Orissa

Kendujhar

39/2000

Kuntala Swain - Complainant(s)

Versus

1. Branch Manager, LIC of India - Opp.Party(s)

Sri D.K. Jena

30 Nov 2002

ORDER

IN THE COURT OF THE PRESIDENT: DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KENDUJHAR

C.D. CASE NO.39 OF 2000

                 Kuntala Swain, aged 27 years,

                 W/o: Late Lambodhar Swain,

                 Village: Dantia, P.O: Bhaluka,

                 Via: Sainkul, P.S: Ramachandrapur,

                 Dist: Keonjhar …………………………………………….Complainant

                                             Versus

            1. Branch Manager, LIC of India, Keonjhar Branch,

                 Dist: Keonjhar-758001

            2. Ananda Ch. Das, LIC Agent No.05858597/597,

                Office of Sainkul, P.O: Sainkul,

                P.S: Ramachandrapur, Dist: Keonjhar

                Home At/P.O: Madanpur, Via: Sainkul,

                P.S: Ramachandrapur, Dist: Keonjhar

            3. Manager Claims, Cuttack Division,

                Jeevan Prakash, Po. Box No.36,

                Cuttack-753001

            4. The Zonal Manager, LIC of India                  

                Eastern Zonal Office,

                4 C.R. Avenue Hindustan Building,

                Calcutta-71……………………………………………………Opp. Parties

 

                For the complainant- Sri D.K. Jena, Adv.

                For the Op. No.1,3 &4- Sri P.K. Patra, A.K. Das & T.K. Mohapatra, Advs.

                For the Op. No.2- Sri S.K. Rout, P.K. Mishra & A.N. Moharana, Advs.

 

Present- Sri B. Mishra, President

                Miss. P. Singh, Member

                Sri G.N. Jena, Member

_____________________________________________________________________________

Date of Hearing: 19.12.2001                                                                  Date of Order: 30.11.2002

Sri B. Mishra, President: The petitioner is the nominee of her deceased husband whose life was insured through policy No.580657218 for Rs.50,000/-. OP No.1, 3 &4 are the officers and OP No.2 is the agent of L.I.C. on 7.2.1998 the OP No.2 in the house of the petitioner made some paper and got it signed by the husband of the petitioner and he himself became the witness to the document and also received the installment amount from the husband of the petitioner in presence of her along with other family members. The insured on 21.2.98 became unconscious and was shifted to S.C.B. Medical College, Cuttack while under treatment died on 1.3.98 there. The OP No.2 when asked confessed to have not deposited the installment amount on the date it was signed but on 27.2.98 and also assured to help in getting the assured amount. That the OP No.1 & OP No.2 enquired into the claim and repudiated the same on the ground of deliberate mis-statement and with-holding of material information regarding health by the insured and intimated the same to the petitioner with a suggestion that in case of dis-satisfaction would write to the OP No.4.

        That the OP No.4 was accordingly intimated but none of the Opp. Parties took proper step to settle the claim of the petitioner and further stated that the revival form was signed on 7.2.1998 and till 21.2.98 the health condition of the deceased was not known and from 21.2.98 to 1.3.98 till death the deceased was unconscious (so deliberate mis-statement and with-holding of material information regarding health does not arise). It alleged that the complicacy have been created by willful negligence and for the personal benefit of OP No.2 to which the other OPs abetted has cause loss to the petitioner of Rs.55,518/- that the petitioner along with others 5 beneficiaries i.e. 4 minor girl child 60 years of old mother of deceased put to un-necessary harassment and mental agony of the collective deliberate wrongful and negligent act of the Opp. Parties and hence the complaint for compensation of Rs.55,000/- i.e. Rs.50,000/- for compensation and Rs.5000/- for cost of litigation from all the Opp. Parties who are jointly and severally liable.

