Fact of the case of the Complainant in short is that Gopa Mukherjee since deceased wife of Complainant purchased a LIC policy bearing no.468874286 sum assured amounting to Rs.1,25,000/-; on 10-08-2010 through  O.P. no.3 agent of O.P. no.1 & 2 and she has paid three (3) premiums  in respect of said policy.

The wife of the Complainant also purchased several LICI Policies in different times from O.P. no.1 & 2.

On 03-09-2011 Gopa Mukherjee policy holder died and the fact of death along with Death Certificate was intimated to the O.P. / LICI and this O.P. / LICI met the demand of LIC in respect of other policies by paying sum assured in said LIC policies but; repudiated the claim in respect of the case policy.  Thereafter, this Complainant being husband as well as nominee of the case policy made prayer to the higher authority of the LICI but they have not met the demand of the case LIC policy.

So, this Complainant has filed this complaint and has made prayer for passing order directing O.P. / LICI to pay the sum assured amounting to Rs.1,25,000/- along with interest @ 18% p.a. and also made further prayer to pay compensation amounting to Rs.50,000/- for physical and mental agony of the Complainant and also made further prayer to award

Rs.20,000/- as Cost of Litigation.

The case is being contested by O.P. no.1 & 2 LIC Company by filing W.V. denying all allegations as made in the petition of complaint contending inter alia that the case is not maintainable, Complainant has no cause of action.

Specific ca se of defence of O.Ps. is inter alia that there was a suppression of fact in the proposal form about the existing of several earlier policies in the name of the Complainant as well as in the name of Gopa Mukherjee since deceased case LIC policy holder.  Moreover, sum assured in the case policy stands in the name of Gopa Mukherjee, wife of Complainant is exceeded the sum assured in the LIC policies stands in the name of Complainant husband of Gopa Mukherjee.  So, as per law Complainant is not entitled to any sum assured in case LIC Policy.  As such, this Complainant is not entitled to any relief.  So, this complaint is liable to be dismissed.

In this case following documents have been marked as exhibit for the Complainant.

1)  Xerox Copy of Certificate of Death marked as exhibit – 1.

2)  Xerox Copy of L.I.C.I. Policy marked as exhibit – 2.

3)  Xerox Copy of Receipt marked as exhibit – 3.

4)  Xerox Copy of letter given to Complainant marked as exhibit – 4.

5)  Xerox Copy of another letter given to Complainant marked as exhibit – 5.

6)  Xerox Copy of another letter given to Complainant marked as exhibit – 6.

7)  Xerox Copy of another letter given to Complainant by Zonal Manager marked as

      exhibit – 7.

8)  Xerox Copy of another letter given by Sr. Divisional Manager to Complainant

      marked as exhibit – 8.

The following documents have also been admitted in to evidence for O.P. No.1 & 2 :-

1)  Xerox Copy of Proposal Form along with marked as  – Exhibit – A

2)  Xerox Copy of Policy details of Complainant marked as – Exhibit – B series.

                                                    Points for Determination.

1)  Is the case maintainable ?

2)  Whether there was any unfair trade practice made by the O.P./ LICI.

 3)  Whether there was any deficiency in service in the matter of payment of sum assured in

      case LIC Policy.

4)  whether non discloser of previous policies of Gopa Mukherjee, case LIC policy holder while obtaining ca se policy was fatal towards admissibility of claim of case policy ?

5)  Is the Complainant entitled to any relief as prayed for ?

                                                       Decision with reasons.

Ld. Advocate for the Complainant argued inter alia that the Gopa Mukherjee since deceased, case policy holder had taken the case policies through agent of the LIC  / O.Ps. no. 1 & 2, disclosing all materials facts as instructed by the agent of O.Ps. / LIC, in the proposal form and the policy holder had paid three premiums of the case policies.  Proposal form was filled in by the agent of O.P. no.1 & 2.

Policy holder Gopa Mukherjee died on 13-09-2011 and the fact of Death was also intimated to the O.P. / LIC and this Complainant being the husband as well as nominee of the case LIC policy submitted claim to the O.P. LIC ; but O.P. LIC repudiated the claim in respect of sum assured in the case policy.  So, this Complainant has filed this case and prayed for relief as stated in the petition of complaint.

Ld. Advocate for the Complainant further argued that this O.P. has paid the sum assured in respect of other LIC policies taken by Gopa Mukherjee LIC policy holder of case policy.

Ld. Advocate for the Complainant further argued that claim of this applicant was repudiated by O.Ps. on flimsy ground, illegally.  So, he prays for relief as stated in the petition of complaint.

