Assam

Dibrugarh

CC/10/2021

SMT. JULIE DUTTA - Complainant(s)

Versus

LIFE INSURANCE CORPORATION - Opp.Party(s)

SRI AJIT BORGOHAIN

20 Mar 2024

ORDER

Date of Argument: 07.06.23 and

                                08.09.2023

                                                                                                            Date of Judgement: 20.03.2024

This C.P. case has been filed U/S 35 of the Consumer Protection Act, 2019 by the complainant praying for directing the O.P.s to pay the death claim under Policy No.136478400 & 403521569 lying  with Life insurance Corporation, Naharkatia Branch, due to death of its policy holder Late Prasanta Dutta, the matured amount of Rs.31,20,000/- and Rs.1,00,000/- along with compensation of Rs.50,00,000/- for giving mental and physical agony to the family members of the deceased and also to pay Rs.50,000/- as cost of litigation.

                                                              JUDGEMENT

1. The complainant submits that she is the legally married wife of Late Prasanta Dutta, having permanent residence at Jaloni Gaon, P.O. Lilapur, P.S. Duliajan, Dist. Dibrugarh, Assam within the jurisdiction of this Commission. The husband of the complainant, i.e. Late Prasanta Dutta during his lifetime insured life vide Policy No.136478400 & 403521569 lying with Life Insurance Corporation, Naharkatia Branch and continued to pay premiums regularly, without any lapse. But unfortunately, he expired on 10.03.2019 at Assam Medical College, Dibrugarh leaving behind him the complainant, his 16 years old son namely Master Mrinmoy Nilim Dutta, who at present is studying in class 10 at Kendra Vidyalaya School, Duliajan, his 14 year old son namely Master Arindom Dutta, who at present is studying in class 8 at New Vista School, Duliajan and his mother, namely Smti. Lilima Dutta, W/O Sri Nandeswar Dutta as his surviving legal heirs and successors.

 

2. The matured amount of Policy No.136478400 and 403521569 is Rs.31,20,000/- and Rs.1,00,000/- respectively. The said policy holder Late Prasanta Dutta took the policies on his own life in compliance with all the legal formalities by depositing a huge amount of money from his hard earned, with an expectation that in his absence, the complainant along with other family members would live a comfortable life.    

 

3. After observing funeral rituals of her husband i.e. Late Prasanta Dutta, the complainant communicated with the O.P.s for receivable amount under the aforesaid policies due to death of her husband and accordingly vide letter dated 23.07.2019, the L.I.C. of Naharkatia Branch asked the complainant to deposited all the relevant original documents in the office of the L.I.C. Jorhat Division through the L.I.C. Naharkatia Branch and the O.P.s assured that she would get the death claim under these policies as the process was going on. However the O.P.s issued a letter vide Ref. JDO/Claims/Repdn/19-20/44B/1423 dated 21.11.2019 informed that as the policy holder during his lifetime suppressed some material fact with intend to mislead the Corporation, hence it has been decided to repudiate all the liabilities under Section 45 of the Insurance Act, 1938. Being aggrieved by the aforesaid facts the complainant placed her grievances before the Insurance Ombudsmen, Guwahati, but she did not get any relief despite repeated request and endeavours.

 

4. It is averred that the policy holder continued the policies by paying premium so the policy holder as well as the complainant is the consumer and the O.P.s committed deficiency in service by not paying the death claim under Policy No.136478400 & 403521569 lying with L.I.C., Naharkatia Branch and giving enormous mental agony and as such the complainant to get compensation for committing such deficiency of service. The cause of action for the complainant’s grievances arose w.e.f. 10.03.2019. It is alleged that the aforesaid unlawful act of the O.P.s, the complainant and other surviving legal heirs of the policy holders have suffered sufficient damages in terms of physical and mental loss beside monetary losses and as such the O.P.s are liable to pay adequate compensation to the complainant. Hence the complainant prays for the following relief and directions-

 

1. To direct the O.P.s to pay the death claim amounting to Rs.31,20,000/- and 1,00,000/-respectively under Policy No.136478400 & 403521569 lying with Life Insurance Corporation, Naharkatia Branch, due to death of its policy holder Late Prasanta Dutta.
2. To direct the O.P.s to pay compensation of Rs.50,00,000/- for giving mental and physical agony to the family members of the deceased.
3. To direct the O.P.s to pay Rs.50,000/- as cost of filling the instant case.

 

5. After receipt of the notice the O.P. No.1 to 3 appeared before this Commission and filed Written Statement on 21.10.2021 interalia contended that there is no cause of action arose as claimed in para 12 of the claim petition. The complaint is also suffered from mis-joinder and non-joinder of necessary parties hence liable to be rejected. The legal heirs of the deceased Prasanta Dutta are not made party(s) to the instant case and in absence of which no effective order/award can be passed by this Commission as prayed by the complainant. The case is barred by the principles of estoppels, waivers and acquiescence and also barred by limitation as such liable to be dismissed. Further stated that the claim petition is false, frivolous and speculative and the claimant has filed the instant case for her wrongful gain causing wrongful loss to the O.P.s and hence the claim is liable to be rejected.

 

6. It is admitted by the O.P.s that the husband of the complainant Late Prasanta Dutta had insured his life with the O.P. No.1 vide Policy No.136478400 and 403521569 on 23.09.2017 against an assured sum of Rs.31,20,000/- and Rs.1,00,000/- wherein the complainant was the nominee. The policy holder Late Prasanta Dutta died on 10.03.2019 at Assam Medical College Hospital, Dibrugarh leaving behind him the complainant. The O.P.s neither admitted nor denied in respect of surviving legal heirs and successors of his 16 years old son namely, Master Mrinmoy Nilim Dutta who at present is studying in class 10 at Kendra Vidyalaya School, Duliajan and his 14 years old son namely, Master Arindom Dutta who is studying in class 8 at New Vista School, Dulajan and his mother Smti Lilima Dutta.

