West Bengal

Paschim Midnapore

CC/68/2016

Ramesh Chand - Complainant(s)

Versus

Sr.Division Manager, L.I.C.I. - Opp.Party(s)

Subrata Das.

23 Aug 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                                                                                                  

Bibekananda Pramanik, President,

Mrs. Debi Sengupta, Member

and 

Kapot Chattopadhyay, Member.

   

Complaint Case No.68/2016                                                        

1. Sri Ramesh Chand,
2. Sri Mukesh Chand,
3.  Sri Satish Chand,
4. Smt. Bhanumati Chand, W/o Late Hem Chand, Vill. Sonamukhi Jholi, P.O. Hijli,

 P.S. Kharagpur (T), District Paschim Medinipur,

            5)   Smt. Sarita Devi, W/o Munindra Prasad, vill- Sonamukhi Jholi, P.O. Hijli, P.S. 

                   Kharagpur (T), District Paschim Medinipur, PIN-721306 .….……Complainants.

                                                                              Vs.

                Sr. Divisional Manager, Life Insurance Corporation of India, Kharagpur Division at

                Claims Department, Near Lal Banglow, P.O Nimpura, P.S. Kharagpur (T), District   

                Paschim Medinipur, PIN-721304                               ..………...........…..Opp. Party.

 

              For the Complainant: Mr.  Subrata Das, Advocate.

              For the O.P.               : Mr. Diptendu Ghosh, Advocate.

 

Decided on: -23 /08/2016

                               

ORDER

                          Bibekananda Pramanik, President – Facts of the case, in brief, is that Hem Chand, since deceased, the father of the complainants nos.1, 2, 3 and 5 and the husband of complainant no.4 was an employee of I.I.T., Kharagpur and he died on 10/01/2014.  During his life time, Hem Chand purchased some L.I.C.I. policies and some of those were matured in his life time.  Thereafter he obtained three other L.I.C.I. policies being no.499401558 dated 26/2/2011 of Rs.2,50,000/-, policy no.499415864 dated 28/07/2011 of  Rs.2,50,.000/- and policy no.499429789 dated 28/11/2011 of Rs. 5,00,000/-

Contd…………………P/2

 

 

( 2 )

from the O.P.- L.I.C.I.  At the time of taking those policies, Hem Chand was 58 years old

 and as per direction of O.P.-L.I.C.I., Hem Chand appeared before the doctors for his medical examination and after being satisfied with the medical reports, the O.P.- L.I.C.I. issued those policies in his favour after receiving proper premium. While he was alive, Hem Chand used to deposit premium of those policies regularly. On 2/1/2014  Hem Chan became ill and he was admitted in B.C. Roy Tech Hospital at I.I.T, Kharagpur for treatment and there he died on 10/01/2014.  After his demise, the complainant no.1, being the nominee, submitted claim application to the opposite party no.1 along with all documents but the opposite party no.1 vide it’s letter dated 15/10/2014 repudiated the claim and adviced the complainant no.1 to submit representation before the Zonal Manager i.e. opposite party no.2 but he also refused to settle the claim on 20/03/2015.  Thereafter the complainant no.1 also made an application before the Insurance Ombudsman but the same has not been properly considered.  It is stated that at the time of taking policies, Hem Chand was medical examined by the L.I.C.I. and thereafter the proposal form was accepted and the opposite parties issued the policies in favour of Hem Chand and therefore the O.P.-L.I.C.I cannot repudiate the claim of the petitioners and as such there is deficiency in service on the part of the O.P.  Hence the complaint, praying for directing the opposite parties to pay Rs.10,00,000/- being the sum assured of those policies to the complainant and to pay Rs.8,00,000/- as compensation for deficiency in service and also to direct the opposite parties to pay Rs.25,000/- as cost of the proceeding.

                  All the opposite parties have contested this case by filling a joint written objection.

                 Denying and disputing the case of the complainants, it is the version of the opposite parties that the present case is not maintainable, that the petition of complaint is barred by limitation, that the petition of complaint is bad for miss-joinder of parties, that the case is barred by the principles of estoppel, waiver and acquiescence and that the petition of complaint is barred by the provision of  res judicata .  It is stated by the opposite parties that Hem Chand purchased three L.I.C.I policies as disclosed in the petition of complaint and in all those policies, complainant no.1 was made as nominee.  At the time of filling up the proposal form, Hem Chand suppressed many material facts and gave false information in column no.11 of the said form in respect of his health condition and about his long suffering from ailments and alcoholic liver disorder with hypertension and about his taking medical leave for 98 days since 23/2/2009 to 26/2/2011 from his service and even on the date of purchase of the first policy,  he was on medical leave.  It is also stated that the life assured Hem Chand was an employee of Kharagpur I.I.T.  He was suffering from Anaemios Penumonia with sepsis, hypertension and alcoholic liver disease since long

