1. This is a case of deficiency of service of the Life Insurance Corporation of India (hereinafter ‘LICI’ for short) as alleged by the legal heir of Deceased Life Assured (hereinafter ‘DLA’ for short) for delaying settlement of insurance claim without any basis.
2. Backdrop of the case, in brief, is that Sri Partha Pratim Nath (hereinafter referred to as ‘the complainant’), son of the DLA Late Birendra Kumar Nath, filed an application under Section 12 of the Consumer Protection Act, 1986 (hereinafter ‘the Act’ for short) stating inter alia that the DLA during his lifetime obtained one policy viz. No. 483372156 covering Rs. 1,08,000/- as sum assured from LICI (hereinafter referred to as ‘the opposite party’). That the DLA having died on 30/01/2007, the complainant, along with all supporting documents, has been approaching the opposite party time and again for settlement of the death claim, but getting no positive response the complainant preferred an application before the Insurance Ombudsman. By final order dated 25/08/2011 the Insurance Ombudsman directed the opposite party to settle the claim within 15 days from the date of receipt of the said order. Even then claim having not been settled the complainant has sought for redressal of his grievances along with costs of litigation and compensation towards financial loss, physical sufferings and mental pain etc.
3. On referring the complaint the opposite party in its written version of the case, admitting the fact that the DLA had obtained Insurance Policy bearing No. 483372156 covering Rs. 1,08,000/- as sum assured from the opposite party denying all averments of allegations made in the complaint, stated that the DLA was an employee in the Office of the Joint Director of Health Services, Nagaon, where from obtaining a certificate bearing No. 10073 dated 12/09/2011 the opposite party could come to know the date of birth of DLA as 01/03/1934 and he retired from his service on 29/02/1992, but concealing the real state of affairs the DLA got his date of birth recorded as 11/03/1959 in the format of the proposal for the Insurance coverage. That the matter having been referred to the Insurance Ombudsman, by letter dated 25/11/2011 the opposite party was allowed to collect undisputable evidence as regards concealment of material facts and to take appropriate decision within the frame work of the Rules to settle the case. That based on the guidelines communicated by the said letter dated 25/11/2011 opposite party deciding to refund entire premiums so subscribed by the DLA, in termination of the policy contract, supplied a copy of discharge voucher to the claimant to fill it up; but he has not responded to the discharge voucher till the submission of version of the case.
4. In consideration of the pleadings of the parties our discussions and decisions are confined to the following issues:
I S S U E S
(1) Whether the DLA had ever suppressed/ concealed the fact of his age at the time of submitting proposal for obtaining insurance coverage in question?
(2) Whether there is deficiency of service from the side of the opposite
party in settling the claim of the complainant?
(3) To what relief/ reliefs the parties are entitled?
5. From the complainant side, the complainant himself has been examined as PW1 and he has been duly cross-examined. The opposite party has examined two witnesses namely, Sri Bonamali Talukdar and Sri KR Kardong as DW1 and DW2 respectively who have also been duly cross-examined.
6. ISSUE No. 1
(a) The complainant in his application under Section 12 of the Act and as PW1 in his evidence-in-chief amongst various statements asserted that the DLA obtained Insurance Policy bearing No. 483372156 covering Rs. 1,08,000/- as sum assured from the opposite party and his father, the DLA, having died on 30/01/2007 observing due formalities the complainant repeatedly requested the opposite party for settlement of the claim. PW1 further stated that getting no positive response the complainant preferred an application before the Insurance Ombudsman. By final order dated 25/08/2011 (Ext 1) the Insurance Ombudsman directed the opposite party to settle the claim within 15 days from the date of receipt of the said order. Even then, not to speak of settlement of claim, opposite party sought for documents after documents and ultimately settlement of claim has been kept pending till filing this case for reasons best known to the opposite party.
(b) The opposite party in its version of the case, amongst other resistance, stated that on receipt of the claim application from the complainant the opposite party made an inquiry and could come to know that the DLA was an employee in the Office of the Joint Director of Health Services, Nagaon whose date of birth is 01/03/1934 and he retired from his service on 29/02/1992. But concealing this fact he disclosed his date birth as 11/03/1959 in the proposal for insurance coverage. It is further stated that in compliance with the order of the Insurance Ombudsman, communicated by a letter dated 25/11/2011, opposite party deciding to refund entire premiums so subscribed by the DLA, in termination of the policy contract, supplied a copy of discharge to the claimant; but he has not responded to the discharge voucher till the submission of version of the case.
(c) Since the opposite party has raised the question of concealment of age at the time of submitting proposal for insurance coverage as fact in issue to take the benefit of Section 45 of the Insurance Act, 1938, burden lies on the opposite party to substantiate this plea.
(d) PW1, during cross-examination, denied the suggestion put by the opposite party that at the time of offering of proposal for insurance coverage DLA suppressing his real state of affairs including age disclosed fake information.
