PER SHRI N. ARUMUGAM, HON’BLE MEMBER.
This an appeal filed by the original opponent against the order passed by the Additional District Consumer Disputes Redressal Forum, Nagpur in Consumer Complaint No. 154/2006 passed on 20/11/2006.
The facts of case in brief are as under:-
The original complainant is the husband of deceased policy holder Smt. Poonam Ramesh Yadav and legal guardian of Master Aniket who is a minor nominee. On 31/03/2004 the deceased Smt. Poonam Ramesh Yadav submitted a proposal of insurance for her own life for Rs.51,000/- under Table-93 for a term of 25 years. The policy was issued on 20/04/2004. The policy holder died on 04/10/2004 due to (G-2, P14 Amenorrhea 33 weeks with twins with polyhydroaminios with eclampsia in shok with cardio respiratory arrest) i.e. premature delivery complication.
The insurance claim was lodged with appellant/original opponent on 31/03/2005. The appellant/original opponent informed to respondent/original complainant that the claim was repudiated stating that the deceased did not disclose that she was pregnant at the time of signing proposal form.
Being dissatisfied with this decision the respondent/original complainant filed a consumer complaint before Additional District Consumer Disputes Redressal Forum, Nagpur claiming the insurance claim of entire sum assured along with cost.
After hearing of both the parties and perusal of the case records the Additional District Consumer Disputes Redressal Forum, Nagpur allowed the complaint stating that the agent appointed by appellant/original opponent is responsible for not filling up the insurance proposal form properly and directed to pay compensation of Rs.10,000/- to the respondent/original complainant.
Being aggrieved by this order the appellant/original opponent preferred this appeal.
Adv. Mr. Quazi for the appellant/original opponent and Adv. Mr. Khare for the respondent/original complainant appeared. Adv. Mr. Quazi for the appellant argued that:-
a) The deceased policy holder at the time of signing proposal form the fact regarding pregency was concealed. For the query regarding pregnancy she has given reply “No” and for the last menstruation date was 18/03/2004.
b) As per the death certificate issued by Mahatma Gandhi Institute of Medical Science, Sewagram, District Wardha at the time of death deceased she was 33 weeks pregnant on 4/10/2004. This clearly demonstrated that the deceased was pregnant at the time of signing of proposal form i.e. 31/03/2004.
c) Thus, the appellant/original opponent rightly repudiated the claim of the respondent/original complainant.
d) That the Consumer Forum came to the conclusion that the fact that the deceased policy holder was pregnant on the date of proposal of insurance and hence, no relief as regards the policy claim was granted by the Additional District Consumer Disputes Redressal Forum, Nagpur in its impugned order.
e) However, the Additional District Consumer Disputes Redressal Forum, Nagpur directed to appellant/original opponent to pay compensation of Rs.10,000/- to the respondent/original complainant on the ground that the agent of appellant/original opponent has taken the signature of the deceased in the blank form and did not ask her any question about pregnancy . Since the agent is not a party to the complaint and thus the said allegation could neither be replied by the agent nor any opportunity in the aforesaid regard was afforded to him. Hence, this allegation against the agent neither justified nor proved finally the advocate argued that the order passed by the Additional District Consumer Disputes Redressal Forum, Nagpur awarding Rs.10,000/- to the respondent/original complainant to be set aside with cost.
The advocate for the respondent/original complainant for argued that:-
a) The entire proposal form was filled by the agent himself. The agent never asked any question to the deceased nor to her husband.
b) The agent asked to sign the proposal form. The deceased studied up to 10th class in Marathi medium and not well versed in the English language. Accordingly the deceased policy holder signed the proposal as directed by the agent.
c) The agent never asked any question regarding pregnancy and menstruation date.
d) The appellant did not medically examine the deceased policy holder which is very important before insuring any person.
e) As per I.R.D.A. regulation the declaration should be signed by other than the agent but in the instant case the agent himself signed the declaration.
f) Finally, he prayed that the order passed by the Additional District Consumer Disputes Redressal Forum, Nagpur is just and proper and no need to interfere with the order and the appeal to be dismissed.
After hearing of both the parties and perusal of the case record we are having the following observation.
1. The agent of the appellant was very causal manner filled the proposal form and the some of the questionnaire /column left blank. For example in page no. 17 of Annexure-I for question of Sr. No. 8 regarding “Girth of chest” kept unfilled. In the same page last portion of the form regarding the information/declaration of Development Officer/ABM/BM/ Sr. DM not filled in.
2. As alleged by the complainant in the complaint application para 7 at page no. 30, proper medical examination was not done. In this regard it is essential to note that the present policy was booked in table-93 of L.I.C. which is available under both medical and non-medical category. The deceased policy holder never asked the agent/LIC to insure in non-medical category. If the agent would have offered the deceased policy holder under medical category she would not have been refused and the problem of not disclosing material fact and repudiation claim would not have arisen.
3. The date of signing proposal form was very important. It was singed on 31/03/2004, the last date of financial year and this day is the last day of the business for the year for appellant/LIC. In the year end closing the agent was hurry to book insurance policies and booked under non-medical category because under medical category the agent has to take lot of steps to arrange medical examination with the authorised medical officers. Hence, the agent of the appellant followed short cut method to book under non-medical category.
4. As for non inclusion of L.I.C. agent as a party in the complaint. Though the L.I.C. agent is a formal party but he is not necessary party. Hence, non inclusion would not affect the merit of the case.
Hence, the Additional District Consumer Forum, Nagpur rightly partly allowed the complaint and awarded Rs.10,000/- as compensation and needs no interference and hence we pass the following order.
ORDER
1. Appeal is dismissed and the order passed by the Additional District Consumer Forum, Nagpur is maintained.
2. No order as to cost.
3. Parties be informed accordingly.
