Orissa

Cuttak

CC/161/2016

Pramila Sahoo - Complainant(s)

Versus

Branch Manager,Life Insurance Corporation of India - Opp.Party(s)

D Mishra

29 Jun 2018

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL FORUM,CUTTACK.

                                                                                    C.C. No.161/2016

               

Pramila Sahoo,

W/o:Late Nabina Sahoo,

Vill:Dhupada,PO:Korua,

P.S:Nuagaon,Dist:Jagatsinghpur.                                        … Complainant.

 

                Vrs.

 

1.        Branch Manager,

Life Insurance Corporation of India,

Paradeep Branch Office,Paradeep,

Jagatsinghpur.

 

1.        Sr. Divisional Manager,

Life Insurance Corporation of India,

Cuttack Divisional Office,”Jeevban Prakash”,

Nuapatna,Cuttack-753001

 

2.        The Zonal Manager,

LIC of India,East Central Zone Office,

Jeevan Deep Building,6^th Floor,

Exhibition Road,Patna-80001.                                            … Opp. Parties.

 

 

Present:               Sri Dhruba Charan Barik,LL.B. President.

Smt. Sarmistha Nath, Member (W).

 

Date of filing:     13.12.2016

Date of Order:  29.06.2018

 

For the complainant:      Mr. D.Mishra,Adv. & Associates.

For Opp.Parties   :            Mr. C.R.Lenka,Adv  & Associates.

 

Sri Dhruba Charan Barik,President.

                The complainant has filed this case with allegation of deficiency in service and unfair trade practice against the O.Ps. and seeking appropriate relief in terms of her prayer in the consumer complaint.

1. The factual aspect of the case of the complainant is as follows:

Late Nabina Sahoo had obtained an LIC policy vide Policy No.518048990 dt.15.1.2011 for a period of 11 years from the O.P No.1.The assured value was Rs.1,55,000/-.The policy was issued by O.P.1 on yearly premium basis @ Rs.16, 414/-.The date of maturity of the said policy was fixed to 15.1.2022.Copy of the proposal form has been filed and marked as Annexure-3.Annexure-4 is the copy of the certificate of the insurance issued by O.P.1.The complainant happens to be the wife of the insured and as such the nominee in the said policy.

It is stated that while the said policy was in force, the insured suffered from heart attack and expired on 12.5.2012.Thereafter the complainant being the nominee lodged a death claim in the appropriate form together with all the relevant documents with the O.P.1.Annexure-5 is the copy of the said claim filed by the complainant

It is stated that the complainant has two sons and one married daughter who are the legal heirs of the deceased insured.Annexure-1 is the copy of the legal heir certificate of the deceased policy holder issued by the competent authority.Annexure-2 is the copy of the school certificate issued by the Headmaster of Chaulia U.P School as regards the age of the deceased insured.On 1.3.2014 O.P.1 intimated the complainant that her death claim has been repudiated on account of the deceased policy holder having suppressed material information regarding his age at the time of taking the policy.Copy of the said repudiation letter dt.1.3.14 has been filed and marked as Annexure-6.Thereafter the Manager (Claims), Cuttack Divisional Office sent a letter dt.26.5.14 to the complainant to the said effect.Annexure-7 is the copy of the said letter of O.P.2, the Sr. Divisional Manager, Cuttack Divisional Office.Thereafter the complainant made an appeal to the Zonal Claim Committee seeking settlement of her claim at an early date and the concerned authority also upheld the decision of the O.Ps 1 & 2 and it was intimated to the complainant vide his letter dt.23.7.15.Annexure-8 is the copy of the said letter of O.P.3, the Zonal Manager,L.I.C of India.The complainant then approached the Insurance OMBUDSMAN for her relief but of no avail.It is specifically averred that the O.Ps have illegally repudiated the death claim made by the complainant by not taking into consideration the age of the deceased policy holder as recorded in the school certificate.It is tantamount to deficiency in service and unfair trade practice on their part.It has also caused serious mental tension and agony to the complainant who is a poor and destitute lady.It is therefore prayed that the O.ps may be directed to settle her claim in her favour or to pay the assured value i.e. Rs.1,55,000/- together with all allied benefits and interest @ 12% per annum from the date of her claim till realization.She has also prayed to direct the O.Ps to pay Rs.50,000/- towards compensation and Rs.10,000/- towards cost of litigation as well as other reliefs as deemed fit and proper in the interest of justice.

