Tripura

StateCommission

A/32/2017

Divisional Manager, LIC of India - Complainant(s)

Versus

Smt. Mampi Dhar (Ghosh) - Opp.Party(s)

Mr. Prahlad Kr. Debnath

17 May 2018

ORDER

Tripura State Consumer Disputes Redressal Commission, Agartala.

 

 

Case No.A.32.2017

 

1. The Divisional Manager,
   Life Insurance Corporation of India,
   Represented by the Branch Manager,
   Life Insurance Corporation of India,
   Branch No.II, Krishnanagar, [TRTC],
   Agartala, P.S. West Agartala,
   West Tripura, Pin: 799 001.

… … … … … Appellant/Opposite Parties.

Vs

 

1. Smt. Mampi Dhar (Ghosh),
   W/o  Late Bipul Kanti Ghosh,

 

2. Sri Bipradip Ghosh,
   S/o Late Bipul Kanti Ghosh,
   [minor represented by mother, Respondent No.1]

Both are residence in C/o Shri Rabindra Dhar,

Ramkrishna Ashram, Gangail Road,

P.S. West Agartala, District: West Tripura,

Pin: 799001.

… … … … … Respondent/Complainants.

3. Smt. Anjali Ghosh,

W/o Late Bhajan Chandra Ghosh,

Vill: Jangaliya, P.O. & P.S. Bisalgarh,
District: Sepahijala, Tripura, Pin: 799102. 

       … … … … … Respondent No.3/ Proforma Opposite Party.

 

Present

Mr. Justice U.B. Saha,

President,

State Commission, Tripura.

 

Mr. Narayan Chandra Sharma,

Member,

State Commission, Tripura.

 

 

 

 

For the Appellants:                                          Mr. Prahlad Kumar Debnath, Adv.

For the Respondent/Complainants:                Mr. Subrata Roy, Adv.

For the Respondent No.3:                                Absent.                 

Date of Hearing & Delivery of Judgment:                  17.05.2018.

 

J U D G M E N T [O R A L]

 

U.B. Saha, J,

The instant appeal is filed by the appellant, the Divisional Manager, Life Insurance Corporation of India, represented by the Branch Manager, Life Insurance Corporation of India, Branch No.II, Krishnanagar, TRTC, Agartala, West Tripura (hereinafter referred to as opposite party nos.1 and 2/Insurance Company/LICI) challenging the judgment dated 20.04.2017 passed by the learned District Consumer Disputes Redressal Forum, West Tripura, Agartala (hereinafter referred to as District Forum) in Case No.C.C.06 of 2017 whereby and whereunder the learned District Forum directed the appellant-opposite party nos.1 and 2 to settle the claim and disburse the amount to the nominee, Anjali Ghosh with further direction to her that she would pay 2/3^rd of the amount to the petitioners, Mampi Dhar (Ghosh) and Bipradip Ghosh, the wife and the minor son of the deceased insured. LICI is to assure that both of them should get 2/3^rd benefits of the policy and also to pay compensation amounting to Rs.20,000/- to the petitioner no.1 and 2 i.e. Smt. Mampi Dhar (Ghosh) and Sri Bipradip Ghosh for their deficiency of service. The direction is to be followed within one month. If the amount is not paid, it will carry interest @ 9% per annum. 

2. Heard Mr. Prahlad Kumar Debnath, Ld. Counsel appearing for the opposite parties/Insurance Company as well as Mr. Subrata Roy, Ld. Counsel appearing on behalf of the respondent nos.1 and 2. None appears on behalf of the respondent no.3, Anjali Ghosh (hereinafter referred to as proforma opposite party).
3. Brief facts needed to be discussed are as follows:-

