The case of the complainant in brief is that the husband of the complainant since deceased purchased a LIC’s policy namely Jeevan Saral (with profit) bearing policy No.496193601 and the premium of first quarter was Rs.919/- from the O.P. Insurance Company, Arambag branch and the commencement date was 1.3.2010 and the date of commencement of risk was 5.3.2010. The maturity sum assured was Rs.42,939/-, death benefit sum assured under main plan was Rs.75,000/- and accidental benefit was Rs.75,000/-. Rupali Mondal, the wife of the deceased insured, is the nominee of the said policy.
After deposited the first premium the husband of the petitioner became ill and he had been admitted to Medical College, Kolkata on 2.6.2010 and expired there on 4.6.2010 and the cause of death ascertain by the doctors being Septecemia.
After the demise of the said Puranjan Mondal (insured), the petitioner informed the death of her husband to the Branch Manager, LIC, Arambag Branch, Dist.-Hooghly and as per demAnd of Arambag Branch the petitioner submitted a petition, claimant’s statement, medical attendant’s certificate, certificate of hospital treatment at Medical College, Kolkata vide Sl. No.106 dated 29.9.2010 and on 4.11.2011. The petitioner also submitted the original bond, declaration paper, address change paper, treatment papers of deceased Puranjan Mondal to the office of the O.P. No.2.
That after acknowledging, the O.P. alleged that due to incorrect statement and incorrect information regarding the health of the deceased insured at the time of effecting assurance the O.P. without proper reason repudiated the claim of the complainant and advised the petitioner to send another representation to the Eastern Zonal Office of LIC, Hindusthan Building, 4, CR Avenue, Kolkata-72. According to their advise the petitioner filed a review application before the Zonal office of LIC on 01.8.2012.
By sending a letter a letter the Zonal Office informed the petition that on 10.4.2013 the Zonal Office rejected the review application and uphold repudiation without showing any reason and cause. The O.P. used the dilatory tactics and persecutes process for nonpayment of claim amount after the death of the insured within stipulated period.
That the petitioner is a rustic distress woman personally met to the O.P. and requested him to look into the matter and release the amount but in vain. Finding no other alternative the complainant filed this case before this Ld. Forum for relief with the prayer to direct the O.P. to pay sum assured amounting to Rs.75,000/- along with 12% interest, to pay Rs.50,000/- as compensation for mental pain and agony and to pay Rs.10,000/- towards litigation cost.
The O.P. contested the case by filing written version denying all the material allegations as leveled against him. That the policy No.496193601 was issued to the life assured Puranjan Mondal on the basis of the information supplied by himself in the prescribed proposal form No.300(Rev.91) submitted on 5.3.2010 after duly signed by him.
At the time of submitting the said proposal form the life assured Puranjan Mondal was to disclose some facts regarding personal history of his health as per specific queries made by the LICI. This O.P. further submits that the life assured Puranjan Mondal expired on 4.6.2010 due to Septicemia and abdominal pain. The death claim is very early in nature i.e. within three months only. As a result, as per statutory provisions of the O.P. Corporation, after submission of the claim form by the complainant vide Claim Form Nos.A, B, B1 and C with the original Policy Bond, OPD Patient card of Medical College Hospital, the O.P. Corporation had to investigate into the instant Death Claim. On investigation it reveals that the answer given by the life assured in the proposal form was false. He made incorrect statement and withheld correct informations from the O.P. Corporation regarding his actual state of health at the time of effecting assurance.
On investigation the O.Ps. hold that there are sufficient evidence and have reasons to believe that the life assured had been suffering from ailments and he had to be referred to the Calcutta Medical College for his medical treatment immediately before submission of the proposal form and on 1.3.2010 he had to undergo operation before proposing for the policy in question. The claimant has admitted the position in her letter which she herself submitted before the O.P. Corporation. It is therefore evident that the life assured had been suffering from piles and was under prolonged treatment since 2000.
