Hon'ble Mr. Haradhan Mukhopadhyay, President.
The basic fact of the case of the complaint as described in the complaint in a few wards is that the Complainant No.1, Subrata Singha is the nominee of the LIC policy and Complainant No.2, Shefali Singha is the wife of Haru Singha since deceased. The O.P. No.1 Branch Manager LICI is the insurance authority. As per required document by the O.Ps the said deceased Haru Singha submitted proposal on 14.08.15. After full enquiry and satisfaction the OP issued LICI policy No.445901974 on the same date and accordingly late Haru Singha paid premium as per terms and condition with accidental benefit sum assured Rs. 1 Lakh. As per terms and condition the said Haru Singha paid premium till his death. On 03.01.17 the said insured Haru Singha died due Heart attack. As per terms and condition the Complainant No.1 informed the total matter before the O.P. No.2, the Divisional Manger of LICI, Jalpaiguri Divisional Office, “Jeevan Prakash”, P.O. & Dist- Jalpaiguri as well as informed the total mater to his Agent Ashok Dutta. Thereafter the O.Ps as well as Ashok Dutta assured that the claim amount was disbursed and the OP received the original policy and other documents issued by the O.P. No.1. Suddenly on 06.06.18 the O.P. No.2 unfortunately issued repudiation letter to the Complainant No.1 on the ground best known to them which is absolutely illegal. Thereafter as per advice of the O.P, Complainant filed a petition before the Zonal Office as well as the Office of insurance ombudsmen to the OP did not consider the petition of the Complainant. Therefore the repudiation of claim of the Complainant by the O.Ps is illegal which amounts to deficiency in service on the part of the OP. The insurance policy was issued by the OP with full satisfaction after due enquiry of the entire matter. The Complainant therefore filed the case in respect of which cause of action arose on 14.08.15, 03.01.17 and 06.06.18. The Complainant therefore prayed for Rs. 1 Lakh as basic sum assured with up to date interest, Rs.50,000/- for mental pain and agony and Rs.10,000/- towards const of litigation and any other further relief.
The O.Ps contested the case by filing written version denying each and every allegation. The positive case of the OP in a nutshell is that the Complainant purchased LIC New Endowment policy “table 814-16” from Cooch Behar Branch Numbering 445901974 date of commencement 28.07.15 with a sum assured of Rs.1 Lakh, quarterly premium payable was Rs.1760/- which includes premium for accident benefit. It is a mandatory rule to submit and authentic proof of age with proposal for insurance during the time of taking a policy. On the basis of standard norms underwriting, LIC issues a policy to a policy holder. It is well known fact that this process of LIC policy underwriting is fully governed by the contract Act. In the instant case the attested Xerox copy of the Epic No. WB/01/004/333058, which is considered to be a non standard age proof because it bears only the age(not date of birth). In the instant case age mentioned in the said copy was 22 as on 01.01.95. The deceased life assured was expired on 03.01.17 exactly after 1 year 4 months and 19 days of taking the policy. The nominee of the said policy as recorded in the OP record is his son Subrata Singha is the plaintiff of this case but there is no mentioning of other plaintiff Ms. Shefali Singha anywhere in the record. The nominee submitted death claim papers to the Office of the OP. As the policy resulted in claim too early, the OP initiated the enquiry as a matter of claim processing. The OP collected the Xerox copy of Aadhar card of the deceased together with his Epic No. WB/01/004/333058. This OP surprisingly observed the age mentioned in the said Epic and Aadhar card is recorded as 32 years as on 01.01.95. It is evident from the said fact that the deceased life assured took LIC policy No.449501974 by fraudulently misrepresenting his age by about 10 years. As per LIC underwriting norms maximum age of entry with non standard age proof is 50 years in the instant case. Had the DLA submitted actual copy of Epic then the proposal for the policy could not have been accepted by this OP. Therefore the repudiation of claim by the OP is justified. That apart as per provisions of section 45 of the insurance Act, any policy of insurance( concluded contract) can be called in question before the expiry of 2 years from the date of conclusion of the contract. About the validity of material fact of document in the instant case, the policy holder knowingly tampered the Epic submitted with the proposal for policy No.445901974 for unlawfully taking out the insurance for his life and the plaintiff being the nominee in the said policy is trying to siphon off public money out of the wrongful Act of the deceased life assured(DLA). As the policy was taken by submitting false statement and fraudulent evidence of age the entire contract of the insurance is vitiated by the DLA and has become void. Therefore the O.Ps repudiation dated 06.06.18 is not illegal and it does not amount to deficiency in service. The OP therefore prayed for the case is liable to be dismissed with cost.
The disputes involved in the instant case as well in respect of the case of the parties demand for the ascertainment of the following points for proper adjudication of the case.
POINTS FOR DETERMINATION
- Whether Complainant is a consumer under the CP Act?
- Whether the disputed insurance policy No. 445901974 was obtained by practicing fraud suppressing material fact?
- Whether the repudiation of the insurance policy dated 06.06.18 is liable and valid?
- Whether the Complainant is entitled to get the relief as prayed for?
- To what other relief if any the Complainant is entitled?
DECISION WITH REASONS
Point No.1.
The issue relates to question as to whether the Complainant is a consumer or not. After perusing the entire pleadings of the parties it transpires that the deceased Haru Singha purchased one insurance policy from the O.Ps by payment of money and as such the relation between the Complainant and the OP appears to be customer and service provider.
Although other than raising a formal question as to the status of the Complainant as a consumer, the Complainant could not project any valid legal factor to hold any unconventional proposition against the Complainant. After perusing pleadings of the parties and evidence on record I am of the opinion that the Complainant is a consumer under the CP Act.
