Date of filing :-11/03/2016.

Date of Order:-26/10/2017.

DISTRICT CONSUMER DISPUTE REDRESSAL FORUM(COURT)

B A R G A R H

Consumer Complaint No. 12 of 2017

Mitu @ Jagendra Meher, aged about 34(thirty four) years S/o- Late Chaturbhuja Meher of Vill/Post/-Bandhapali, P.s./ Tahasil – Barpali Dist- Bargarh

..... ...... ..... ..... ..... Complainant.

V e r s u s

1. Branch Manager, Life Insurance Corporation of India, Bargarh Branch Po/P.s./Dist- Bargarh.

2. Divisional Manager, Life Insurance Corporation of India, Sambalpur Division, At-Jeevan Prakash, Ainthapali, Sambalpur, Po/Ps/Dist- Sambalpur.

1. Zonal Manager, Life Insurance Corporation of India East Central Zonal Office, At-Jeevan Deep, 6^th Floor, Exibition Road, Patna, Po/Ps/Dist- Patna -800001

   ..... ..... ..... .....Opposite Parties.

Counsel for the Parties.

For the Complainant:- Sri R.Panda, Advocate with other Advocates.

For the Opposite Parties :- Sri K.Pradhan, Advocate with other Advocates.

-: P R E S E N T :-

Sri Krishna Prasad Mishra ..... ..... ..... ..... ..... P r e s i d e n t.

Sri Pradeep Kumar Dash ..... ..... ..... ..... ..... M e m b e r.

Ajanta Subhadarsinee ..... ..... ..... ..... ..... M e m b e r(w).

Dt.26/10/2017 -: J U D G E M E N T :-

Presented by Sri K.P. Mishra, President:-

Brief fact of the Case-

In pursuance of the Section 12 of the Consumer Protection Act 1986 the Complainant has preffered to file this case against the Opposite Parties pertaining to the allegation of deficiencies of service and un-fair trade practice on the part of the Opposite Parties which is briefly narrated hereunder.

The case of the Complainant is that his wife namely Late Kunti Meher during her life time had insured her life by entering in to two policies with the office of the Opposite Parties vide Policy No-59363838, under 75(seventy five) table namely JEEVAN SATHI (Double Cover Joint Plan) of the L.I.Corporation for a sum assured amount of Rs.1,05,000/-(Rupees one lakh five thousand)only on Dt.13.07.2009, for which she has paid an amount of Rs.1,702/-(Rupees one thousand seven hundred two)only in quarterly mode, and another Policy vide Policy No-593638485 under the 89(eighty nine) table of the said corporation against which she has paid an amount of Rs.3,780/-(Rupees three thousand seven hundred eighty)only in quarterly mode on Dt.17.07.2009 for a sum assured amount of Rs. 2,00,000/-(Rupees two lakhs) for a period of 20(twenty) years and 15(fifteen) years respectively. But during the subsistence of the said policies she died on Dt.28.07.2009 leaving behind her, her husband the Complainant who was also the nominee in her both aforesaid policies.

In consequence whereof the Complainant claimed for the sum assured amount of both the said policies of his wife before the office of the Opposite Party No.1(one) but it did not take any step for such payment for a long time, and after several reminder on Dt.01.03.2013 the Opposite Party No.1(one) asked to submit several documents to which he complied with all wanting document thereafter the Opposite Party No.1(one) reffered the claim to the Opposite Party No.2(two) for consideration, but even after complying with required documents of the same the said Opposite Party No.2(two) did not take any steps for the payment of the claim, and ultimately on Dt.14.06.2016 repudiated the same claim and informed about the same to the Complainant. So seeing no other alternative the Complainant appealed before the Opposite Party No.3(three) on Dt.01.11.2016 but there also, he did not get any response thereby causing him with much mental and physical stress and agony in consequence upon which the cause of action arose and has filed the present case before the Forum with a prayer to issue a direction to the Opposite Parties for payments of all the sum assured amount of both the afore said policies with a compensatory amount of Rs. 50,000/- (Rupees fifty thousand)only for his mental and physical harassment, in total amounting to Rs.3,55,000/-(Rupees three lakh fifty five thousand)only along with litigation expenses. And to substantiate his such Claim has relied upon some documents as mentioned below.