(d) As the opposite party has failed to elicit, from the witness of the complainant side during cross-examination as to the fact of understatement of age divulged by DLA at the time of submitting proposal for insurance coverage raised in the written version, as provided by Section 45 of the Insurance Act, 1938, entire responsibility has to be shouldered by the opposite party that the statement as regards age of the DLA made in the format of the proposal for insurance was inaccurate or false.
(e) To discharge the burden, the opposite party examined Sri Bonamali Talukdar and Sri KR Kardong as DW1 and DW2 respectively who have simply, in their evidence on affidavits, stated that the DLA was a pharmacist under the Joint Director of Health Services, Nagaon, Assam, and according to the certificate No. 10073 dated 12/09/2011, received from the Health Services, date of birth of DLA is 01/03/1934 and the DLA was retired from service on 29/02/1992. But the opposite party has neither exhibited the certificate No. 10073 nor has produced Joint Director of Health Services and/or his representative in the witness box. Thus, an adverse inference can be drawn against the opposite party that the fact set up in the written version of the case as well as in their evidences are not based on truth.
(f) Taking into totality of the entire materials available on record, as have been revealed during the discussion under Issue No. 1, we are constrained to hold that the opposite party has awfully failed to establish its case by cogent and reliable evidence that the DLA had ever suppressed his age at the time offering proposal for insurance coverage enabling the opposite party to take recourse to Section 45 of the Insurance Act, 1938, in repudiating the claim of the complainant. Therefore, opposite party ought to have settled the claim within the period prescribed in the Rules or as directed by the Insurance Ombudsman. Hence, this issue is answered in the negative and in favour of the complainant.
7. ISSUE No. 2
It is an admitted position that the DLA obtained one policy bearing No. 483372156 covering Rs. 1,08,000/- as sum assured from the opposite party and during evidence complainant pressed into as many as 13 numbers of documents and opposite party has not raised any under objection resisting the documents. The main contention of the opposite party is that the DLA had suppressed/ concealed the fact of his age at the time of submitting proposal for obtaining insurance coverage in question and hence, instead of making payment against the claim, the opposite party is willing to refund entire premiums subscribed by the DLA in termination of the contract. But the insurer, that is, the opposite party has not succeeded in establishing its plea as has been discussed under Issue No. 1 above. Such being the position, it is the prerogative of the complainant to opt for whether he would accept the entire premiums subscribed by his father or would accept the due claim on the death of the insured. In the last sub-para of para 7 and during evidence of both the DWs it has been stated that the complainant in spite of receiving discharge voucher personally on 20/12/2011 has not submitted the filled in form to the Opposite party. From the very demeanour of the complainant it is unveiled that the complainant is willing to accept due claim amount instead of entire premiums subscribed by the DLA and, therefore, vehemently insisting the complainant to accept the terms prescribed by the opposite party withholding the claim amount is being not made in a justifiable manner amounts to deficiency of service on the part of the opposite party.
Accordingly this issue is answered.
8. ISSUE No. 3
(a) It is admitted fact that the DLA obtained one policy viz. policy No. 483372156 covering Rs. 1,08,000/- as sum assured from the opposite party. Death of the DLA and the complainant’s status as legal heir being the son of the DLA are also not disputed. As discussed under Issue No.1 and Issue No. 2 above that the opposite party is not entitled to take the benefit of Section 45 0f the Insurance Act, 1938, and withholding of claim of the complainant is not made in a justifiable manner respectively, the complainant is entitled to get entire benefit of insurance coverage promised by the said policy in question.
That apart, the complainant has been deprived of his legitimate claim for which he has to move from pillar to post for a considerable period to establish the genuineness of his claim and thereby he has been suffering a lot, financially,
physically and mentally. Such being the position the complainant is not only entitled to get interest on the sum assured from the date of his claim before this Forum but also entitled to get an additional amount as compensation to solace his physical and mental tiredness as well as financial involvement.
This issue is answered accordingly.
ORDER
The opposite party Life Insurance Corporation of India is hereby ordered to disburse the assured sum covered by policy No. 483372156 along with accumulated bonus/interest thereon to the complainant, the son of the DLA obtaining proper identification within 30 (thirty) days from the date of receipt of this order.
The opposite party Life Insurance Corporation of India is further ordered to pay interest at the rate of 6% per annum on the total sum (i.e. sum assured plus bonus/interest thereon) from that date of filing this case, that is, with effect from 21/07/2014 till the date of finally settled the disbursement of the due amount.
It is further ordered that Life Insurance Corporation of India shall pay a
sum of Rs. 10,000/- (Rupees ten thousand) only as compensation to solace the physical and mental sufferings and another sum of Rs. 5,000/- (Rupees five thousand) only as costs of the litigation to the complainant along with the payment of assured sum as has been indicated above.
Given under our hand and seal of this Forum this 10th day of August, 2017.
