BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 42 of 2017
Date of Institution : 22.2.2017
Date of Decision : 29.11.2017.
Lakhwinder Kaur aged about 38 years widow of Shri Bahadur Singh, resident of village Bajekan, Tehsil and District Sirsa.
……Complainant.
Versus.
The Branch Manager, Life Insurance Corporation of India, LIC Building, Sangwan Chowk, Sirsa District Sirsa.
...…Opposite party.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SMT. RAJNI GOYAT ………………… MEMBER
SH. MOHINDER PAUL RATHEE …… MEMBER.
Present: Sh. Narender Sharma, Advocate for the complainant.
Sh. Pawan Kochar, proxy counsel for Sh. K.K. Relan, Advocate for opposite party alongwith Sh. P.P. Sharma, Nodal Officer (Legal) LIC, Branch Office, Sirsa.
ORDER
The case of the complainant in brief is that husband of complainant namely Bahadur Singh during his lifetime purchased a life insurance policy from the opposite party vide policy No.178614922 dated 26.5.2010. The husband of the complainant had to pay a sum of Rs.6065/- after every six months and as per the policy, the sum assured was Rs.2,50,000/-. It is further averred that after purchase of the policy, husband of the complainant was regularly paying the amount of premium with the op without any delay and interruption. He never delayed even a single premium under the policy. The complainant is the nominee of her husband in the above said policy. It is further averred that on 10.2.2016, the husband of complainant had expired and as per the terms and conditions of the policy, the complainant being the nominee of the deceased is entitled to the sum assured. That after the death of her husband, she intimated the op about the death of her husband and requested to initiate the necessary proceedings with regard to release of sum assured in favour of the complainant. That on being contacted, the op had asked the complainant to deposit the original insurance policy, the deposit receipts as well as other relevant documents and promised to release the amount under the policy to the complainant within a day or so. It is further averred that complainant submitted the abovesaid necessary documents with the authority in the month of February, 2016 and an investigation was also conducted in this regard by the LIC authorities but inspite of it the sum assured has not been released in favour or complainant nor any cogent reason has been disclosed in this regard. That the complainant thereafter a number of times visited the office of op and requested to release the amount of sum assured to her but the op kept on avoiding the matter on one false pretext or the other and the complainant is still making rounds to the office of LIC time and again but the same proved futile. That the complainant also issued a registered legal notice to the op on 10.8.2016 and thereafter on 21.11.2016 a reminder was also sent to the op but to no effect. Hence, this complaint.
2. On notice, opposite party appeared and filed reply taking certain preliminary objections regarding maintainability; cause of action; suppression of material facts and that the complainant did not avail the departmental remedy of filing representation against the repudiation of the claim before the Zonal Office, New Delhi before filing the present complaint and that complaint is not within the period of limitation. On merits, it is submitted that the competent authority has repudiated the liability under the policy on genuine ground and informed the complainant by registered letter dated 31.1.2017. The aforesaid policy has not completed three years from the date of revival i.e. 12.12.2014 from the date of death of the LA. As such the op examined the claim in view of provisions of Section 45 of Insurance Act, 1938. While examining the Form No.680 dated 12.12.2014 regarding declaration of good health submitted at the time of revival of the policy, the deceased LA had answered the following questions as noted here in below:
2. Since the date of your proposal for the above mentioned policy:
Answer ‘Yes’ or ‘NO’
Have you ever suffered from any illness/ disease requiring treatment for a week or more?
Answer ‘ NO/
Did you ever have any operation accident or injury?
Answer ‘ NO’
Did you ever have undergone ECG, X-RAY and screening, Blood, Urine or Stool examination?
Answer ‘NO’
Are you at present in sound health?
Answer ‘Yes’
However, it is submitted that all these answers were false as the op hold indisputable proof (form-3816) to show that LA was not maintaining good health and was suffering from k/c/o Pulmonary Koch’s with Septicemia/DM2/CHF. As per form 3784, Dr. Surender Swami is the family physician of LA since 10 years and LA was taking treatment for sugar for last three years. It is further submitted that life assured had not disclosed this adverse history in the revival papers. The suppression of material facts which have a bearing on the granting of risk, was clearly done with intent to mislead the corporation. The op is refunding premiums paid for revival and paid up value prior to date of revival towards full and final settlement of above claim. It is further submitted that the competent authority has repudiated the liability under the above policy on genuine ground. Remaining contents of the complaint are also denied.
