pay the accidental benefit assured sum of Ra.50,000/- in view of the correction in the Final Report, but the opposite party failed to pay the same. The complainant submits that the opposite party is bound to pay the amount of Rs.50,000/- towards accident benefit coverage and non-payment of the same constitutes deficiency of service on their part. Hence sought direction for payment of the said amount with damages and costs.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]3. The opposite party filed counter stating that the husband of the complainant obtained Endowment Assurance Policy for Rs.50,000/- having a term of sixteen years. On 24.8.2006 opposite party received death intimation of the policy holder from the complainant as she being the nominee under the policy. On receipt of the said claim papers the opposite party admitted the claim for Basic sum assured and eligible Bonus which comes to Rs.50,000/- towards assured sum and Rs.4,500/- towards Bonus and paid the said amount of Rs.54,500/- on 23.11.2006. It is further submitted that the claim of the complainant for payment of Rs.50,000/- towards double accident benefit coverage was not considered as the policy holder committed suicide. It is submitted that as per the Final Report submitted by Railway Police the cause of death is shown as suicide. Again the complainant submitted another Final Report submitted by the Railway Police to the Executive Magistrate showing the death of the policy holder as a case of accidental death. On receipt of the same the opposite party referred the same to the Zonal Office and the claim of the complainant for payment of double accident benefit is rejected. There is no deficiency of service on their part as they have already paid the assure sum, hence opposite party prayed for dismissal of the complaint.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]4. The complainant filed Proof Affidavit reiterating the contents of the complaint and filed the documents which are marked as Ex.A1 to A9. Ex.A1 is the copy of Policy Bond bearing no. 683928047. Ex.A2 to A5 are the premium receipts issued by opposite party. Ex.A6 is the attested copy of F.I.R. in Crime No.131/2006 Dt: 26.6.2006. Ex.A7 is the attested copy of Inquest Report in Crime No.131/2006 issued by Station House Office, Govt Railway Police, ROP, Ramagundam, RPS, Bellampally (in 3 sheets). Ex.A8 is the attested copy of Report of Postmortem Examination Dt: 26.6.2006 (in 3 sheets). Ex.A9 is the attested copy of Charge Sheet filed by Sub Inspector of Police, Bellamplly Dt: 6.8.2006. [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]5. On behalf of opposite party, the Proof Affidavit of its Administrative Officer is filed and got marked documents as Ex.B1 to B3. Ex.B1 is the original copy of Ex.A1. Ex.B2 is the original copy of Charge Sheet Dt: 6.8.2006 (in 2 sheets). Ex.B3 & A9 are one and the same documents. [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]6. The points for consideration are:[/FONT]
    [FONT=&quot](1) Whether there is any deficiency of service on the part of opposite party?[/FONT]
    [FONT=&quot] (2) If so, to what relief the complainant is entitled? [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]7. The case of the complainant is that the husband of the complainant obtained Insurance Policy from the opposite party under Ex.A1 with double accident benefit coverage for basic sum of Rs.50,000/- and nominated the complainant as his nominee enabling her to receive the assured sum after his death. It is contended that the policy holder met with an accident on 26.6.2006 as he was hit by a goods train while crossing the Railway Track between Bijjigiri Sharief and Potkapally and he died on the spot. The Railway Police registered a case by issuing FIR under Ex.A6. After his death Police conducted Inquest over the dead body and sent it for Postmortem to Govt. Hospital, Sultanabad. It is contended that the Railway Police filed Final Report before the Executive Magistrate, Odela Mandal on 6.8.2006 under Ex.A9 reporting that the deceased while crossing the Railway Track to answer the calls of nature was hit by a train and sustained injuries and died on the spot. Further reported that there is no Foul Play suspected in his death. After the death of policy holder the complainant submitted claim for payment of double accident benefit assured sum of Rs.1,00,000/- with bonus, but the opposite party paid an amount of Rs.50,000/- towards basic sum with bonus of Rs.4,500/- treating the death of the policy holder as a case of suicide. Infact it is a case of accidental death and the opposite party ought to have paid the sum under double accident coverage. Therefore, the complainant sought direction for the said amount.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]8. It is contended by the opposite party that the deceased policy holder committed suicide and as per the terms of the policy the complainant is entitled to receive Rs.50,000/- towards basic sum assured with bonus. Along with her claim she submitted copy of Final Report under Ex.B2 in which it is stated that the death of the deceased as suicide. But another report is filed by the complainant under Ex.B3 in which it is stated that the death of the policy holder is an accidental while crossing the Railway Track. As per the terms of the policy the opposite party paid basic sum of Rs.50,000/- with bonus of Rs.4,500/- on 23.11.2006. As the policy holder committed suicide, the complainant is not entitled to receive double accident benefit coverage. Therefore, the opposite party prayed for dismissal of the complaint.[/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]9. The case of the complainant is that the opposite party failed to pay the accidental benefit coverage even though the policy holder died in train accident while crossing the Railway Track. The complainant relied on the Criminal Case records under Ex.A6 to A9. A perusal of Ex.A6 F.I.R. reveals that the Railway Station Incharge filed a complaint with Railway Police that the dead body of the Male person is found on the Railway Track. On receipt of the same a case was registered and the Railway Police conducted Inquest over the dead body of Mattepally Sambaiah on 26.6.2006 in the presence of panchas and witnesses and the dead body was referred for postmortem examination to Govt. Hospital, Sultanabad. A perusal of contents of Column NO.9, 15 and 22 of Inquest Report under Ex.A7 reveals that the deceased was crossing the Railway Track at 4.30A.M. to attend calls of natures without observing the Goods Train and he was hit by it due to which he died on the spot. The said incident was witnessed by one Gare Yakub who is working as Gateman at Gate No.28. The doctor who conducted PME reported that the deceased died due to multiple injuries received on the head. Subsequently the Police filed Charge Sheet/Final Report before the M.R.O., Odela. A perusal of the said report under Ex.A9, the Investigating Officer reported that, [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]"From the evidence collected so far revealed that the deceased Mattepalli Sambaiah R/o. Potkapalli of Karimnagar district while crossing the railway track at KM No.315/5-7 between Bisugirsharief and Potkapalli railway stations to answer the calls of nature he was hit by TKD up train, resulting which he sustained injuries and died on the sport. There is no foul play suspected in his death.[/FONT]
    [FONT=&quot] As such the case has been referred as Accidental death and the Hon'ble Court may kindly be referred the case accordingly after due enquiry and issue further proceedings[/FONT][FONT=&quot]". [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]10. On receipt of the claim from the complainant the opposite party paid Basic Assured sum of Rs.50,000/- with bonus of Rs.4,500/- on 23.11.2006 treating the death of the deceased as a case of suicide by relying on the copy of the Charge Sheet, Final Report under Ex.B2 in which in the last para it is stated that the death of the deceased is a suicidal. A perusal of the contents of Ex.B2 reveals that the Investigating Officer has conducted Investigation in which it is revealed that the deceased was hit by a train when he was crossing the Railway Track to attend calls of nature and he died on the spot due to the said injuries. In the last para it is stated that the case has been referred as suicidal death. Relying on the said report the opposite party treated the death of the policy holder as suicidal and paid basic sum. [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]11. The opposite party filed 2 reports Ex.B2 & B3 copies of 2 Charge Sheets. In Ex.B2 it is referred at last para as follows, "As such the case has been referred as suicidal death and the Hon'ble Court may kindly be referred the case accordingly after due enquiry and issue further proceedings." In Ex.B3 it is referred as follows "As such the case has been referred as Accidental death and the Hon'ble Court may kindly be referred the case accordingly after due enquiry and issue further proceedings." But the facts gathered as referred above it is clear the deceased while crossing the track to attend the natural calls hit by Goods Train. As such it cannot be said that he intentionally made any attempt to commit suicide. Hence the reference of suicidal death in Ex.B2 might be a mistake of typing as contended by the counsel for petitioner. But perusal of another Final Report filed by the opposite party under Ex.B3 reveals that the deceased died due to train accident. When the opposite party received 2 different reports regarding the death of the policy holder the opposite party ought to have made their own enquiry to know the cause of death of the deceased. [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]12. Further as per Ex.A7 Inquest Report Dt: 26.6.2006 conducted on the same day by SHO Railway, ROP, Ramagundam at Co.No.4 it is stated that the Panch witnesses Sl.No.3 to 6 who are the wife and children of deceased have stated that they have seen him lastly while on 26.6.2006 at 4.30 A.M., while he was leaving the house along with water bottle. Thus it is clear at that time deceased left the house only to attend the natural calls and not with any intention to commit suicide. After considering the case record it is established that death of deceased met with an accident as referred supra and rejecting the claim by the opposite party on the ground that it is a suicidal death is unjust and amounts to deficiency of service. [/FONT]
    [FONT=&quot] [/FONT]
    [FONT=&quot]13. In the result the complaint is partly allowed directing the opposite party to pay an amount of Rs.50,000/- with interest @ 7.5% per annum from the date of filing of the complaint i.e. 14.7.2008 till the date of realization along with costs of Rs.500/- within a period of one month from the date of receipt of this order.[/FONT]
    [FONT=&quot] [/FONT]
  • adminadmin Administrator
    edited September 2009
    C.C.No.50 / 2008