 

7. O.P.s further admitted that after receipt of communication from the complainant to release the assured amount due to the death of her husband, the O.P. No.3 issued a letter on 23.07.2019 asking the complainant to provide the case history sheet, discharge summary and previous treatment particulars of Late Prasanta Dutta as per the procedure laid under the Life Insurance Corporation of India and accordingly the complainant submitted all those relevant documents to the O.P. No.2 for disposal of the case. After examining the claim of the complainant, the O.P. noticed that husband of the complainant i.e., policy holder Late Prasanta Dutta suppressed some material facts regarding his long term diseases in the serial No.11 of the proposal Form at the time of taking the policies as per the provisions of the Insurance Act, 1938 and hence the O.P. No.2 repudiated all the claims of the aforementioned policies. O.P. stated that the policies in question were accepted from the policy holders on the basis of his declaration on the proposal form in serial No.11. And as per the Medical Attendant’s Certificate and Certificate of the Hospital Treatment issued by the Competent Authority of Assam Medical College Hospital, Dibrugarh wherein it is clearly stated that the policy holder Late Prasanta Dutta was suffering from T2 DM and HTM since last 10 years along with several diseases which he had not disclosed at the time of submitting the proposal form for Insurance as stated above. Furthermore the aforementioned policies have not completed three years from the date of commencement of risk/from date of last revival and it is within 2 years from the date of life assured as such the claim by complainant is repudiated by O.P.s keeping in view the provisions of Section 45 of the Insurance Act, 1938.

 

8. It is submitted that the O.P. No.1 has been constituted to provide the best service to its policy holders whenever their policy is being matured. But the deceased policy holder Late Prasanta Dutta deliberately mislead the O.P. No.1 while he disclosed the “Personal History” as mentioned in Column No.11 of the Proposal for Insurance on own life. Life Insurance contract is done on the principle of “Uberrimafide”- “utmost good Fath”. It is the burden duty of the proposer to disclose all material information’s regarding health and habits truthfully while filling the proposal form of Insurance Contract. But the policy holder, the deceased Late Prasata Dutta violated the ground principle of Insurance Contract by submitting false statements in his personal history of proposal form under Serial No.11- a, b, c, d, e, f, g, h (i, ii, iii, iv), i and j. So the authority of the O.P. No.1 repudiates the said claims on the grounds of wilful suppression of material facts at the time of proposal of the policies U/S 45 of the Insurance Law (Amendment) Act, 2015 and hence, the O.P.s act cannot be claimed as “Bolt from the blue” for the complainant.

 

9. It is submitted that the complainant has no right to claim against the O.P.s in accordance with the Principles of Natural Justice as the complainant of the deceased Late Prasata Dutta being the alleged nominee of the aforesaid policies deliberately concealed the material facts of the claim just for her wrongful gain causing wrongful loss to the O.P.  It is the complainant who has filed the instant case just to give harassment to the O.P.s as the claim petition has already been repudiated by the Insurance Ombudsman earlier to the filing of the instant case. The deceased policy holder might have continued the policies by paying the premiums just for misleading the O.P. and after due scrutiny of the entire records, it was found that the deceased policy holder Late Prasanta Dutta insured his life by suppressing the real material facts about his health and habits which leads to establish malafide intentions of the policy holder, which is against the terms and condition of the contract of the Life Insurance Corporation of India and therefore the O.P. has rightly repudiated the death claim under Policy No. 136478400 and 403521569 of Late Prasata Dutta, under Section 45 of the Insurance Act, for suppression of material fact. The O.P. also denied that as a result of the aforesaid unlawful acts and deficiency in service on their part, the complainant and the other surviving legal heirs of the policy holder has suffered sufficient damages in terms of physical and mental loss besides monetary losses and as such the O.P. is liable to pay adequate compensation to the complainant. It is submitted that the complainant is not bonafide or genuine and the O.P.s repudiated the claim of the complainant as per provisions of the Insurance act. Further the complaint filed by the complainant under the misconception of law as well as in facts and for that reason the complaint petition is liable to be dismissed.  

 

10. In this case complainant, Smti. Julie Dutta has submitted her evidence on affidavit as P.W.1 and three other witnesses namely Smti Mrinalee Dutta, Sri Barri Balraj and Sri Madhujya Dutta as P.W.2, P.W.3 and PW4 respectively to support her claim and exhibited as many as 5 documents. In the evidence the P.W.1 has reiterated the same facts as has averted in her complaint petition. Complainant stated that she is legally married wife of Late Prasanta Dutta, permanently residing at Jaloni Goan, P.O. Lilapur, Duliajan, P.S. Duliajan, Dist. Dibrugarh, Assam. Her husband i.e. Late Prasanta Dutta during his lifetime being L.I.C. policy holder of Policy No.136478400 and 403521569 lying with Life Insurance Corporation, Naharkatia Branch, continued to pay premiums regularly, without any lapse. But very unfortunately, he expired on 10.03.2019 at Assam Medical College, Dibrugarh leaving behind herself i.e. the complainant, his 16 years old namely Master Mrinmoy Nilim Dutta, who at present is studying in class X at Kendra Vidyalaya School, Duliajan, his 14 year old son namely Master Arindom Dutta, who at present is studying in Class VIII at New Vista School, Duliajan and his mother, namely Smti Lilima Dutta, W/O Sri Nandeswar Dutta as his surviving legal heirs and successors.