           In support of the claim the petitioner filed documents which are copies of special premium receipt, receipt of 1^st premium, another receipt a letter addressed to the petitioner from manager claim L.I.C of India dtd.9.9.2000 regarding repudiation of death claim and another letter dtd.31.3.2000 addressed to the petitioner by Sr-Divisional Manager, L.I.C of India, the result of the enquiry and further suggestion, personal statement regarding the health of the deceased letters of L.I.C. dtd.2.9.99, 29.9.99 & 24.12.99 addressed to the petitioner in which asking for some documents from the petitioner, Copy of the proposal form, Advocate notice and replies of the L.I.C. to the advocates, A/D payment receipt of Rs.1339/- dtd.28.10.97 and Medical reports and Medical bills. To supports the case of the petitioner’s affidavits sworn by Bijay Kumar Swain of Dantia, Santosh Kumar Satpathy of Madhapur are filed.

            After service of notice OP No.1, 3 &4 filed joint version on 15.2.2001 and in Version denied the deficiency of service of these OPs but admitted of taking the L.I.C. Policy of Lambodar Swain for sum assured of Rs.50,000/- and acceptance of installment premium of Rs.1339/- in which the petitioner was the nominee and further stated that the policy was lapsed on March,1997 due to non-payment of half yearly premium and it was revived on 27.9.98 after receipt of arrear premium along with interest and admitted to have repudiated the claim of the petitioner on the ground that the deceased had made mis-statement and withheld material information about health before revival of the policies and the repudiation had been done after due application of mind and there is no deficiency in service, so the dispute be dismissed with costs.          

        In support of the contentions filed copies of personal statement regarding health of the insured letter of L.I.C. dtd.31.3.2000 & 11.4.2000 addressed to the petitioner (complainant also filed the above documents).

      The OP No.2 filed version on 31.5.2001, in version denied the allegations of the petitioner and further stated to have received the installment amount on 27.2.98 along with the proposal form but not on 7.2.1998 as alleged, also stated that this OP had never gone to the house of the petitioner, not prepared any papers and got it signed from the husband of the petitioner and received any installment amount from the insured in presence of the petitioner with other family members rather the deceased/ insured met this OP on 17.2.1998 at his village Madhapur and disclosed about to revive the lapse policy by claiming all the dues and so he supplied the D.G.H. from to the deceased/insured  and this OP became a witness after the signature of the deceased and came to know about the death of the insured through the Development Officer Mr. Jatindranath Rout denied to have known the petitioner except the insured. The deceased insured was a contractor by profession and was a literate man and could not cheated by this OP and there is no deficiency of service by this OP. The complaint is made against him to tarnish his image and business and so the complaint be dismissed with costs. In support two counter affidavits of this OP and one of Dhruba Charan Behera of Madhapur are filed.

       That the receipt of the premium/ amount of Rs.1339/- and the revival form regarding the health condition of deceased/ insured Lambodar Swain and the petitioner is the nominee of the insured and the insured expired on 1.3.98 at S.C.B. Medical College Hospital, Cuttack are not in dispute. The only dispute is the date on which the deceased/ insured put his signature on the revival/ personal statement regarding health.

       The petitioner claims that the O.P No.2 came to her house on 7.2.1998 and took signature of her husband Lambodar Swain on the papers and receipt premium/ installments in presence of herself and also other family members and on 27.2.1998 the deceased was not in a condition to sign the statement as he was unconscious and was undergoing treatment at S.C.B. Medical College Hospital, Cuttack and the O.P No.2 had falsely inserted the date in the form instead of 7.2.98 to cheat and harass this petitioner. On the other hand the other OPs except the O.P No.2 stated to have repudiated the claim on the reasons that the deceased had made mis-statement and withheld material information regarding the status of health. And the O.P No.2 had repeated that this OP became a witness in the personal statement regarding health of the deceased and received the installment amount on 27.2.98 not on 7.2.98 and the conditions of health of the deceased was good on 17.2.98.

      In support of the contentions of the petitioner an affidavit by one Sri Bijay Kumar Swain brother of the deceased Lambodar Swain filed and to support the contentions of the O.P No.2. Affidavits of Santosh Kumar Satpathy & Dhruba Charan Behera both of village of Madhapur and two affidavits of the O.P No.2 himself are filed.           