Smt. Mampi Dhar (Ghosh) along with her minor son Sri Bipradip Ghosh, the respondent no.1 and 2 herein, (hereinafter referred to as petitioners) filed an application before the learned District Forum, West Tripura, Agartala under Section 12 of the Consumer Protection Act, 1986 stating, inter alia, that her deceased husband Bipul Kanti Ghosh purchased two insurance policies before her marriage from the opposite party LICI being Policy No.492726635 dated 31.03.2010 for a sum assured of Rs.2 lacs and Policy No.492729648 dated 08.05.2010 for a sum assured of Rs.2 lacs and the nominee for those policies was Smt. Anjali Ghosh, the , the mother of her deceased husband. Her husband, deceased Bipul Kanti Ghosh died on 29^th December, 2011 and thereafter she claimed the sum assured from the opposite parties-LICI. The opposite parties-LICI informed her to obtain succession certificate from the competent court of law as the nominee of the insured in those policies was her mother-in-law Smt. Anjali Ghosh. Accordingly, Smt. Mampi Dhar (Ghosh) filed a case on behalf of her as well as her minor son Bipradip Ghosh before the Court of the learned Civil Judge, Senior Division, Court No.1, Agartala, West Tripura for getting succession certificate and the said case was registered as Misc (Succession) No. 21/2012 wherein her mother-in-law, the respondent no.3 herein, and the opposite parties-Life Insurance Corporation of India were made party. The learned Civil Judge, Senior Division, Court No.1, Agartala, West Tripura after hearing the parties ultimately issued succession certificate in favour of the deceased insured’s wife Mampi Dhar (Ghosh), the respondent no.1 herein and her minor son, but in spite of production of succession certificate, the assured amount was not paid to her by the opposite parties-LICI. Therefore, she filed the complaint case before the learned District Forum for directing the opposite parties-Insurance Company to pay the insured amount with 12% interest from the date of claim made by her and till the realization of actual payment and also to grant an amount of Rs.2,00,000/- as compensation for mental agony and for non-payment of insured sum along with Rs.30,000/- as cost of litigation.

4. The opposite parties-Insurance Company appeared and filed their written statement denying the claim on the ground that the claim is to be settled with the nominee, Anjali Ghosh, mother of the life assured. It is also contended that the nominee, Smt. Anjali Ghosh could not produce the treatment particulars including the discharge summary of deceased life assured on being treated before death at Tripura Medical College & Dr. B.R. Ambedkar Memorial Teaching Hospital (hereinafter referred to as TMC) for settlement of the claim which were to be received from the claimant as required for releasing the benefits of the policy. It is further contended that before deciding the claim with the nominee subject to submission of requirements as called for and found satisfactory, the opposite parties-LICI were refrained from processing the claim by a prohibitory order of the learned Civil Court, Agartala passed in the proceedings of the succession case being Succession Certificate Case No.Misc (Succession) 21 of 2012 in the Court of learned Civil Judge, Senior Division, Court No.1, Agartala, West Tripura.
5. In the written statement, the opposite parties-LICI has admitted that they have received the claim petition from the proforma opposite party Anjali Ghosh and it is also admitted that they have received the photocopies of the succession certificate dated 21.07.2016 and the prayer of the succession certificate holder Smt. Mampi Dhar (Ghosh) dated 01.08.2016 to settle the claim in her favour, though contended that the photocopies of the succession certificate has no legal status as those are not duly attested by the competent authority. Further case of the opposite parties-Insurance Company is that the claim is under process of inquiry in collecting the other important information regarding bona fide health status and complete treatment particulars of deceased life assured including discharge summary of TMC and Dr. BRAM Teaching Hospital for which the opposite parties-Insurance Company wrote letter on 27.07.2016 and a reminder letter on 11.01.2017 to the nominee.
6. The learned District Forum on the basis of contention raised by the parties framed the following points for deciding the case:-

1. Whether the petitioner was entitled to get the sum assured and other benefits of the policy of her deceased husband?
2. Whether there was deficiency of service by the LICI?