Contd…………………P/3

 

( 3 )

prior to purchase of the said policies as well as at the time of purchase of the those policies,  he was treated by several doctors for his such illness said ultimately said life assured Hem Chand became ill and he was admitted in B.C. Roy Technology Hospital at Kharagpur I.I.T.  with breathing problem on 2/1/2014 and he  expired on 10/01/2014. From the claim form, treatment papers, medical documents and letter issued by the Section Medical Officer of B.C. Roy Technology Hospital and other documents, it is clearly seen that said Hem Chand was habitual alcoholic for about 25-30 years prior to his death and he was a known case of alcoholic liver disorder with hypertension along with other disease and such fact has been deliberately suppressed by him and thereby he misguided the opposite parties at the time of obtaining those policies.  After repudiation of the claim of those three policies, the complainant no.1 approached to the Zonal Manager of L.I.C.I. who upheld the decision of repudiation and thereafter the complainant approached before the Insurance Ombudsman, State of West Bengal vide complaint reference no.KOL-L-029-1516-0098. After examining both parties and after hearing at length Ld. Ombudsman has been pleased to hold and observe that the deceased life assured did not disclose his adverse physical condition and his terminal disease is related to alcoholic liver disorder and therefore the decision taken by the insurer in repudiating the claim stands upheld and the complainant is closed without giving any relief to the complainant vide his award dated 14/03/2016.  It is therefore stated that the complainants have no right to file the present case because it is barred under the provisions of res judicata.  Opposite parties therefore claim dismissal of the petition of complaint with cost.

                                                                 Point for decision

1. Is the case maintainable in it’s present form and prayer ?
2. Is the case barred by principal of res judicata ?
3. Are the complainants entitled to get the reliefs, as sought for ?  

Decision with reasons

For the sake of convenience and brevity, all the above points are taken up together for consideration.

In this case neither the complainants nor the opposite parties have adduced any sort of evidence, either oral or documentary but they have relied upon some documents, so filed by them. 

Admittedly Hem Chand, since deceased, the father of the complainant no.1, during his life time obtained those three policies of L.I.C.I. from the opposite party.  Admittedly, after the death of said Hem Chand, the complainant no.1 being the nominee of those policies submitted a claim of Insurance of those policies before the opposite party and his claim was repudiated by the opposite party no.1 vide letter dated 15/10/2014. Admittedly being

Contd…………………P/4

 

( 4 )

aggrieved by such repudiation, the complainant no.1 made representation before the opposite party no.2 who upheld the decision of repudiation. Thereafter the complainant no.1 approached before the Insurance Ombudsman and after hearing of both sides, Insurance Ombudsman, State of West Bengal has been pleased to upheld the decision taken by the insurer in repudiating the claim vide award dated 14/03/2016.  Admittedly, thereafter the present petition of complaint has been filed.  Now the question arises, as raised by the opposite party, as to whether the present complaint is barred by principal of res judicata?  Admittedly, after such repudiation of claim by opposite party no.1, the present complainant no.1 made a representation against such order of repudiation before the opposite party no.2 who also upheld the decision of repudiation by opposite party no.1.  Admittedly, against such order, the complainant no.1 approached before the Insurance Ombudsman, State of West Bengal regarding such repudiation and Insurance Ombudsman vide Award dated 14/03/2016 upheld the decision taken by insurer in repudiating the claim of the complainant no.1.  This Forum is not an appellate authority of Insurance ombudsman and when the grievance of the complainant no.1 regarding such repudiation of his claim has been finally decided by a competent authority i.e. the Insurance Ombudsman vide it’s Award dated 14/03/2016, so this Forum being not the appellate authority of the said competent Insurance Ombudsman cannot interfere with the decision taken by another competent authority. The petition of complaint is therefore held to be barred by principal of res judicata and as such it is liable to be dismissed. 

All the points are accordingly disposed off.  In the result, the petition of complaint stands failed.

 

                                                Hence, it is,

                                                               Ordered,

                                 that the complaint case no.68/2016 is hereby dismissed on contest but in the circumstances without cost.

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

             Dictated and Corrected by me

                    Sd/-B. Pramanik.               Sd/- D. Sengupta. Sd/- K.K.Chattopadhyay.   Sd/-B. Pramanik. 

                            President                          Member                       Member                      President

                                                                                                                                       District Forum

                                                                                                                                   Paschim Medinipur