Madhya Pradesh

StateCommission

A/16/878

LIC - Complainant(s)

Versus

MRS. GAYTRI YADAV - Opp.Party(s)

03 Jul 2023

ORDER

M. P. STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,                          

                             PLOT NO.76, ARERA HILLS, BHOPAL

 

                                      FIRST APPEAL NO. 878 OF 2016

(Arising out of order dated 22.06.2016 passed in C.C.No.53/2015 by District Commission, Chhatarpur)

 

1. REGIONAL MANAGER,

    LIFE INSURANCE CORPORATION OF INDIA,

    CENTRAL REGIONAL OFFICE,

    60-B, HOSHANGABAD ROAD,

    BHOPAL (M.P.)

 

2. CLAIM DEPARTMENT, LIFE INSURANCE

    CORPORATION OF INDIA,

    DIVISIONAL OFFICE, KRISHA COMPLEX,

    KRISHN NAGAR, SATNA (M.P.)

 

3. LIFE INSURANCE CORPORATION OF INDIA,

    CHHATARPUR, THROUGH MANAGER.                                                    … APPELLANTS.

 

                  Versus

 

1. SMT. GAYATRI YADAV,

    W/O LATE SHRI MAHESH KUMAR YADAV,

   

2. KU SHIVANI,

    D/O LATE SHRI MAHESH KUMAR YADAV,

    THROUGH LEGAL GUARDIAN MOTHER

    SMT. GAYATRI YADAV.

 

3.  YASHWARDHAN,

     S/O LATE SHRI MAHESH KUMAR YADAV,

     THROUGH LEGAL GUARDIAN,

     SMT. GAYATRI YADAV.

 

ALL R/O VISHWANATH COLONY,

MAHOBA ROAD, CHHATARPUR (M.P.)  

 

4. RAGHUNATH SHARMA,

    LIC AGENT, OFFICE OF THE LIFE

    INSURANCE CORPORATION OF INDIA,

    CHHATARPUR (M.P.)                                                                           …. RESPONDENTS.  

 

                     

BEFORE :

            HON’BLE SHRI A. K. TIWARI                : PRESIDING MEMBER

            HON’BLE DR. SRIKANT PANDEY        :          MEMBER

                     

 

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COUNSEL FOR PARTIES :

                Ms. Chitra Sharma, learned counsel for the appellants.

           Shri Akshay Khare, learned counsel for the respondent no.1 to 3.

           None for the respondent no.4.

 

 

 O R D E R

(Passed On 03.07.2023)

                                The following order of the Commission was delivered by A. K. Tiwari, Presiding Member: 

           

                   This is an appeal by the opposite party no.1, 3 & 4/appellants against the order dated 22.06.2016 passed by the District Consumer Disputes Redressal Forum, Chhatarpur (for short ‘District Commission) in C.C.No.53/2015 whereby the complaint filed the complainants/respondent no.1 to 3 has been allowed.

2.                The brief facts of the case as stated by the complainants in their complaint are that the complainant no.1’s husband and complainant no.2 & 3’s father Late Shri Mahesh Kumar Yadav (hereinafter referred to as deceased-insured) during his life time had obtained life insurance policy no.357439218 for sum insured of Rs.12,00,000/- on 28.09.2011 for a period of 20 years.  On 06.01.2013, when he was on his way from Chhatarpur to Delhi by his own truck bearing registration number MP-17 H-0368 for unloading the bags of wheat, at Kosikala near Mathura (UP) he was found dead in his truck. He was suspected to be murdered as the local police registered the crime under Section 302/201 of IPC. 

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3.                It is alleged by the complainant/respondent that when she being a nominee filed a death claim with the LIC for sum insured of Rs.12,00,000/- on 09.07.2014, the same was denied by the LIC on 30.11.2014. Legal notice was also sent to the LIC but was not replied.  Alleging deficiency in service on part of opposite parties LIC she approached the District Commission seeking sum insured of Rs.12,00,000/- with interest, compensation and costs.