 

11. The matured amount of policy No.136478400 and Policy No.403521569 is Rs.31,20,000/- (Rupees Thirty One Lakh Twenty Thousand) only and Rs.1,00,000/- (Rupees One Lakh) only respectively. Late Prasanta Dutta took the policies on his own life in compliance with all the legal formalities by depositing a huge amount of money from his hard earned, with an expectation that in his absence, complainant along with her other family members would live a comfortable life. After observing funeral rituals, complainant communicated with the O.P.s for receivable amount under the aforesaid policies due to death of husband i.e. Late Prasanta Dutta and accordingly vide letter dated 23.07.2019, the L.I.C. of Naharkatia Branch asked to provide case history sheet, discharge summary and previous treatment particulars of the deceased. The complainant deposited all the relevant original documents in the office of the L.I.C. Jorhat Division through the L.I.C. Naharkatia Branch and the O.P.s assured that complainant would get the death claim under these policies as the process was going on.

 

12. During continuation of the aforesaid activities by the O.P.s, a letter was issued to the complainant vide Ref. JDO/Claims/Repdn/19-20/44B/1423 dated 21/11/2019 from the office of the Jorhat Division with an information that as the policy holder during his lifetime suppressed some material fact with intend to mislead the Corporation, hence it has been decided to repudiate all the liabilities as per Section 45 of the Insurance Act, 1938. The letter bearing No.DJO/Claims/Repdn/19-20/44B/1423 dated 21/11/19 sent from the office of the Jorhat Division L.I.C. Office was issued without any justified ground. Thereafter the complainant placed her grievances before the Insurance Ombudsmen, Guwahati for redressal of her redressal of grievances, but to no effect, despite repeated requests and endeavours. Due to repudiation of the aforesaid policies for no fault of the policy holder, the complainant and her family members are passing their days tremendous mental hardship and agony. The policy holder continued the policies by paying premiums so the policy holder as well as the complainant is the consumer of the O.P.s and the O.P.s committed great deficiency in service by not paying the death claim under Policy No.136478400 & 403521569 lying with Life Insurance Corporation, Naharkatia Branch and thereby giving enormous mental agony and harassment to the complainant, hence the complainant entitled to get compensation.  It is also stated that as a result of the unlawful act of the O.P.s, the complainant and other surviving legal heirs of the Policy Holder have suffered sufficient damages in terms of physical and mental loss besides monetary losses. Complainant has filed below mentioned exhibits to substantiate her claim which are as follows-

 

1. Exhibit No.1 is the attested copy of the Insurance policy being L.I.C. Policy No.136478400.
2. Exhibit No.2 is the death certificate of Late Prasanta Dutta dated 28.03.2019.
3. Exhibit No.3 is the letter dated 23.03.2019 sent by the L.I.C. Office, Naharkatia Branch to the complainant
4. Exhibit No.4 is the letter vide Ref.JDO/ claims/Repdn/19-20/44B/1423 dated 21/11/2019, sent from the office of the Jorhat Division to the complainant
5. Exhibit No.5 complaint filed before the Insurance Ombudsmen, Guwahati

 

13. P.W.2 Smti Mrinalee Dutta depose on behalf of the complainant and stated that she is sister of the deceased and sister-in-law of the complainant and being the Insurance agent of the L.I.C. Policy No.136478400 & 403521569 lying with Life Insurance Corporation, Naharkatia Branch, is well acquainted with the facts and circumstances of the case. Further stated that Late Prasanta Dutta during his lifetime being L.I.C. policy holders of Policy No.136478400 & 403521569 lying with Life Insurance Corporation, Naharkatia Branch, continued to pay premiums regularly, without any lapse and matured amount of these policies are Rs.31,20,000/- and Rs.1,00,000/- respectively. But unfortunately, the policy holder expired on 13.03.2019 at Assam Medical College, Dibrugarh leaving behind him the complainant, his 16 years old son namely master Mrinmoy Nilim Dutta, who at present is studying in class X at Kendra Vidyalaya School, Duliajan, his 14 year old son namely Master Arindom Dutta, who at present is studying in class VIII at New Vista School, Duliajan and his mother, namely Smti. Lilima Dutta W/O Sri Nandeswar Dutta as his surviving legal heirs and successors. After observing funeral rituals of husband, the complainant communicated with the O.P.s for her receivable amount under the aforesaid policies due to death of her husband i.e. Late Prasanta Dutta and accordingly vide letter dated 23.07.2019, the L.I.C. of Naharkatia Branch asked her to provide case history sheet, discharge summary and previous treatment particulars of the deceased and accordingly, she deposited all the relevant original documents in the office of the L.I.C. Jorhat Division through the L.I.C. Naharkatia Branch and the O.P.s assured that complainant would get the death claim under these policies as the process was going on. During the continuation of the aforesaid activities on the part of the O.P.s, a letter was issued to the complainant vide Ref. JDO/claims/Repdn/19-20/44B/1423 dated 21/11/2019 from the office of the Jorhat Division with an information that as the policy holder during his lifetime supressed some material fact with intend to mislead the Corporation, hence, it has been decided to repudiate all the liabilities in terms of the provisions of Section 45 of the Insurance Act,1938. Thereafter the complainant placed her grievances before the Insurance Ombudsmen, Guwahati for redressal of her grievances, but to no effect, despite repeated requests and endeavours made by her. It is stated that the policy holder continues the policies by paying premiums so the policy holder as well as the complainant is the consumer of the O.P. and the O.P.s committed great deficiency in service by not paying the death claim under policy No.136478400 & 403521569 lying with Life Insurance Corporation, Naharkatia Branch and thereby giving enormous mental agony to get harassment to the complainant, hence the complainant is entitled to get compensation for committing such great deficiency of service by the O.P.s.

