DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, LUCKNOW
CASE No.758 of 2005
Sri Swami Dayal Gupta.
……Complainant
Versus
1. Life Insurance Corporation of India,
Chowk Branch, Khun Khunji Road,
Chowk, Lucknow.
Through Senior Branch Manager (Life Insurance).
2. Life Insurance Corporation of India,
(Claim Section) 30 Hazratganj,
Lucknow.
Through Senior Divisional Manager (Life Insurance).
3. Life Insurance Corporation of India,
Yogdomyam, Life Insurance Road,
Mumbai-400021.
Through Chairman (Life Insurance).
.......Opp. Parties
Present:-
Sri Vijai Varma, President.
Smt. Anju Awasthy, Member.
JUDGMENT
This complaint has been filed by the Complainant against the OPs for payment of insurance amount of Rs.1,00,000.00, bonus from 1989 to 2005 of Rs.93,500.00, interest from 01.03.2005 to 31.08.2005 of Rs.17,415.00, from 01.09.2005 of Rs.18,982.00, compensation and cost of litigation of Rs.20,000.00.
The case in brief of the Complainant is that he and his wife Smt. Sarojini Devi had taken a Jeevan Sathi policy table No.89 for a period of 15 years the sum assured being Rs.1.00 lakh. His wife Smt. Sarojini Devi died on 29.05.1990 and she was cremated on 30.05.1990. The policy was to mature on 28.02.2005. As per the rules after the death of one person and despite stoppage of payment of premiums, there is the provision for payment of bonus upto the fixed period,
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therefore the bonus from the financial year 1989-90 till 28.02.2005 i.e. Rs.93,500.00 was payable. As per agreement 9% six months cumulative interest from 01.03.2005 to 31.08.2005 Rs.17,415.00 and from 01.09.2005 till the filing of the case the interest amount of Rs.18,982.00 was payable. Since the OPs did not make payment of the aforesaid amounts despite demand, hence a registered notice was sent to them for payment but no action was taken, hence this complaint.
The OPs have filed the WS wherein it is mainly submitted that the Complainant’s wife Smt. Sarojini Devi submitted two proposals dated 28.02.1990 in her single name and proposal dated 09.03.1990 jointly with the Complainant for coverage of risk for a sum of Rs.1,00,000.00 and Rs.50,000.00 under table and terms 88-15 with Chowk branch of the LIC and the branch office after taking the answers given to each and every question contained in the proposal to be true and correct in all respects alongwith the declaration made at the foot of the proposal as the basis of contract accepted the proposal and issued first premium receipt cum acceptance letter indicating there in the policy No.210168847 and 210168687. As per information conveyed by the Complainant the death of his wife Sarojini Devi occurred on 30.05.1990 and the maturity period as indicated in the policy in question was 28.02.2005. According to the policy document even after the death of any one of the assured, the surviving assured was entitled to waiver from payment of future premium, still the policy was to participate for bonus till maturity. However this concession is allowable if the death claim under the policy had been admitted and paid on the death of any one of the assured. There was no agreement through which compound interest at 9% per annum was payable at any point of time under the policy. Rather a perusal of the policy bond stipulates no payment of interest. The receipt of the letter dated 10.09.2005 sent by the Complainant is not denied. However amount was
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not payable in view of the fact that risk was suspended under the policy in question during the life time of the Complainant’s wife Sarojini Devi due to adverse facts about her health and she taking treatment at the time of submission of the proposal came to the knowledge of the OPs and later on she died during the period the risk remained suspended. As the risk under the policy remained suspended during her life time and no effort was made to get removed the suspension of risk the policy did not remain in force during her life time and even after her death the Complainant cannot turn around and say that the policy being in full force, he is entitled to the benefits flowing out of the policy. Due to non payment of death claim under the policy in dispute under the complaint and other policies the Complainant has filed a complaint bearing No.458/92-93 before Hon’ble SCDRC, UP, Lucknow and the same is fixed for arguments. No premium has been paid under the policy No.210168847 after the death of one of the life assured Sarojini Devi while death claim has been denied under the policy in question on account of the risk remaining under suspension upto the death of Sarojini Devi. The present complaint is not maintainable in view of one complaint already pending on the same cause of action. The present complaint is barred by time prescribed under the Act as the cause of action arose on the death of joint policy holder Sarojini Devi i.e. on 30.05.1990. The Complainant is not entitled to any relief and the complaint is liable to be dismissed with exemplary costs.
The Complainant has filed reply to the WS with 21 annexures.
The Complainant has filed an affidavit in support of application dated 24.01.2013 with 3 annexures and 1 annexure with the complaint. The Complainant has filed objection with affidavit against counter affidavit filed by the OPs with 3 annexures. The OPs have filed the affidavit of Sri R.J. Saroj, Administrative Officer (Legal), LIC with 11 annexures and
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photocopy of proposal form with WS. The OPs have filed the counter affidavit of Sri D.V. Verma, Administrative Officer (Legal), LIC with 28 papers.
