This case has been filed U/s.12 of the Consumer Protection Act, 1986 by the complainant that being convinced the cousin brother of the complainant Sagar Chakraborty agreed to take insurance policy from the opposite parties and took two policies in the name and style LIC’s JEEVAN LABH and after fulfilling all the terms and conditions and submitting the requisite documents to the opposite parties, cousin brother of the complainant got two policies being policy no. 400109355 proposal no. of which is 10047 date of proposal 23.08.2017, sum assurance of the death benefit of the said policy was Rs.80,00,00/- only on payment of first premium of Rs.9270/- receipt dated 23.8.2017, and policy no. 400109325 proposal no. 9978 dt. 23.08.2017, date of commencement of risk 23.08.2017 sum assurance of the death benefit of the said policy was Rs. 8,00,000/- on payment of first premium of Rs.9687/- receipt dt. 23.8.2017 in respect of the aforesaid two policies the cousin brother of the complainant (since deceased) being unmarried made nominee to this complainant out of love and affection and during the continuance of the aforesaid Policy the cousin brother of the complainant suddenly on 30.8.2017 lost his life and after elapsed of considerable period the complainant rushed to the opposite party no.3 and intimated the death news of his cousin brother through letter dt. 7.9.2017 which was also received by the opposite party no. 3 and the complainant requested the opposite party no. 3 to do the needful initially for death claim of the said policy.
The complainant also states that after receiving the said letter the opposite party no.3 did not issue any claim Form to the complainant, the complainant a number of times visited to the office of the opposite party no.3 and requested to the opposite party no.3 for issuing claim Form and settle the claim but the opposite party no.3 did not provide any satisfactory reply to the complainant regarding this and thereafter finding no other alternative on 25.9.2017 the complainant sent a legal notice addressing to the opposite party no.3 through his Ld. Advocate stating all the facts and requesting for this claim which was refused by the opposite party no.3 and the opposite party no. 3 did not came forward with any communication.
Complainant filed the complaint petition praying directions upon the opposite parties to pay sum of Rs. 16,00,000/- (8,00,000/- + 8,00,000/-) towards insurance policy claim against the policy nos. 400109325 and 400109355 with interest @ 18% p.a. with effect from 7.09.2017 and to pay a sum of Rs.2,00,000/- towards compensation and to pay a sum of Rs.20,000/- towards costs of the litigation and any other relief/reliefs as the Ld. Forum may deem fit and proper.
The Opposite Parties contested the case by filling written version denying inter alia all the material allegations leveled against them. These Opposite parties submit that the two Insurance Policy being nos. as 400109355 and 400109325 have been purchased by Sagar Chakrkaborty on 23/08/2017 from Life Insurance Corporation of India, Chinsurah Branch and the aforesaid fact is clear from the status report of the two policy being nos. 400109355 Plan/Term/Pterm: 836/25/16 sum assured 8,00,000/- and Policy No. 400109325, Plan/Term/Pterm: 836/25/16 sum assured 8,00,000/- and the L/A made nominee to his cousin Pradip Chanda (complainant) and the date of proposal is on 23/08/2017 in both two policies and the policy holder died on 30/08/2017 but the fact has never been intimated to the answering opposite parties and no such legal notice send to the opposite party and on getting the copy of plaint from the Ld. DCDRF, Chinsurah they came to know that L/A Sri Sagar Chakraborty died on 30/08/2017 and all the necessary claim forms were duly issued on 07/08/2018 to the registered nominee vide Speed Post No. RW 13163735IN.
The complainant filed evidence on affidavit which is nothing but replica of complaint petition and supports the averments of the complainant in the complaint petition & denial of the written version of the opposite parties.
The answering opposite parties filed evidence on affidavit which transpires the averments of the written version so it is needless to discuss.
Complainant and opposite parties filed written notes of argument. The evidence on affidavit & written notes of argument of both sides are taken into consideration for passing final order.
Argument as advanced by the agents of the complainant and the opposite parties heard in full.
From the discussion herein above, we find the following Issues/Points for consideration.
ISSUES/POINTS FOR CONSIDERATION
1. Whether the Complainant Pradip Chanda ‘Consumer’ of the opposite party?
2. Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?
3. Whether the opposite parties carried on unfair trade practice/rendered any deficiency in service towards the Complainant?
4. Whether the complainant proved his case against the opposite party, as alleged and whether the opposite party is liable for compensation to him?
DECISION WITH REASONS
In the light of discussions here in above we find that the issues/points should be decided based on the above perspectives.
1).Whether the Complainant Pradip Chanda is a ‘Consumer’ of the opposite party?
From the materials on record it is transparent that the Complainantbeing nominee of LIC policiesof deceased life assured, is a “Consumer” as provided by the spirit of section 2(1)(d)(ii) of the Consumer Protection Act,1986. The complainant herein being thenominee of LIC policies of deceased Sagar Chakraborty andopposite parties are the branch manager of insurance company & its different offices in which the life of the brother of the complainant being insured, so being abeneficiary/ nominee he is a consumer and entitled to get service from the opposite party insurance company.
