West Bengal

Birbhum

CC/19/2016

Sri Chanchal Gope, S/O M.Gope - Complainant(s)

Versus

Branch Manager, L.I.C.I, Suri Branch - Opp.Party(s)

Gopinath Mukherjee

08 May 2018

ORDER

Dr. Soumen Sikder_Member

The petitioner filed a complaint against the Br. Manager, LICI, Suri Branch and others stating that Sudhakar Gope, elder brother of the petitioner had two policies on his life. Later he took another two policies of sum assured Rs. 1 lakh each on 28.07.2012 and 31.07.2012. The insured died on 05.02.2014. After demise of the policy holder the nominee of the 1^st two policies received the sum assured money. In case of the last two policies the petitioner being nominee of the policies applied for sum assured money. The O.P Insurance Co. repudiated the claim. Being aggrieved the petitioner has come to the Forum.

O.P No. 1 and 2 appeared and contested against the complaint through Ld. Advocate. They filed written version stating that the insured suppressed the material facts at the time of filling up the proposal form. Insurance is a contract between the insured and insurer on good faith. As the insured violated the terms and conditions of the policy the claim of the policy has been repudiated and if the petitioner is aggrieved he may appeal before the Ombudsman.

O.P No.3 the agent of the O.P No. 1 and 2 has been expunged through amendment of the cause title of the complaint vide order No. 6 dated 17.06.2016.

Both parties have filed certain copies of documents in support of their complaint and written version. The petitioner examined himself as PW by filing evidence in chief on affidavit, he was also cross examined. Both parties filed written arguments.

Upon pleading of the parties the following points are to be considered for discussion.

Points

1. Whether the petitioner is a consumer or not?
2. Whether there is deficiency in service on the part of the O.Ps?
3. Is complainant entitled to get relief as prayed for?

 

Decision with reasons

Point No.1:: Sudhakar Gope, the insured took two life insurance Jeevan Saral policies vide No. 448692070 and 4486922300 under O.Ps No. 1 and 2 on 28.07.2012 and 31.07.2012 respectively. The insured nominated Chanchal Gope, brother of the insured as nominee (as per copy of the policy certificate). The insured died on 05.02.2014 (as per death certificate issued by the doctor, Suri Sadar Hospital). Before his death the insured paid policies premium regularly. After death of the insured the petitioner being nominee of these policies filed claim form with relevant documents. As the nominee, Chanchal Gope is a beneficiary of the policy he is consumer under the Consumer Protection Act, 1986.

Point No.2:: Admittedly the insured had two Jeevan Saral policies under the O.Ps. It is also admitted that the nominee of the policies applied for claim of sum assured money with requisites properly. But O.P No. 1 and 2 repudiated the claim on the ground that the insured did not mention the number of two previous policies taken before policies in question at the time of filling up of the proposal forms of policy No. 448692070 and No. 4486922300. It is suppression of fact. The insurance is a contract based on good faith, any suppression of fact or misrepresentation of fact is caused of repudiation. (repudiation letter No. B DO/claims/repudiation/461/AAO dated 20.07.2015).

            The Forum goes through the copies of the proposal forms submitted by O.P No. 1 and 2. There is some observation mentioned below.

1. Who has filled up the proposal forms? Apparently it reveals that the insured did not fill up. The insured had signed on proposal forms in Bengali and the signature shows that he was mere a literate, that means, he could only sign in any way in Bengali. No doubt, he neither knew English nor Hindi. He was a layman lived in remote village. In this case there is a provision mentioned on the last page of the proposal form where the proposer gives declaration – I certify that the contains of the form and documents have been fully explained to me by (name, designation, occupation) Mr. /Mrs. …. and I have understood the significance of the proposed contract. Signature of thumb impression of the person whose life is proposed to be assured…

There is no name, designation, occupation in this column.

            Have any signature on the column where states that I hereby declare that I have fully explained the above questions to the proposer and I have truthfully recorded the answer given by the proposer? The answer is ‘no’.