4.                The opposite party no.1 and 3-LIC in their reply stated that it is not true that the deceased-insured was not having any other policy. In fact he was having another insurance policy no. 357437258 for a sum insured of Rs.15,00,000/- the claim of which was paid to the nominee as per rules. Proposal for the said policy was given on 05.12.2011 while the proposal for the policy no.1357439218 in question was given on 31.12.2011. The deceased-insured suppressed the necessary information in the proposal form that he was having another policy and therefore, the LIC denied the claim made by the complainant.  There has been no deficiency in service on part of LIC. The complainant is not entitled to get any relief. It is thus prayed that the complaint be dismissed.

4.                The opposite party no.2-agent that the deceased-insured at the time of filling up the proposal form had stated that he did not take any other policy. For the policy no.357439218, the complainant was made nominee

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and at the time of taking the said policy the deceased-insured told his that he did not have any other policy. The disputed policy was taken by the deceased-insured through him. It is therefore prayed that the complaint be dismissed.

5.                The District Commission holding the LIC deficient in service allowed the complaint. The LIC was directed to pay sum insured under the policy in question Rs.12,00,000/- with interest @ 8% p.a. from the date of death i.e. 06.01.2013 till payment. It is further directed that since the complainant no.2 and 3 are minor, therefore, the account be opened in their names in nationalized bank and Rs.3,00,000/- each be deposited in fixed deposit in their names till attaining the majority. Remaining amount with interest be paid to the complainant no.1. Compensation of Rs.5,000/- along with costs of Rs.2,000/- is also awarded. Hence this appeal by the LIC.

6.                Heard the arguments advanced by learned counsel for the parties. Perused the record carefully.

7.                Learned counsel for the appellants-LIC argued that the impugned order passed by the District Commission is against the law and principles of natural justice. The District Commission erred in not appreciating the complete facts and evidence available on record. The deceased-insured submitted the proposal form on 05.12.2011 and on that basis policy no.357437258 was issued to him, of which the claim has

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already been paid to the complainant. Thereafter the deceased-insured after filling the proposal form on 31.12.2011 had obtained the policy in question no.357439218 and at the time taking the policy in question he did not give information about the previous policy, whereas as per rules it ought to have been given in the prescribed columns. Contract of insurance is based on good faith between the parties and if any of the party had given wrong or incomplete information, then the contract can be terminated and the LIC is free to deny the claim. The District Commission did not consider this important aspect and therefore, the impugned order deserves to be set-aside. Learned counsel argued that the appeal be allowed. In support of her contentions she relied upon the decisions of the Hon’ble Supreme Court in Satwant Kaur Sandhu Vs New India Assurance Co.Ltd. 2009 CTJ 956 (SC) (CP), Civil Appeal No.4261 of 2019 (Reliance Life Insurance Co.Ltd.&Anr Vs Rekhaben Nareshbhai Rathod) decided on  April 24, 2019, Civil Appeal No.5322 of 2007 (P. C. Chako & Anr Vs Life Insurance Corporation of India) decided on  April 24, 2019 and in Life Insurance Corporation of India & Anr Vs Dharam Vir Anand III (1998) CPJ 3 (SC) and the decisions of the Hon’ble National Commission in First Appeal No.163 of 1993 (Life Insurance Corporation of India and another Vs M. Gowri and others) decided on 10^th October, 1994, Seema Agrawal & Ors Vs LIC of India & Anr) III (2015) CPJ 616 (NC), Umar

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Amad Bholim (Deceased) THR LR Vs United India Insurance Co. Ltd. & Anr II (2015) CPJ 618 (NC), Revision Petition No. 1573 OF 2012 (Sanjay Atmaram Patel Vs LIC of India) decided on 14 Dec 2017, Revision Petition No. 382 & 383 of 2011 (Life Insurance Corporation of India Vs Vidya Devi & Ajay Kumar) decided on 16^th July 2012, ICICI Prudential Life Insurance Co.Ltd. Vs Lalita Jain II (2015) 246 (NC) and Life Insurance Corporation of India Vs Surat Mal Tak 2011 CTJ 265 (CP) (NCDRC).