    BETWEEN:

    Konari Simhachalam, S/o.Ramayya, aged 33 years, H/o.of late Mahalakshmi,
    Madanapuram Village, Kottapalli Post, Saravakota Mandal, Srikakulam District. ...Complainant.

    AND:

    01) Life Insurance Corporation of India, rep.by its Branch Manager,
    Palasa, Kasibugga, Main Road, Srikakulam District.

    02) Life Insurance Corporation of India, rep.by its Senior Divisional Manager,
    Divisional Office, Dabagardens, Visakhapatnam. …opposite parties.

    This complaint coming on 06-04-2009 for final hearing before us in the presence of Sri T.Khagendranadh, Advocate for complainant and Sri Y.Murali Mohana Rao, Advocate for opposite party Nos. 1 and 2 and having stood over to this day for consideration, this Forum made the following:[FONT=&quot][/FONT]

    O R D E R

    (By Sri K.Sivaramakrishna, Male Member)

    This is a complaint filed under Section 12 of the Consumer Protection Act, 1986 and facts of the case briefly are as follows:
    Wife of the complainant by name Konari Mahalakshmi obtained LIC Policy for Rs.50,000/- on 30-3-2005. She died on 4-7-2005. Complainant is nominee under the policy. Complainant submitted original policy, death certificate of the deceased and claimed the insurance amount, but the opposite parties did not settle the claim. Complainant issued notice dated 7-4-2008 to opposite party Nos.1 and 2 claming the insurance amount. There was no settlement of the claim. Hence complaint is filed for a direction to the opposite parties to pay the insurance amount of Rs.50,000/- and premium of Rs.3,311/- and compensation of Rs.20,000/- and costs.
    2) Opposite party No.2 filed counter stating that the insured had died by committing suicide and hence the claim is rejected.
    Opposite party No.1 filed memo adopting the counter filed by opposite party NO.2.
    3) Both parties filed affidavits. Exs.A1 to A6 are marked on behalf of the complainant. Ex.B1 is marked on behalf of the opposite parties.
    Heard both parties.
    Point for consideration is:
    Whether there is deficiency in service on the part of the opposite parties.

    4) Point:
    Ex.A3 is copy of letter dated 25-5-2007 issued by opposite parties to the complainant stating that the insured committed suicide within one year from the date of the policy. Hence the policy has become null and void and nothing is payable under the policy. Opposite parties filed two letters given by Surpanch of Madanapuram Panchayat and another person by name P.Lingamurthy stating that the insured Konari Mahalakshmi died by committing suicide. These letters are not marked, because the letters are not evidence. Opposite parties ought to have examined the persons who gave the letters. Opposite parties ought to have filed affidavits of those persons to support their defence that the insured died by committing suicide. Complainant may have got opportunity to cross-examine those persons. By filing letters given by some persons, opposite parties cannot prove their defence. The letters cannot be relied on. The letters are not evidence.
    5) There is no proof that the insured died by committing suicide. The burden is on the opposite parties to prove that the insured died by committing suicide. Opposite parties have not discharged their burden of proof of their defence. Hence the defence is not accepted.
    6) Ex.A2 is certificate of death extract of the insured Konari Mahalakshmi. There is no denial of the fact of the death of the insured Konari Mahalakshmi on 4-7-2005. Opposite parties have failed to prove that the insured died by committing suicide. They have to pay the insurance amount to the complainant. We therefore hold that there is deficiency in service on the part of the opposite parties. Hence, we answer the point accordingly.
    In the result, complaint is allowed. Opposite parties are directed to pay Rs.50,000/- (Rupees fifty thousand only) to the complainant with interest at the rate of 12% per annum from the date of filing the complaint i.e., 22-4-2008 till the date of payment and costs of Rs.500/- (Rupees five hundred only). Advocate’s fee is fixed at Rs.500/- (Rupees five hundred only).
  • adminadmin Administrator
    edited September 2009
    C.C.No.142/2007
    Between:

    Dharmala Sugana, W/o Nageswara Rao, Hindu, Aged 42 years,
    R/o D.No.2-7-2, Kannamathalli Temple Street, Alcot Gardens,
    Rajahmundry. ..Complainant.
    A N D

    1.The Zonal Manager, L I C of India, Zonal Office/ Central Office,
    South Central Zonal Office, Saifabad, Hyderabad, 500 463.
    2.The Divisional Manager, Divisional Office, L I C of India,
    Morampudi Road, Rajahmundry.
    Opposite parties.
    This case is coming on 20.3.2009 .for final hearing before this Forum and upon perusing the complaint, and other material papers on hand and upon hearing the arguments of Sri T V Satyanarayana Reddy, Advocate for the complainant and Sri M Siva Subbarao, Advocate for the opposite parties and having stood over for consideration till this day, this Forum has pronounced the following.
    O R D E R
    (By Smt.H V Ramana, Member)
    This is a complaint filed under section.12 of the Consumer Protection Act, 1986 by the Complainant to direct the opposite parties to pay an amount of Rs.5,68,527/and to award costs.


    2. The case of the Complainant as set out in the complaint in brief is that, the complainant’s husband obtained policy from the opposite party under Jeevan Anand in the month of September, 2003 and paid necessary premium. The opposite parties issued policy bearing No.802921246, Dt.19.12.2003 assuring a sum of Rs.4,00,000/- under the said policy. The complainant’s husband died intestate on 2.6.2005 leaving behind the complainant and his only daughter. In the above said policy the complainant was made a nominee and she filed all the necessary papers before the opposite parties for settlement of claim, for which the 2nd opposite party passed an order under his letter Dt.18.4.2006 LIC of India, Divisional Office, Rajahmundry, addressing the complainant that the policy of Dharmala Nageswara Rao, SA.Rs.4,00,000/--Plan and term of 149-50 with A B stating that the 2nd opposite party repudiated the claim on the basis of suppression of material facts. The complainant several times approached the opposite parties for settlement of claim, but in vein. Hence, the complaint.


    3. The 2nd opposite party filed written version and the same was adopted by the 1stopposite party. This opposite parties denied all the material allegations made by the Complainant. The opposite parties submits that there is no previty of contract between the complainant and the opposite parties and there is no service under taken for consideration by the opposite parties infavour of the complainant. The claim of the complainant repudiated by the opposite parties after thorough investigation and realizing the fact that the policy in question was secured by suppressing the material information by the life assured. With a dishonest intention the LA obtained the policy. The opposite parties requested the complainant to give all the requisite information and fill the claim forms. In spite of several reminders the complainant failed to furnish the required information. When this opposite parties received reliable information from various sources, it is came to known that the life assured was a known case of stage.II Non-Hodgkin’s Lymphoma with multiple relapses on savage Chemotherapy and he is also a diabetic since two years prior to death and was taking treatment at South Central Railway Hospital, Rajahmundry as outpatient. It is further realized that the life assured was on sick leave for more than 7 days on many occasions prior to commencement of policy and the same was not disclosed in the proposal form purposefully. The enquiries have also revealed that the life assured took treatment from Dr N Rama Krishna E N T and Dr B Thrinadha Rao, Rajahmundry for cancer. As per the report given by the Jagruthi Laboratory, Rajahmundry the Life assured was diagnosed to be suffering non-specific lymphadenitis and this clearly shows that the life assured was a diabetic and also at the primary stage of cancer at the time of taking the policy and the same was not disclosed and intentionally suppressed the same in the proposal form. With reliable evidence only, the opposite parties repudiated the claim and the complainant is not entitled for any relief and the complaint may be dismissed with costs.


    4. Exs.A.1 to A.11 has been marked on behalf of the complainant and Exs.B.1 to B.21 on behalf of the opposite parties and no oral evidence has been adduced on either side.


    5. Heard both sides. The complainant filed written arguments.
    • The points that arise for consideration are:

    1) Whether there is any deficiency in service on the part of the opposite
    parties?
    2) Whether the complainant is entitled for any relief, If so, to what
    relief?

    7.POINT NO.1: The Admitted facts in the case are that the complainant’s husband obtained LIC policy bearing No.802921246 on 20.11.2003 by paying a premium amount of Rs.34,384/-. The opposite parties issued Jevan Anand Policy to the Life Assured vide Ex.A.2 = Ex.B.2 and he also paid premium in the month of September, 2004. The complainant’s husband died on 2.6.2005 due to cancer vide Ex.A.1 and the same was intimated to the opposite parties for claim and the opposite parties repudiated the same for suppression of material facts under Ex.A.3=Ex.B.10. The complainant is a nominee to the policy and the same is reflected in Ex.B.2. The complainant gave a reply to the 2nd opposite party by narrating the health condition of her husband and the same has been marked under Ex.A.4. The complainant contended that the opposite parties failed to settle the claim with false allegations and she filed medical certificate marked under Ex.A.5 issued by Dr A Rama Krishna and E N T Surgeon. She also filed different laboratory reports under Ex.A.6, A.7, A.8 and A.9. The discharge summery and other reports issued by Indo American Cancer Centre institute and research centre has been marked under Ex.A.10. The death summary report issued by the Yashodha Hospital has been marked under Ex.A.11.
    The opposite parties contended that the life assured had secured the policy by suppressing the material facts in the proposal form and the same has been marked under Ex.B.1. They also contended that the complainant failed to give all the required information in the claim form and the same has been marked under Ex.B.3 and the burial ground certificate has been marked under Ex.A.4. The opposite parties further contended that the life assured was on sick leave for more than 7 days on many occasions prior to the date of commencement of the policy, rather submission of proposal form. In the said proposal form the details were also not disclosed and to that extent the opposite parties filed Ex.B.6. They also contended that they received reliable information that the life assured was a known case of stage II Non-Hodgkin’s lymphoma with multiple relapses on salvage Chemotherapy and he was a diabetic since two years prior to his death and to that extent they relied on Exs.B.7,B.8 B.9 and B.10. The opposite parties also filed copy of medical certificate and fitness certificate marked under Ex.B.12 and B.13. A letter written by the life assured to their management is marked under Ex.B.14. The opposite parties also filed the medical record from 25.1.2002, and leave account under Ex.B.15 and B.16. The life assured’s out patient tickets have been marked under Ex.B.17 to B.21.
    After perusing the entire material on record filed by both the parties as we observed that the life assured had taken leave on several occasions under Ex.B.6 for domestic purpose and also under medical grounds. The life assured obtained the policy on 28.9.2003 and by this date the life assured was not diagnosed as cancer patient. The said policy was issued by the opposite parties under non medical category. As per Exs.A.7 report Dt.18.1.2004 the complainant’s husband was diagnosed that there is a possibility of Angio Lymphoid Hyperplasia. By this date the life assured already taken the policy from the opposite parties. The opposite parties filed the medical record of the life assured under various exhibits which were showing that the life is taking treatment for cancer. But, these records are not prior to the issuance of the policy. Even in other documents which were filed by the opposite parties prior to the issuance of policy, no way reveals that the life assured was suffering from cancer.
    Further, the complainant relied on decisions reported in; I 1999 CPJ Page.230, Haryana State Consumer Disputes Redressal Commission, Chandigarh between Life Insurance Corporation of India Vs Mrs Santosh, wherein it was held that; rejection of claim by the opposite party on ground of complainant being diabetic is arbitrary”.
    As per this the contention of the opposite parties that the life assured was a diabetic and taking medicines since 2002 and the same was not disclosed at the time of taking the policy. The diabetic was not an ailment, patient where of stood disqualify from being insured, as such the diabetic is not a disease, but it is only a disorder.
    As per the aforesaid observation the repudiation of claim by the opposite parties caused serious prejudice to the complainant. Hence, the complaint of the complainant is allowed and she is entitled for the claim.