2. The O.Ps have jointly filed written version of their case denying all material averments in the complaint.  It is also stated that the complainant is not a consumer and there is no deficiency in service or unfair trade practice on their part.  This Forum lacks jurisdiction to entertain the case.  That apart it is also stated vide para-6 of their written version that the deceased policy holder while obtaining the policy had deliberately suppressed some material facts which amounts to violation of terms and conditions of L.I.C contract for which the death claim was rightly repudiated by the series of authorities.  Accordingly it is stated that the consumer complaint filed by the complainant is baseless and needs to be dismissed in limini.
3. We have heard the learned counsel for the complainant as well as for the O.ps at length and gone through the documents filed by them in support of their respective claims.
4. The crux of the matter in this case is suppression of material fact by the deceased policy holder with regard to his age at the time of taking this policy.  While the complainant has denied the same, the O.Ps have categorically reiterated their stand that there was deliberate suppression of material facts by the said deceased pol.icy holder with regard to his age.  Annexure-3 is the proposal form where from it is revealed that date of birth of the deceased policy holder is 13.5.1956.  Annexure-3 corresponds to Annexure-A.  To this effect, the complainant has filed Annexure-2 which is the photocopy of the school certificate issued by the Headmaster of the concerned school and from this document; it is found that 13.5.1956 is the date of birth of the deceased policy holder as revealed from the admission register of the said school.  This Annexure-2 corresponds to Annexure-B filed on behalf of the O.Ps.  The controversy with regard to date of birth of the deceased policy holder arises from Annexure-C & D.  In Annexure-C it is found that 17.3.1952 is the date of birth of the deceased policy holder.  Similarly in Annexure-D it is recorded that age of the deceased policy holder was 48 years as on 1.1.2002.  Relying upon the above two documents vide Annexure-C & D, the learned counsel for the O.Ps has vehemently argued that there has been deliberate suppression of material facts with regard to age of the deceased policy holder while entering into agreement with the O.Ps with a view to getting some monetary gain.  It is also submitted that the insurance contract is based on the doctrine of Uberima fides and the deceased policy holder by suppressing the material facts has violated the terms and conditions of the policy for which the death claim lodged by the complainant was repudiated,  not only by the O.P No.1 but also confirmed by the other O.Ps who are superior to him.
5. The learned counsel for the complainant has vehemently opposed the stand taken by his counterpart in this case.  It is fairly submitted that when the school certificate reflecting the age of the deceased policy holder has been filed, other documents cannot be taken into consideration to negative the effect of such certificate issued by the competent authority.

Law is well settled that in absence of horoscope, it is the school certificate issued by the competent authority which comes first in order of preference to prove the age of a particular person.In the instant case Annexure-2 has been issued by the competent authority on the basis of the admission register of the school and the contents of Annexure-2 have not at all been called in question by the O.Psin any manner.It is also equally well settled that Annexure-C & D which are the PAN card and voter identity card of the insured are not documents by themselves to prove his age.In view of the above and in absence of anything to the contrary, the date of birth of the deceased policy holder as recorded in Annexure-2 cannot be view with suspicion. Except the sole ground of manipulation/suppression of age of the deceased policy holder, there is apparently no other ground raised by the O.Ps for repudiation of the death claim made by the complainant.Hence ordered;

ORDER

The consumer complaint is allowed on contest against the O.Ps.  The repudiation letter vide Annexure-6 of the death claim made by the complainant of her husband is hereby set aside.  The O.Ps are directed to settle the death claim made by the complainant in her favour and the amount so settled together with compensation of Rs.20,000/- and litigation cost of Rs.5000/- to be paid to her or  they are directed to pay Rs.1,55,000/- which is the assured value of the insurance policy together with all allied benefits and interest @ 8% per annum to the complainant from the date of the claim till realization of the same together with the amount of compensation and litigation cost as indicated above.  This order shall take effect within a period of 45 days of receiving the copy of this order.

Typed to dictation, corrected and pronounced by the Hon’ble President in the Open Court on this the 29^th    day of June,2018 under the seal and signature of this Forum.

                                                                                                                                                  

    (   Sri D.C.Barik )

                                                                                                                       President.

                                                                                                                            

                                                                                                               (Smt. Sarmistha Nath)

                           Member(W)