OFFICE OF THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ANGUL
PRESENT:- SRI DURGA CHARAN MISHRA.
PRESIDENT
A N D
Smt.Sunanda Mallick &Sri K.K.Mohanty,
MEMBER .
Consumer Complaint No. 43 of 2014
Date of Filling : - 16.05.2014.
Date of Order :- 08.11.2018.
01.Satyabhama Singh,W/O.Late Prafulla Ku.Singh,
& D/O.Late Pitambar Singh.
02. Rudramohan Singh,S/O.Late Prafulla Ku.Singh,
All are of Vill/P.O.Paranga,P.S.Nisha Industrial,
P.S/S.D/Dist.Angul.
03.Sabita Singh,D/O.Late Prafulla Ku.Singh & W/O.
Khirod Samal,At/P.O.Parang,P.S.Nisha Industrial,
P.S/S.D/Dist.Angul,At present:- At/P.O.Balaramprasad,
P.S.Nalco Nagar,Dist.Angul.
__________________________Complainant.
Vrs.
- Senior Divisional Manager,Cuttack Divisional
Office,Jiban Prakas,Post Box No.36,Cuttack-753001.
02.Chief Manager,LIC of India,Angul Branch,
Vill/P.O/P.S/Dist.Angul-759122
03.Life Insurance Corporation of India (LIC),
Represented through its- Chief Manager,LIC of India,
Angul Branch,At/P.O/P.S/Dist.Angul- 759122.
04.Rama Ch.Samal,S/O.Umesh Ch.Samal,Vill/
P.O.Paranga,P.S.Nisha Industrial,P.S/S.D/Dist.Angul.
…................................Opp. parties
For the complainant :- Sri S.N.Mishra & associates(Advs.).
For the opp.parties :- Sri S.N.Mishra & associates(Advs.).
: J U D G E M E N T :
Smt.S.Mallick, Member.
The petitioners have filed this case against the opp.parties, seeking for payment of the sum assured on the life of the deceased covered under the policy amounting to Rs. 10,000,00/- with interest along with the compensation and litigation expenses.
2. The case is that Late Prafulla Kumar Singh had availed 3 LIC policies i.e for sum assured of Rs. 50,000/- vide policy No. 584861307 on 28.07,2001 and sum assured of Rs.2,000,00/- vide policy No. 589417529 on 28.05.2007 and last policy for a sum assured of Rs. 10,000,00/- vide policy No. 587970007 on 24.8.2010 respectively. After acceptance of the proposals the premiums under the above policies were regularly paid. Unfortunately on 17.07.2012 life assured Prafulla Kumar Singh expired. The petitioners being the nominee and legal heirs of the life assured informed his death to opp.party No.2 and supplied the necessary requirements for settlement of the claim of the life assured, but opp.party Nos.1, 2 & 3 allowed the claim of complainant in respect of two policies worth of Rs.50,000.00 & Rs.2,00,000.00 respectively but repudiated the claim of the third policy of Rs. 10,000,00.00 on the ground that the deceased life assured withheld material information with regard to his treatment at the time of effecting the insurance .According to the petitioner the repudiation is not based on valid ground.
3. The opp.party Nos.1,2 & 3 have filed a joint written version through their counsel.They have settled the death claims against policy nos. 584861307 and 589417529 and have paid Rs. 73,504.00 & Rs.2,50,400.00 respectively and repudiated the 3rd policy bearing No. 587970007.As per Section-45 of Insurance Act ,1938 if there is miss-statement of facts in the proposal form as well as the personal statement of health with regard to material facts has been suppressed, the corporation is at liberty to repudiate the claim as early claim. They further pleaded that they have not committed any deficiency in service and prayed to dismiss the complaint case.
The opp.party No.4 has contested the case by filing separate written version.He admitted all the facts including that when the policies were opened, life assured Prafulla Kumar Singh was hell and hearty.He pleaded that when the third installment of the yearly premium of Jibanananda policy was due on 24.08.2012, the life assured Prafulla Kumar Singh died on 17.07.2012.He further added his honest view in his pleading that the genuine claim of the customer and the policy holder ought not to have been discriminated and the repudiation has to be established by opp. Party No.1 to 3 with genuine reasons.
5. In view of the above pleadings of parties, the following issues arise for consideration
Issues:-
- Whether there is consumer and service provider relationship exists between them ?
- Whether the insured has fraudulently suppressed the material facts regarding his health when the policies were made ?
- Whether the opp.parties have committed deficiency of service by repudiating the insurance claim of the complainants ?
- Whether the complainants are entitled to relief claimed ?
: F I N D I N G S :
Issues No.(i):-Admittedly the deceased life assured Prafulla Kumar Singh had availed the policies 584861307, 589417529 & 587970007 under the opp.parties.by paying the due premiums for the above policies.So there is consumer and service provider relationship exists between them.