Ld. Advocate for the O.P. no.1 & 2 LIC, argued inter alia that the Gopa Mukherjee since deceased policy holder did not disclose the factum of obtaining her previous LIC Policies while filling the proposal form for obtaining the case policies.

Ld. Advocate for the O.Ps. LIC further argued that this Complainant also purchased LIC policy and sum assured in the policies of the Complainant who is husband of Gopa Mukherjee case LIC policy holder are more than the sum assured in the LIC policies of Complainant.  So, repudiation of the claim of the case LIC policies is not illegal and

Complainant is not entitled to any relief for non discloser of material fact in proposal form,

at the time of the taking of the case policy.  So, this case will be dismissed.

We have carefully heard the submissions made by the Ld. Advocate for the both sides.  Perused the written argument submitted by Ld. Advocate for the O.P. LIC.

We have also examined the material available in the case record and the document admitted in to evidence and the decision referred by Ld. Advocate for the both sides.

It appears that it is undisputed that the Gopa Mukherjee since deceased was holder case LIC policy, she also purchased several LIC policies previous to the case LIC policy.  As per case of the LIC that the Gopa Mukherjee had not disclosed the factum of obtaining previous LIC policies while filing the proposal form for obtaining the policy i.e. the case policy.

Exhibit – 1 is the certificate of death of Gopa Mukherjee.  Gopa Mukherjee who was the policy holder of the case policy who died on 13-09-2011.  It is also undisputed that this Complainant is the husband of Gopa Mukherjee.

Exhibit – 2 is the photocopy of case LIC policy it proves that case policy has taken for sum assured to the tune of Rs.1,25,000/-.

It is not disputed that at the time of Death case LIC policy was in force i.e. not lapsed.

Exhibit – 3 is the Xerox copy of receipt about payment of premium of case LIC policy.

Exhibit – 6 is the letter given to this Complainant informing him about repudiation of his claim towards case policy as per letter exhibit - 6 para – 3 that the claim of the case policies was repudiated on the ground inter alia that the Gopa Mukherjee LIC policy holder made incorrect statement and withheld correct information regarding her previous insurance at the time of effecting the assurance.  As such, in terms of the policy contract and the declaration contend in the Form of Proposal for assurance was repudiated.  Exhibit – A is the Xerox copy of proposal form and as per Exhibit – A only existing of one previous policy was disclosed. 

So, we find from exhibit – 6 that Gopa Mukherjee, policy holder made incorrect statement and withheld correct information regarding her previous insurance policy, as such the claim made by Complainant in respect of case LIC policy was repudiated.

So, we find that the claim of the Complainant was repudiated only on the ground that factum of the obtaining previous policies was not disclosed ; but Ld. Advocate argued that the sum assured in the policies of the Gopa Mukherjee was more than the sum assured in the LIC policies of the Complainant / husband of Gopa Mukherjee.  So, Complainant is not entitled to any claim ; so we find that the case policy was not repudiated on the ground that the sum assured of the policy of Gopa Mukherjee  was more than that sum assured in the LIC policies of the husband of the Gopa Mukherjee.  So, reasons for repudiation of case LIC policy was only for withholding factum of previous LIC policy in proposal form by Gopa Mukherjee.  Moreover, there is nothing in proposal form baring  Gopa / wife to take LIC policy, more than that sum assured in LIC Policy of husband.

So, argument advanced by the Ld. Advocate for the O.P. about the sum assured in the LIC policies of Gopa Mukherjee more than that the sum assured in the policy of her husband is beyond pleadings and not acceptable.

In the present case it is undisputed that Gopa Mukherjee did not disclose about the factum of her previous LIC policies while she obtained case policy.  In this regard Ld. Advocate for the O.P. referred 2008(WBLR) (SC) page 573.

It appears to us that as per argument advanced by the Ld. Advocate for the Complainant that the Gopa Mukherjee took all her LIC policies through agent of O.P. no.1 & 2 under O.P. no.1’s office.  So, factum of the previous policies of Gopa Mukherjee was very much within the knowledge of the LIC O.Ps. as records of all LIC policies including previous policies  of Gopa Mukherjee were  in the office of O.Ps. no.1 & 2.

We also find that it was the duty of the LIC to check their own record before taking a decision to issue further policies to any applicant as we find that the all records regarding obtaining previous policies of any applicant were in the record, maintained in the office of the O.P. LIC.

It also appears to us that at the time of issuing policies the insurance company took a very liberal approach and did not care to examine the proposal properly.  There was no evidence to prove that case LIC policy holder was told that she had to disclose factum of obtaining her all previous policies, otherwise her case policy would not be accepted and claim might be repudiated.

If said fact was brought to the knowledge of Gopa Mukherjee at the time of filling proposal form, then she would not take the case LIC policy.