 

14. P.W.3 Sri Barri Balraj depose on behalf of the complainant and stated that the complainant is the legally married wife of Late Prasanta Dutta permanently residing at Jaloni Goan, P.O. Lilapur, P.S. Duliajan, District Dibrugarh, Assam and during his life time the policy holder insured his life vide Policy No.136478400 & 403521569 lying with Life Insurance Corporation, Naharkatia Branch, continued to pay premiums regularly, without any lapse. But unfortunately, he expired on 10.03.2019 at Assam Medical College, Dibrugarh leaving behind him the complainant, his 16 year old son namely Master Mrinmoy Nilim Dutta, who at present is studying in class X at Kendra Vidyalaya Scholl, his 14 year old son namely Master Arindom Dutta, who at present is studying in class VIII at New Vista School, Duliajan and his mother, namely Smti. Lilima Dutta as his surviving legal heirs and successors. The matured amount of policy No.136478400 and 403521569 is Rs.31,20,000/- and Rs.1,00,000/- respectively. After observing funeral rituals of husband, the complainant communicated with the O.P.s for her receivable amount under the aforesaid polices due to death of her husbands i.e. Late Prasanta Dutta and accordingly vide letter dated 23.07.2019, the L.I.C of Naharkatia Branch asked her to provide case history sheet, discharge summary and previous treatment particulars of the deceased and accordingly, she deposited all the relevant original documents in the office of the L.I.C. Jorhat Division through the L.I.C. Naharkatia Branch. During continuation of the aforesaid activities on the part of the O.P.s, aletter was issued to the complainant vide Ref. JDO/Claim/Repdn/19-20/44.1423 dated 21.11.2019 from the office of the Jorhat Division with an information that the policy holder during his lifetime suppressed some material fact with intend to mislead the Corporation, hence it has been decided to repudiate all the liabilities as per Section 45 of the Insurance Act, 1938. Thereafter the complainant placed her grievances before the Insurance Ombudsmen, Guwahati for redressal of her grievances, but to no effect, despite repeated requests and endeavours made by her. Due to repudiation of the aforesaid policies for no fault of the policy holder, the complainant and other surviving legal heirs of the policy holders have suffered sufficient damages in terms of physical and mental loss, besides monetary losses and such O.P. are liable to pay adequate compensation to the complainant.

 

15. P.W.4 Sri Madhujya Dutta depose on behalf of the complainant and stated that being the brother of the policy holder i.e.  Late Prasanta Dutta and brother-in-law of the complainant, he knows that during his life time Late Prasanta Dutta insured his life vide Policy No.136478400 & 403521569 lying with Life Insurance Corporation, Naharkatia Branch and continued to pay premiums regularly, without any lapse. But unfortunately, he expired on 10.03.2019 at Assam Medical College, Dibrugarh leaving behind him the complainant, his 16 year old son namely Master Mrinmoy Nilim Dutta, who at present is studying in class X at Kendra Vidyalaya Scholl, his 14 year old son namely Master Arindom Dutta, who at present is studying in class VIII at New Vista School, Duliajan and his mother, namely Smti. Lilima Dutta as his surviving legal heirs and successors. The matured amount of policy No.136478400 and 403521569 is Rs.31,20,000/- and Rs.1,00,000/- respectively. After observing funeral rituals of husband, the complainant communicated with the O.P.s for her receivable amount under the aforesaid polices due to death of her husbands i.e. Late Prasanta Dutta and accordingly vide letter dated 23.07.2019, the L.I.C of Naharkatia Branch asked her to provide case history sheet, discharge summary and previous treatment particulars of the deceased and accordingly, she deposited all the relevant original documents in the office of the L.I.C. Jorhat Division through the L.I.C. Naharkatia Branch. During continuation of the aforesaid activities on the part of the O.P.s, a letter was issued to the complainant vide Ref. JDO/Claim/Repdn/19-20/44.1423 dated 21.11.2019 from the office of the Jorhat Division with an information that the policy holder during his lifetime suppressed some material fact with intend to mislead the Corporation, hence it has been decided to repudiate all the liabilities as per Section 45 of the Insurance Act, 1938. Thereafter the complainant placed her grievances before the Insurance Ombudsmen, Guwahati for redressal of her grievances, but to no effect, despite repeated requests and endeavours made by her. Due to repudiation of the aforesaid policies for no fault of the policy holder, the complainant and other surviving legal heirs of the policy holders have suffered sufficient damages in terms of physical and mental loss, besides monetary losses and such O.P.s are liable to pay adequate compensation to the complainant.

 