2).Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?
Both the complainant and opposite parties are residents/carrying on business within the district of Hooghly. The complainant prayed for a direction upon the opposite party to pay the sum assured to the tune of Rs.16,00,000/- ( Rs.8,00,000/- + Rs.8,00,000/-) towards insurance policy claim against the policies being No.400109325 & 400109355 with interest @ 18% p.a. effect from 07.09.2017 and an award of Rs.2,00,000/- as compensation for willfully neglecting the claim of the complainant and deprivation of information by the opposite parties constituting deficiency in service and thereby causing mental agony, harassment and anxiety, another Rs.20,000/- for legal costs and other relief or reliefs as this Forum deems fit and proper ad valorem which is within Rs.20,00,000/- limit of this Forum. So, this Forum has territorial/pecuniary jurisdiction to entertain and try the case.
3).Whether the opposite party carried on Unfair Trade Practice/rendered any deficiency in service towards the Complainant?
The opposite party being the largest Insurance Company of the Nation associated with the insurance of a lot of people of throughout the whole nation since a long back with self generated assets i.e. goodwill of the business. So, the credibility of the opposite party Insurance Company is unquestionable and that is why the cousin brother of the complainant insured his life before the said company without any doubt. It is well settled proposition of law that a contract of insurance is based on the principles of utmost good faith-uberrimae fidei, applicable to both the parties. The rule of nondisclosure of material facts vitiating a policy still holds the field. The bargaining position of the parties in a contract of insurance is unequal. The insured knows all the facts; the insurer is unaware of anything which may be material to the risk. Very often, it is the insured who is the sole person who has this knowledge. The insurer may not even have the means to find out facts which would materially affect the risk. The law, therefore, enjoins on the insured an absolute duty to disclose correctly all material facts which is within his/her personal knowledge or which he ought to have known had he made reasonable inquiries. A contract of insurance, therefore, can be repudiated for non disclosure of material facts.
The expression “material fact” is not defined in the Insurance Act, 1938 and therefore, as observed by the Supreme Court in Satwant Kaur Sandhu -vs- New India Assurance Company Ltd. 2013 (3) CPR 644 (SC), it has to be understood in general terms to mean as any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether he would like to accept the risk. Any fact, which goes to the root of the contract of insurance and has a bearing on the risk involved, would be “material” and if the proposer has knowledge of such fact, he is obliged to disclose it, particularly while answering questions in the proposal form. Any inaccurate answer will entitle the insurer to repudiate their liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance.
The case of the complainant is that he is the nominee of the deceased policy holder namely Sagar Chakraborty, S/O-Lt. Subhas Chakraborty of Binoy Polly, Chinsurah, Hooghly, who insured his life in policy Nos. No.400109325 & 400109355 and the policies contain the name of the complainant as nominee. During the policy period the policyholder died due to cardio respiratory failure. The complainant being the nominee informed the death report before the opposite party No.3 through letter dated 07.09.2017 and requested the opposite party No.3 to do the needful. After receiving the letter the opposite party no.3 did not take any steps for settlement of the said policy and did not issue claim Form inspite of receiving legal notice from end of the complainant. After waiting for a prolonged period of getting positive reply the complainant filed the instant complaint praying directions as incorporated in the prayer portion of the complaint petition.
The opposite party in their written version & written notes of argument averred that the opposite party no.1 is to be expunged from this proceeding as he is the appellate authority of any claim of aggrieved persons and further stated that the two insurance policies were purchased by said Sagar Chakraborty on 23.08.2017 from the Life Insurance Corporation of India, Chinsurah branch and it is clear that the status report of the two policies being Nos. 400109325, plan/Term/ Pterm: 836/25/16 sum assured Rs.8,00,000/- & No. 400109325, plan/Term/Pterm: 836/25/16 sum assured Rs.8,00,000/-. The LA made nominee to his cousin “PRADIP CHANDA” but the name of the complainant is that “PRADIP CHANDRA” and the date of proposal is 23.08.2017 in both the policies and policy holder died on 30.08.2017 within 7 days from the date of proposal. But the fact has never been intimated to the answering opposite parties and there is no such legal notice received by the opposite parties. On receiving the notice of CDRF, Hooghly the opposite parties came to know that LA Sagar Chakraborty died on 30.8.2017 i.e. within 7 days from the date of execution of policy. In this situation it may be presumed that the life assured suppressed the fact of his illness at the time of doing his policies and the complainant should be filed a succession certificate from any civil court. After receiving all the necessary papers from the registered nominee, the answering respondent will proceed to process the claim as per rule. The answering opposite parties denied that they did not come forward with any communication keeping the complainant in darkness about the fate of the claim and lastly prayed to reject the claim of the complainant with exemplary cost.