    8. POINT NO.2: In the result, the complaint of the complainant is allowed directing the opposite parties to pay the sum assured i.e Rs.4,00,000/- (Rupees four lakhs only) with interest @9% P.A from 2.6.2007 till the date of realization. The opposite parties are further directed to pay Rs.1,000/- (Rupees one thousand only) towards costs.
  • adminadmin Administrator
    edited September 2009
    CONSUMER COMPLAINT NO.04/2008.
    Friday, the 17th day of April, 2009.
    Between:
    1. K.V.Meenakshi, W/o. Late K.V.Satyanarayana,
    Hindu, 32 years, Housewife, R/o D.No.8-17-3,
    Sivalal Street, Vankayalavari Street, Rajahmundry.

    2. K.V.Bapi Raju, S/o. Ramakrishna Rao,
    Hindu, 45 years, Business, R/o. D.No.8-17-3,
    Sivalal Street, Vankayalavari Street, Rajahmundry. ...Complainants.
    A N D

    1. Life Insurance Corporation of India,
    Rep. by its Branch Manager, Rajahmundry.

    2. Life Insurance Corporation of India,
    Rep. by its Branch Manager, Ravulapalem.

    3. Life Insurance Corporation of India,
    Rep. by its Divisional Manager, Rajahmundry. … Opposite parties.


    This case is coming 20.03.2009 for final hearing before this Forum and upon perusing the complaint, version of the opposite parties and other material papers on hand and upon hearing the arguments of Sri D.Appa Rao, advocate for the complainants 1 and 2being represented by Sri B.Srinivasa Rao, advocate for the Opposite parties 1 to 3 having stood over for consideration till this day, this Forum has pronounced the following.
    ORDER


    (PER SRI K CH MOHANTHY,PRESIDENT)

    This is a complaint filed by the complainants under Section 12 of the consumer Protections Act to direct the opposite parties to pay an amount of Rs.11,50,000/- towards the insurance amount under four policies with interest @12% P.A from 30.1.2006 till realization, to pay subsequent interest @12% P.A, to pay costs of the complaint and other reliefs.


    2. The case of the complainants as set out in the complaint is that the 1st complainant’s deceased husband used to run a shop under the name and style of VS Prink point (Screen printers) at Rajahmundry. The deceased died suddenly due to jaundice on 5.8.2004 prior to his admission into the hospital and taking medicine. The deceased life assured was hale and healthy and never suffered from any ailments, but unfortunately the DLA suffered from jaundice for the first time and he took country medicine at Vella, which is familiar in the Godavari districts for cure of jaundice, but to the misfortune of the complainant the DLA died on 5.8.2004 due to jaundice and the same was intimated to the opposite parties.
    It is further submitted that during the lifetime of the deceased the DLA life insurance polices from the opposite parties as mentioned below.
    SL. No.
    Name of the policy
    Sum assured
    Date of commencement
    Name of issuing branch
    Name of the nominee
    1
    802505943
    1,00,000
    28.2.2002
    Rajahmundry.
    1st complainant
    2
    801756137
    50,000/-
    28.3.2003
    Rajahmundry.
    1st complainant
    3
    802518912
    5,00,000/-
    1.11.2003
    Rajahmundry.
    1st complainant
    4
    802519278
    1,00,000/-
    6.12.2003
    Rajahmundry.
    1st complainant
    5
    802522571
    5,00,000/-
    7.3.2004
    Rajahmundry.
    2nd complainant