16. On the other hand Sri Mehilo Kath, the Senior Branch Manager of L.I.C. Naharkatia Branch, Dibrugarh, Assam has filed evidence on affidavit on 04.02.2023 on behalf of O.P. No.1 to 3 as D.W.-1 and exhibited Exhibit No.A to H and Document No 1 to 15 to rebut the case of the complainant. The O.P.s stated in the evidence that the case is not maintainable in law and the claimant has no right to claim against the O.P.s. Further stated that there is no cause of action against the corporation i.e. L.I.C.I, as claimed in para 12 of the complaint petition for the case nor any cause of action arose on any dates as alleged. The case is bad for non-joinder and misjoinder of necessary parties hence liable to be rejected. The legal heirs of the deceased Late Prasanta Dutta are not made party(s) to the instant case and in absence of which no effective order/award can be passed by the Commission as prayed by the complainant. The case is barred by the principles of estoppels, waivers and acquiescence and also barred by limitation. It is stated that the claim petition is false, frivolous, and speculative and the claimant has filed the instant case for her wrongful gain causing wrongful loss to an esteemed organisation and hence the claim is liable to be rejected. It is admitted by the O.P.s that the husband of the complainant, Late Prasanta Dutta had insured his life with Life Insurance Corporation of India, vide policy No.136478400 on 23.09.2017 against an assured sum of Rs.31,20,000/- and vide Policy No. 403521569 on 28.01.2019 against an assured amount of Rs.1,00,000/- wherein the complainant was the nominee. The aforesaid policy holder Late Prasanta Dutta who died on 10.03.2019 at Assam Medical College Hospital, Dibrugarh leaving behind him the complainant. The O.P.s neither admitted nor denied in respect of surviving legal heirs and successors of his 16 year old namely, master Mrinmoy Nilim Dutta who at present is studying in class 8 at New Vista Scholl, Duliajan and his mother Smti Lilima Dutta. It is admitted that the complainant communicated with the O.P.s i.e., L.I.C.I, Naharkatia Branch against the aforementioned policies to release the assured amount due to the death of her husband and on receipt of such communication from the said complainant the LICI, Naharkatia Branch issued a letter to the said complainant on 23.07.2019 asking the  complainant to provide the case history sheet, discharge summary and previous treatment particulars of Late Prasanta Dutta as per the procedure laid under the Life Insurance Corporation of India and accordingly the complainant submitted all those relevant documents to the LICI, Jorhat Divisional Office for the disposal of the case.

 

17. It is also admitted that LICI, Jorhat Divisional Office i.e. O.P. No.2 repudiated all the claims of the aforementioned policies, because the husband of the complainant i.e. policy holder Late Prasanta Dutta suppressed some material facts regarding his long term diseases in the serial No.11 of the proposal Form at the time of taking the policies. O.P.s stated that the policies in question were accepted from the policy holders on the basis of his declaration on the proposal form in serial No.11. As per medical Attendant’s certificate and certificate of the Hospital treatment issued by the competent authority of Assam Medical College Hospital, wherein clearly stated that the policy holder Late Prasanta Dutta was suffering from T2 DM and HTM since last 10 years along with several diseases which he had not disclosed at the time of submitting the proposal form for Insurance as stated above. Moreover the aforementioned policies have not completed three years from the date of commencement of risk/from date of last revival and it is within 2 years from the date of life assured. As such the claim by complainant is repudiated by the corporation keeping in view the provisions of Section 45 of the Insurance Act, 1938.

 

18. It is submitted that an esteemed Corporation like LICI has been constituted to provide the best to its policy holders whenever their policy is being matured. But the deceased policy holder Late Prasanta Dutta deliberately mislead the corporation while disclosing his “Personal History” as mentioned in Column No.11 of the Proposal for Insurance on own life. As Life Insurance contract is done on the principle of “Uberrimafide”- “utmost good faith”. It is the bounded duty of the proposer to disclose all material information’s regarding health and habits truthfully while filing the proposal form of Insurance contract. But the policy holder, Late Prasanta Dutta violated the ground principle of Insurance contract by submitting false statements in his personal history of proposal form under serial No.11-a,b,c,d,e,f,g,h (i, ii, iii, iv), i and j as such the concerned office had legally and rightfully repudiated the said claims on the grounds of wilful suppression of material facts at the time of proposal of the policies under Section 45 of the Insurance Law (Amendment) Act, 2015. O.P.s submitted that the complainant has no right to claim against the corporation LICI in accordance with the principles of natural justice as the complainant of the deceased Late Prasanta Dutta being the alleged nominee of the aforementioned policies deliberately concealed the material facts of the claim just for her wrongful gain causing wrongful loss to the corporation.

 

19. O.P.s denied the allegation of the complainant that the corporation has committed the offence of deficiency in service as provided under the Consumer protection Act, 1986. The deceased policy holder might have continued the policies by paying the premiums just for misleading the corporation and after due scrutiny of the entire records, it was found that the deceased policy holder Late Prasata Dutta insured his life by suppressing the real material facts about his health and habits which leads to establish malafide intentions of contract of the Life Insurance Corporation of India and therefore the appropriate authority of the organisation has rightly repudiates the death claim under policy No.136478400 and 403521569 as per Section 45 of the Insurance Act, for suppression of material fact. The deposition made by the CW2, CW3 and CW4 are entirely denied by the O.P.s as all depositions of the witnesses are based on mere presumptions. CW2 Smti Mrinalee Dutta is one of the agent of the organisation i.e. LICI, under agency code No.055084921 under development officer code No.0826047 of Naharkatia Branch, wherein she has stated in column 1(b) of the Agent’s confidential Report/ Mortal Hazard report that she is not related with deceased Late Prasanta Dutta and she put her signature in the column of signature of the agent in the Agent’s Confidential Report/Moral Hazard Report. In the deposition made by Smti Mrinalee Dutta as CW2 wherein para 1 of her deposition, she has stated that she is the sister of the deceased Late Prasanta Dutta and sister-in-law of the complainant. O.P. has filed below mentioned exhibit to rebut the case of the complainant which are as follows-

 