Issue No.(ii) :- Life Insurance Corporation is a statutory body constituted under the Life Insurance Act, 1952.After the Act came into force, LIC of India became the sole authority to have Life insurance in India.For insuring a life, the proposal is to be made by the life sought to be insured, the proposer is to be medically examined by medical examiner approved by the insurer who is to give confidential report to the insurer (opp.parties) and the premium amount required is to be paid. Possessed by these two documents insurer is to decide the question of acceptance of the proposal. Once the proposal is accepted, contract is complete and policy is to be issued.
The opp.parties have taken the plea that when Late Prafulla Kumar Singh, the father of Rudramohan Singh took the policy, he has made some false declarations by denying about his diseases. They have further argued that since the policy has been obtained by misrepresentation and suppression of material fact, the petitioners are not entitled to get benefit and the opp.parties have rightly repudiated the claim as early claim. In support of their plea they have submitted medical certificate of Dr. S.C.Sahu, another from Dr. P.K.Sahu and leave application made by Prafulla Kumar Singh. His leave application dt. 26.6.2008 does not disclose about any decease for which it is not fatal to the petitioners. Both the medical certificates stated above reveal about diabetes disease but in non of the certificates the range of diabetes has been written. Further , all the employees when availing medical leave (commuted leave) give a false and imaginary plea and without proper test, verification and treatment the doctors also issue such certificates only basing on the statement of the person. Further, from those two certificates it cannot be inferred that the policy holder was actually suffering from disease (diabetes).It can be presumed that he might have obtained a false certificate only with intention to use it for leave purpose . In that case it was his department which could have proceeded against him for giving false information but from those Xerox copies , the contents cannot be accepted as conclusive proof without verifying the linked and relevant records or without examining the doctor. Therefore this plea of the opp.parties that the insurer gave false statement about his treatment falls to ground having no force or merit. He might have given such an information only for availing leave without any fraudulent intention and these certificates are not the true admission of the insurer .Thus this forum cannot come to a definite conclusion that the grounds given for taking leave was absolutely right and he made fraudulent declaration before the opp.parties for taking the policy. It is important to mention here that the declaration form was not filled up by the insurer himself but it has been made either by the agent or by the insurance office. So how the insurer made fraudulent declaration ? When the opp.parties are taking such plea, why they did not examine the insurer before issuing the policy which is mandatory.
The petitioner has relied on number of decisions which revealed that on the ground of suffering from diabetes, repudiation of claim is illegal . Hon’ble Haryana State Consumer Disputes Redressal Commission in a decision between Life Insurance Corporation Vrs. Rampati reported in (Vol-II) 1997 CPJ 137, has held that “diabetes was not such a serious ailment which was necessary for the insured to bring it to the notice of the Insurance Corporation. For these reasons , the repudiation of the claim by the LIC was wholly arbitrary without any cogent or convincing reason”. The policy holder has already deposited approximately two lakhs in two installments and within very few days of his death the 3rd installments was to be deposited and after that the plea of early claim was not available. The cash of Rs. 2,01,958.00 deposited by the policy holder in 2010 & 2011 might have been grown to a higher extent. In this circumstances refusing benefit on flimsy ground is not in accordance with natural justice, equity and fair play. So opp.parties are bound to release the matured amount and the petitioners being legal heir are entitled to get it. In a case reported in “AIR 2001(S) 549 in LIC of India Vrs. Asha Goel” the Hon’ble Supreme Court held that:- “LIC should not deal with its customer in a very mechanical ways and routine manner but with extreme care and caution”.
Issue No.(iii):- From the discussion made above in issue No. (ii), it is found that the opp.parties have denied the claim of the petitioner on improper and whimsical ground. Thus they have committed deficit in rendering the service to the petitioners and they should compensate the petitioners properly for it.
Issue No.(iv):- The opp.parties should give the insurance amount to the petitioners along with cost of litigation .
6. Hence the order :-
: O R D E R :
The case is disposed of on contest by both the parties against the opp.parties.The opp.parties are directed to pay the assured amount of Rs. 10 lakhs along with Rs. 10,000.00 towards cost of litigation within 45 (forty-five ) days of getting this order. It is made clear that in case of any deviation of this order by the opp.parties, the opp.parties shall pay 12% quarterly compoundable interest on the assured amount of Rs. 10,000,00.00 from the date of filing of this case i.e. from Dt. 16.5.2014 till actual payment if made besides other penalties provided in the C.P.Act, 1986.
Order delivered in the open forum today the 8th November, 2018 with hand and seal of this Forum.
Typed to my dictation
and corrected by me Sd/-
(Sri D. C. Mishra)
Sd/- President.
( Smt.S.Mallick)
Member. Sd/-
(Sri K.K.Mohanty),
Member.
