The complainant,Smt. Purnima Dhar, on 30. 08.11 by filing a petition U/S 12 of the C.P. Act , 1986 has prayed for an order against the O.Ps./ insurers for payment of Rs. 1,00,000/- each in respect of two policies ( total Rs. is 2,00,000/-) including all benefit and interest @ Rs. 9% from the date of death of policy holder i.e. 24.12.09 together with compensation of Rs. 50,000/- along with litigation cost of Rs. 2,500/- and any other relief or relieves as the Forum thinks fit and proper.
The case of the complainant in short is that as per direction of the O.P. no. 1 one Kalyan Kanti Dhar during his life time purchased two policies bearing no. 456144871 and 456144872 of LICI of Rs. 1,00,000/- each on 05.11.09, after completing medical examination arranged by the O.P.no.1 and he also paid premiums regularly . But all on sudden he died on 24.12.09 .After the death of the policy holder being a wife as well as a nominee of the said policies the complainant claim the death claim before the O.Ps./insurers. But without any valid ground O.Ps./insurers repudiated her claim .So, finding no other alternative the complainant field this case before this Forum to get proper relief.
On the other hand O.Ps. by filing their W.V. have contested this case denying all the allegations made against them in the complaint by the complainant . Their specific case has been stated by the O.Ps. in paragraph no.7 in their W.V. According to them the claim of the complainant is repudiated on the ground for non-disclose of material facts by the deceased policy holder as contract of insurance. So, O.Ps. have prayed for dismiss the case with cost .
To establish the case the complainant has filed one affidavit –in –chief sworn by herself as p.w.1 along with some documents. She was examined and cross examined by the Ld. Lawyer of both parties. The O.Ps. have also fifed document for supporting their case .
Decision with reason
Giving due consideration to the contents of the petition of complaint, W.V., documentary evidence of record and advanced by the Ld. Lawyer of both the parties , the Ld. Forum has come to the findings as follows ;-
It is admitted fact that during his lifetime deceased Kalyan Kanti Dhar purchased two insurance policies from the insurers , sum assured of Rs. 1,00,000/-each(total of Rs. 2,00,000/-) on 05-11-09. It also not denied by the O.Ps./insurers that Smt Purnima Dhar, the wife of the deceased is the nominee of the deceased policy holder. Further we got the support of the above from the policy certificates itself. The Xerox copy of the certificate of death and the Doctor’s death certificate show that the said policy holder died on 24.12.09 due to heart failure. From the Xerox copy of the two letters which has been issued by the complainant to the O.Ps. it show that the complainant informed the death news to the O.Ps./ Insurers and filed the death claim to the O.Ps. within specified period.
But the O.Ps./insurers have asserted in their W.V. that the said deceased policy holder submitted two separate proposals on the same day without giving any information of each other to the insurers . Due to that misrepresentation given by the deceased policy holder, the O.Ps. had accepted his two policy simultaneously ; actually the assurance of the deceased life could be made for one time only as it was a special policy under non –medical ( general) scheme . So, the senior divisional manager of the LICI on 29.11.2010 issuing a letter informed to the complainant that on what ground her claim is repudiated and as because they are not liable to give any payment under the above policies. For supporting their statements; the O.Ps. also filed one attested copy of their official circular Ref. no. U& R/3/2007 dt. 15.01.08.
But in the above document as submitted by OP no where it has been mentioned if any policy holder, who submitted his or her two proposal forms for same policy on the same day must be informed to the insurer about the details of each and other proposal in writing; otherwise in future at the time to give payment his or her claims will be repudiated, if it is happened, it is the duty of the OP/ insurer to check the same before acceptance of the same. Generally, we see that the proposal form is filled-up by the authorized agent / person of the concerned insurance company who are generally duty bound to achieve target assigned by the OP/ Insurer by hook and crook and under his instruction client only signed on it; even the contents of the proposal form and other formalities does not also bring to their client’s knowledge. Here in this case the complaint has also asserted that after satisfaction and direction given by the O.Ps.no.1 the deceased policy holder was submitted his proposal forms and after acceptance the same by the insurers he paid the premiums regularly. So, question arises if the deceased policy holder had broken any terms and conditions of the proposals forms at the time when he submitted those then why the insurers had accepted the same without doing any proper enquiry and why accepted his premiums also without giving any objections and thereafter why they issued two separate policy certificates in his name . So after acceptance of proposal forms, premiums and issuing the certificate of policy deeds arising such type of questions by the insurers is not at all justified. So, at this stage by denying the settlement of the complainant’s claim the O.Ps. /insurers opened a file of dispute ignoring their duty to the insured, who was their client. This is nothing but the deficiency in service on the part of the O.Ps./ insurers . So, we can not accept the plea taken by the insurer on refusing to give the claim amount of the complainant rather we do hold that the complainant has established a good case to succeed. As such she is entitled to get all insured amount from the O.Ps./insurers.
Fees paid are correct.
Hence, it is ordered
that this case bearing no. 44/11 is allowed on contest against the O.Ps./insurers with cost.
That the complainant do get an order of award of sum assured of Rs. 1,00,000/-each for her two insurance policies and compensation of Rs. 1000/- together with litigation cost of Rs. 500/- against the O.Ps./insurers , which is total of Rs. 2,01,500/- be paid within one month from passing this judgment , failing which the order may be put into execution .
Furnish the true photocopies of this final order to the parties free of cost.
