The fact of the case of the complainants in a nutshell is that  the predecessor of this petitioners, namely Kartick Chandra Das was a LICI policy holder vide LICI Policy number 496989594 and Policy No. 496980940. The period covered from 24.4.2013 to 10.4.2029 vide table no.014, term no.16 and Table no.048 proposal no. 21342 and said Kartick Chandra Das paid yearly instalment premium Rs.25,715/- & Rs.50,165/- respectively against the said policies and after

perusing the all formalities the LICI of India issued policy certificates in respect of said Kartick Chandra Das. Unfortunately, on 8.10.2013 said Kartick Chandra Das died at Jeebandeep Seba Sadan, Kamarkundu, Singur Hooghly due to Cardio Respiratory failure in a case of Myo Cardial Infraction. The petitioners being a legal heirs as well as nominee in respect of said policies informed the death report to the Office of the oP concerned and thereafter they submitted death claim against the said policy along with all relevant original papers. On 22.1.2014 the OP no.1 issued a notice to the petitioners with a request to submit some treatment particulars of deceased Kartick Chandra Das. After receiving the notice the petitioners submitte4d all relevant treatment documents in respect of deceased Kartick Chandra Das, to the office of the oP. But the Ops kept silent regarding the settlement of the said death claim of late Kartick Chandra Das. Hence this complaint.

            The Ops contested the case by filing Written version denying inter alia all material allegations. The Op admitted that the Life Assured Kartick Chandra Das , since deceased, purchased two Insurance policies as mentioned above. The Op also admitted that statutory claim forms have duly been supplied to the complainants and they have also duly submitted the same before the answering

Ops after duly filled up of the same.  The Ops further case is that since  the death of the Life Assured Kartick Chandra Das occurred within a few months from obtaining the policies, so after submission of the Claim forms by the complainants before the Op authorities they have investigated into the death claim in compliance of their statutory provision as the claim is very early in nature and it revealed from there that the Life Assured Kartick Chandra Das had made false statements deliberately by withholding correct information from the O.P., L.I.C.I. regarding his actual state of health at the time of effecting the assurance b foiling the Proposal form on his part.  The Ops further state that in view of Sec. 45 of Insurance Act, 1938 read with Section 17 of Indian Contract, 1872 and in terms and conditions of the Policy as mentioned in clause 5 on the back of the Policy Bond itself, the answering Ops are well justified in repudiating the claim of the complainant due to concealment of material facts by the Proposer/Life Assured in the Proposal form which was on material matters, but suppressed by him which he knew himself to be false and which should have positively been disclosed by him to the ops. The Ops pray for dismissal of the complaint.

             The complainant filed photo copy of Death certificate of Kartick Chandra Das, copy of LIC policy, Copy of Advocate’s letters, copy of letter addressed to the

Branch Manager, LICI, Tarakeswar Branch, issued by the complainant no.1, Smt. Nilima Das. Complainants also filed Affidavit in chief, Written Notes of Argument.Ops on the other hand filed photo copy of policy bond, photo copy of Voter Identity card of Kartick Chandra , photo copy of some prescription issued by Dr. Asit Kumar Das and some other photo copy of documents. Ops also filed Affidavit in chief, Written version and Written Notes of argument. 

POINTS FOR DECISION :

1)Whether the complainant is a consumer ?                                        

2)Whether there is any deficiency in service on the part of the oP ?                                                                                               

3)Whether the complainant/petitioner is entitled to get relief as prayed for ?

DECISION WITH REASONS :  

            It is admitted position that complainant legal heirs  had insurance policy through their predecessor in interest i.e. Kartick Chandra Das, since deceased. But after getting claim the oP repudiated the claim on the ground that life assured Kartick Chandra Das had made false statement deliberately by withholding correct information from the oP/LICI regarding his actual state of health at the time of effecting the assurance by filling the proposal form on his part.

          But in the Evidence in chief and in the Written version there is no statement of Op how complainant withhold correct information. Naturally question arises who put those questions to the complainant. The Op/Insurance company did not adduce any evidence that the said form was filled in by the complainant fully knowing the contents by himself or there is no evidence that the contents was read over to the complainant. The burden of proof shifts to the Op to prove the case of misrepresentation as stated by the Opposite party. But the same fact or representation must have been proved by the oP/Insurance company. Within the fourcorner of the documents that the Op or any agent of the oP had taken any initiative to that effect. Merely, taking the plea is not enough and that must be proved by the oP/Insurance company. But the Opposite party /LICI  company did not do it . So, in absence of any evidence that the complainant suppressed the fact as stated by the Opposite party , the Ops  reason becomes unreasonable and not proved. In the LIC policy the date of commences of risk started from 20.2.2013 and after that Kartick Chandra Das died. It is the LICs version in the first page. So LIC /OP cannot take such plea and which is not proved by the Ops by adducing cogent evidence. It is pertinent to note that agent Ananda Koley did not come forward to say and to prove who has filled in the form and whether the said

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form was read over to  Kartick Chandra Das, whose signature has been put below the signature of Kartick Chandra Das on 30.11.2013 with agent code.       The sum assured is Rs.4,65,000/- . Therefore, reason stated hereinbefore , we have no hesitation after examining the LIC policy that the legal heirs of said Kartick Chandra Das is entitled to get the sum assured. But the Op company with the intention to avoid payment did not apply mind and attributed different plea to save their interest, which is not tenable in law and the complainants are entitled to get relief due to the deficiency in service of the oP. After refusal the complainant has filed this case on 11.6.2015. The complainants are entitled to get relief not only sum assured but also compensation for delaying in dispose of the grants in favour of the legal heirs of late Kartick Das i.e. Nilima Das and Tanushree Mallick. Hence it is –

                                                                        Ordered

            That the C.C. case no. 102 of 2015 be and the same is allowed on contest.

The Opposite parties/LICI are directed to pay Rs.4,65,000/- plus bonus against the Policy no. 496980940  and Rs.3,00,000/- plus bonus against the Policy no.49698594 to the complainants being the legal heirs of late Kartick Chandra Das, the policy holder. The Ops are also directed to pay Rs.40,000/- to the

complainants towards compensation for their unnecessary harassment, pain and mental agony. The Ops are further directed to pay Rs.10,000/- towards litigation cost to the complainants. The Ops are directed to comply the above orders within 45 days from the date of this order i.d. complainants are at liberty to file Execution case to execute the above order.

          Let a copy of this order be made over to the parties free of cost.