DATE OF DISPOSAL: 25.04.2019
Sri Purna Chandra Tripathy, Member:
The complainant Bhimsen Patro has filed this consumer complaint Under Section 12 of the Consumer Protection Act, 1986, alleging deficiency in service against the Opposite Parties ( in short the O.Ps) and for redressal of his grievance before this Forum.
2. Briefly stated the case of the complainant is that being induced by the agent and field officials of the Opposite Parties Company, the son of the complainant Mahesh Patro since deceased availed two life insurance policy of the O.Ps i.e. “Life Insurance Corporation of India” regular premium, vide policy No. 573631942 dated 28.08.2012 for Rs.2,595/ quarterly premium of Branch-II, Berhampur and No.573585828 dated 26.11.2013 for Rs.3,851/- quarterly premium at Branch-1 Berhampur. The said policy was for minimum death benefits of Rs.2,00,000/- (Rupees Two Lakhs) only commenced from 28.08.2012 and another policy for minimum death benefits of Rs.3,00,000/- (Rupees Three Lakhs) only dated 26.11.2013. The maturity dates of the policies are 28.04.2033 and 26.08.2034 respectively and since the purchasing of policy, the policy holder deposited the premium regularly. The complainant, the father of the policy holder is the nominee under the policy referred above. During February, 2014 the deceased life assured, while he was suffering from headache/fever, accordingly medical treatment was given at MKCG Medical college Hospital, Berhampur and also admitted as an Indoor Patient subsequently discharged from the hospital and also treatment was done at his residence. During dialysis period on 20th day of April 2014 the deceased life assured died. The complainant being the nominee under the policy complied all the required papers and approached several times before the office of the O.Ps requesting the insurer for settlement of death claim but unfortunately the O.Ps repudiated the claim on 30.03.2015 by giving a letter mentioning incorrect statement regarding health condition of insurer in the form of proposal for assurance. By virtue of the contract of the insurance the complainant being the nominee under the policies are a consumer and since the O.Ps have arbitrarily repudiated the genuine and lawful claim assured under the policy and thereby caused negligence and deficiency in rendering assured service to the bonafide consumer by violating the guide lines of IRDA and laws of the land. The complainant had no option left them to present this application seeking protection of his right under C.P. Act and rules made there under. Due to unexpected death of son of the complainant and on account of not settlement of lawful death claim, the entire family members are subjected to harassment. Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.Ps to make payment of assured sum of Rs.5,00,000/- covered under the policies referred above together with 18% interest per annum till disposal of the case and pay all other loss suffered by the consumer under the heads of harassment, mental agony and for day to day expenses to Forum on dates of postings.
3. Upon notice the O.Ps filed version through his advocate. It is stated all the averments made in the petition are all not true and correct and the petitioner is put to strict proof of such of the allegation, which is not specifically admitted herein. The complainant has insured his life under policy bearing No.573631942 and 573585828 both have been issued on date d 28.08.2012 and 26.11.2013 for sum assured of Rs.2,00,000/- and Rs.3,00,000/- with quarterly premium of Rs.2595/- and 3851/- respectively and his father i.e. the complainant is the nominee therein. The life assured died on 20.04.2014 while undergoing dialyses. As the policy holder died within the period of two years from the commencement of the policies, the claims were classified as early claims and necessary investigation was conducted by these O.Ps. On verification of the certificate of hospital treatment, it was observed that, the life assured has reported his illness to the doctor and the doctor has diagnose the same as “Chronic kidney disease, state-V”. On further reference of the report to our DMR, who is a senior doctor, these O.P. could conclude that, the policy holder have taken the policies by suppressing his earlier kidney ailment and by giving wrong/misleading information in the proposal form. Thus these O.Ps vide its letter dated 30.03.2015 intimated the repudiation of the claim based on the above documents and observations. The averments made in the rest of the paras of the complaint petition are not all true and correct and the complainant is put to strict proof of the same. The policies were taken by the life assured. At the time of taking the policies the deceased life assured has given the proposal form stating his health condition as good and he has not been suffering from any diseases. The deceased life assured had also clearly stated “no” to all the questions mentioned vide clause No.11(I to viii) and stated “good” to the question mentioned in 11(ix). However, being an early claim (claim arising within two years from