Accordingly point No.1 is decided on behalf of the Complainant.
Point Nos.2 & 3.
Both the points have very closely nexus to each other and accordingly these points are taken up together for the shake of convenience and brevity of discussion.
It is the admitted fact that the Complainant are the legal hires of the deceased life assured (DLA Haru Singha) and it is also an admitted fact that the said DLA Haru Singha died on 03.01.17 after one year 4 months 19 days of taking the policy. The nominee of the said policy being the Complainant No.1, Subrata Singha is which mentioned in the proposal form dated 26.08.15 for the said policy having basic sum assured Rs.1 Lakh and the date of maturity as 28.07.31.
As per the said LIC New Endowment plan Annexure-A the date of birth of the DLA Haru Singha was recorded as 17.01.1973.
The said ensure namely Haru Singha died on 03.01.17 as a result of which claim was raised to the OP through Annexure-D. There is no plea of the Op the claim was not raised within time. The Defence plea is that well taking the policy the said DLA submitted self attested Xerox copy of his Epic No. WB/01/004/333058 which is considered to be a non standard age proof because it bears only the age and not date of birth. The said plea of the OP is not sufficient in as much as before issuing the policy the OP had sufficient scope to verify to actual death of birth. Instead of doing the proper enquiry and verifying the document the OP claims to have issued the LIC policy to the DLA appears to have been not sufficient and proper in the age of Law.
The OP raised the point of fraud and suppression of material fact of age of the DLA after death of the DLA Haru Singha.
This kind of administrative action on the part of the LIC authority was taken up heavily and exceptionally by the Hon’ble Apex Court in a case law referred by the Complainant reported in NC Vol-2(CPJ511 NC). Hon’ble Apex Court held in the said case law inter alia that it is an unwarranted and albeit uncalled for attempts of the insurance company to put the age of the insured into question after his demise is not viewed favourably. The repudiation is not justified.
The said case law squarely applies here.
The OP further claim the age mentioned in the said Epic and Aadhar card is recorded as 32 years as on 01.01.95. This scrutiny ought to have been done by the OP earlier. The inaction of the OP led the Complainant to suffer huge mental pain and agony because of the said policy upon the DLA, the Complainant continued depositing premium on different dates by virtue of which they right to claim the policy of DLA of the nominee of the DLA. The Complainant filed a bunch of documents relating to deposit of premium on the said insurance policy being No. 445901974 in the name of the DLA Haru Singha. The OP accepted on those premium as valid and proper it is further evident from the document filed by the Complainant that without explaining sufficient ground the OP by its letter dated 15.09.18 pushed the Complainant to take recourse of insurance ombudsmen.
The Complainant also filed complaint to the appellate authority like the ombudsmen LIC who also ultimately dismissed the prayer of the Complainant in a casual manner stating some flimsy ground. So the Complainant ran from post to pillar in order to get justice for obtaining the matured money of the insurance policy deposited from the heard earned money of the deceased father.
The OP referred to a decision being reported in Civil appeal 5322 of 2007, Complainant P.C. Chacko and another vs respondent Chairman LICI and other wherein it was held inter alia that the well settled law in the field of insurance is that contract of insurance are contracts uberrima fides and every facts of materiality must be disclosed otherwise there is good ground for rescission.
The said case Law does not apply in as much as the deceased during his life time disclosed his age on the basis of the document claimed by the OP. There was sufficient scope for the OP to verify the said document and either approve or reject the proposal. But the OP negligently slept over the matter after issuing the insurance policy and also accepted premium up to the death of the ensure(DLA) Haru Singha. Such indolence on the part of the OP is a clear act of negligence which is contrary to the principals set forth by the Hon’ble Apex Court in the said decision.
Hon’ble National Commission categorically stated in the aforesaid decision reported in Vol-II 2019 CPL 511NC after the aforesaid case law based in 2007 which is referred by the OP, that there is no concealment of the age at the time of taking the proposal by the life assured. It is unwarranted albeit and uncalled for attempts of the insurance company to put the age of the insured into question after his demise. Repudiation is not justified.
Thus in the light of the aforesaid assessment of evidence and the observation made here in above I am of the view that the deceased DLA Haru Singha cannot be held to have acted fraudulently by suppressing material fact. Accordingly the repudiation of the claim of the Complainant by the OP Company is not valid and proper.
Issue Nos. 2 & 3 are accordingly decided in favour of the Complainant.
Point Nos.4 & 5.
Issue Nos. 4 &5 are corollary to the main issue No. 2 & 3. Since all the issues No. 1,2 & 3 are answered in positive in favour of the Complainant, so issue Nos. 4 & 5 are also answered in affirmative and held on be behalf of the Complainant.
Hence, it is
Ordered
That the complaint case No. CC/22/2019 be and the same is allowed on contest with cost of Rs.5,000/-.
The Complainant do get an award of Rs. 1 Lakh as the basic sum assured up to date interest @ 6% per annum, Rs.20,000/- towards mental pain and agony and Rs.5,000/- for litigation cost.
The O.Ps are directed to pay to the Complainant No.1 a sum of Rs. 1,25000/-(One Lakh twenty five thousand) only together with interest @ 6% per annum from the date of the maturity of the premium failing which the entire awarded sum shall carry an interest of 6 % per annum from the date of passing the Final Order till the date of payment to be borne by the O.Ps.
Let a plain copy of this order be supplied to the parties concerned by hand/by post forthwith, free of cost for information and necessary action, if any.
The copy of the Final Order is also available in the official Website www.confonet.nic.in.
Dictated and corrected by me.