      From the material available on record and from the submissions of the counsels for the parties, it is not clear to ascertain the actual date when the statement was signed by the deceased and the installment/ premium of the revival of the lapsed policy was made. On perusal of record it is known that the statement of health was made on 27.2.98 and the premium amount of Rs.1339/- is received by the L.I.C. on 28.2.98. It is also not fully clear whether the deceased was able to sign or make any statement on 27.2.98.

       Und4er these circumstances, it would have been reasonable for the L.I.C. to have a detail enquiry about the allegations made by the petitioner against the O.P No.2, the agent for the L.I.C before repudiation of the claim. As neither party came with clear facts it is hard to assess and come to a specific finding in this regard. But it is evident that the L.I.C. has received the premium amount of Rs.1339/- on 28.2.98 for revival of the lapsed policy of deceased Lambodar Swain in which the petitioner is the nominee. It is not clear regarding the actual ailment for which the deceased had to be treated at S.C.B. Medical College Hospital, Cuttack whether it is the consequence of previous long ailment or sudden illness. Neither party led any positive evidence in this regard except the statement of the complainant that the deceased became unconscious on 21.2.98 and did not regain sense till his death. But this statement alone is not adequate enough to came to a definite conclusion in this regard.                

      Hence I am of the opinion that the complainant/ petitioner has failed to substantiate the allegations made against the OPs. However the L.I.C has received Rs.1339/- from the deceased for revival of the lapsed policy and has not returned the same to the complainant/ the nominee. So it will not be un-reasonable for a direction to the L.I.C to refund the premium amount to the petitioner with interest @12% per annum from the date of receipt of the premium dtd.28.2.2001 till final payment within 30 days of receipt of this order.

      Accordingly the case is disposed.   

 

     Orders pronounced in the open court today i.e. on 30^th day of November, 2002 under my hand and seal of this Forum.                       

 

           I agree                                                    I agree

      Sri G.N. Jena                                           Miss P. Singh                           Sri B. Mishra   

         Member                                                   Member                                 President

 

                                                                                      Dictated and Corrected by me.

                                                                                                     Sri B. Mishra   

                                                                                                        President

 

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION ODISHA, CUTTACK

C.D. APPEAL No. 613 OF 2003

(From an order dated 30/11/2002 passed by the District Consumer Disputes Redressal Forum, Keonjhar in C.D. Case No.39 of 2000)

 

                   Kuntala Swain

                   W/o: Late Lambodhar Swain,

                   Village: Dantia, P.O: Bhaluka,

                   Via: Sainkul, P.S: Ramachandrapur,

                   Dist: Keonjhar                              

                                                                                                                   .   .   .   Appellant

                                                   -Versus-

                   Divisional Manager,

                   Life Insurance Corporation of India Limited, Cuttack & Others

                                                                                                                  .   .   .   Respondent(s)

                    For the Appellant                         : M/s. P.K. Rout & Associates

                    For the Respondent nos.1 to 3    : M/s. S.K. Mohanty & Associates

                    For the Respondent nos.4            : M/s. B. Pujari & Associates

PRESENT:

                    THE HONORABLE SHRI JUSTICE R.K. PATRA, PRESIDENT

                                                                                         AND

                                                               SHRI SUBASH MAHTAB, MEMBER

 

O R D E R

DATE: THE 30^th DECEMBER, 2005

JUSTICE SHRI R.K. PATRA, PRESIDENT:

Being felt aggrieved by the order of the Keonjhar District Forum dismissing her complaint (except to refund of Rs.1,339/- with interest @ 12% per annum from 28/02/2001) the complainant has filed this appeal.

2. The case of the appellant is that she is the nominee of her deceased husband- Lambodhar Swain, whose life was insured for Rs.50,000/-. On 07/02/1998, the respondent No.4- Ananda Chandra Das, LIC agent came to their house, handed over certain papers and got them signed by her deceased husband. He also received the installment amount from her husband. On 21/02/1998, her husband became unconscious and was shifted to the S.C.B. Medical College & Hospital, Cuttack. While undergoing treatment there, he died on 01/03/1998. The respondent No.4- Ananda Chandra Das when asked as to whether he deposited the premium received by him admitted that he had not deposited it. This matter was brought to the notice of respondent Nos.1 &2, who instead of disbursing the assured amount repudiated the claim. Finding no other way, she filed the complaint.