7. The proforma opposite party, Anjali Ghosh, the nominee and mother of the deceased life assured Bipul Kanti Ghosh did not file any written statement before the learned District Forum.
8. The petitioners, the respondent nos.1 and 2 herein, produced the succession certificate, birth certificate, written statement of LICI in the succession certificate Case No.Misc (Succession) 21/2012, death certificate of the insured Bipul Kanti Ghosh, survival certificate of the insured. She has also submitted her statement on affidavit and examined herself as P.W.1.
9. The opposite parties-Insurance Company produced the reply letter, reminder letter addressed to the nominee and speed post letter and also statement on affidavit of one Nabarun Ghosh, Branch Manager of LICI and examined him as O.P.W.
10. The learned District Forum after considering the evidence on record passed the impugned judgment.
11. Being aggrieved by the aforesaid judgment, the opposite parties-Insurance Company, the appellant herein, filed the instant appeal along with a condonation petition for condoning the delay of 29 days in preferring the appeal. The Commission after hearing the parties condoned the delay and in consequence thereto, admitted the appeal.
12. During the pendency of the appeal, the opposite parties-Insurance Company filed an application to allow it for submitting the additional documentary evidence at the appellate stage without annexing any documents with the application. On 03.08.2017, this Commission after hearing the parties allowed the appellant-opposite parties to file the additional documents furnishing the copy of the same to the Ld. Counsel for the respondents and thereafter, list the said application for order on adducing additional documentary evidence. On 05.09.2017, the opposite parties-Insurance Company submitted 12 documents and on that date, the complainants have prayed for time to file objection against the prayer for adducing additional documentary evidence by the opposite parties-Insurance Company and finally, filed their objection. After hearing the parties and considering the Law Reports submitted by the parties on 09.01.2018, this Commission rejected the prayer for adducing additional evidence holding that the appellant-Insurance Company was not at all diligent or interested to collect those documents when they contested the case before the learned District Forum and only after the judgment of the learned District Forum, they approached the Tripura Medical College & Dr. B.R. Ambedkar Memorial Teaching Hospital for obtaining those documents that itself shows that the appellant-Insurance Company now by way of adducing additional evidence tried to fill up the lacunae or gaps to patch up its weak points and make up the omission made by it before the learned District Forum and fixed the case for final hearing. On query of this Commission, Mr. Debnath, Ld. Counsel has submitted that the appellant/Insurance Company did not prefer any Revision Petition before the Hon’ble National Commission against the aforesaid order dated 09.01.2018 of this Commission. Hence, the said order has become final.   
13.  Mr. Debnath, Ld. Counsel while urging for setting aside the impugned judgment would submit that the learned District Forum failed to consider that for processing the claim of the petitioners, the documents regarding the treatment and health status of her deceased husband, insured were required to be submitted by the claimants. He also submits that the appellant-opposite parties-Insurance Company admittedly was a party in the succession certificate Case No.Misc (Succession) 21/2012 wherein the Insurance Company appeared and contested the case. He again submits that the nominee of the insured, the mother-in-law of the petitioner no.1, was asked to produce the necessary papers regarding the treatment and health status of the deceased insured, but she did not produce any documents for which the claim of the petitioner could not be settled. He has finally contended that the learned District Forum though discussed that “LICI had Enquiring Cell. So it could collect the information from the hospital if any doubt arise about the cause on the death of life assured”, but failed to understand the facts that unless the claimant replies to the letter assigning the reason that she was unable to collect the medical papers from the hospital and unless the claimant authorises the LICI to collect the medical papers of policy holder from the TMC Hospital, the LICI cannot/should not permit the Enquiry Cell to collect medical papers of the policy holder. Therefore, the opposite parties-LICI cannot be held liable towards deficiency and negligency of service and also to pay compensation as sought for. According to him, this is a fit case for setting aside the impugned judgment and to remand the case before the learned District Forum for deciding afresh. In support of his aforesaid contention, he has relied upon a decision of the Maharashtra State Consumer Disputes Redressal Commission, Mumbai, Circuit Bench at Aurangabad in FA No.767/2009 (The L.I.C. of India, through its Branch Manager, Parbhani, District - Parbhani Vs Ramesh Bhagwat Viveki).  