    The complainants made claims on 8.11.2004 in respect of the above said polices, for which they are nominees. But, to the surprise of the complainants the claims were repudiated by the 3rd opposite party herein vide its letter Dt.30.1.2006 on the ground that the life assured had suffered from acute Myeloid Leukemia, for which he consulted a reputed hospital prior to the date of commencement of the policy. It is submitted that in fact the deceased life assured never suffered from any disease much less the alleged Leukemia at any point of time prior to taking the policies in dispute. The complainants preferred revision before the Zonal office, but in vein and confirmed the earlier repudiation on 14.3.2007. So, the opposite parties without considering the genuine claims of the complainants improperly repudiated the claims thereby causing mental agony to the complainants which amounts to deficiency in service on the part of the opposite parties. But surprisingly the 3rd opposite party after repudiating the claim made payment of Rs.1,00,000/- against the policy No.802505943 on 27.4.2007 even though the Zonal office confirmed the repudiation of policies on 14.3.2007. The present complaint is with regard to other policies for which the complainant are entitled as there is every deficiency of service on the part of the opposite parties. Hence, this complaint.
    3. The opposite parties filed their written version denying all the main and material allegations made in the complaint and the complaint is not maintainable either in law or on facts. It contended that it is not true and correct that the deceased life assured died due to a sudden effect of jaundice and there is no possibility to join the deceased in hospital. It is true that the deceased life assured obtained policies vide NOs.802305643, 802518912, 802519278 and 802522571 from the Rajahmundry main branch and the policy bearing No.801756137 from the Ravulapalem. In the said policies one policy bearing No.802522571 one K V Bapiraju brother of assured was placed as nominee and for the rest of the policies deceased’s wife was placed as nominee.
    It was contended that the life assured did not disclose the particulars of the earlier policies, while applying for the policies in the subsequent proposals submitted at Rajahmundry and Ravulapalem. AS per the death certificate received by this opposite parties, the DLA died on 5.8.2004 at Rajahmundry. It was further submitted that the 1st complainant informed in her letter of intimation on 18.11.2004 under four policies for which she was nominated stating that her husband was died with blood cancer with jaundice. The 2nd complainant informed vide his letter Dt.24.11.2004 under policy No.802522571 the cause of death has been stated as blood cancer with jaundice. Later the corporation received claim forms from both the complainants wherein the cause of death stated as jaundice.
    On enquiry by our investigating officials it is learnt that the life assured had obtained B+ve blood from Jagruthi blood bank, Rajahmundry 14 times from 23.4.2004 to 31.7.2004, which was confirmed by the said blood bank vide their letter Dt.9.11.2005 stating that the DLA obtained the blood as his platelet count is low due to acute Myeloid Leukemia. It is further submitted that the Sowbagya hospital doctor who is family physician of the deceased life assured orally informed that the deceased took treatment for cancer in one of the hospitals at Visakhapatnam. Our enquiries made at lines club cancer hospital, Visakhapatnam fetched nothing about the treatment of DLA. One Thota Krishna Kumar Brother in law of DLA in his letter Dt.23.7.2005 stated that the DLA used to visit Dr Paramahamsa, after expiry of DLA the said Dr Paramahamsa informed them that the life assured underwent blood transfusion through Sowbhagya hospitals. It is further submitted by this opposite party that the agent who canvassed the policies bearing No. 802505943, 802519278 and 802518912 respectively is a relative of the DLA and there is no possibility of the agent not knowing the health condition of the DLA. It is further submitted that the complainants informed in the claim forms that the DLA died of jaundice and there is no treatment, but they informed in their intimation that the DLA died of blood cancer and jaundice. It is further submitted that the blood transfusion was done very close to the date of commencement of policy and the blood transfusion is generally required at the last stage of cancer. It is further submitted that the DLA had taken high risk plans within short duration for huge some assured. The life assured submitted the proposal for assurance and he answered the following questions as follows:
    (a) During the last five years did you consult a medical practitioner for any ailment requiring treatment for more than a week? Ans: No.
    (b) Have you ever been admitted to any hospital or nursing home for general checkup, observation, treatment or operation? Ans: No.
    (c) Are you suffering from or have you ever suffered from ailments pertaining to Liver, stomach, Heart, lings, Kidneys, Brain or Nervous system? No.
    (d) Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Presure, Low Blood Presure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease? Ans:No.
    (e) What has been your usual state of health ? Ans: Good.


    The above answers were false and the life assured had suffered Acute Myeloid Leukemia and the details of the said ailment, till the treatment was not disclosed in the proposals which are material for assessing the risk and the deceased life assured made incorrect statement and withheld correct information from the corporation regarding his health at the time of effecting insurance. As the life insurance contracts are based on contract of utmost good faith there is a bounden duty on the contracting parties to disclose all facts which are material. So, it is submitted that the deceased life assured has deliberately suppressed his past illness and treatment with an intention to defraud the opposite parties and to make money. Hence, this opposite parties submits that the repudiation basing on the evidence collected and as per the declaration made by the proposal at the end of the proposal. So, the decision of repudiation of claim by the opposite parties is legal and there is no deficiency of service on the part of the opposite parties. Hence, the opposite parties prays the Honourable Forum may be pleased to dismiss the complaint with costs.


    4. Heard both the parties. Both the parties filed their written arguments.



    5. Points to be considered in this case are that;

    1. Whether there is any deficiency in service on the part of the opposite parties?
    2. Whether the complainants are entitled for the claim amounts and other
    reliefs asked for? If so, to what extent?


    6. Exs.A.1 to A.13 were marked on behalf of the complainants and Exs.B.1 to B.23 were marked on behalf of the opposite parties.



    7. Admitted facts in this case are that the deceased life assured i.e the 1st complainant’s husband and brother of the 2nd complainant obtained five life insurance policies from the opposite parties during his lifetime. Out of which the policy bearing number 801756137 for a sum assured Rs.50,000/- on 28.3.2003 at Ravulapalem branch vide Ex.A.2 of the 3rd opposite party herein, rest of the policies bearing numbers 802505943 for Rs.1,00,000/- Dt.28.3.2002 vide Ex.A.1, 802518912 for Rs.5,00,000/- Dt.1.11.2003 vide Ex.B.22, 802519278 for Rs.1,00,000/- Dt.6.12.2003 vide Ex.B.23 and 802522571 for Rs.5,00,000/- Dt.7.3.2004 vide Ex.B.13. The DLA’s wife was nominee to the above said policies except the policy bearing No.802522571 for Rs.5,00,000/- for which the brother of the DLA i.e the 2nd complainant herein was placed as nominee. The DLA died on 5.8.2004 at Rajahmundry vide Ex.B.7=Ex.A.7. The opposite parties paid only one policy amount of Rs.1,00,000/- vide policy No.802505943 vide Ex.A.1 on 27.4.2007 vide Ex.A.13 to the 1st complainant and the remaining amounts on four policies including the 2nd complainant who was nominee for the policy bearing No.802522571 were repudiated by the opposite parties on 30.1.2006 vide their repudiation letters Exs.B.11 and B.20 and the same was confirmed by RM vide Ex.B.21.