In this case, it is not disputed that the Complainant had taken the insurance policy for a sum of Rs.1.00 lakh for himself and his wife. It is the case of the OPs that due to non payment of death claim under the policy in dispute under the complaint, the Complainant has filed a complaint bearing case No.458/92 before the Hon’ble SCDRC Lucknow, hence the present case is not maintainable as for the same cause of action the case is pending in the Hon’ble State Commission. The disputed point according to the Complainant is that the OPs did not make payment of the insurance amount as well as the bonus payable on the death of his wife Smt. Sarojini Devi whereas according to the OPs the risk under the policy was suspended during the life time of the Complainant’s wife Smt. Sarojini Devi due to adverse facts regarding her health and hence there was no deficiency on their part.
We take up the first point as to whether this case is maintainable in this Forum as with regard to the same matter relating to the policy for payment of death claim that the matter is pending in the Hon’ble State Commission. In this regard, the OPs have filed documents to show that the case No.458/92 was pending with the Hon’ble State Commission. The Complainant acknowledges the existence of a Case No.458/92 pending in the Hon’ble State Commission but has taken the stand that case relates to the death claim whereas this case pertains to the matter of bonus etc. From the documents filed by the OPs and the statement of the Complainant in his replication filed on 05.12.2006 it is clear that a case was filed in the Hon’ble State Commission pertaining to the same cause of action i.e. the death of Smt. Sarojini Devi. Since the matter
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pertains to the same cause of action, therefore this case is not maintainable with regard to the same life insurance policy in this Forum, therefore this case deserves to be dismissed on this score itself.
Now, we take up the point that the OPs did not make payment of the insurance amount as well as the bonus payable on the death of his wife Smt. Sarojini Devi whereas according to the OPs the risk under the policy was suspended during the life time of the Complainant’s wife Smt. Sarojini Devi due to adverse facts regarding her health and hence there was no deficiency on their part. In this regard, the stand of the OPs is that the policy of the Complainant was suspended as certain facts which were adverse to the status of the health of the deceased Smt. Sarojini Devi were found out subsequent to the issuing of the policy and hence the policy was suspended and the matter was informed to the Complainant telegraphically as is evident from the copy of the telegram on 08.05.1990 sent by the OPs to Smt. Sarojini Devi wherein it is mentioned “risk cancelled under policy No.210168847 letter follows…….chek “kk[kk] pkSd] y[kuÅA” Subsequently a letter dated 10.05.1990 indicating the reasons as to why the policy was cancelled/suspended was sent to Smt. Sarojini Devi wherein it is mentioned that she was suffering from some disease before she proposed for the aforesaid policy and that she had taken treatment and was admitted in the hospital and hence her policy was suspended. She was called upon to divulge the details of the ailment and treatment taken by her for further action in that matter. A letter written by Smt. Sarojini Devi to the Branch Manager of the LIC Chowk Branch was also sent wherein Smt. Sarojini Devi has challenged the one sided decision taken by the OPs for suspending the policy. However, the Complainant’s wife died on 30.05.1990. The OPs have filed the documents of Mishra Nursing Home of 23.09.1989 and ESI Hospital of 25.10.1989, 02.11.1989, 20.01.1990,
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23.01.1990 the prescription of Dr. Krishnand Sinha, Professor KGMC and GM and Associated hospital’s treatment card dated 23.01.1990 etc. From these documents it is clear that the deceased Smt. Sarojini Devi was suffering from serious ailment and therefore the statements given by her in her proposal form that she was not suffering from any disease of any kind was not correct statement made by her to the OPs in her proposal form. The deceased should have correctly informed the OPs regarding her ailments or the treatment received by her before the date on which she filled up the form i.e. on 09.03.1990. It is noticeable that from the documents filed by the OPs it is clear that Smt. Sarojini Devi was suffering from ailments before this date i.e. 09.03.1990 and that too on the dates which were closure to the date of she filling up the form, therefore there was valid reason for the OPs for suspending the insurance policy in question relating to Smt. Sarojini Devi and even though Smt. Sarojini Devi did reply to the letter sent by the OPs on 10.05.1990, she did not divulge the information regarding her ailments prior to the filling up the form of the proposal. Smt. Sarojini Devi, after she received treatment in the hospitals on September, October 1989 and in January, 1990 succumbs to her ailments and ultimately dies. It is not for nothing that she dies within very short span of taking the policy on 09.03.1990 and dying on 29.05.1990. Obviously, the Complainant tried to conceal material facts about the status of her health and the ailments and the insurance policy pertaining to Smt. Sarojini Devi. The argument advanced from the side of the Complainant that she was medically examined by the doctor appointed by the OPs is of no avail as she did not answer correctly to the information and the queries put to her. In fact she lied about the correct status of health and ailment and therefore it is of no consequence that she was medically examined by the doctor of the OPs. Therefore, on the basis of the discussions made above
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it is clear that the Complainant concealed material facts about the status of her health and ailment and therefore the OPs correctly suspended the policy and when the policy was in suspension then there was no question of the Complainant getting the amount of insurance and bonus, if any, accrued on it. The complaint therefore deserves to be dismissed.
ORDER
The complaint is dismissed.
The parties to bear their own costs.
(Anju Awasthy) (Vijai Varma)
Member President
Dated: 1 September, 2015