1. Exhibit No. A- The original copy of the LIC’s Jeevan Labh Policy No.136478400
2. Exhibit No. B- The original copy of the Proposal form of the Policy No.136478400
3. Exhibit No. C- The original copy of the e proposal form of the Policy No.403521569
4. Exhibit No. D- The original copy of the Policy No.403521569
5. Exhibit No. E- The original copy of the letter of Repudiation sent from Jorhat Divisional Office with Ref. JDO/Claims/Repdn./19-20/44b/1423 dated 21/11/2019
6. Exhibit No. F- The original copy of the Medical Attendants Certificate
7. Exhibit No. G- The original copy of Certificate of Hospital treatment of the deceased policy holder Late Prasanta Dutta
8. Exhibit No.B(i)- The original copy of the Agent Confidential Report/Mortal Hazard Report
9. Exhibit No. H- The Medical Documents of the deceased policy holder Late Prasanta Dutta against Policy No.403521569

 

20. The complainant has filed written argument on 07.06.23 and reiterated the facts as narrated in the complaint petition. The complainant submitted that the O.P.s in their written statement stated that they repudiated all the claims under the provisions of Section 45 of the Insurance Act,1938 because husband of the complainant i.e. policy holder Late Prasanta Dutta suppressed some material facts regarding his long term disease in the serial No.11 of the proposal form at the time of taking the policies. Moreover the above mentioned policies have not completed 3 years from the date of commencement of risk/from date of last revival and it was within 2 years from the death of the life assured and as such the claim of the complainant repudiated by the O.P.s keeping in view the provisions of section 45 of the Insurance Act, 1938. Denying the aforesaid submission of the O.P.s, the complainant submitted that the Commission is based upon the principle of natural justice hence this Commission is not bound to follow the strictest provision of civil Procedure Code, Evidence Act etc. Moreover the complainant in her complaint dated 24.08.2021 as well as affidavit evidence filed on 31.08.2022 and that of her witnesses namely Smti Mrinalini Dutta, Sri Barri Balraj and Sri Madhurjya Dutta clearly mentioned that policy holder namely Late Pranata Dutta expired on 10.03.2019 leaving behind the complainant his 16 years old son namely Master Mrinmoy Nilim Dutta and his 14 years old son namely Master  Arindom Dutta and his mother, namely Smti Lilima Dutta as his surviving legal heirs and successors of factual  matrix on the part of the complainant does not arise.

 

21. Learned counsel for the complainant further submitted in written argument that after completing the proposal form the proposer has to undergo a medical examination through one of their approved medical doctors on points regarding his health, height, weight, chest, tongue, eye and throat, condition of chest, heart, urinary system, nerve system etc. The medical report is directly submitted to the insurance company for consideration. The insurance company is at liberty to either accept or reject the proposal based on the doctor’s report. It is the duty of the Insurance Company to examine the person to be insured by their own doctor hence the question of suppression of the long term disease on the part of the husband of the complainant at the time of taking the policies does not arise. The insurance premium will be higher if condition of health is not good. After the medical report the agent’s confidential report is submitted to the company. It contains details relating to the personal history of insured. The purpose of this report is convincing the life insurance corporation regarding the object of insurance, financial position of the insured and again his health conditions. After getting Medical Report and confidential report of agent, the insurance company after studying those reports can accept or reject the proposal. The first premium notice is sent along with the letter of intimation regarding the acceptance of the proposal. This makes the insurance contract complete. The proposer is required to submit the proof of his age which may be a copy of school certificate or horoscope, certificate from Municipalities or Municipal corporation etc for verification of the date of birth as mentioned in the application form. The premium is a consideration of insurance contract and is regularly paid to the insurance corporation agreed in different ways. Normally, one month period of grace of annual premium and 15 days in case of monthly premium beyond the due date is allowed. After the payment of first premium the risk commences and the proposer becomes insured. The insurance company is liable to pay the full amount of insurance in the event of pre-mature death. The premium must be paid within the due date or within the days of grace, otherwise, the corporation is not liable for any payment. Having completed all the required formalities, the Insurance Company prepares the Life Insurance Policy and sends it to the Insured. The back of the policy contents all the details of the policy such as terms and conditions. It has all the details of the proposal, i.e. name, address, sum assured, mode of premium, maturity date and amount, etc. The policy bears the seal of the corporation and the signature of the competent authority.

 

22. O.P. No.1 to 3 have filed their written argument on 08.09.2023 reiterated all the contents as narrated in the written statement and evidence in affidavit.  The Learned Counsel for the O.P.s referred the Judgement of Hon’ble National Consumer Disputes Redressal Commission passed in Dr. Poonam Makija vs Life Insurance Corporation of India in C.C. No. 2279 of 2018 wherein held that “It is proved that the deceased life assured had withheld the material information regarding his health history in the proposal form, which amounts to fraudulent representation. The Insurer is perfectly justified to avoid the policy and repudiate the claim. Impugned repudiation letter dated 16.12.2017, does not suffer from any illegality.”

            Point to be decided

1. Whether the complainant is a consumer of the Opposite Parties under the Consumer Protection Act?
2. Whether the Opposite Parties are liable for deficiency of services towards the Complainant.
3. Whether the complainant is entitled to relief prayed for in the complaint petition?

