OFFICE OF THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANGUL
PRESENT:- SRI DURGA CHARAN MISHRA.
PRESIDENT
A N D
Mrs. S.MALLICK & Sri K.K.Mohanty,
MEMBER .
Consumer Complaint No. 104 of 2013
Date of Filling : - 24.12 .2013.
Date of Order :- 02.11.2016.
Bishnupriya Sahoo,W/O.Late Dayanidhi Sahoo,
Vill-Deulbeda Telisahi,P.O.Handidhua,P.S:-
Colliery,Dist.Angul.
_________________________Complainant.
Vrs.
01.Branch Mnager L.I.C of India,Talcher Branch,
At-Angarua,Near Telephone Bhawan,P.O:-
Talcher Town,SD/PS-Talcher,Dist.Angul.
02. Sr.Divisional Manager,L.I.C of India,
Cuttack Divisional Office,Jeevan Prakash,
Post Box No.36,Cuttack- 753001.
_________________________ Opp. parties.
For the complainant :- Sri B.B.Mohapatra & associates(Advs.)
For the opp.parties :- Sri R.P.Pattanaik & associates(Advs.)
: J U D G E M E N T :
Mrs.S.Mallick,Member.
The complainant being the nominee of her deceased husband Dayanidhi Sahoo has filed this case with prayer to direct the opp.parties to pay all the sum assured money with bonus along with compensation and cost of litigation.
2. The case of the complainant in short is that her late husband had availed two policies under Unique Link Policy for Rs. 65,000.00 and Rs. 25,000.00 vide policy No. 589864201 & 586914134 as the sum assured on his life ( on payment of required premium) on dt.18.4.08 & 12.03.07 respectively. Another policy No. 586927250 was also availed under Jeevan Sathi Policy scheme for Rs. 1,00,000.00 on dt. 10.12.07 which was a joint policy of the deceased Dayanidhi Sahoo with his wife( complainant). The premiums under the policies were regularly paid. Unfortunately on dt.16.01.09 life assured Dayanidhi Sahoo expired. The complainant being the nominee of the life assured informed the death of his husband to opp.party No.1, with the request for early settlement of the death claim, but the opp.partyNo.1 did not settle. Then she approached the CRM,LIC of India,Division Office,Nuapatna,Cuttack and made correspondence but the opp.parties repudiated the claim .After receiving the legal notice from complainant, they sent two letters to settle the policy Nos. 586914134 and 589884201 in her favour,but they settled only one policy i.e 586914134 on exoration basis and repudiated other two policies . Therefore she filed this case seeking the reliefs as stated in para No.1.
3. The opp.parties have contested the case by filing written version stating that the case is not maintainable. They submitted that the policy holder had with-held the material information relating to his state of health at the time of making the proposal. So the claim of the complainant was repudiated as provided in sec-45 of insurance Act 1938. They further prayed to dismiss this complaint case.
4. In view of the above pleadings of the parties the following issues arise for consideration.
Issues:-
- Whether there is consumer and service provider relationship exists between them (parties)?
- Whether the insured has suppressed the material facts regarding the health when the policies were made ?
- Whether the opp.parties have committed deficiency of service ?
- Whether the complainant is entitled to the reliefs claimed ?
: F I N D I N G S :
Issue No.(i):- Admittedly the deceased life assured, Dayanidhi Sahoo had availed the policies No. 589864201,586927250 and 586914134 under the opp.parties. He had also paid the due premiums on the above policies. So there is consumer and service provider relation exists between them.
Issue No.(ii) & (iii):- We have carefully considered the records of the case and heard learned counsels for the parties. In written statement of the opp.parties, they have raised an issue about the suppression of material facts by the life assured at the time of filing in the proposal form. According to the opp.parties the prescriptions of Dr. M.R.Rath dt. 15.05.2007(Annexure-1) filed by them show that the insured was under treatment for DM / HPTN but those documents are not clear and don’t reveal so. As per Annexures- II & III the B.P of insured was 110/80 and F.B.S was 110/per mg which are very normal. So the assertion of the opp.parties that the insured made fraudulent and false information at the time of opening of the policies regarding his treatment cannot be accepted as it is not substantiated by any cogent evidence.
It is not understood why the opp.parties settled the policy NO. 586914134 under Unique Link Policy where as repudiate the other two, particularly the policy No. 589864201 under the same Unique Link Policy on the ground of “suppression of material facts “after a long period of almost 4 years i.e on dt. 08.11.2013 .
Section 45 of Insurance Act is extracted below for clear adjudication of the case :-
Policy not to be called in question on ground of mis-statement after two years – No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement {was on a material matter or suppressed facts which it was material to disclose and it was fraudulently made} by the policy-holder and that the policy-holder knew at the time of making it that the statement was false { or that it suppressed facts which it was material to disclose}.
The Hon’ble Supreme Court in “Civil Appeal No.7437 of 2011” has held that “ Since the respondents had come out with the case that the deceased did not disclose correct facts relating to his illness, it was for them to produce cogent evidence to prove the allegation.
Issue No.(iv):- As per the above mandatory provision, repudiation can be made within two years from the date of commencement. Since the policy No. 586914134 was commenced on dt.12.03.2007 and death of insured was reported on dt.13.06.2009,and two years had already passed, the opp.parties settled the claim.
The opp.parties have repudiated other two claims i.e policy No.589864201 & 586927250 vide repudiation letter dt.8.11.2013 (Annexure-IV).Thus the repudiation has been made after two years of the prescribed period which is not admissible. Since two years had already passed, the nominee/married wife of Dayanidhi Sahoo ( complainant ) is entitled to get the assured amount.
The opp.parties have not filed the policy documents for which the other terms and conditions regarding bonus, interest or any other benefit could not be ascertained but since the dues of the complainant has been illegally withheld by the opp.parties, the petitioner is entitled to get interest on the assured amount from the date of filing of this case.
5. Hence ordered :-
: O R D E R :
The opp.parties are directed to pay the matured amount of the policy No. 589864201& 586927250.i.e Rs. 1,65,000.00 (Rupees One Lakh Sixty-Five Thousand) along with simple interest @5% per annum from the date of filing of the case i.e from dt.24.12.2013.till actual payment is made and Rs. 5,000.00 (Rupees Five Thousand) towards compensation along with Rs.5,000.00 (Rupees Five Thousand) towards cost of litigation. This order shall be complied within 45(forty-five) days from the date of receipt of this order.
The case is allowed accordingly on contest.
Order delivered in the open forum
today the 2nd November,2016 with hand and seal of this Forum.
Typed to my dictation
and corrected by me
Sd/-Mrs.S.Mallick Sd/-Sri K.K.Mohanty Sd/- Sri D. C. Mishra Member . Member. President.