1. Xerox copy of L.I.C. Bond vide Policy No.593638485.

2. Xerox Copy of receipt of premium bearing No-1257386 Dt-17.07.2009.

3. Xerox Copy of L.I.C.Bond No.5936388381.

4. Xerox Copy of Premium Receipt No.1330435.

5. Original Letter of repudiation by the Opposite Party No.1 to the Complainant.

6. Copy of Appeal sent by the Complainant to L.I.C East central Zonal office .

7. Postal receipt.

8. Computerized Copy of acknowledgment.

And later on at the time of final hearing of the case, the Complainant submitted some documents along with his written arguments through his Advocate.

9. Certified Copy of F.I.R and the copy of the police case.

10. Certified copy of postmortem report.

11. Certified copy of the deposition of Dr.D.P.Sahu in C.T.R Case No. 42/2017.

12. Xerox copy of Letter Dt.02.03.2013 sent to him by the L.I.C Bargarh Branch.

13. Xerox copy of replay of Jagendra Meher to B.M., L.I.C.Bargarh

    along with some noteable decision.

     

Heard the Advocate for the Complainant and verified the documents filed by him which seemed to be genuine one hence the case was admitted and notice was served on the Opposite Parties and on being noticed the Opposite Parties appeared and filed their version. And on going through their version the same were in all total evasive to the case of the Complainant excepting the facts of the commencement of the said insurance policies of the deceased wife of the Complainant.

In the version of the Opposite Parties has claimed the repudiation of the claim of the Complainant as justified on the sole ground that the since the death of the deceased has occurred within a very short time from the commencement of the policies and in furtherance to their averments in support of the repudiation they have alleged that the claim of the sum assured amount is barred by limitation further more they have contended that since a case of dowry torture has been initiated in the name of the Complainant and during it’s investigation it was found that the deceased has suppressed some materials fact at the time of the query made by the Opposite Party’s agency to know as to whether the life assured was suffering from any prolonged illness or any thing of that sort but later on it was found from the statements of her father before the court of sessions judge that she was suffering from some prolonged weakness and others as such the policy condition has been violated hence it’s repudiation of the claim is justified. And Later on the Advocate for the Opposite Parties filed his written arguments along with decision of some Higher Courts.

At the time of final hearing of the case vehemently presented their respective cases with their respective pleas in their support.

On going through all the material available in the record and hearing the respective counsels of both the Parties it came to our notice that the case rests on the following points of determination for proper adjudication of the same.

1. Whether the is claim is barred by limitation ?

2. Whether there is any suppression of material fact by the insured while entered in to the policies with the Opposite Party ?

3. Whether there is any deficiencies in service on the part of the Opposite Party ?

4. Whether the complainant is entitled to the claim made by him ?

Having gone through the Complaint, version and other materials available in the record and delving deep in to the same and on hearing very care fully the submission advanced by both the concerned learned counsels of the respective parties we would like to examine the points for determination individually.

So while examining the 1^st points for determination we referred all the materials available before us and found that after the death of the deceased the Complainant has claimed for the sum assured amount before the Opposite Party No.1(one) but he has not responded immediately to the said claim till Dt.02.03.2013 when it has sent a letter vide Ref;Bgh/claims/pk to the Complainant with reference to the said policies of the deceased wherein it has stated that he is sending herewith claim form requesting the Complainant to return the same by filling up with all the required information, to which the Complainant has complied with, then again it reveals from the record that ultimately the Opposite Parties have sent an information to the Complainant in the month of February-2016 repudiating his such claims with several grounds, besides that there is no mention of any denial statement in either of any documents or in it’s version to show that the claim has been made by the Complainant beyond the period of limitation, also it reveals from the record that the claim was duly filed in time otherwise the Opposite Party No.1(one) could have raised the same in it’s letter Dt.02.03.2013, so for the purpose of limitation in filing the claim in our view, the claim has been duly filed within the time further more so far as the filing of the case in hand before the forum the same has been filed within two years from the final date of repudiation of the claim by the Opposite Parties, hence our views regarding the point of limitation in filing the Claims is answered affirmatively in favor of the Complainant, which of our such views has been fortified by the Honourable Apex Court of the Country vide it’s judgment Civil Appeal No-15611 of 2017. Wherein their lordship have held that The Consumer Protection Act aims at providing better protection of the interest of consumer and it is a legislation that deserves Liberal Construction. This loudable object should not be forgotten while considering the claims made under the Act and have opined that the Insurance claim can not be rejected for mere delay in intimating insurer. And the Decision cited by the Advocate for the O.Ps Reported in A.I.R.1989 by Allahabad High Court,another of the same High Court reported in A.I.R.1989 is not similar to the case in Hand as such are not applicable . Accordingly it is answered affirmatively in support of the Complainant.