Moreover, in the column of “I hereby declare that I have explained the contents at these form to the proposer in …. (Language) and that the proposer has affixed the thumb impression above after fully understanding the contents thereof.

Is there any signature of the declarant? The answer is ‘no’. So, it can be presumed that the contents at these form has not been explained to the proposer. The Agent filled up the form without taking any answer from the proposer. He did it as he thought fit.

 

2. How the O.Ps have passed and issued the policy certificate based on the incomplete proposal form, where the proposer was a layman living in remote village having no knowledge in English or in Hindi. He was a petty businessman.
3. The O.P Company prints the proposal forms in English and Hindi, why not in regional language. Life Insurance Corporation of India is a service rendering benevolent institution for the citizen of India. So, when LICI performs a contract between the insured why he doesn’t explain the contents and terms and conditions in regional language for common people of that region.
4. Most of the cases the agents of the Insurance Co. like LICI fill up the proposal forms on their own handwriting as and when they think for increasing their number of policies given target by the O.Ps. They only direct the proposer to sign on the Forms and it has been done. Circumstantial evidence proves that the present case has been passed following such practice.

In this way thousands of family of the policy holders being layman, illiterate and half-literate are being deprived from their legitimate claims for the acts of the Agent. The main objective of Insurance Co. is violated.

5. The Authority has passed the incomplete proposal forms without verifying it. May be a layman has no knowledge of reading such terms and conditions laid down in the form in languages other than regional language. It is the duty of the Agent to clarify the contents to be filled up, and to explain the terms and conditions. Did the agent do so in this case? If he did why there is no signature of the declarant. Whose deficiency arises in this regard?
6. There is also a liability of the Authority to check up the proposal form before executing it into a contract. The Contract Act says if there is any ambiguity or incomplete proposal and acceptance then there is no contract. In such situation how the Authority has issued policy certificate without making a valid contract, how the Authority has taken several premiums on these policies year after year. (premium receipts No. A4683474, A1650854, A4973259 of policy No. 448692070 and 448692300 in the name of the deceased Sudhakar Gope).
7. Law of Agency under Indian Contract Act 1872 says that if an Agent makes contract with third party by false statement or fraudulently in that case the principal is to be liable for such kind of act of the Agent. Agent and Principal is treated as identical person, not different person. (Sec.238).

Ld. Advocate for the O.Ps has cited some rulings relating to suppression of facts and ignorance of terms and conditions of the policy. But in this case the main point is that the O.P did not read over and explain the contents, term and conditions of the proposal form of the policy to the policy holder. The Forum thinks that the cited ruling by the O.Ps are not relevant to this case.

From the above discussion the Forum has observed that O.P No.1 and 2 have deficiency in service. They cannot repudiate the claim on the ground of suppression of facts by the insured. Rather the O.Ps No. 1 and 2 and their Agent make the policies with incomplete proposal form avoiding terms and

conditions for their personal gain.

Point No.3:: The petitioner is entitled to get the claim. The O.Ps are liable to pay the sum assured of said

two policies along with other benefits as per terms and conditions. They are also liable to pay 8% interest on the amount payable to the petitioner/nominee for the period from 05.02.2014 to the date of actual payment.

Proper fees have been paid.

Hence,

O R D E R E D

                                                that C.F case No. 19/2016 be and the same is allowed on contest against the O.Ps No.1 and 2 with a cost of Rs. 5000/-.

The O.Ps No. 1and 2 are jointly and severally directed to pay the sum assured of policy No. 448692070 and 448692300 along with other benefits as per terms and conditions of the polices. They are also directed to pay 8% P.A interest on the amount payable to the petitioner for the period from 05.02.2014 to the date of actual payment to the complainant.

The payments shall be made to the complainant within one month from the date of this order failing which the complainant shall be at liberty to execute the order as per law and procedure.

            Copy of this order be supplied to the parties each free of cost.