F I N A L O R D E R
This case has arisen out of an application U/s 35 of the Consumer Protection Act, 2019.
The case of the complainant is that during life time Navin Maskara purchased 08 LIC policy Nos:452076606, 456958202, 456265642, 452349344, 453218558, 998984745, 401449985 & 404885179 from the O.Ps for his and his family’s safe guard. At the time of purchase of policies the O.P concern collected all information from their Agent and the insured person and satisfied all corner the O.Ps concern issued policies in favour of the deceased.
That the insured Navin Maskara died on 30.06.2019 at Anandalok Hospital, Siliguri leaving behind his mother, wife and son i.e the complainants as his legal heirs.
That out of 08 policy(s) 02 number of policy(s) being No:-401449985 & 404885179 sum assured Rs.1,50,000/- and Rs.2,00,000/- respectively, have been repudiated by the O.P concern in the month of December, 2020 on the ground that “the suppression of material facts, which have had a bearing on the granting of Risk, was clearly done with intent to defraud the Corporation, so it has been decided to repudiate all liabilities under the aforesaid policy(s) and all the money received by the Corporation under the aforesaid policy(s) stand forfeited in terms and conditions and nothing is payable.”
That the complainant several time requested O.Ps concern for payment of the sum assured, but the O.Ps whimsically & illegally repudiated the claim thereby complainants suffer irreparable loss and injury causing mental pain and agony & for deficiency and negligence in service of the O.Ps concern this complaint is filed, praying for direction to the O.Ps to pay sum assured Rs.1,50,000/- & Rs.2,00,000/- of above mentioned policies + interest + vested bonus & benefit, compensation of Rs.1,00,000/- & litigation cost of Rs.20,000/-.
O.Ps contested the case by filing W.V admitting that above numbered 08 policy(s) were issued on the life of Navin Maskara during his life time, of which death claim for first 06 policy(s) viz 452076606, 456958202, 456265642, 452349344, 453218558 & 998974745 were settled in favour of the recorded nominee in time, but as the death of DLA (Deceased Life Assured) occurred within 02 years from the DOC (Date of commencement), as per Section 45 of Insurance Act, the claim pertaining to policies viz 401449985 & 404885179 were treated as EARLY in nature. As date of commencement of those policy(s) found 28.03.2018 & 28.03.2018 and the death of the life assured was occurred on 30.06.2019, as such the duration of policy No:401449985 is 1 Yr 3 Months and for policy No:404885179 is 3 Months only. The DLA at the time of taking the policy(s) made statement in the Proposal Form which is the basis of the contract, where he answered No against pre-existing disease etc, answering Good against question what has been your usual state of health & all the answers given by the DLA were false and he had made false statements with an intention to defraud LIC by suppressing the material facts regarding his health. In thorough investigation it is established that the DLA was suffering from various ailments and under regular treatment before taking the policy(s)-in-question, but he suppressed the material facts by answering False in the relevant section of Proposal Form. Hence, LIC has rightly repudiated their claim.
However the complainant being aggrieved with the decision of repudiation of claims by O.P.No-2, represented the consideration of her claim to Zonal Office Claim Dispute Redressal Committee, Kolkata, which uphold the decision of repudiation by O.P.No-2, justified.
Moreover, the complainant also knocked the door of Insurance Ombudsman, Kolkata which also uphold the decision of repudiation by O.P.No-2, justified. There was no deficiency and negligence on the part of the O.Ps and O.Ps pray for dismissal of the case.
Points for consideration are:-
- Whether there was any deficiency or negligence in service on the part of the O.Ps which gives rise cause of action to file the complaint and the complainants are entitled to get the claim?
D e c i s i o n w i t h r e a s o n s
Admittedly, during his life time Navin Maskara purchased 08 Life Insurance Policies being No:452076606, 456958202, 456265642, 452349344, 453218558, 998974745, 401449985 & 404885179 from LIC/O.Ps concern.
It is also admitted that Navin Maskara had died on 13th day of June, 2019 at Anandalok Hospital, Siliguri, leaving behind the complainants i.e his mother, wife and son as his only legal heirs.
It is further admitted that out of the above 08 policies death claim for first 06 policy(s) were settled in favour of recorded nominee of DLA/Navin Maskara, in time.
The dispute rests on later 02 policy(s), details of which are as follows:-
Policy No:-401449985, Sum Assured-Rs.1,50,000/-, Plan/Term-814/16, DOC/Date of Commencement-28.03.2018, Duration of Policy 1 year 3 months, as the death of Life Assured was occurred on 30.06.2019.
Policy No:404885179, Sum assured Rs.2,00,000/-, Plan/Term-814/16, DOC/Date of Comencement-28.03.2019, Duration of Policy 3 months, as the death of Life Assured was occurred on 30.06.2019.
According to O.Ps concern, as the death of DLA/Navin Maskara occurred within 02 years from the date of commencement, as per Section 45 of Insurance Act, the claim pertaining to policy numbers 401449985 & 404885179 were treated as EARLY in nature and investigation was started to ascertain the genuineness of the claim of the complainants in respect of those two policies.
Proposal form of above numbered two policy(s) are produced by O.P concern, wherein Section11. Personal History-the DLA/Navin Maskara had given answers “No” against Sub Section a.b.c.d.f, “Does not arise” against Sub Section e & Good against Sub Section g. what has been your usual state of health?
Claim Form B-1 (produced) shows that the DLA was admitted at Anandalok Hospital, Siliguri, on 29.06.2019 & he died on 30.06.2019 and the primary cause of death is h/o Convulsion from 1:00 p.m that day and past h/o Seizure Disorder and second cause of death is Sepsis with MODS in case of Stutus Epelepticus. Prescriptions of Dr. Ratan Lal Agarwal, Dr. S.K. Agarwal are produced. From these it is established that the DLA/Navin Maskara was suffering from various ailments and under regular treatment before taking the policy(s)-in-question but suppressed those facts by answering False in the relevant section of the Proposal Form in order to obtain those policy(s).
Admittedly, 02 nos of Policy(s) being No:401449985 & 404885179, Sum Assured/SA Rs.1,50,000/-& Rs.2,00,000/- respectively have been repudiated by the O.Ps concern by 02 separate repudiation letter dated 18th December, 2020 on the ground that “the suppression of material facts which have had a bearing on the granting of Risk, was clearly done with intent to defraud the Corporation, so it has been decided to repudiate all liabilities under the aforesaid policy(s) and all the money received by the Corporation under the aforesaid policy(s) stand forfeited in terms and conditions and nothing is payable.”
The complainant No-1/P.W.1 stated that the O.Ps concern whimsically and illegally repudiated the claim, whereby she suffers irreparable loss and injury due to deficiency and negligence of the O.Ps concern.
Admittedly, the complainant being aggrieved with the decision of repudiation of claims by O.P.No-2, represented the consideration of her claim to Zonal Office Claim Dispute Redressal Committee, Kolkata, which uphold the decision of repudiation by O.P.No-2, justified.
It is also admitted that the complainant also knocked the door of Insurance Ombudsman, Kolkata which also uphold the decision of repudiation by O.P.No-2, justified.
Under the above facts and discussion we find that there was no deficiency or negligence on the part of O.Ps concern in repudiating the claim of the complainant under provision of Section 45 of Insurance Act, 1938 and consequently the complainants are not entitled to get relief(s) as prayed for.
In the result the case fails.
Hence, it is
O R D E R E D
that the C.C-33/2021 be and the same is dismissed on contest but without any cost.
Let a copy of this order be given to the parties free of cost.