14. Mr. Roy, Ld. Counsel while supporting the impugned judgment would contend that the learned District Forum did not commit any error while passing the impugned judgment as the opposite parties-Insurance Company neither in their written statement nor adducing evidence stated that at any point of time they have asked the petitioner- claimants as legal heirs in terms of the decision of the Ld. Civil Judge, Sr. Division, Court No.1, Agartala in Case No. Misc (Succession) 21/2012 (hereinafter referred to as succession case) to produce any paper regarding the treatment of the deceased insured and his health status. He also submits that in the succession case, admittedly, the Branch Manager, LICI, Agartala, Branch No.II was a party and the Insurance Company has submitted its written statement wherein the Life Insurance Corporation urged upon the Hon’ble Court to grant succession certificate to the actual legal heirs/successors of the deceased life assured in order to expedite the settlement of the claim and also direct the proforma opposite party, nominee to submit the specific requirements like claim forms, medical certificate etc. along with succession certificate to them for settling the claims, but did not submit before the Court to direct the petitioners herein, to produce any medical papers including the health status of the insured. He again contends that the succession certificate was granted in favour of the petitioners by the Ld. Civil Judge, Sr. Division, Court No.1, Agartala against which the appellant-Insurance Company did not prefer any appeal. In consequent thereto, the petitioner no.1 made the claim for the insured amount to the opposite parties-Insurance Company. At no point of time, the opposite parties-Insurance Company asked the petitioners to submit any paper regarding the health status of the insured though the petitioner no.1 Mampi Dhar (Ghosh), wife of the deceased insured made claim for the benefit of the insurance policy of her deceased husband on behalf of her and on behalf of her minor son to the opposite party-Insurance Company along with the order passed by the Ld. Court in the succession case and the death certificate, survival certificate and other necessary documents. He has again submitted that in Shubhangi Shivajirao Ghatge Vs L.I.C. of India reported in 1996 (2) CCC 968, the Hon’ble National Commission decided almost a similar case wherein there was a dispute regarding the share of the sum assured in the insurance policy between the nominee and the legal heir of the insured. The Hon’ble National Commission rightly held that the policy holder of that case though nominated the appellant therein as his nominee under the policy, but when another legal heir made claim that she is entitled to a share in the amount, the only legal consequence of such nomination is that if the insurer pays the amount due under the policy due to the nominee the insurer will get a valid discharge and when another person comes forward with a claim that he/she is a legal heir of the deceased entitled to a share and demands payment of such share of the proceeds of the policy, the Insurance Company is not bound to pay the whole amount to the nominee. According to him, in the aforesaid judgment, the Hon’ble National Commission upheld the claim of the legal heir in that case and held that the Insurance Company is not bound to pay whole amount to the nominee. In the instant case, the learned District Forum also did not allow the entire amount to the nominee of the policy, but directed the Insurance Company to settle the claim, disburse the amount to the nominee, the mother of the insured, Anjali Ghosh directing her to pay 2/3^rd of the amount to the petitioners, Mampi Dhar (Ghosh) and Bipradip Ghosh, minor son of the petitioner no.1 and also to ensure that both of them should get 2/3^rd benefits of the policy being legal heirs. Thus no wrong committed by the learned District Forum.
15. We have gone through the pleadings and evidences adduced by the parties before the learned District Forum as well as the impugned judgment. Nowhere either in the written statement or in the evidence adduced by the opposite parties-Insurance Company it is stated that at any point of time they have asked the petitioners, the respondents herein to produce any medical documents including the health status of the insured. It is admitted position that the opposite parties-Insurance Company has appeared in the succession case filed by the petitioners wherein they have filed their written statement and urged before the Court to grant the succession certificate in favour of the actual legal heirs of the deceased insured and admittedly the Ld. Civil Judge, Sr. Division, Court No.1, Agartala granted the succession certificate in favour of the petitioners. Thus it cannot be said that the opposite parties-Insurance Company was not aware regarding the legal status of the petitioners and their claim for the benefit of two policies of the deceased insured. Admittedly the appellant-Insurance Company at no point of time asked the petitioners for producing any medical document regarding the treatment of the insured and his health status after making their claim before the opposite parties and it is also admitted position that their claim was not settled by the Insurance Company even after submission of their claim for the insured amount along with the order of the Ld. Civil Judge, Sr. Division passed in the succession case. It is the admitted position that the insured Bipul Kanti Ghosh was died on 29.12.2011 and his mother Anjali Ghosh, the nominee of the deceased insured made a claim for insured amount immediately after the death of insured and the petitioners also made the claim, but the claim is not settled by the opposite parties-Insurance Company on the ground that the claimants did not fulfill the normal requirements for making claim as mentioned in the insurance policy. There is no doubt that the insurance policy is a contract between the insured and the Insurance Company and the Court has no power/right to rewrite the policy, but at the same time, it is the duty of the Court to provide justice to the nominee and the legal heirs or the insured so that they cannot be deprived of the insured amount on mere technical ground like the paper relating to medical treatment of the insured and his health status prior to his death as asked for. In the death certificate produced by the nominee of insured Bipul Kanti Ghosh as well as the petitioners, it is specifically mentioned that his treatment was at TMC & Dr. BRAM Teaching Hospital, Agartala and the Insurance Company after receipt of the said death certificate could have easily collected the necessary information from the said hospital regarding the treatment of the insured