BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION.
KAMRUP
C.C.No.49/2010
Present: I) Shri A.F.A.Bora, M.Sc.,L.L.B.,A.J.S(Rtd.) -President
II) Smti Archana Deka Lahkar,B.Sc.,L.L.B. -Member
III) Shri Tutumoni Deva Goswami, B.A.L.L.B. - Member
Ms.Karishma Jain (Legal heir) - Complainant
D/O Late Sapna Devi Jain
-vs-
Life Insurance Corporation of India - Opposite party
Appearance:
For the complainant Sri B.K.Jain, Sri M.Dasgupta Learned advocate .
For the opp.party Sri N.Deka Learned advocate
Date of filing written argument:- 9.11.2021
Date of oral exparte argument:- 7.12.2021
Date of judgment: - 5.1.2022
JUDGMENT
1) This is a complaint filed under Section 12 of the Consumer Protection Act, 1986 by the original complainant (since deceased) Smti Sapna Devi Jain, against Life Insurance Corporation of India opposite party for deficiency of service rendered by them.
2) The case of the complainant is that Late Sanjay Jain, the husband of the complainant was a practicing Chartered Accountant . In the evening of 23.9.2006 while performing a religious singing program at Maligaon Jain Temple, Maligaon, Guwahati -11, he felt chest pain. He was immediately taken to nearby Sanjeevani Hospital, Maligaon,Guwahati-11, for treatment, but inspite of treatment , he died due to sudden cardiopulmonary arrest on the same day at about 11-45 p.m.
3) The complainant stated that the husband of the complainant was a normal and healthy person and he never suffered from any ailment or decease worth mentioning prior to his death. The husband of the complainant purchased a life insurance policy being policy No. 481460845 from the life insurance corporation of India, Mirza branch, under Guwahati Division, for a period of 30 years, which commenced on and from 28.6.95 and the date of maturity was 28.6.25. The sum assured was Rs.3,00,000/- (Rupees three lakhs) and the yearly premium payable was Rs.3405/- The deceased paid first premium of Rs. 3405/- on 22.8.95, which was duly received by the opp.party and thereafter deceased continue to pay the yearly premium and the LIC policy issued by the opp.party was subsisting at all material time.
4) The complainant further stated that prior to accepting the proposal of insurance and undertaking the above policy and during the continuance of the policy the doctor of LIC thoroughly examined the deceased and found him quite normal person , accepted the proposal and issued the said policy. Immediately after the death of Sanjay Jain, complainant being the wife cum nominee of the deceased under the policy, formally preferred her claim on 15.11.2006 before the opp. party. Thereafter , by letter dated 15.2.08 issued by the Mirza Branch Office of the opp.party, requesting the complainant to fill up the claim form sent with the said letter .
5) The complainant further stated that she complied with the request of the opp.party and accordingly submitted a completed claim form along with the documents namely ,
i) Medical attendant certificate
ii) Certificate of Hospital Treatment
iii) Certificate of identity and Burial or cremation
iv) Death certificate duly attested
v) Attested copy of Affidavit by the complainant regarding place of death and place of cremation.
vi) Affidavit in connection with the name of the complainant as well as the name of her father in law.
vii) Original policy copy.
6) After submission of the claim form, the complainant was waiting for settlement of her claim but to delay she gave reminders dtd.10.2.08, 28.2.08, 24.6.08 to the opp.party, thereby requesting for an early settlement of her claim. After unreasonable delay, the complainant received a letter dated 26.2.09 from the Zonal Manager , LIC of India , Eastern Zonal Office at Culcutta thereby repudiating her claim on the allegation that the deceased had suffered from various types of fatal disease as on date of medical check up on 1.3.2002.
7) The complainant states that there was no suppression of material facts . The deceased had no ailment and he was never hospitalized . He was neither involved in any accident nor under gone any radiological , Cardiological, pathological test or suffered from any ailment pertaining to lever, stomach, heart, lung, kidney, brain or nervous system any time prior to taking up the policy.
8) The complainant states that during the continuation of policy in the year 2002 , deceased went for pilgrimage and after hectic tour of 30 days , he reached Chennai. Due to tiring journey the deceased suffered from hypertension etc. and for that reason he visited Apollo Hospital on 1.3.2003 for general check up and he was a out door patient. The complainant claims a sum of Rs. 3,00,000/- being the sum assured as well as claims Rs.1,26, 641/- being the interest @12% per annum on the insured sum from 23.9.2006 till filing of this case. As well as also claim a sum of Rs. 50,000/- for damages.