    8. POINT NO.1: The case of the complainants is that the opposite parties paid only one policy amount of Rs.1,00,000/- pertaining to the DLA, though the DLA obtained five policies in all amounting to Rs.12,50,000/- during his life time. The opposite parties repudiated the claims of the complainants herein with a baseless allegation of blood cancer as against the ailment of jaundice with which the deceased died on 5.8.2004. So, the complainants contention is that they are entitled for the rest of the amounts totaling to Rs.11,50,000/- as per the polices obtained by the DLA during his life time.
    Whereas the opposite parties contended that the deceased life assured obtained 5 policies from the opposite parties, withholding the information with regard to his ailment and treatment of Acute Myeloid Leukemia and incorrect statements while submitting proposals for the above said policies. The DLA gave false answers to the questionnaire in the proposals under Column.11A supplied by the opposite parties, so that the opposite parties denied an opportunity of arriving a correct decision in accepting the risk. The 3rd opposite party herein made payment of Rs.1,00,000/- against policy No.802505943 on 27.4.2007 as the said policy crossed 2 years period.
    On perusal of the entire record placed before the Forum, We find that the contention of the opposite parties is that the DLA failed to mention and suppressed the fact about the earlier policy bearing No.802505943, while obtaining policy-bearing No.801756137 from Ravulapalem branch, further, this policy number.801756137 was not disclosed while obtaining policy No.802522571. With regard to this contention of the opposite parties, it is found that the policy bearing No.801756137 for Rs.50,000/- was obtained through an agent by name M S N Prabhakar Rao. On observation of the proposal for this policy it is found that the DLA subscribed only his signature on the proposal for this policy without his presence, but the rest was nothing but the handy work of the so-called agent of the opposite parties as the height of the DLA was noted as 174 Cms, whereas in all other proposals the height of the deceased was mentioned as 165 Cms. Further, the said proposal was obtained under medical category and signed by the panel doctor of the opposite parties by name Dr Chinta Papareddy of Ravulapalem and we do not understand how the panel doctor of Insurance company could certify the proposal without the proposor. If the panel doctor really examined the DLA in the present case, he could correct the height of proposor in the proposal form, even though the form was completed by the agent or others. This shows that the agents and officials of the opposite parties without verification of the statements and information furnished by the proposors, doing insurance business even in the absence of the proposors under the guise of procuring life insurance policies from the general public.
    Further, it is also observed that all the policies in the present case, were issued by the opposite parties after taking a reasonable time for acceptance of the proposals made by the DLA and the opposite parties had good time to enquire about the statements made and information furnished by the DLA. Generally, the insurance companies enquire into the information furnished by the proposers like age, health and earnings after receiving proposals and before issuing policy, particularly where the proposals are for higher amounts they are used to be very cautious. Here, in the present case the proposals were submitted for policies bearing No.802518912 for Rs.5,00,000/- on 1.11.2003 and the policy bearing No.802522571 for Rs.5,00,000/- on 7.3.2004 and the policies were issued by the opposite parties mentioning the issue date as 1.4.2004. So, the opposite parties have a reasonable time to inquire into the information furnished by the DLA, but it is evident that the opposite parties failed to do so, which responsibility rests on nothing but the opposite parties. The opposite parties for the non medical policy issued by them vide No.802519278 for Rs.1,00,000/- on 6.12.2003, the opposite parties relied on medical report filed in the proposal for policy No.802518912 for Rs.5,00,000/- on 1.11.2003.
    The opposite parties alleged that the complainants herein in their death intimation and claim forms stated that the cause of death was jaundice and blood cancer, but in the claim statements they mentioned that the DLA died of jaundice and the complainants did not give any particulars in medical attendance certificate and stated that the DLA was not hospitalized. On perusal of Death intimation vide Ex.B.4, B.5 =Ex.A.8 and Ex.B.6 and B.14 claim forms it appears that the matter was same in this documents and was written in English by some one else for which the complainants subscribed their signatures only and the complainants might not aware of what it contained. Further, as per Ex.B.18 letter Dt.23.7.2005 purported to be written by one Thota Krishna Kumar who is said to be the brother in law of the DLA is also not supported by any constructive evidence and what prompted him to write that letters.



    It is further observed that the opposite parties herein relied on Ex.B.19 document while repudiating the claim of the complainants. But, the doctor by name G Nageswara Rao of Jagruthi blood bank who issued the certificate under Ex.B.19, and the details appended to this certificate regarding issuance of blood to the DLA was prepared on ordinary papers and even one of them is nothing but a rough paper of the opposite parties with improper details and they were not the extracts of the records pertaining to the Jagruthi blood bank, which was a registered blood bank with the Government which is supposed to maintain blood indent register as per the rules and can be secured by the opposite parties to prove their case. Further, it is also observed that as per the blood indent details contained in Ex.B.19 it was mentioned on the first page that “the deceased has been treated as OP as entered in the OP register either one or two days earlier to issue of blood by the blood bank or on the same day. It is further observed on perusal of Ex.B.19 that the DLA obtained B+ve blood in all 14 times from Jagruthi Blood bank stating that his platelet count is low as he was suffering from Acute Myeloid Leukemia, but there was no referring letter or indent for blood from the said Sowbhagya hospital as stated in blood indent details. Further, it was mentioned that the doctor of Sowbagya hospital is family physician of the deceased family” and signed by one C B Chowdary whose details were not mentioned. How can a third person certify that the DLA’s family physician was doctor of Sowbhagya Hospital? The opposite parties contended that the blood transfusion was done very close to the date of commencement of the policies. But there is no proof from the opposite parties, that blood was transfused on the said dates to the DLA in the said hospital. Here it is observed that the two policies for higher amounts i.e Rs.5,00,000/- proposals were submitted on 1.11.2003 and accepted on 22.11.2003, 2nd one submitted on 22.2.2004 and accepted on 7.3.2004 by the opposite parties and issued policies on 1.4.2004. Whereas, as per Ex.A.19 details for the first time it was mentioned that DLA obtained blood on 23.4.2004, but there was no evidence that blood was transfused to the DLA on the said dates and there is no authenticated evidence that the said Jagruthi blood bank authorities supplied blood to the DLA on the said dates and that blood was transfused to the DLA at the said Sowbhagya hospital.


    Whereas, as per Ex.A.6 medical certificate issued by one Dr S V T R K Paramahamsa of Sowbhagya Hospital certified that “the DLA was examined by him at DLA’s house on 3.8.2004 and found to be having severe jaundice and as the deceased was taking some nature treatment at Vella, the doctor did not interfered in their treatment but, prescribed and executed intravenous fluids to correct dehydration for two days and the patient was expired on 5.8.2004 due to hemorrhage followed by shock. There is nothing mentioned about Acute Myeloid Leukemia. Further, the opposite parties in their version stated that the doctor of Soubhagya Hospital orally informed that the DLA had taken treatment for cancer at Visakhapatnam, but they themselves admitted that the enquiries made by their officials for possibility of treatment at Lions Club Cancer Hospital, Visakhapatnam revealed nothing. The opposite parties failed to prove contra for the contention of the complainants that the DLA was not hospitalized before his death.




    The opposite parties in their repudiation letter showed the reasons as the DLA gave false answers under Column.No.11 (a) (b) (d) (e) and (i) contained in the proposal form submitted at the time of obtaining policies from them and the DLA had suffered from Acute Myeloid leukemia for which he had consulted a reputed hospital prior to the date of commencement of the policies and had taken treatment. The proposals were submitted on 28.3.2003,1.11.2003, 4.12.2003 and 22.2.2004 while he was suffering from the above ailments and the details of the said ailment and treatment was not disclosed in the proposal, which is material for assessing the risk. But the opposite parties failed to prove the above said reasons stated for the repudiation of claims preferred by the complainants with any constructive proof of evidence, that the DLA took treatment for the said ailment in any hospitals before obtaining policies or after obtaining the said policies.