3. The respondent Nos.1, 2 &3 (LIC officials) filed a joint written version denying the claim. They admit that the deceased Lambodhar Swain had taken a Life Insurance Policy of his own life vide Policy No.580657218. The date of commencement of the Policy was 28/03/1996 and the sum assured was Rs.50,000/-. The mode of payment of installment/ premium was half yearly at the rate of Rs.1339/-. Due to non-retirement of half yearly premium due in March, 1997 the Policy got lapsed. It was however revived on 27/02/1998 on the basis of a Personal Statement furnished by the life assured and on receipt of arrear premium from March, 1997 to September, 1997 along with interest. The Personal Statement was signed by the life assured himself on 27/02/1998. The allegation made in the complaint that respondent No.4- Ananda Chandra Das received the premium is denied. The further case of the contesting respondents is that life assured admittedly fell ill on 21/02/1998 and was shifted to S.C.B. Medical College& Hospital, Cuttack in a unconscious stage for treatment. He expired on 01/03/1998 while undergoing treatment there. The deceased is guilty of suppression of material fact in as much as when he furnished personal statement on 27/02/1998, he was ill and was undergoing treatment. Had this fact been disclosed or made known at the time of considering revival of the lapsed policy, the Corporation would not have accepted the risk of the deceased. Insurance contract is a contract of good faith and it is obligatory upon the insured to disclose all the facts truthfully for proper assessment of risk. The life assured failed to comply his part of obligation in not disclosing his ailment and treatment being undertaken by him during the days preceding the revival of the policy. As the life assured suppressed material facts, the nominee is not entitled to any benefit under the policy.

4. There is no dispute that the life of the deceased husband of the appellant was assured for Rs.50,000/- vide LIC Policy No.580657218. Its date of commencement was 28.06.1996. The installment premium was Rs.1339/-. The policy lapsed due to non-remittance of half yearly premium due in March, 1997. It was revived on 27/02/1998 on the basis of a personal statement made by the life assured and after payment of arrear premium from March, 1997 to September, 1997 along with interest. The life assured had signed the personal statement himself on 27/02/1998. It is also an admitted fact that he fell ill on 21/02/1998 and was unconscious when he was shifted to S.C.B. Medical College& Hospital, Cuttack for treatment. He expired on 01/03/1998 while undergoing treatment. From the above facts, there can be no doubt that the deceased got his policy revived while he was undergoing treatment at S.C.B. Medical College& Hospital, Cuttack. A personal statement was made by him on 27/02/1998, while he was undergoing treatment. We may profitably refer to the answer to the respective questions in the form of personal statement on the strength of which the policy of the deceased was revived for full sum assured furnished below:

                  Q. No.2       Since the date of your proposal for the

                                      above mentioned policy:-

                   a)                Have you suffered from any illness/

                                      disease requiring treatment for a week or more?                            No                   

                   b)                Have you had an electro cardiogram, X-ray or

                                       screening, Blood, Urine or Stool Examination?                              No

                  Q. No.4       Are you at present in sound health?                                                 Yes

To the query No.4, the deceased replied that he was in sound health, which did not reflect his actual state of health. He was already undergoing treatment at S.C.B. Medical College & Hospital, Cuttack for heart disease. Therefore there is valid ground for the LIC to say that had it been disclosed to them that his health was not sound, they would not have accepted his risk. It is a material piece of information. For its non-disclosure the policy becomes void.

5. For the reasons mentioned above, the repudiation of claim by the appellant being based on valid ground, we are not inclined to interfere with the order. As the policy has became void, the order of the District Forum directing the LIC authorities to refund to the appellant a sum of Rs.1339/- with interest thereon cannot be sustained in law, which is hereby set-aside.

6. In the result, the complainant filed by the appellant is dismissed being devoid of any merit. This appeal has thus no merit, which is hereby dismissed. No costs.

                                                                                                                                                                                             Sd/-

                                                                                                                                                                   Justice Shri R.K. Patra, President                                             

                                                                                                                                                                                             Sd/-

                                                                                                                                                                          Shri S. Mahtab, Member