9) The op.party has contested the case by filing written statement . They had stated in their written statement that complaint is incorrect and hence denied. It is denied by the op.party that deceased was a normal and healthy person and never suffered from any disease prior to his death. The deceased was admitted for medical check up on 1.3.2002 at the Apollo Hospital ,Chennai. According to the medical check up report of Apollo Hospital the deceased was suffering from hypercholesterolemia, hemianopia , a known case of systemic hypertension for about 5 years prior to the check up and was on regular medication.
10) The opp.party states that the deceased failed to pay the premium timely , that the policy was a “Bima Kiran “policy and the mode of payment of premium was yearly and the date of such payment was 28th of June every year. As per the terms and condition of the policy a grace period of one month from the due date is allowed for making payment of the premium i.e. the grace period was up to the 28th day of July every year . If the policy holder fails to pay premium within the grace period then the policy lapses.
11) The opp.party states that the policy of the deceased was lapsed, but same was revived on 8.2.2006 and accordingly due date for payment of the next premium was 28.6.2006 as well as grace period was up to 28.7.2006. However , the deceased failed and neglected to pay the premium within the grace period i.e. 28.7.2006 and as such , on the date of his demise the policy was in a lapse condition. Therefore , the claimant is entitled only for refund of premiums paid as per the terms and condition of the policy. The opp.party also stated in their written statement as the deceased had suppressed the material fact at the time of revival of the policy i.e. on 8.2.2006 , they are not bound to pay the insured amount .
12) We have duly taken notice of the papers and documents available on record and the pleading of the parties from where it reveals that the opp.party claims that the policy of the claimant was lapsed and the due date for payment for premium was on 28.7.2006 with a grace period. The opp.party in the written statement makes it clear that policy was lapsed and it was revived on 8.2.2006 .In such a situation the plea taken by the opp.party is that deceased was suffering from hypercholesterolemia, hemianopia for about 5 years. This ground stated in the written statement is a pleading of the opp.party and has not been proved by adducing any evidence . Moreover, if patient has been suffering from such pre-disease prior revival of the policy the opp.party could have taken notice of this facts and could have done appropriate action in the matter. On the other hand, we have taken notice of one of the Annexures i.e. Annex.1 submitted by the opp.party along with their written statement which indicates that there is no history of heart disease . These documents given as annexure is found contradictory pleading of the op.party itself.
13) The another plea taken by the opp.party in the written statement is that the policy has been lapsed , but to the contrary the claimant on his evidence claims that the premiums of the concerned policy were regularly paid . So, in such a case without any evidence from the op.party it is difficult to accept the view that the policy was lapsed. At para 4 of the evidence on affidavit of the complainant it is stated that the policy was subsisting. As such, the plea taken by the opp.party for repudiation of the claim of the complainant for the reason of lapse of said the policy cannot be accepted.
14) During argument the complainant have pointed out and referred their documents termed as Ext.7 which is a letter addressed to the claimant Sapna Jain by the Zonal Manager, LIC of India for which the policy holder was suffering from various type of fatal disease and same was not disclosed at the time of revival of the policy and therefore , the claim made by the complainant has been repudiated, but it is pointed out by the claimant that there was not a single whisper by the op.party on Ext.7 that the policy was lapsed for non-payment of premium. In such a situation we are also of the view that it cannot be said without any evidence that the policy concerned was lapsed for which the claimant is not entitled for full benefit of the policy.
15) In the result it is held that claimant is entitled for the total sum assured to the tune of Rs.3,00,000/- (Rupees three lakhs) only with an interest @ 6% from the date of filing of the claim petition till realization and also an amount of Rs.50,000/- as compensation. The decretal amount is to be paid within 45 days from the date of judgment failing which op.party have to pay an interest @ 12% per annum from the date of judgment till realization on the entire amount.
Given under our hand and seal of the District Commission, Kamrup, this the 5th day of January /2022.
Shri Tutumoni Deva Goswami
Member
District Consumer Commission, Kamrup
Smti Archana Deka Lahkar
Member
District Consumer Commission, Kamrup
Shri A.F.A.Bora
President
District Consumer Commission, Kamrup
Dictated and corrected by me
Shri A.F.A.Bora
President,
District Consumer Commission, Kamrup.
Typed by me
Smt Juna Borah
Stenographer,
District Consumer Commission, Kamrup.