and his health status as it has its own machinery like Enquiry Cell, but fact remains that though the O.P.W. Branch Manager of the opposite party-Insurance Company in his cross-examination specifically stated that LICI has Enquiry Cell and in this case enquiry conducted and nominee laid the claim before the Insurance Company, but they have not stated that the discharge summary is required. In view of the evidence given by the Branch Manager of LICI, the O.P.W. it can easily be presumed by this Commission that in this case an enquiry was made by the Enquiry Cell and admittedly no report has been submitted before the learned District Forum by the opposite parties-Insurance Company regarding the enquiry done by the Enquiring Cell. We are unable to accept the contention of Mr. Debnath, Ld. Counsel so far his contention, inter alia, that the Insurance Company can ask the enquiring cell for enquiry regarding the medical treatment and health status of the insured after his death only when authorized by the nominee. There may be a case that the nominee and the legal heirs are not aware regarding the formalities required by the Insurance Company and in that case, according to us, it is the duty of the Insurance Company to help the nominee and legal heirs of the insured to fulfill the requirements, if so required, which the Insurance Company did not do so.  
16. From the pleadings and the evidences adduced by the opposite parties-Insurance Company, we do not find any contention made by the Insurance Company communicating the petitioners regarding their doubt so far the death of the insured and his health status prior to his death. Unless the petitioners are communicated by the opposite parties-Insurance Company regarding the requirements to settle the claim, how they will fulfill the requirements as asked for by the Insurance Company. Though according to the Insurance Company, they asked the nominee for submitting the particulars regarding the treatment including the discharge summary of the hospital of deceased insured, but the opposite parties-Insurance Company did not receive the same from the nominee. If the aforesaid contention of the opposite parties-Insurance Company is correct, then also the opposite parties-Insurance Company cannot delay for settling the claim on that ground as it has their own enquiring cell for enquiry regarding the medical treatment and health status of the insured.
17. The learned District Forum rightly observed as “LICI had enquiring Cell. So it could collect the information from the hospital if any doubt arise about the cause on the death of life assured. It was not done and unnecessarily claim was not settled after 5 years of the death of Bipul Kanti Ghosh life assured. This is deficiency of service by LICI. As the claim was not settled so the petitioners being the legal heirs and successors of Bipul Kanti Ghosh suffered a lot. They are entitled to get the policy benefits. It is true that time was taken for collection of succession certificate. But as per Insurance Act the amount or sum assured could have been disbursed to the nominee within the 5 years without succession certificate. Nominee is duty bound to disburse the amount to actual legal heirs. This is the principles laid down by our Apex Court. Even after production of succession certificate the benefits of the policy sum assured was not released till today. This is again deficiency of service of the LICI.”
18. In the instant case, admittedly, the deceased insured purchased the policy before his marriage and thus he had no opportunity to make the present petitioners as his nominee in the insurance policy and rightly he nominated his mother as nominee.
19. Today at the time of final hearing, none appeared for the nominee, the proforma opposite party, the mother of the deceased assured. On earlier occasion, Mr. Alik Das Ld. Counsel who appeared for the nominee, the proforma opposite party categorically submitted that the nominee has no objection to the prayer for the claimant-petitioners so far their share is concerned and not only that, the nominee admittedly did not file any written statement challenging the contention of the claimant-petitioners. Therefore, according to us, it can be easily presumed that she has no grievance so far the claim of the petitioners is concerned and also she never raised any objection before the opposite parties-Insurance Company regarding the claim of the petitioners as she is ready to pay 2/3^rd amount of the policy to the respondent no.1 Mampi Dhar (Ghosh) and her grandson Bipradip Ghosh or to his natural guardian in proof of minority. Therefore we are of the opinion that it was the duty of the opposite parties-Insurance Company to provide the benefit of the Insurance Policy to the helpless nominee and the claimants as at no point of time the opposite parties-Insurance Company informed regarding their doubts so far the death and health status of the insured is concerned. The Insurance Act is a beneficial legislation and the insurance is done by an insured for the benefits of his survivors. Insurance Company should not deny the benefits of insured policy to the true nominee and legal heirs of the insured on the technical ground, which they have done in the instant case.
20. We have also gone through the judgment of the Maharashtra State Consumer Disputes Redressal Commission in Ramesh Bhagwat Viveki (supra). According to us, the aforesaid case has no application in the instant case as the facts of that case are totally different than the case in hand. In that case, deceased insured was not survived by any legal heir, like the case in hand.  

In view of the above facts and circumstances, we are of the considered opinion that the learned District Forum did not commit any error while passing the impugned judgment. Thus, no interference is called for.

In the result, the appeal is dismissed being devoid of merit.

Send down the records to the learned District Forum, West Tripura, Agartala.