    The complainant relied on the following decisions reported in
    1)2009 CPJ 324, Himachal Pradesh State Consumer Commission, between Life Insurance Corporation of India Vs Kanthadevi, wherein it was held;” Even if it be assumed for the sake of argument that the deceased was suffering from cancer, does not show any nexus between the cause of death and the alleged disease of cancer from which he was suffering according to the appellant”.


    2)II 2008 CPJ 374, APSCDRC between United India Insurance Company Vs Anumolu Ramakrishna wherein it was held that; “Consumer Protection Act, 1986 – Section 2(1)(g) – Insurance – Repudiation of claim – Suppression of material facts alleged – Life assured suffering from alleged disease and was in knowledge of disease, deliberately suppressed it prior to issuance of policy, not proved – Deficiency in service on part of insurance company proved – Complaint allowed by Forum – Order upheld in appeal”


    3)2008 NCJ 353 (NV)NCDRC, between M/s Mono Industries Vs New India Assurance Company Ltd, wherein it was held that;”if the amount is with held by the insurance company for years together lump sum award as compensation covering both interest and costs not suffice. Hence, just compensation is required to be awarded. Just compensation would mean award of reasonable rate of interest in case of loss suffered in terms of rupees. In other words proper measure or yardstick for granting compensation would be award of appropriate of rate of interest on the amount which complainant would have received had the claim been settled at the right time”.


    4)2005 NCJ 272 (NC) NCDRC, New Delhi between Life insurance corporation of India Vs Badri Nageswaramma (Deceased ) and others wherein the apex commission relied on earlier decision of Apex court in LIC of India Vs Chennabasamma AIR 1991 SC 392 and in LIC and others Vs Asha Goel (2001) 2 SCC 160, it was held that the burden of proving that the insured had made false representations and suppressed material facts is undoubtedly on the corporation, basing on this it was held that; “ as there is no conclusive evidence on record to suggest that there was any suppression on the part of the deceased, the insurance company has failed to prove the suppression on the part of the deceased relying”.


    5) 2005 NCJ 340 (NC), NCDRC, New Delhi between National Insurance Company Ltd Vs Bipul Kundu wherein it was held that; Consumer Protection Act, 1986 – Section 21(b)- Insurance Claim – Repudiation by insurer – Rheumatic heart disease – No evidence on record – Held – Repudiatin unjustified and baseless – Company liable to pay amount of policy”


    6) 2002 (4) ALD 520 Branch Manager, LIC of India, Kodad and another Vs Ambati Laxmamma, wherein it was held that;”Insurance Act, 1938 – Sec.45 – Repudiation of policy by Life Insurance Corporation on the ground of mis-statement by policy holder at the time of revival of policy – Corporation failed to establish that the misconduct was made by the policy holder and with a fraudulent intention – In case of any doubt, benefit should go to the policy holder or claimants – Hence, the Corporation has to pay the amount covered by the policy to the claimants”.
    Whereas, the opposite parties relied on the following decisions reported in:
    1)Uttar Pradesh State Consumer Disputes Redressal Commission, Lucknow
    between Shahida Khatoon Vs LIC of India & others.
    2)II 2003 CPJ 135 (NC) NCDRC, New Delhi between LIC of India Vs Mansa Devi.
    3)III 2003 CPJ 15 (NC) NCDRC, New Delhi, between Panni Devi Vs LIC and
    others.
    The opposite parties also filed some medical literature with regard to Acute Myeloid Leukemia.
    The decisions filed by the complainants are very much applicable to the facts and circumstances of the present case. Whereas the decisions filed by the opposite parties including the medical literature about Acute Myeloid Leukemia however not applicable to the facts and in the context of the case.


    With the above said discussion and on perusal of the decisions reported by both the parties, we are in the considered opinion that the complainants herein are entitled for the claims preferred by them with the opposite parties under the above disputed policies obtained by the DLA during his life time as the opposite parties miserably failed to prove their case with any cogent evidence and we opine that the repudiation was made in a routine and negligent manner, for which kind of act the complainants suffered mental agony to some extent. Hence, the opposite parties herein are liable to pay an amount of Rs.11,50,000/- in all as claimed by the complainants in the present complaint under the above said four policies in dispute with accrued benefits if any, on the policies along with a reasonable interest ,since the claims are pending for a long time with the opposite parties. The 1st and 2nd complainants are entitled for the respective claim amounts for which they were nominated by the deceased DLA. However, the opposite parties are entitled to deduct the premium amounts due on the said four policies if any for that current year in which the DLA died.


    9.POINT NO.2: In the result, the complaint of the complainants is allowed directing the opposite parties to pay an amount of Rs.11,50,000/- (Rupees eleven lakhs fifty thousand only) on the four policies in dispute with accrued benefits if any on that policies along with interest @9% P.A from the date of repudiation i.e 30.1.2006 till payment after deducting the due premium amounts if any on the said policies. We further direct the opposite parties to pay an amount of Rs.2,000/- (Rupees two thousand only) towards the costs of this complaint.
  • adminadmin Administrator
    edited September 2009
    Order delivered by Sri. Nazeer Ahmed U. Shaikh, Member
    1)[FONT=&quot] [/FONT]This is a complaint praying to direct the OPs to pay the remaining 50% of the insured amount with interest and costs.

    2)[FONT=&quot] [/FONT]Brief facts of the complaint are that the mother of the complainant while working under OP-3 as a sweeper took two LIC policies under No.631589-305 and 631589306 each for Rs.1,00,000-00 under Salary Saving Scheme (SSS) with the OPs1&2. She expired on 20-10-2006. The complainant being the nominee submitted claim with the OPs 1&2. They paid 50% of the insured amount, but refused to pay the 50% remaining amount through letter dated 16-6-2007. This is the deficiency of service by the OPs and they are liable.

    3)[FONT=&quot] [/FONT]The OPs 1 & 2 appeared and filed WS. The OP-3 failed to appear before this Forum even after service of notice. Hence the OP-3 is set ex-parte.