Upon consideration of the evidence adduced by the parties, this Forum observed that the Insurance Company always tried to evade their responsibility of paying the assured amount to this complainant as nominee and the answering opposite parties assailed that the complainant failed to inform the information of death before getting notice from this Forum. But in the written version the opposite parties admitted that they supplied the claim Form to this Complainant by referring the mode of suppliance. So it is transparent that the opposite parties willfully avoided the course of settlement of claim of the complainant which tantamount to deficiency of service on the part of the opposite parties. The complainant referred the case decision of Hon’ble Supreme Court in Ruksanas & others Vs. Nazrunnisa (smt) and Another(2000)9 SCC 240 it is contended that succession certificate is not required in the circumstances of the case where the amount to be received is compensation the amount in any other case has already been deposited by the insurance company before the Tribunal or court and the succession certificate is requested to be produced where the amount under the insurance policies is not deposited before the tribunal or court. So the allegations of the opposite party in respect of production of succession certificate are bereft of merit and no leg to stand. The complainant referred the Xerox copy of ‘The Gazette of India Extraordinary” part –II, page 20 in which it is stated that the holder of a policy of life Insurance on his own life may when effecting the policy or at any time before the policy matures for payment, nominate the person or persons to whom the money secured by the policy shall be paid in the event of his death.
It is also pertinent to mention that the opposite parties alleged that the policyholder suppressed the material fact regarding the health condition of the policyholder in the policy Form. But by making answer in respect of questions put in the policy but they failed to prove that the life assured was suffering from any disease prior to accepting those policies in question. It appears from the case record that the complainant compelled to take the recourse of this Forum for getting the claim. From the face of the policies it appears that 2 policies were accepted within a short period in the month of August, 2017 in connivance with the authorized agent of LICI and this complainant and the life assured died of heart attack in the month of August, 2017. Only the complainant and the agent of the opposite party can say whether the life assured was suffering from heart disease or not. It is not clear from the case record regarding the cause of death of the policyholder. We have nothing to disbelieve the claim of the complainant.
It appears from the LIC’s Jeevan Labh insurance policy being No.400109325 & No.400109355 that in both policies the sum assured is Rs.8,00,000/- each, date of commencement of policy is 23.08.2017, mode of Payment Qly, amounting to Rs.9270/- in the name of Sagar Chakraborty and the name of nominee is Pradip Chanda. The Xerox copy of death certificate of the life assured is in the case record, which transpires that the life assured died on 30.8.2017 due to cardio respiratory failure in a case of Myo cardial Infraction.
Fact remains that after the death of life assured the nominee of the said policy tried his best to avail of the death benefit of the impugned policy. But the opposite parties failed to settle the claim inspite of receiving several reminders and legal notice. So the complainant being the nominee of the deceased life assured compelled to file the instant complaint case before this Forum praying directions upon the opposite parties as incorporated in the prayer portion of the complaint petition.
The opposite parties in their written version, evidence on affidavit and written notes of argument tried to evade their responsibility by stating that they are not properly informed regarding the death of the life assured and admitted that if they get the claim Form they will settle the claim of the complainant.
So from the above discussion we are in the opinion that there is no impediment of getting the sum assured of the death benefit of deceased life assured by this complainant. The complainant proved his case beyond the reasonable doubt, so he is entitled to get the sum assured of 2 policies amounting to Rs.16,00,000/- including interest @8% since the date of death of the policyholder i.e. 30.08.2017 till realization.
4). Whether the complainant proved his case against the opposite party, as alleged and whether the opposite party is liable for compensation to him?
The discussion made herein before, we have no hesitation to come in a conclusion that the Complainant has abled to prove his case and the Opposite Party is liable to pay the ordered amount. The ordered amount includes the interest so there is no question of allowing compensation.
ORDER
Hence, it is ordered that the complaint case being no.80 of 2018 be and the same is allowed on contest against the Opposite Party with a litigation cost of Rs.10,000/-.
The whole gamut of the facts and circumstances leans in favour of the complainant. We, therefore, allow the complaint and Opposite Party Life Insurance Corporation of India is directed to pay the sum amounting to Rs.16,00,000/- along with interest @ 8% p.a. since the date of death of the life assured on 30.08.2017 till realization to this complainant within 45 days from the date of order.
No other reliefs are awarded to the complainant for harassment and mental agony.
At the event of failure to comply with the order the Opposite Party shall pay cost @ Rs.100/- for each day’s delay, if caused, on expiry of the aforesaid 45 days by depositing the accrued amount, if any, in the Consumer Legal Aid Account.
Let a plain copy of this Order be supplied free of cost to the parties/their Ld. Advocates/Agents on record by hand under proper acknowledgement/ sent by ordinary post for information & necessary action.