8.                Learned counsel for the complainants/respondent no.1 to 3 supporting the impugned order argued that the deceased-insured did not take any policy earlier to the policy in question no. 357439218 which came in force on 28.09.2011, therefore, the denial of the claim by the LIC on that basis tantamount to deficiency in service and therefore the District Commission has rightly directed the LIC to pay sum insured of the policy in question with interest, compensation and costs.

9.                The complainant no.1 has filed her affidavit and affidavit of Rameshwar Yadav along with documents C-1 to C-12 as per list in support of her contentions. On behalf of opposite party no.1, 3 and 4 affidavit of Shri G. R. Deshraj, Manager, Legal along with documents R-1 to R-6 have been filed. The opposite party no.2 Raghunath Sharma, an agent of LIC has also filed his affidavit.

10.              We have perused the complaint, reply, affidavits and documents filed by both parties. In the affidavit of agent Raghunath Sharma in paragraph 4 he has stated that the deceased-insured had obtained policy no.357439218 through him. Under the documents filed as R-6, there is Agent Confidential Report at page 63 wherein in column 7 he accepted that he has explained fully the terms and conditions of the proposed plan to the proposer. At page 64 & 65 which is alleged to have been proposal form dated 31.12.2011 of disputed policy, in the column of personal history or else there is no question that have you taken any other policy, thus there is no question of suppression of material fact of taking another policy. The deceased-insured was murdered, there is no ulterior motive to obtain the policy.

11.              Admittedly, the deceased-insured during his life time had obtained life insurance policy no.357439218 (C-1) for sum insured of Rs.12,00,000/- on 28.09.2011 for a period of 20 years. The policy came in force on 28.09.2011 and the defense of the opposite party LIC is that the proposal form for the same was filled on 31.12.2011    . How it can be possible that a policy which came in force from 28.09.2011, the proposal for which was filed on 31.12.2011 more particularly when there is receipt of premium of Rs.15,000/- (R-1) is also of dated 28.09.2011. Even in appeal the LIC failed to produce any such document in aforesaid regard.

12.              It is contended by the LIC that the deceased-insured had earlier obtained policy no. 357437258 for sum insured of Rs.15,00,000/- for which proposal form was filled on 05.12.2011. The sum insured of that policy has already been paid to the complainant being nominee of the deceased-insured. Since the deceased-insured did not give information about the said policy while filling the proposal for obtaining the policy in question bearing number 357439218, therefore the sum insured was not paid to the complainant. But we find that the LIC failed to produce that policy no.357437258 or any document in that regard in order to substantiate that the deceased-insured had obtained the said policy earlier to the policy in question.

13.              Thus, it is clear that the deceased-insured had not taken any other policy earlier to the policy in question bearing number  no.357439218 (C-1) for sum insured of Rs.12,00,000/- which came in force on 28.09.2011 for a period of 20 years.        

14.              It is also pertinent to mention here that in the repudiation letter dated 30.11.2014(C-6), there is nothing that which condition number of the policy terms and conditions were violated. Policy terms and conditions were also not filed in order to show that which condition has been violated by the deceased-insured. No condition in this regard has been shown that If a person not shown that he had taken policy, nothing has been mentioned as such by the insurance company that which condition was breached.

15.              The decisions relied upon by learned counsel for the LIC are related to non-disclosure of earlier policies taken by the insured while obtaining the policy but in the present case, the LIC failed to substantiate its contention that the deceased insured had obtained any other policy earlier to the policy in question of which claim has been made. Thus the decisions relied upon by learned counsel for the LIC are not benefitted to the appellant.

16.              Considering the overall circumstances, we find that the District Commission has rightly allowing the complaint directed the LIC to pay sum insured of Rs.12,00,000/- with interest, compensation and costs.  We do not find any perversity, illegality or infirmity in the impugned order calling our interference in appeal.

17.              In the result, the appeal being devoid of any merit is dismissed. No order as to costs.                   

                  (A. K. Tiwari)                          (Dr. Srikant Pandey)

            Presiding Member                             Member