Decisions and Reasons thereof

1. We have carefully gone through the averments of the complainant, written statement, evidence in affidavit along with annexed documents and written argument on record by both the parties and it is found that the O.P.s have admitted that the husband of the complainant, Late Prasanta Dutta had insured his life with the O.P. No.1 vide Policy No.136478400 and 403521569 with an assured sum of Rs.31,20,000/- and Rs.1,00,000/- from Life Insurance Corporation of India and paid the required policy premiums in terms of money wherein the complainant was the nominee of the aforesaid policies. Complainant relied upon Exhibit No.1 to prove the same and hence, there is no iota of doubt that the present complainant is a consumer under the O.P. No.1 to 3.  
2. About deficiency in service we found that the husband of the complainant, the life assured died on 10.03.2019 at Assam Medical College Hospital, Dibrugarh and after his death, the complainant has put forward her claim as a nominee of the said policies with the O.P.s for her receivable amount and after receipt of communication vide letter dated 23.07.2019, the L.I.C. of Naharkatia Branch asked the complainant to deposit all the relevant original documents in the office of the L.I.C. Jorhat Division through the L.I.C. Naharkatia Branch and assured her that she would get the death claim under these policies. However, the O.P.s vide Ref. JDO/Claims/Repdn/19-20/44B/1423 dated 21.11.2019 informing the complainant that as the policy holder during his lifetime suppressed some material fact with intend to mislead the Corporation, hence it has been decided to repudiate all the liabilities under Section 45 of the Insurance Act, 1938. After repudiation of claim, the complainant submitted an application before Insurance Ombudsman, Guwahati, but the complainant did not get any relief despite repeated request and endeavours. Hence the complainant filed consumer compliant before this Commission and prayed for granting reliefs as mentioned in the relief clause of the complaint.

 

            On the other hand O.P.s contended that after receipt of communication from the complainant to release the assured amount due to the death of her husband, the O.P. No.3 issued letter on 23.07.2019 asking the complainant to provide the case history sheet, discharge summary and previous treatment particulars of the policy holder, Late Prasanta Dutta. And after examining the Medical Attendant’s Certificate and Certificate of the hospital treatment issued by the competent authority of Assam Medical College Hospital, Dibrugarh wherein it is stated that the policy holder Late Prasanta Dutta was suffering from T2 DM and HTM since last 10 years along with several diseases which he had not disclosed at the time of submitting of proposal form for insurance. The Learned counsel of the O.P. argued that the policy holder, Late Prasanta Dutta violated the ground principle of insurance contract by submitting false statement in his personal history of proposal form under serial No.11-a, b, c, d, e, f, g, h (i, ii, iii, iv), I and j.  Further the aforementioned policies have not completed three years from the date of commencement of risk/from date of last revival and it is within 2 years from the date of life assured as such the claim of the complainant is repudiated by O.P.s as per Section 45 of the Insurance Act, 1938. Furthermore the CW2 Smti Mrinalee Dutta is one of the agent of the O.P.s under agency code No.05508491 under Development officer Code No.0826047 of Naharkatia Branch, wherein she has stated in column 1(b) of the Agent’s Confidential Report/ Moral Hazard Report that she is not related with the deceased Late Prasanta Dutta. However in evidence of affidavit CW2 has clearly stated that she is the sister of the deceased Late Prasanta Dutta and sister-in-law of the complainant which is self explanatory and as such both the statements cannot be taken into consideration. Hence the claim of the complainant is repudiated keeping in view the provisions of Section 45 of the Insurance Act, 1938. Rebutting the contention of the O.P.s, the Learned Counsel for the complainant argued that after completing the proposal form, the proposer has to undergo a medical examination through one of their approved medical doctors on points regarding his health, height, weight, chest, tongue, eye and throat, condition of chest, heart, urinary system, nerve system etc. The medical report is directly submitted to the insurance company for consideration. The insurance company is at liberty to either accept or reject the proposal based on the doctor’s report. It is the duty of the Insurance Company to examine the person to be insured by their own doctor hence the question of suppression of the long term disease on the part of the husband of the complainant at the time of taking the policies does not arise.

 

            Considering the rival submission of both the parties it is noticed that since the claim of the complainant falls under the category of early claim i.e. (within 2 years from policy issuance), the O.P. investigated about the genuineness of the said claim. The Learned Counsel of the O.P.s argued and much emphasize on the medical document of the Assam Medical College and Hospital, Dibrugarh and according to the said document the life assured Late Prasanta Dutta was suffering from type 2 DM HTM since 10 last years prior to his death. It is also contended that the above facts have been suppressed in the proposal form at the time of obtaining issuance policy. We have gone through the repudiation letter dated 21.11.2019 i.e. Exhibit No.E filed by the O.P.s wherein ground of repudiation is mentioned that “As per treatment particular dated 09.01.2019 of Assam Medical college Hospital, Dibrugarh deceased life assured was suffering from T2 DM HTM since last 10 years” which was considered as suppression of material facts by the O.P.s as the policy holder had given false information at the time of filling the proposal form. We have perused the Medical Attendants Certificate and Certificate of Hospital Treatment of Assam Medical College Hospital, Dibrugarh i.e. Exhibit No. F and G filed by the O.P.s and the exact cause of death was mentioned as “Coma as a result of spontaneous rupture of cerebral vessels, consequent to CVA (cerebrovascular accident)” and in Point No.6 and 7 it is written as “T2 DM with hypertension with CAD C HOCM C PSVT and CV-A” as other diseases or illness. Whereas at the same time we also perused Exhibit No.1 (Medical Examiner Confidential Report) filed by the complainant wherein transpires that at the time of taking the insurance policy, the policy holder Sri Prasanta Dutta had undergone medical examination on 24.09.2017 with the empaneled medical doctors of LICI on the points regarding his health, height, weight, chest, tongue, eye and throat, condition of chest, heart, urinary system, nerve system etc. required by LICI along with the attached questionnaire which was filled and signed by doctor Dr S. Bhattarcharjee, M.D. Pathologist. In the aforesaid report in Point No.15, Dr S. Bhattarcharjee had written ‘yes’ on the query that “On examination whether he/she (life assured) appears mentally & physically healthy.” The O.P.s are at liberty to accept or reject the issuance of policy to the policy holder based on the test reports forwarded by the panel doctors and pathological examinations conducted by their approved doctors. In fact as it was a Medical Examiner’s Confidential Report, the reports were directly furnished to the O.P.s as such reports are in domain of the O.P.s. Therefore, as per medical report filed alongwith Exhibit No.1 by the complainant, it appears that prior to the issuance of the insurance policy, the life assured Late Prasanta Dutta was examined by the approved doctors of the LICI and he was found completely healthy as per Medical Examiner’s Confidential Report submitted by their doctor Dr S. Bhattacharjee. Thus it can be perceived that after satisfying themselves with all medical tests and report as conducted by panel doctor of LICI, the O.P. issued the policies, and the policy holder as a bonafide insured person paid premiums regularly for two years and that there is no risk of pre-existing illness. If there were any health issues then the LICI would have definitely rejected the proposal form based on the doctor’s report and hence there is no question of suppression of material fact on the part of the complainant regarding his health at that time. Further there is no other evidence aliunde on the record adduced by the O.P.s that the fact of already suffering from T2 DM HTM was in knowledge of the insured and he concealed this fact from O.P.s. Sometime a person is not conscious, if he is suffering from hypertension or diabetes of routine type without exhibiting worst symptom thereof. Apart from that, as per Medical Attendants Certificate i.e. Exhibit No.F of O.P.s, the death of the life assured was due to CVA (Cerebrovascular accident), but the O.P.s have failed to establish a link between the cause of death of the deceased and the decease T2 DM and HTM. Regarding the repudiation of insurance claim, the Hon’ble National Consumer Disputes Redressal Commission in the matter of Manjula vs PNB Metlife India Insurance Co. Ltd. & anr. (Appeal No. 1564 of 2019) decided on 26^th September 2023 observed that if there was no nexus between the material fact/ decease, which was not disclosed, and the cause of death, the insurance company’s action of repudiation the claim on the ground of suppression of material facts/ non disclosure of pre-existing ailment is not correct. So, under such circumstances, the repudiation of the claim of the complainant was not justified.