    4)[FONT=&quot] [/FONT]The OPs 1 & 2 filed WS admitting the issuance of the policies, the complainant being the nominee and payment of 50% of the insured amount to the complainant after the death of the insured, and further stating that the Life Assured failed to pay the premium for 5 months and the policy was in lapsed condition. A letter was issued to the life assured regarding the non-payment of 5 premiums. But there was no any reply from her. On humanitarian grounds the OPs have considered the claim and paid the half of the sum insured. There is no deficiency of service by OPs and they are not liable to pay the balance amount.

    5)[FONT=&quot] [/FONT]Both the parties have filed their affidavits. The complainant has got marked Ex.C-1 to C-9 and the OPs1&2 Ex.R-1 to R-5.

    6)[FONT=&quot] [/FONT]The point that arises for our consideration is: “Whether there is deficiency of service on the part of the OPs?

    7)[FONT=&quot] [/FONT]We have heard both the counsels in length. It is admitted fact that the mother of the complainant while she was working under OP-3 insured her life under 2 policies, under SSS with the OPs 1 & 2. After the death of the life assured the OPs 1 & 2 have paid 50% of the insured amount to the complainant and denied to pay the balance amount for the reason that the life assured even after issue of notice has not paid 5 premiums. Ex.R-5 is a copy of letter said to be sent by the OPs to the life assured. But there is no record to show that the letter has reached the life assured. The OP-3 being an agent of the OPs 1 & 2 has to make payment of the premiums regularly to the OPs 1 & 2. The failure to pay the premium amount by the employer makes liable the insurance Company to pay the full insurance amount with all benefits. The non-payment of the insured amount is deficiency of service on the part of the OPs and they are liable with cost of the complaint.
    So, we pass the following order.
    ORDER

    The complaint is allowed. The OPs are directed to pay to the complainant the balance 50% of the assured amount with all benefits and with cost of Rs.1000-00
  • adminadmin Administrator
    edited September 2009
    Order delivered by Sri. Nazeer Ahmed U. Shaikh, Member
    1)[FONT=&quot] [/FONT]This is a complaint praying to direct the OPs to pay Rs.80,000-00 on each certificate with 18% interest, damages of Rs.10,000-00, compensation of Rs.25,000-00 towards mental torture and cost to the complainant.

    2)[FONT=&quot] [/FONT]Brief facts of the complaint are that on an application No. T 1358310, the OP-2 issued certificate No.T 0132728 under Registered Folio No.T 03323333, worth Rs.5,000-00 of 500 number of units on 15-4-93. On another application also the complainant has received certificate worth Rs 5000-00 of 500 units both the certificates under the LIC Mutual Fund sponsored Dhan Vikas (I) scheme, which was to be terminated on 15-4-1998. After the termination of the scheme the complainant requested the OPs to return with formidable amount + interest with Bonus Units. On 29-9-93 he wrote a letter seeking payment of maturity amount. But the OPs till today have not repaid the amount. There is deficiency of service by the OPs and they are liable.

    3)[FONT=&quot] [/FONT]The OPs filed WS admitting that the complainant applied for the Dhan Vikas Scheme by investing Rs.5,000-00 under Certificate No.01382728. The scheme was converted as an open ended scheme as LIC MF Equity Fund- Growth plan. A paper notification was issued in the daily newspaper. A letter to the applicants was also made to opt either the dividend or the growth option. The complainant has not replied the same. So his earlier scheme was converted into LIC MF Equity fund growth plan. He has not invested any amount of Rs.5,000-00 in another scheme. As on 24-2-2009 the unit value was increased to Rs.13.5296 as against the issue price of Rs.10-00. The NAV (Net Asset Value) of the fund is market related and changes daily. Therefore the complainant is entitled for the value of the unit on which the market value of the unit depends. There is no deficiency of service by OPs. The OPs pray to dismiss the complaint with costs.

    4)[FONT=&quot] [/FONT]Both the parties have filed their affidavits. The complainant has got marked Ex.C-1 to C-10 and the OP Ex.R-1

    5)[FONT=&quot] [/FONT]The point that arises for our consideration is: “Whether there is deficiency of service on the part of the OPs?

    6)[FONT=&quot] [/FONT]It is the contention of the complainant that he invested Rs.5,000-00 + Rs.5,000-00 in the LIC Mutual Fund sponsored Dhana Vikas (I) scheme on 15-4-1993. The scheme is terminated on 15-4-1998. After the termination of the scheme the complainant demanded back the invested money with interest. But the OP till today has not paid the same. There is deficiency of service by the OPs and they are liable.

    7)[FONT=&quot] [/FONT]On the other hand the counsel for the OP vehemently urged that the complainant has invested only Rs.5000-00 but not Rs.10,000-00 in the LIC Mutual Fund sponsored Dhana Vikas (I) scheme which was later converted into LIC MF Equity Fund Growth Plan after giving paper publication and issuing notice to the applicants. The fact is within the knowledge of the complainant. The market value of the units changes every day. So, the complainant is entitled for the value of the unit on which the market value of the units depends. The complainant is not entitled for the claim amount. There is no deficiency of service by the OPs and they are not liable.

    8)[FONT=&quot] [/FONT]We have gone through the pleadings, affidavits and documents submitted by the parties. It is a fact that the complainant has invested Rs.5000-00 in LIC Mutual Fund sponsored Dhana Vikas (I) scheme in the year 1983. It is also a fact that the said scheme was converted into LIC MF Equity fund growth plan. The OPs contend that while converting this scheme it was published in the daily newspapers and intimation was sent to the applicants. But the records produced by the OPs are not sufficient to hold that any notice was issued to the complainant to show that the conversion of the scheme was intimated to the complainant. The complainant also has not taken any action since 1998. He has not denied the contention of the OP that the value of the unit depends upon the market value on every day. The (NAV) Net Asset Value of the fund is market related and changes daily. So, the complainant is entitled only for the value of the unit on the day he claims value of the Units under certificate No.T 0132728. Since the complainant has not substantiated the claim for another certificate it shall be rejected. So in our view if we allow the complaint directing the OPs to pay to the complainant the value of the units on the day the complainant seeks the refund. Since there is no record produced by the OPs that the scheme was converted into another scheme the OPs are liable to pay compensation of Rs.1,000-00 to the complainant with cost of Rs.500-00
    We pass the following order.
    ORDER
    [FONT=&quot] The complaint is allowed. The OPs are directed to pay to the complainant the value of the units under certificate No.T 0132728 on the day the complainant seeks refund and pay compensation of Rs.1,000-00 (Rs.One thousand only) and cost of Rs.500-00 (Rs. Five Hundred only). The other claim of the complainant is rejected. [/FONT]
Sign In or Register to comment.