3. The complainant produced her affidavit Ex.CW1/A, copy of legal notice Ex.C1, copy of reminder Ex.C2, status report Ex.C3, attested copy of death certificate Ex.C4, letter dated 8.12.2016 Ex.C5. On the other hand, op produced affidavit of Sh. Rajendra Singh Manager Ex.R1, copy of proposal form Ex.R2, copy of letter dated 31.1.2017 Ex.R3, copy of status report Ex.R4, copy of revival form Ex.R5, copy of voter identity card Ex.R6, copy of medical examiner’s confidential report Ex.R7, copy of certificate of hospital treatment Ex.R8, copy of certificate of doctor Ex.R9, copy of status report of policy Ex.R10, copy of status report Ex.R11, copy of form Ex.R12 and copy of indoor file Ex.R13, copy of treatment chart Ex.R14 and copies treatment record Ex.R15 to Ex.R18.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. It is an admitted fact of both the parties that policy in question was issued to Bahadur Singh, since deceased husband of complainant on 26.5.2010 and the sum assured of the policy is Rs.2,50,000/-. It is also not in dispute that complainant is the nominee in the above said policy. The perusal of the death certificate Ex.C4 reveals that death of Bahadur Singh life assured took place on 10.2.2016. The case of the complainant is that as per the terms and conditions of the policy, the complainant being the nominee of the deceased is entitled to the sum assured. According to the opposite party, there was break in the policy due to non payment of premium in time and the policy was revived on 12.12.2014 but the policy has not completed three years from the date of revival i.e. 12.12.2014 and the date of death of the LA which took place on 10.2.2016 and since the deceased had withheld the material information regarding his illness in the revival form as he was taking treatment for sugar for last three years, the claim is not payable as per Section 45 of the Insurance Act, 1938. However, we do not see any substance in the contentions of the opposite party. The perusal of the status report of the policy Ex.R11 reveals that life assured paid installments of seven premiums in time and on one occasion i.e. in the month of November, 2013 the premium was not paid in time and it is an admitted fact that policy in question was revived after payment of premium amount alongwith late fee by the life assured. The perusal of the revival form dated 12.12.2014 Ex.R5 reveals that to the questions regarding health condition of the deceased, the answers have been written as ‘No’ in English and the life assured signed the revival form in Hindi. In the end of the revival form a declaration is to be given by the agent that he has specifically explained the questions to the life assured and he has written the answers correctly as given by the life assured and that he has read over the facts of this form to the life assured and after understanding the same he has signed/ thumb marked the same but the above said columns regarding declaration of the agent in the revival form are vacant and are also not signed by any agent. The agent of the opposite party has failed in his duty in this regard. Further more, at the time of revival of the policy, the life assured was subjected to medical examination by the doctor on panel of the insurance company as is evident from copy of medical examiner’s confidential report Ex.R7 and on the basis of this medical examiner’s confidential report, the policy in question was revived condoning the delay. The opposite party has only relied upon documents Ex.R8 and Ex.R9 i.e. alleged certificates of the doctors in order to prove its plea but has not proved through any cogent and reliable evidence that deceased life assured was suffering from the above said disease at the time of revival of the policy i.e. on 12.12.2014. No treatment record of the deceased life assured for the above said disease has been placed on file by the opposite party in this regard in support of its plea. So, in our considered opinion the opposite party has wrongly and illegally repudiated the genuine death claim of the complainant. The complainant being nominee of the deceased life assured is entitled to the sum assured/ benefits of the policy in question. The authorities cited by learned counsel for ops in cases titled as LIC of India Vs. Jyothi Sudhir, RP No.1134 of 2016 (NC) and LIC Vs. Lachha Devi, RP No.2025 of 2011 are not applicable to the facts and circumstances of the present case.
6. Thus, as a sequel to our above discussion, we allow the present complaint and direct the opposite party to pay the benefits/sum assured amount of Rs.2,50,000/- to the nominee/ complainant (after deducting the amount, if any already paid) alongwith interest @4% per annum with effect from the date of repudiation of the claim i.e. 31.1.2017 till actual payment within a period of one month from the date of receipt of copy of this order, failing which the complainant will be entitled to additional interest @9% per annum from the date of order till actual payment. We also direct the opposite party to pay further an amount of Rs.10,000/- as composite compensation and litigation expenses to the complainant. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:29.11.2017. Member Member District Consumer Disputes
Redressal Forum, Sirsa.
