The Complainant has filed this case alleging deficiency-in-service by the O.Ps, where O.P No.1 is the Branch Manager, Life Insurance Corporation of India, Balasore, O.P No.2 is the Divisional Manager, Claims Department, Cuttack Division Office, O.P No.3 is the Zonal Manager, L.I.C of India, East-Central Office, Patna and O.P No.4 is Sri Sarat Panda, Bateswar, Khaira, Balasore. 

                    1. The hub of the dispute is that the Complainant is the husband of deceased Gourimani Roul alias Behera, who had taken three nos. of LIC Policies from O.P No.1 to 3 by the persuasion of O.P No.4. The above said three LIC Policies bearing No.(1)589930199, D.O.C-21.07.2008, S.A Rs.1.00 Lakh, (2)598396511, D.O.C-21.10.2011, S.A Rs.1.00 Lakh and (3)598399549, D.O.C-28.11.2011, S.A Rs.5.00 Lakhs. All these Policies were in force, when she died on 20.01.2012 by immediate Heart Attack. And after death of Gourimani Roul, the Complainant being the nominee of these Policies claimed for settlement of claim before the O.Ps. The O.Ps settled the claim for Policy Nos.589930199 and 598396511 for S.A Rs.1.00 Lakh each, but they did not settle the claim against Policy No.598399549 (Jeevan Tarang) S.A Rs.5.00 Lakhs. Being the higher sum of Rs.5.00 Lakhs plus, the O.Ps No.1 to 3 repudiated the claim vide their letter dt.27.02.2015. The Zonal Manager, L.I.C East-Central Zonal Office, Patna repudiated the claim of the Policy narrating as “Repudiate our liability under the above Policy on account of the deceased having withheld material information regarding previous Policy particulars at the time of effecting this insurance on 29.11.2011”. Prayer for settlement of claim amount along with interest and also compensation and cost of litigation.

                     2. Sufficient opportunities were given to the O.P No.4, but he did not appear in this case, hence the O.P No.4 is set ex-parte.

                     3. On perusal of the case record available in this case and the documents filed by both the contesting Parties, it is noticed that:-

(i) Written version filed by the O.Ps No.1 to 3 through their Advocate, where they have denied about the maintainability as well as its cause of action.

(ii) As per complaint petition filed by the Complainant, the deceased Gourimani Roul had taken three life Policies from the O.Ps for Rs.7.00 Lakhs (Rupees Seven lakhs only) sum assured.

(iii) Insurance on female lives as has been decided by the O.Ps (L.I.C of India) dt.01.03.2005 to review the underwriting guidelines applicable to female lives married women: with own income from 08.03.2015 filed by the O.Ps, which is narrated as “Self employed married women not filing income tax returns, Employed but not fulfilling eligibility conditions for Category-I women, unearned income but not filing income tax returns, Maximum cover equal to 7 times of average annual income subject to an upper ceiling of Rs.1 Lakh, if illiterate or educated up to 8th Standard and Rs.5 Lakhs, if educated up to 9th Standard or above”. 

(iv) Proposal form for taking a Life Policy duly signed by the deceased Gourimani Behera, where she has mentioned- Tuition with rice business under present occupation and exact nature of duties (Col. No.4A), Educational Qualification:+2, Annual Income: Rs.72,000/- and Source of Income: Business (Col. No.5).

(v) The deceased Gourimani Behera has also not disclosed the details of previous insurance (including Policies surrendered/ lapsed during last 3 years) under Col. No.9, which is kept blank (Copy of Proposal form filed herewith).

(vi) Thus, the deceased Gourimani Behera had taken this Policy under Female Category-III-Married Women (b) with own income, as per the Proposal form submitted by the deceased before the O.Ps.

(vii) Accordingly, the deceased Gourimani Roul comes under Category-III of the underwriting rules as she has not filed income tax return, so she is entitled for taking insurance maximum Rs.5.00 Lakhs, not above. Thus, the O.Ps repudiated the claim of the Complainant and the O.Ps have taken the decision as per Law and rules of the Corporation, hence there is no deficiency of service to the Complainant.

(viii) However, the O.Ps No.1 to 3 through their written version filed have submitted in Para-9 as “The Deceased Life Assured (DLA) had not disclosed the previous Policy particulars, which she had taken i.e. the above said two life Policies in the Col. No.9 of the Proposal form, which is a material fact. Had it been disclosed by the deceased at the time of taking the insurance Policy of Rs.5.00 Lakhs on 28.11.2011, Policy of Rs.5.00 Lakhs S.A would not have been allowed to her as per underwriting rules of the Corporation. 

                    4. In view of the above averments of the Parties, the point for determination are as follows:-

(i) Whether the Complainant is a Consumer, whether there is deficiency of service by the O.Ps to the Complainant to what relief the Complainant is entitled for.

(ii) In view of the averments of both the Parties, it is argued on behalf of the Complainant side that he being a Consumer, being the nominee of the Policy holder is entitled for insured amount of Rs.5,00,000/- from the O.Ps. On the other hand, it is an argue on behalf of O.Ps No.1,2 & 3 that as the Policy holder had mange to obtain the Policy of Rs.5,00,000/- by suppressing the material facts regarding earlier Policy of Rs.1,00,000/- each. According to the criteria available to the Policy holder, more than Rs.5,00,000/-, Policy cannot be hold by one Policy holder. The nominee is the Complainant in this case, who is a Consumer, being the Legal heir/ representative of the Policy holder. Though it is the duty of the Policy holder to disclose about the previous Policy to the insurer, non maintaining of the same is no way fatal, as the Insurance Company is also duty bound to verify it from their record regarding previous Policy before issuing fresh Policy to the Policy holder.

                     5. In the instant case, the Insurance Company i.e. the O.Ps have failed to comply the duty sincerely, for which they should not shift the burden to the Policy holder. So in our opinion, the nominee/ Complainant is entitled for the claimed Policy amount and non-payment of same on time should carry interest from the date of institution of this case. The Complainant is also entitled for other relief, like compensation of Loss of injury suffered by the Complainant, due to negligence of the Parties with cost. Hence, this Forum has opined that this is a fit case to allow the claim of the Complainant with above relief. Hence, ordered:-            

                                                     O R D E R

                         The Consumer case is allowed on contest against the O.Ps No.1,2 & 3 and on ex-parte against O.P No.4. The O.Ps are directed to settle the claim of the nominee/ Complainant according to the Policy amount of Rs.5,00,000/- by following interest @ 9% per annum from the date of 01.12.2015 till settlement. Further, the O.Ps are directed to pay compensation of Rs.10,000/- towards loss injury suffered by the Complainant due to their negligence and cost of Rs.1,000/- to the Complainant. The cost and compensation must be paid within two months from the date of receiving of this order, failing which 9% interest will carry on the defaulted amount. Any failure to comply the order by the O.Ps in time, the Complainant is at liberty for realization of the same from the O.Ps on due process of Law.

                         Pronounced in the open Forum on this day i.e. the 15th day of March, 2017 given under my Signature & Seal of the Forum.