the date of commencement of the policy), on verification it was found that, the deceased life assured was suffering from kidney ailment. So, it is clear that, the deceased life assured by suppressing material facts regarding his illness and treatment, has taken the aforesaid policies. So these O.Ps have repudiated the death claim arising out of the policies and intimated the same to the nominee vide its letter dated 30.03.2015. So nothing is payable under these policies. The contract of insurance is a contact of UBERRIMA FIDES, i.e. contract of utmost good faith. In this case the policy holder has by deliberately suppressing his health condition taken these policies and these O.Ps on detection of the same has rightly repudiated the claim. No medical examination was required to be conducted, since the coverage of insurance is granted on the basis of self declaration of good health only. The health condition of a policy holder is a material condition in the cont4act of insurance and as the material condition was suppressed, these O.Ps have rightly repudiated the claim. The Life Insurance Corporation of India is the Trustee of policy holder’s money. So, all the claims are dealt carefully by its officers. It requires collection of information from various sources like Hospitals, co-villagers, policy holders etc. which requires time. Hence there is no deficiency in services of the O.Ps, in this case nor they have caused any mental agony or hardship to the complainant. Rather the life assured tried to defraud the corporation, which was detected with proof. This case involves complex question of facts, evidence and law. Hence, this Hon’ble Forum has no jurisdiction to try the same and the matter can be properly adjudicated in the civil court, where it is pending. The petition is barred by limitation and the same has not been properly valued. The complaint is not maintainable due to non-joinder and mis-joinder of the parties. Hence these O.Ps prayed to dismiss the case with exemplary cost in the interest of justice.
4. On the date of final hearing of the consumer complaint, the learned counsels for both parties are present. We heard argument at length from both parties and perused the complaint petition, version, written argument, citation and documents placed on the case record. On dated 17.04.2018 the advocate for the complainant filed a memo and stated that the O.P. disbursed the sum assured amount of Rs.2,00,000/-vide policy bearing No.573631942 to the complainant in the month of April 2018 but did not pay interest, damages and cost till date. The Hon’ble National CDR Commission, New Delhi has held in case of ICICI Prudential Life Insurance Company Limited versus Smt. Bimal Kanta Kharab reported in 2013 (1) CPR 160 that “Death claim can not be repudiated on technical grounds”. And also another decision the Hon’ble National CDR Commission, New Delhi has held in case of SBI Life Insurance Company Ltd. versus Mr. Butu Harijan reported in 2012 (1) CPR 303 that “Death claim cannot be repudiated where complainant has already submitted original policy bond and death certificate with claim form to insurance company”. After death of the policy holder, the nominee of the said life insurance policy the complainant had submitted the all required papers and approached several times before the office of the O.Ps but unfortunately the O.Ps repudiated the claim on 30.03.2015 by giving a letter mentioning incorrect statement regarding health condition of insurer in the form of proposal for assurance. In our considered view, we therefore, hold that the O.Ps are not justified repudiating the claim of the complainant and due to non-settlement of genuine claim of complainant in technical ground, they are deficient in services. However, we direct the O.Ps to pay cost of this litigation since the O.Ps even after receipt of the claim form they did not prefer to settle the genuine claim of the complainant vide LIC policy No. 573585828 of sum assured Rs.3,00,000/-.
5. On foregoing discussion it is crystal clear that the O.Ps are negligent in rendering proper service. Hence, in our considered view there is deficiency in service on the part of O.Ps.
In the result, complainant’s case is partly allowed against the O.Ps who are jointly and severally liable as such they are directed to pay the sum assured amount of policy No. 573585828 alongwith 6% interest from the date of filing of this case i.e. from 06.04.2017 alongwith Rs.2000/- towards costs of litigation to the complainant. The aforesaid order shall be complied by the O.Ps within 45 days from the date of receipt of this order failing which all the dues shall carry 12% interest per annum till final payment is made. The case of the complainant is disposed of accordingly. No order as to compensation.
The order is pronounced on this day of 25th April 2019 under the signature and seal of this Forum. The office is directed to supply copy of order to the parties free of cost and a copy of same be sent to the server of www.confonet.nic.in for posting in internet and thereafter the file be consigned to record room.