Moreover, O.P. no.1 & 2 issued the case LIC policy in favour of Gopa Mukherjee, without checking its own record maintained in their office about existing of previous LIC policy of Gopa Mukherjee.

So, O.P. no.1 & 2 also did not discharge their duty in this regard, carefully, while they accepted the proposal form and issued case LIC policy to Gopa Mukherjee.

So, O.P. no.1 & 2 are estopped from taking plea about obtaining of previous policy of Gopa Mukherjee and to repudiate the claim made by Complainant in respect of case LIC policy.

We have sufficient reason to believe that O.P. no. 1 & 2. have taken said plea only to absolve themselves from praying the claim of case LIC policy to Complainant.

It has been observed by the Hon’ble State Commission reported in 2016(4) CPR page 523 (NC) inter alia that “Consumer Protection Act, 1986 – Sections 15, 17, 19 and 21 – Insurance – Death claim – LIC settled claim under one policy only – LIC refused to pay death  claim for remaining policies on ground that deceased had not disclosed factum of obtaining first policy while filling proposal form for obtaining subsequent policies – State Commission reduced amount of compensation from Rs.1 Lakh to Rs.10,000/- - Direction to pay sum of Rs.16 Lakhs under the policies was kept intact – All policies had been taken through one agent only and factum of obtaining previous policy was very much in knowledge of LIC – It was duty of LIC to check their own record before taking a decision to issue further policies to applicant – It has not been shown anywhere that deceased was suffering from any disease – There is no question of concealment of any material information about status of health of deceased – Order passed by State Commission does not suffer from any infirmity, illegality or jurisdictional error – Revision petition dismissed.”

It has also been observed by the Hon’ble National Commission reported in 2016(4) CPR page 33 (NC) inter alia that “ It is the duty of insurance company to have verified information given in proposal form by obtaining suitable expert opinion”.

In the present case exhibit – A is the proposal form.  As per proposal form one policy obtained previously was disclosed by Gopa Mukherjee in this form.

There is nothing on record to show that the O.P. LIC checked their own record before taking decision to issue further policies i.e. case policy to Gopa Mukherjee.  So, we find that this LIC Corporation O.P. has failed to perform their duty to get the information given in proposal form verified before issuing case policy.

It also appears from the submissions made by the Ld. Advocate for the O.Ps. as well as the Complainant that the claim made by this Complainant in respect of other policies  issued in favour of Gopa Mukherjee have been allowed and sum assured have been paid.

So in view of the above facts & circumstances and discussing made above and in view of observation of the Hon’ble National Commission reported in 2016(4) CPR page 523(NC) that this Complainant is entitled to get the sum assured in the case policy bearing no.468874286 stands in the name of Gopa Mukherjee since deceased and the repudiation

of the claim made by the O.P. no.1 & 2 in respect of the case policy is  illegal, arbitrary and not according to law.

The fact of the decision referred by the Ld. Advocate for the O.P. LIC is not identical to the fact of this case in hand.  So, the decision referred by the Ld. Advocate for the O.P. will not come to aid him in this case.

In view of the above facts and circumstances and discussion made above we hold that Complainant is entitled to relief as prayed for in the matter of payment of sun assured in case LIC policy.

Considering the other facts and circumstances we find that if Rs.5,000/- is awarded for physical and mental agony and harassment of Complainant and if Rs.3,000/- is awarded towards litigation cost to Complainant then none would be prejudiced.

So, we find that both the O.Ps. no.1 & 2 are jointly & severally liable to pay the assured amount of case LIC Policy.

Complaint case is liable to be dismissed against O.P. no.3 (LIC Agent) as no relief has been prayed  against him.

Hence, it is

                                                                                 Ordered

That the Complaint Case no.113 of 2014 be and same is hereby allowed on contest against the O.P. no.1 and 2 and dismissed exparte against O.P. no.3. / LIC agent.

O.P. no.1 & 2 are hereby directed to pay the sum assured to the tune of Rs.1,25,000/- in respect of case LIC policy bearing no.468874286, to Complainant / nominee of the policy holder Gopa Mukherjee by sixty days from the date of receipt of copy of this Judgement ; failing which it will carry simple interest @ 8% p.a. from the date of expiry of sixty days from the date of receipt of copy of Judgement till it’s full realization.

O.P. 1 & 2 are also further directed to pay Rs.5,000/- as physical and mental agony and harassment of Complainant and Rs.3,000/- as cost of litigation by sixty days from the date of receipt of copy of Judgement.

If the O.P. no.1 & 2 fail to pay the amount awarded above by the stipulated period mentioned above then Complainant is at liberty to realize the same with due course of law.

Let a plain copy of Judgment be given to the both sides free of cost.