West Bengal

Paschim Midnapore

CC/20/2017

Ranjit Jana - Complainant(s)

Versus

Sarada Insurance Consultancy Ltd. - Opp.Party(s)

25 Sep 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                            

 Bibekananda Pramanik, President,

Pulak Kumar Singha, Member

and

Sagarika Sarkar, Member

   

Complaint Case No.20/2017

 

   Ranjit Jana, S/o-late Mohanlal Jana ,  Vill &  P.O.-Jot-Ghanashyam,

              P.S.-Daspur, District- Paschim Medinipur..…….……Complainant.

              Vs.

1. Sarada Insurance Consultancy Ltd., Corporate Agent of LICI, licence no.5389734, Registered Office-103-S.N. Banerjee Road, Kolkata-700014
2. The Zonal Manager, LICI of India, Eastern Zonal Office, 4, C.R. Avenue, Kolkata-700072
3. B.M., LICI, Midnapore, Collectorate, P.O.-Midnapore, P.S.-Kotwali, Dist-Paschim Medinipur………………………… .Opp. Parties.

                                                    

            For the Complainant  :  Mr. Pradip Kumar Neogi, Advocate.

            For the O.P.                 : Mr. Swapan Bhattacharya, Advocate.

                                                                    

                                                                                             Decided on: -25/09/2017                             

                               

ORDER

                         

                        Sagarika Sarkar, Member – This instant case is filed u/s-12 of the C.P. Act, 1986 by the complainant Ranjit Jana alleging deficiency in service on the part of the above mentioned O.Ps.

Case of the complainant, in brief, is that the complainant obtained two LICI policies bearing no.495088447 and 495561416 insuring his wife Shrabonti Jana (now deceased) on 14/01/2013 and on 07/12/2013 respectively.  It is

                                                                                                                                                            Contd………..P/2

 

                                                                              ( 2 )

stated in the petition of complaint that being a semi-literate person the complainant did not know the rules and regulations of  the LICI that a pregnant lady could not be insured by obtaining life insurance policies.  It is further stated in the petition of complaint that the O.P. no.1 did not disclose the terms and conditions of the policies to the complainant and also did not examine his wife (now deceased) by any doctor before acceptance of the proposal forms and moreover, the  said forms were filled up by the agent of the O.P. and  signed by the policy holder. It is stated by the  complainant that the insured Shrabonti Jana (now deceased) gave birth to a male baby on 05/05/2013 and died on  15/05/2013  which indicated that the deceased was pregnant for three or four months at the time of obtaining the policies.  It was the specific allegation made by the complainant that the  corporate agent of LICI who filled up the proposal form did not advice the policy holder  to undergo check up by doctor to make sure whether she  was able to fulfill their terms and conditions before obtaining the same and the O.P.-Insurance Company being the principal should be held  responsible for the acts of its  agents. The complainant has further stated that he had paid premiums of Rs.4,804/- and Rs.4,804/- in respect of policy no. 495086447 and  policy no. 495561416 on 27/12/12 and on 30/11/2012 respectively. It is further stated by the complainant that he had the Ombudsman on 15/03/2016 after repudiation of the said policies by the Sr. Divisional Manager on 12/09/2015. The complainant has further stated that the insured was a healthy lady and she did not suppress anything regarding her health. Accordingly complainant has prayed for direction upon the O.Ps. to pay (Rs.1,00,000/- + Rs.1,00,000/-) = Rs.2,00,000/-for two LICI policies with interest and, to pay Rs.50,000/- towards mental agony and harassment and to pay Rs.20,000/- towards cost of litigation.

The O.Ps. contested the case and filed written version, denying all the material allegation paragraph wise, stating, inter alia, that the instant case is not maintainable as the complainant did not approach the Forum  with clean hand. It is stated in the  written version that the complainant obtained two policies by filling the Forms duly suppressing the facts of pregnancy of the insured. The O.P. has further submitted that the insured obtained two policies of LICI  through the branch office in Kolkata and in the proposal form para-13 of the said policies bore some proposal in questionnaire form where there was a  specific question  Are you pregnant ? against which the insured replied No though  during that period she was pregnant and thus the insured suppressed the fact of  pregnancy to the O.P.  for which she was not entitled to get any relief as per terms and conditions of the policies.  It is further stated by the O.P. that the complainant filed a petition before the Ombudsman for settlement of his claim

                                                                                                                                                              Contd………..P/3

 

                                                                            ( 3 )

but the petition was rejected by the Ombudsman after hearing.  Accordingly O.P. has prayed for dismissal of the case.

Both parties adduced evidence. In support of their case both parties deposed on dock as PW-1 & OPW-1 and  during their deposition some documents are marked as exhibit X series and exhibit A series,  exhibit E respectively.

                           Points for  determination

1. Whether  the consumer complaint is maintainable before this Forum ?
2. Whether the O.Ps. have deficiency in providing service.
3. Whether the complainant is entitled to the relief as claimed.

                    Decision with reasons

Point No.1.

The complainant’s wife (now deceased) obtained two insurance policies being nos.495088447 and 495561416 by making  payment of premia and thus has became consumer under the O.Ps. as per section 2(1)(d) of the C.P. Act 1986 and the complainant being beneficiary of his wife, the insured, has became consumer under the O.Ps.

O.P. carries business within territorial jurisdiction of this Forum.

Cause of action arose within the specified  time as per section 24A of the C.P. Act.

The case is maintainable before this Forum.

Point no.1 is decided accordingly.

              Point no.2.

On perusal of the Photostat copies of the policy documents it appears that nowhere in the proposal form the insured disclosed that the insured was pregnant at the pertinent point of time.

The complainant, however, alleged that the proposal forms were filled up by the agent of the O.P.  insurer and  his wife only put her signature therein. Be that as it may, but putting signature under any declaration implies that the declaration made by the declarant who put signature there under. Therefore, it is construed that the insured herself made the  declaration in the proposal form where she did not disclose her actual physical condition i.e. her pregnancy.

The complainant also stated that his wife was not aware of the fact that during pregnancy no life insurance policy might be obtained. However, ignorance of law can not be taken and hence the same cannot be taken into consideration.

To sum up, the complainant, failed to prove that repudiation of the claim

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                                                                         ( 4 )

has been done by the insurer on frivolous and  baseless ground which is liable to be considered as deficiency in service on the part of the O.Ps.

Point no.2 is decided accordingly.

                Point no.3.

Since the complainant has failed to prove deficiency on the part of the O.Ps. no question of granting relief arises at all.

Point no.3 is decided accordingly.

                      In the result the instant consumer complaint does not succeed.

                                 Hence, it is,

                                                          ORDERED

                                   that the consumer complaint case being no. 20/2017 is hereby dismissed without cost.

                Let plain copy of this order be given to the parties free of cost.

         Dictated and Corrected by me

                      Sd/- S. Sarkar                            Sd/-P.K. Singha                        Sd/-B. Pramanik. 

                        Member                                         Member                                   President

                                                                                                                          District Forum

                                                                                                                       Paschim Medinipur