            To support their contention the Learned Counsel for the O.P.s referred the Judgement of Hon’ble National Consumer Disputes Redressal Commission passed in Dr. Poonam Makija vs Life Insurance Corporation of India in C.C. No. 2279 of 2018. In the said decision the insured had having disease and was taking treatment prior to taking policies and the O.P. has proved by producing heath history. But the said decision is not helpful to the O.P.s, as the facts are totally different for the simple reason that in the present case the O.P.s neither placed any cogent or convincing evidence to substantiate their allegation that the deceased insured had having knowledge of his suffering from any above pre-existing disease prior to taking of insurance policies or giving information for proposal form. Further the O.P.s have not examined or filed affidavit, the doctor who prepared, medical documents to corroborate their claims which fatal to the case of the O.P.s.

              Regarding the contention of the O.P.s that the CW2 Smti Mrinalee Dutta is one of the agent of the O.P.s the under agency code No.05508491 under Development officer Code No.0826047 of Naharkatia Branch, who had falsely stated in the Agent’s Confidential Report/ Moral Hazard Report that she is not related with the deceased life assured Late Prasanta Dutta, but, in evidence on affidavit she deposed that she is the sister and of the deceased life assured and sister in law of the complainant. This contention of the O.P.s has nothing to do with the repudiation of claim by the O.P.s as because in letter dated 21.11.2019, it clearly stated that the claim of the complainant was repudiated on the ground of non-disclosure of material facts/pre-existing disease. Moreover, at the time of issuance of the aforesaid policies, the O.P.s did not made enquiry about these facts and collected the premium from the complainant without objection, but, at the time of claim repudiated the claim by showing unreasonable grounds. However, it is worthy to mention here that besides the P.W.2 Smti Mrinalee Dutta, other two witnesses PW3 and PW.4 deposed on behalf of the complainant to substantiate the facts of the complainant.

          It is also pertinent to mention here that, the complainant, though claims sum assured amount of Rs. 1,00,000/- (one lakh) of Policy No.403521569, she has not exhibited the said Policy. But fortunately O.P.s has submitted the said policy alongwith their evidence as well as Written Statement. From that exhibit i.e. Exhibit No.D, it is established that the deceased policy holder Prasanta Dutta was the insured and the complainant was the nominee of that policy and as such the complainant is entitled to get the sum assured of the said policy also. 

3. On the basis of above discussion and observation we have come to the conclusion that the complainant has proved her claim of deficient and negligent services against the O.P.s and held that the O.P.s were not justified in repudiating the claim of the complainant and hence this Commission directs the O.P. i.e. Life Insurance Corporation, Naharkatia Branch to pay to the complainant :

1. A sum of Rs. 31,20,000/- (Rupees thirty one lakh twenty thousand) only towards the sum assured under LICI Policy No. 136478400. in respect of death claim of deceased life assured Late Prasanta Dutta.
2. A sum of Rs. 1,00,000/- (Rupees one lakh) only towards the sum assured under LICI Policy No. 403521569 in respect of death claim of deceased life assured Late Prasanta Dutta
3. A sum of Rs. 20,000/- (Rupees twenty thousand) only as compensation for causing mental and physical agony and
4. A sum of Rs. 5000/- (Rupees five thousand) only as cost of litigation.

       All the above amounts be deposited into the credit of this Commission by the Opposite Party,   Life Insurance Corporation, Naharkatia Branch within 30 (thirty)b days from the date of receipt of this judgement and order, failing which an interest @ 9% per annum on the awarded sum will have to be borne by the O.P.s.

This instant C.C. No. 10/2021 is accordingly disposed on contest.

Send copy of this judgement and order to the O.P.s for compliance. Complainant is to take step.

Next date fixed ……………..for compliance of order and judgement.