The complainant Lal Bachan Mandal has filed this complaint petition against Branch Manager, Birla Sun Life Insurance company Ltd., and Managing Director, of the same company for realization of Rs. 5,63,000/-(sum assured) due to death of insured person Usha Kumari D/O complainant with 18 % p.a. interest from the date of death of life insured person till date of final payment , realization of Rs. 45,000/- for compensation as mental agony, physical harassment, and Rs. 25,000/- as litigation cost.
The case of the complainant, in brief, is that complainant Lal Bachan Mandal has filed this case in the capacity of nominee father of life assured person namely Usha Kumari Proposer of the said policy. The further case is that the o.p company after being satisfied with the soundness of health, age, and others formalities, gave an proposal form to the complainant on 10-09-2014 for insurance of his child life. The further case is that the complainant paid Rs. 13,000/-as premium amount on the same day i.e on 10-09-2014 to the company and purchased a policy for sum assured of RS. 5,63,000/- along with other monitory benefits. The further case of the complainant is that entire proposer form was filled up by the company agent in the presence of company officials because the complainant had no knowledge of English and the complainant only put the signature whereas the agent of said office directed him to do so. The further case is that after accepting the premium amount against policy No.- 006591973 the aforesaid company issued premium receipt and bond in the name of life assured person namely Usha Kumari (minor) and hence the said company started risk coverage of life of Usha Kumari from 29-09-2014 with sum assured Rs. 5,63,000/- along with other monitory benefits . The Further case is that in the morning 11-11-2014, all of sudden life assured namely Usha Kumari died due to chest pain. The further case is that after incident, complainant filed death claim against policy No.-006591773 to the aforesaid insurance company with all documents, but after persistent demand and several requests by the complainant the company repudiated the claim of the complainant on the ground that the complainant had not stated about prior policy detail pertaining to the life assured in the proposal form and therefore suppressed material information.
The complainant has filed the following documents with the complaint petition - photocopy of premium receipt in the name of Usha Kumari annexure-1-, photocopy of death certificate of Usha Kumari annexure-2-, photocopy of income tax return of Lal Banchan Mandal annexure-3-, photocopy of repudiation letter by the company to the Lal Bachan Mandal annexure-4-, photocopy of Pan Card of Lal Bachan Mandal annexure-5-, photocopy of certificate in respect of income of Lal Bachan Mandal annexure-6.
O.Ps appeared on 30-03-2017 and filed his w.s. on 05-03-2018. It has been mentioned in the w.s. that the complaint petition is false , frivolous and vexatious, and the same is liable to be dismissed u/s 26 of Consumer Protection Act., it has been further mentioned that no cause of action has been disclosed in the complaint petition so, complaint petition is liable to be dismissed as per section 11 (2) (C ) of the Consumer Protection Act 1986. It has been mentioned in the w.s. that the claim of the complainant has been repudiated by the company because complainant has suppressed the material fact u/s – 45 of the insurance Act 1938 vide letter dated 25-03-2016. He has also mentioned that the complainant had taken other policies in the name of diseased and he didn’t mention the same in the proposal form and as he suppressed the fact.
A list of insurance policies, purchased in the name of Usha Kumari has also been mentioned in the w.s.
The following documents has been annexed with the w.s. on behalf of o.ps photocopy of certificate incorporation pursuant to change of name of the company annexure-A-, photocopy of proposal form in the name of Usha Kumari annexure-B-, photocopy of death claim of claimant dated 14-12-2015 annexure-C-, photocopy of E.mails exchange annexure-D, photocopy of repudiation letter dated 25-03-2016 annexure-E.
On behalf of complainant PW-1 Lal Bachan Mandal (complainant himself), has deposed on affidavit and he has supported his complaint petition and exhibited the papers filed on his behalf as Exhibit 1to 6.
Both parties have filed Written Arguments. The learned lawyer for the o.ps has relied on many ruling mentioned in the written arguments as well as in w.s. whereas the learned lawyer for the complainant relied on ruling of the case of Renu Devi V/s PNB Mate Life Insurance Company Ltd. Bangalore and others granted by State Consumer Dispute Redresal Commission, Bihar Patna vide order dated 07-12-17 in complaint case No.- 64/2016, Judgment of Hon’ble Supreme court in the case of Om Prakash V/s Reliance General Insurance and another (civil Appeal No. 18611/2017 arising out of SLP ( c )No. 742/2015 certified copy of order dated 16-10-2015 in complaint C. No.- 53/2014 passed by this forum and certified copy of order dated 31-08-2017 passed by Hon’ble State Consumer Forum Bihar, Patna in the case of Branch Manager, Birla Sun Life Insurance Company Ltd. V/s Pramod Roy.
The main question for determination is as to whether the o.ps company has rightly repudiated the claim of claimant due to suppression of material fact or not? The complainant has asserted in the complaint petition itself that the proposal form was filled by the agent in the presence of officials of the o.ps and he only put his signature. The learned lawyer for the complainant has submitted that the claim of the complainant cannot be repudiated on the ground that he has taken other policies before issuance of this policy. He has relied on the order dated 07-12-2017 passed by Hon’ble State Consumer Dispute Redressal Commission Bihar, Patna passed in Renu Devi/Vs. PNB Mot life insurance company Ltd.
On perusal of order of the Hon’ble State Commission Bihar, Patna, passed in the above case it transpires that the same type of matter had come before the Hon’ble State Commission in which insurance company had also cited several decisions of the Hon’ble court and the company had repudiated the claim of the claimant on the same ground. After considering all the facts, Hon’ble Commission has held that the objection raised by the o.p and insurance company is not tenable and the same cannot be sustained in law Hon’ble State Commission has also observed that the complainant is entitled to get insurance amount with other benefits .
So, from the above judgment it transpires that Hon’ble State Commission has scrutinized all the facts raised by the insurance company and the Hon’ble State Commission, was pleased to hold that the o.p company cannot repudiate the claim of the complainant on the ground of prior issuance of policy.
The complainant has supported his version by examining himself on affidavit and exhibited the claims filed on his behalf, Whereas the insurance company has not adduced any evidence in support of his version. It is admitted fact that o.ps company issued the policy in the name of complainant’s daughter Usha Kumari. On perusal of the proposal form it transpires that the same is not in the hand writing of Lal Bachan Mandal. Death of the Usha Kumari is not under the challenge. So, on the basis of above discussions we are of the opinion that the o.p company has wrongly repudiated the claim of the claimant and there is deficiency in service on the part o.p
O.P No. 2 B Managing Director, Birla Sun Life company Ltd. had filed a petition on 05-03-2018 for deletion of his post name / cause of title of complaint and after hearing both parties on 02-11-2018 order has been passed that the o.p No. 2 B has made party as proforma defendant.
Accordingly the claim petition of the complainant is allowed and the o.p 2 A Branch Manager Birla Sun Life Insurance company/ Aditya Birla Sun Life Insurance Company is directed to pay Rs. 5,63,000/- as sum assured with 8 % interest p.a. from the date of filing of the complaint petition, Rs. 30,000/- as compensation for mental agony and physical harassment and Rs. 10,000/- as litigation cost to be complainant within 2 months of the order / receipt of order, of failure he shall be liable to pay the sum assured with 9 % p.a. interest from the date of filing till realization. Let a copy of this order be furnished to both the parties as per rule.