This O.P. further submit that the contract of Life Insurance Policy is based upon a contract of utmost good faith which requires full disclosure of correct material/information which may be concerned with the health having history of past illness, usual state of health etc. of the life to be assured at the time of effecting the contract or revival of Life Insurance Policy. Deceased life assured did not disclose these factual statement at the time of revival or proposing for the above noted policies keeping the corporation in dark and hence in terms of the policy contract and the declaration contained in the personal statement of health and in the proposal form for such assurance this O.P., therefore, rightly repudiated the claim and conveyed to the complainant vide letter No.HDO/Repdt. Clm/ARM/12-13/02 dated21.05.2012.
In response to the claimant’s representation before the Zonal Claim Review Committee, the said authority also duly reviewed the claim and decided to uphold the repudiation action and the said decision was also conveyed to the complainant. Hence, the O.P. prayed before this Forum to dismiss the case with cost.
The O.P. No.2 also contested the case by filing written version denying inter-alia all the material allegation as leveled against him. The O.P. No.2 submits that claims are filed up without the knowledge of the O.P. No.2 and the terms and condition appended therein are not made in concurrence with the O.P. No.2, the said documents are not binding upon O.P. No.2 and cannot be said to be in continuity with each other to revive any cause of action in favour of the complainant to file the instant case. The present complain case is suffered from the lacuna of inherent cause of action and suppressing the disease of complainant and be liable to be dismissed.
The O.P. No.2 also stated that the claim made in the prayer is unjustified, untrue and beyond the agreed terms. The claim is having no form to be inferred against or the same has been taken by complainant on mis-representation. In view of the contents made in the forgoing paragraph of the instant written version the prayer of the complaint case liable to be dismissed with explanatory cost.
The complainant filed evidence on affidavit which is nothing but the replica of complaint petition. The complainant also files photocopies of LIC’s money receipt, LIC Bond, death certificate, death claim letter, repudiation letter etc. Argument advanced by the parties heard in full. They also filed the written notes of argument which are taken into consideration for passing final order.
Points for consideration
- Whether complainant is a consumer ?
- Whether the complainant is a holder of LIC’s Jeevan Saral Policy?
- Whether the O.P. is liable for deficiency in service ?
- Whether the complainant is entitled to get relief as prayed for
DECISION WITH REASONS
Point No. 1, 2 & 3 are taken up together for brevity and convenience of the case.
The complainant filed 9 documents and evidence in chief. Complainant stated that the husband of the complainant purchased LIC’ Jeevan Saral Policy, mode of payment quarterly and got money receipt on 5.3.2010. The husband of the complainant became ill and was admitted into Medical College & Hospital on 2.6.2010 and expired therein on 4.6.2010. Cause of death was Septicemia.
The complainant thereafter informed the O.P. by petition and filed claim petition along with documents mainly medical attendance certificate, certificate of hospital treatment and other relevant papers on demand of O.P. along with original policy bond bearing No.496193601 and others papers as per contentions in para-5. But after receiving the claim form the O.P. rejected the application and repudiated the claim without showing any reason.
It appears from the documents filed by the complainant that the policy was started by proposal No.41825 dated 5.3.2010. The next due date of the policy was 06/2010 as per policy receipt serial No.A7623463. The receipt addressed to Puranjan Mondal.
The O.P. appeared and contested the case. The O.P. admitted the alleged policy in the name of the deceased but O.P. has taken the defence that the insured person had previous illness, who died after receiving the policy. The O.P. denied to make payment only ground of not furnishing fact at the time of proposal. The O.P. has taken plea the suppression of fact of illness by the deceased. O.P. has filed Xerox copy of proposal form wherefrom it is seen that the deceased was not literate person. He had education qualification was class-VII. He had a business man and his annual income was 59,000/-. His state of health was good. The Xerox copies shows signature of the insured person. It cannot be ascertained from such Xerox copy that those specific questions regarding personal history was actually put to the insured person. There is endorsement in the proposal form that the declaration of the proposal was made after knowing fully the contents of this form and admittedly he was not in a position to read the such small letter of the policy showing terms and conditions. Not only for that insured since deceased but also to other persons such writings in the declaration form U/s.41 & 45 of Insurance Act, 1938 is not legible. So, the defence of O.P. attributed in the case regarding not allowing the claim is devoid of any cogent reason. O.P. has filed another letter deemed to have been written by Rupali Mondal, addressed to Manager,LICI, Howrah Division. The subject matter of the letter is nothing but information of health condition of the deceased insured but there is no evidence to establish that Rupali Mondal has written this letter on her on accord. Furthermore, this Rupali Mondal is illiterate village lady who somehow put her signature. This statement has been given from memory which is doubtful and cannot be accepted as per Evidence Act. Because this Rupali Mondal is village illiterate lady. The O.P. had duty to enquire this matter before issuing the policy to the deceased insured for which there is a provision of declaration U/s. 41 & 45 of Insurance Act, 1938. On 21.5.2012 the O.P. has issued one letter containing that ‘it is therefore evident that he had made incorrect statement and with-held correct information from us regarding his health at the time of effecting assurance and hence in terms of the policy contract and the declaration contend in the form of proposal for assurance we hereby repudiated the claim and accordingly we are not liable for any payment under the above policy and all money that have been paid in consequence thereof belongs to us’. This letter does not prove that the deceased made false declaration when no specific question was put to this illiterate village person who was unable to know the actual fact of declaration. The letter of Rupali Mondal is also not reliable and may be concocted because that contention has not bearing with this case.
