Samaresh Kumar Mitra, Member:
The case of the complainant is that she is the nominee of the deceased policy holder namely Shibu Biswas Dhara S/O- Chunnu Dhara of 1 No. Mohisila Colony, P.O.- Asansol, Burdwan-713301 who insured his life in policy Nos.496739498, 496738615,496741966 &496741967 and the policies contain the name of the complainant as nominee. During the policy the policyholder died due to cardio respiratory failure. The complainant was highly dependent on her uncle the policyholder so she became helpless after the death of her uncle and informed the death report before the OP No.3 who on his turn requested to submit necessary documents for issuance of claim Form and accordingly the complainant submitted relevant documents and questioned about the locus standi of the complainant for having the claim Form. The complainant getting no claim form filed a Consumer Case being case No.36 of 2013 before this Forum and after hearing the OP this Forum pleased to find order dated 30.09.2015 directing the OPs to supply requisite claim Form in favour of the complainant. In accordance with the order of this Forum the OP issued claim Form in favour of the complainant and the complainant deposited the same before the OP who on his turn rejected the said claim of the complainant on the ground that the claim is barred by limitation since the claim has not been submitted within 3 years from the reported date of death of the deceased life assured. Hence nothing is payable under the above mentioned policy as death benefit. Inspite of knowing the fact that the complainant had applied to the OP for issuance of claim Form within due period and being refused by the OPs the complainant was compelled to lodge C.C. case 36of 2013 and the said case was pending till 30.09.2015 and thereafter the Ld. CDRF , Hooghly has been pleased to direct the Op to issue the claim Form in favour of the complainant. So the OP has no authority to declare that the claim of the complainant is time barred. Getting no alternative the complainant filed the instant complaint before this Forum and prior to filing this complaint petition she filed an advocate notice to look into the matter. The conduct of the OP tantamount to gross deficiency of service and unfair trade practice so the complainant filed the instant complaint before this Forum praying for direction upon the OP to settle the claim of the complainant amounting to Rs.437500/- according to policy certificate, compensation amounting to Rs.200000/- for causing mental agony, anxiety and harassment and a litigation cost amounting to Rs.50000/-.
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 OP.
The answering OP filed evidence on affidavit which transpires the averments of the written version so it is needless to discuss.
Both sides filed written notes of argument which are taken into consideration for passing final order.
Argument as advanced by the agent of the complainant and the OP heard in full.
From the discussion herein above, we find the following Issues/Points for consideration.
ISSUES/POINTS FOR CONSIDERATION
1. Whether the Complainant Smt. Kumkum Das ‘Consumer’ of the opposite party?
2. Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?
3. Whether the O.Ps carried on unfair trade practice/rendered any deficiency in service towards the Complainant?
4. Whether the complainant proved her case against the opposite party, as alleged and whether
the opposite party is liable for compensation to her?
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.
- Whether the Complainant Smt. Kumkum Das is a ‘Consumer’ of the opposite party?
From the materials on record it is transparent that the Complainant is a “Consumer” as provided by the spirit of section 2(1)(d)(ii) of the Consumer Protection Act,1986.The complainant herein being the policyholder of a LIC policy and OP is the branch office of insurance company in which the life of the complainant being insured, so being a policyholder he is a consumer and entitled to get service from the OP 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 OP to pay the maturity amount of Rs.123821.97 alongwith accrued interest from the date of 12.2.2013, an award of Rs.75,000/- for mental agony, sufferings, harassment and deficiency of service, another Rs.25,000/- 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 OP Insurance Company is unquestionable and that is why the complainant insured her 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 case of the complainant is that she invested a sum in the ‘’Market Plus” on 12.02.2008 for a sum of Rs.100,000/- and the maturity for the said policy was on 12.2.2013. After 12.02.2013 the complainant submitted the certificate and related papers for maturity thereby the complainant came to know that the scheme for medical ground was rolled in. Then the complainant made a representation on 28.5.2013 requesting the OP regarding payment of the maturity amount to the complainant. The higher authority of the OP sent a letter dated 25.04.2013 to this complainant that it was a contractual obligation from which the OP cannot deviate and the OP compelled the complainant to submit the duly filled up Form for option to transfer the amount to the pension account as the OP stated that the policyholder unit account shall be compulsorily utilized to provide a pension based on the prevailing annuity rules. That lastly on 07.11.2014 the complainant sent a letter to the OP requesting to disburse the maturity amount of Rs.123821.97 but of no result.
OP in his written version averred that as per terms and conditions the policy holder could have surrendered the policy after three years from the date of commencement of the policy but before the date of maturity vesting on 12.02.2013 she did not exercise her option of cooling off or surrendering the policy. But after vesting on the date of maturity, the proceeds of the policy is compulsorily and automatically transferred to pension fund as per policy condition which is clearly mentioned on the front page of the policy bond. Serampore branch office in their letter dated 17.09.2015 informed the complainant that she can surrender the policy on medical ground supported by Medical Certificate.
After perusing the documents in the record as produced by the complainant that she made several correspondences with the OP to get the invested money for her need but the OP turned down her plea by the name of terms and condition as enumerated in the policy that her matured amount has rolled on to pension policy. If a person cannot use her investment for her personal use then what is the necessity of her investment. The OP in his written version and in the notes of argument stated that the policyholder can withdraw her investment on medical ground supported by medical certificate. It is not expected from the part of an insurance company to turn down the plea of their policyholder on lame excuse. Is it the fact that the
insurance company relish at the suffering of their policyholder? This policyholder and her husband are suffering from different ailments as it is depicted from the prescriptions of doctors. As per the version of the OP that he informed the complainant that she can withdraw her pension fund on the medical ground supported by medical certificate on 17.09.2015 then
why he refused the complainant on several requests after the date of maturity on 12.02.2013. So from the above discussion we may hold that the insurance company not put this complainant in distress by rejecting her valid claim but also destructed the myth of utmost on good faith.
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 matured amount to this complainant in her need although there is a provision to disburse the same on medical ground. So the complainant suffered at the behest of negligence/deficiency of service on the part of the insurance company. Hence we may safely conclude that mere direction upon the opposite party to pay the matured amount of Rs. 123821.97 along with interest thereon @9% since the date of maturity on 12.02.2013 till realization to this 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?
The discussion made herein before, we have no hesitation to come in a conclusion that the Complainant has abled to prove her 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.C.C.29 of 2016 be and the same is allowed on contest against the Opposite Party with a litigation cost of Rs.5,000/-.
The whole gamut of the facts and circumstances leans in favour of the complainant. We, therefore, allow the complaint and Opposite Party is directed to pay the sum amounting to Rs.123821.97 along with interest @ 9% p.a. since the date of maturity on 12.02.2013 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.