Secondly while considering the points of determination with regard to the allegation as to whether there is any suppression of materials fact by the deceased at the time of commencement of the said policies, with utmost care and most attentively examined all the relevant documents available in the record and the submission of the counsels of both the parties, wherein it came to our observation that the Advocate for the Opposite Parties have put much emphasis on the query portion of the policy bond wherein some material question have been put to the deceased wife of the Complainant and in her reply she has denied, and also has referred a criminal case which was registered against the Complainant U/S.498-A, 304-B,/34 I.P.C in the Court of Asst Sessions Judge Bargarh vide C.T.Case No.42 of 2012 wherein the opinion of a doctor who has opined that the deceased was suffering from general weakness, further they have relied on the statement of the Complainant where he has stated that prior to her death she was suffering from prolonged illness, And on the contrary the Complainant through his Advocate has submitted before the Forum that both Life Insurance Proposal form and Life Insurance Bond are two different materials. And submitted that Life Insurance proposal form is unilaterally signed by the proposer only the acceptance of the same is subject to the verification and ascertainment of the same is the liability of the insurer, and once it is accepted can not be questioned later on as per the Section 45 of the Insurance Act, on the ground of mis–statement unless it shows that such statement was on a material matter. And while the policies were accepted by the Opposite Party should have ascertained the factual aspects of the statement of the deceased if at all any mis-statement were made, which they have not done so, as such in a stage of payments the question of such plea is not tenable, In this regard the Complainant has relied on a decision of our own High Court reported in OLR 2010(1)534 which is a compilation of number of decision of different higher courts expressing their same views in different cases, supporting his case. And along with those the complainant has also filed the certified copy of the Judgment of the Asst Sessions Judge, Bargarh wherein the Accused/Complainant has been acquitted, the certified copy of the statements of the witness, and also has filed the postmortem report to prove that there is no nexus between the death of the deceased and her illness rather she has died of some fever and diarrhea. So on close scrutiny of all the materials available with us in the record it clearly reveals that there is no nexus between the cause of death of the deceased and the suppression of materials facts as alleged in the cause of repudiation of the claim of the Complainant, and also the decision cited by the complainant is squarely applicable in this case,where as the decision filed by the Advocate for the opposite Parties reported in A.I.R 1974 of Mysore with regard to the mis-statement or suppression of material facts are not similar to the present case. Hence our views is expressed in affirmative in favor of the Complainant.

Thirdly while considering the points of determination with regard to question as to whether there is any deficiencies in rendering service to the Complainant. In this regard as we have already expressed our views in the foregoing paragraphs expressing affirmatively in favor of the Complainant, in our judicious view the aforesaid narration of the activities in dealing with the case of the Complainant and ultimately repudiating his claim, amounts to deficiencies of service on the part of the Opposite Parties, hence our view is expressed unanimously in favor of the Complainant.

While considering the question of the entitlement of the claim amount by the Complainant, as it is already decided that the Opposite Parties have committed deficiencies in giving service to the complainant by repudiating his claim, it is obvious that the Complainant is entitled to the claim amount for which all the Opposite parties are jointly and severally liable,accordingly our views is expressed in favor of the Complainant. Hence order follows .

O R D E R

Hence the Opposite Parties are directed jointly and severally to pay an amount of Rs.3,05,000/-(Rupees three lakhs five thousand)only in total against the Policy No-593638381 for an amount of Rs.1,05,000/-(Rupees one lakh five thousand)only and Rs.2,00,000/-(Rupees two lakhs)only against Policy No-593638485 with interest @ of 6%(six percent) per annum to the Complainant and to pay him Rs.5,000/-(Rupees five thousand)only against compensation for mental and physical harassment caused to him, from the date of filing of the case till the date of this Order, within thirty days of receipt of the order, in default of which the total amount would accrue an interest @ of 9% (nine percent) per annum from the date of filing of the case till the actual date of realization of the total amount.

Accordingly the complaint is allowed against the Opposite Parties and disposed off to-day i.e. on Date.26.10.2017.

Typed to my dictation

and corrected by me.

 (Sri Krishna Prasad Mishra)

          P r e s i d e n t.

                   I agree,                                        I agree,

        (Ajanta Subhadarsinee)            (Sri Pradeep Kumar Dash)

                   M e m b e r.                                M e m b e r.