On the other hand the LIC’ Jeevan Saral Policy column of benefit of death shows ‘a sum equal to death benefit sum assured along with all premium paid shall be payable provided the policy is in force on the date of death’. The document of the O.P. it shows that the next due date by the receipt No.A7623463 dated 05.03.2010 is 06 of 2010. The death certificate of Puranjan Mondal i.e. husband of the complainant was 4.6.2010 at 3.40 PM. The policy was valid from 5.3.2010 to 5.6.2010. So, the husband of the complainant died within the continuation of valid policy. As per clause -2 laid down in the policy that there is grace period of 30 days for next premium if deceased added with the due date laid down in the receipt. The policy deemed to be continued throughout the month of June till 6.7.2010. The Jeevan Saral Policy itself speaks of benefit of death reflected in the first page of policy bond.
Admittedly husband of the complainant died on 04.06.2010 i.e. within the continuation of the valid policy and this complainant Rupali Mondal is the nominee U/s.39 of the Insurance Act, 1938. In this case the O.P. has put some questionnaire. In absence of the original policy holder i.e. the husband of the Rupali Mondal, it is not actually possible to state existing of any condition of mind, body and other physical condition of the deceased. This questionnaire prepared by the O.P. has been answered by the Rupali Mondal which is not acceptable as per law. Another document (claimant statement) has been signed by the Rupali Mondal wherein question was when did the deceased first complaint of being not in usual good health. The answer is 28.5.2010. This statement has been authenticated by Pradhan and also counter signed by Divisional Officer, LICI, Arambag Branch. So, from, this documents produced by the LIC also proves that the deceased became ill on 28.5.2010 and died later on 04.06.2010 and duration of last illness was 6 days only. Certificate of hospital treatment also shows that the deceased admitted in the hospital on 2.6.2010. So, all the points, as per discussions herein before goes in favour of the complainant and against the O.P. and conclusion stands that husbands of the complainant died within the continuation of the valid policy. Accordingly the O.P. is liable for deficiency in service to the complainant.
Point No.4: Accordingly the complainant is entitled to get relief. The complainant prays death benefit sum assured under main plan of Rs.75,000/- along with interest @12%. It is pertinent to note that the complainant has approached before this Forum only when the O.P. did not allow the prayer of the complainant causing much harassment to the widow village illiterate lady. So, the complainant entitled to get interest from date of filing of this case till full realization of the above amount along with other amount mention herein after. Hence, it is
Ordered
that the case be and the same is allowed on contest against the O.Ps and exparte against the O.P. No.2. The O.P. is directed to issue A/c. payee cheque in favour of the complainant amounting to Rs.75,000/- along with calculated interest @ 9% from 21.6.2013 to the date of full payment. The O.P. is also directed to pay compensation of Rs.50,000/- to the complainant who has been knocking the temple of justice for her redressal. The O.P. is also directed to pay litigation cost of Rs.10,000/- to the complainant. The O.P. is also directed to comply the above order within 45 days from this date of order i.d. the complainant is at liberty to execute this order in accordance with law.
