Date of Argument – 23.05.2022.
Date of Judgment – 19.12.2024.
This complaint was filed by the complainant u/s 12 of the Consumer Protection Act, 1986 claiming to direct the Opp. Parties to pay the sum of ₹1,00,000/-against LICI policy No.445082562 to the complainant with interest, to pay a sum of ₹1,50,000 as compensation for physical harassment and mental agony and the cost of this proceeding along with other relief/reliefs available.
Judgement
The case of the complainant is that the complainant is the wife of late Sankar Bhattacharjee, a permanent resident of Bagchipara, East Chowkidingee, Dibrugarh within the jurisdiction of this commission and is also a consumer under the Consumer Protection Act, 1986.
The complainant being a house wife has been living with her one daughter and a son in a very pitiable condition after the death of her husband, who was the only bread earner of his family and he was a priest by profession.
The complainant’s husband purchased one Life Insurance policy named ‘Jeevan Prakash’ from Life Insurance Corporation of India (LICI), Dibrugarh Branch being policy No.445082562 on 28.11.2014 (Complainant’s doc. No.1). After proper verification the policy was approved in the name of the insured, Sankar Bhattacharjee. At the time of issuing the policy no question were asked to the deceased person about his health and all the formalities were done by the agent. The premium for the policy was ₹2331/- only to be paid quarterly and the insured paid the installments regularly.
The insured, Sankar Bhattacharjee died on 01.08.2015 living behind him the complainant, a son and a daughter (Complainant’s doc. No.2 is the death certificate of the insured). After death of her husband the complainant claimed for the insurance sum assured ₹1,00,000/- before the Dibrugarh Branch of LICI.
The Jorhat Divisional Office of LICI vide their letter dtd. 24.08.2016 informed the complainant that LICI has decided to repudiate the liability under the above policy on account of deceased having suppressed some material information regarding his health (Complainant’s doc. No.3 is the letter of LICI dtd. 24.08.2016).
Thereafter the complainant sent a legal notice to the Zonal Manager LICI, Jorhat Division through her advocate. In reply to this legal notice, O.P. No.1 vide letter dtd. 26.07.2018 informed the complainant that “our competent authority has repudiate the claim as referred to above on the ground of suppression of material facts as regards his health at the time of effecting the insurance by the life insured. The decision of the repudiation action based on the document/evidence of treatment particulars of the deceased life insured at the time of taking the policy, which he had suppressed while taking the policy in his propel for insurance and was very much material for accepting the policy.” The complainant has stated that though O.P. No.1 stated that in the medical report the reason of death was shown as excess of alcohol consumption but it was the duty of the Opp. Party to prove that at the time of effecting the policy whether any medical examination was done to ensure that the insured was a heavy alcoholic and if medical examination was done then it cannot be said that the insured has suppressed some material facts (Complainant’s doc. No. 4 & 5 are legal notice, dtd. 18.07.2018 and LICI’s reply of dtd. 26.07.2018).
The complainant claim that it was the duty of the agent to take all relevant information from the insured and then it was the duty of the verification officer of the O.P. to verify all the relevant information. At the time of paper works the agent of Opp. Parties neither intimated the insured about the terms and conditions nor advised about its consequences of breach. No medical examination was also done by the O.P. so as to ensure whether the policy holder had been suffering from any disease or whether he had concealed some material facts.
The Opp. Parties failed to act in discharging his/their proper duty and acted in a casual manner at the time of effecting the insurance by the life insured for which the complainant has to suffer both mentally and physically.
The service of the Opp. Parties were faulty, imperfect and inadequate in quality, hence the present case has been filed by the complainant before the Forum.
The complainant submits that the insured had neither suppressed nor concealed anything at the time of effecting the insurance by the life insured but those were Opp. Parties who were very negligent and unprofessional at the time of effecting the policy. IF the Opp. Parties performed their duty carefully and adequately the mistake might not have taken place. The complainant claims that there were serious negligent and deficiency in service on the part of the Opp. Parties in rendering proper service and security to the complainant. Finding no other remedy available, the complainant had filed this complaint before the Commission praying to direct the Opp. Parties :
- To pay the sum insured amount of ₹ 1,00,000/- of policy No.445082562 dtd. 28.11.2014 to the complainant with interest till the date of actual payment.
- To direct Opp. Parties to pay damages of ₹1,50,000/- on account of mental agony and physical agony suffered by the complainant due to negligent and unprofessional treatment by the Opp. Parties.
- Cost of litigation which the Forum deems fit and proper.
- Any other relief/reliefs that the Forum deems fit and proper.
After registering the case notices were issued to the Opp. Parties and the Opp. Parties contested the case by filing their W/S. In their W/S, the opposite parties have submitted jointly that the complaint petition is not maintainable in law as well as on facts and the case was filed with false facts and suppression of real and actual facts.
Replying to para-4 of the complaint petition it has been submitted by the O.Ps. that Sankar Bhattacharjee (since deceased) took the insurance policy not “Jeevan Prakash” but “New Money Back Policy” vide policy No.445082562 on 28.11.2014 and the said policy was obtained by the deceased policy holder with malafide intention knowing fully that he was a patient of alcoholic for last 22 years and by suppressing this fact obtained the policy. The concerned official of opposite parties only verify the form whether the same is properly filled up and issued the policy on the utmost good faith according to the statements furnished by the policy holder.
In reply to para-10 of the complaint petition the O.Ps. have submitted that they received a legal notice dated 18.07.2018 from the advocate of the complainant which was replied by O.P. No.1 on 26.07.2018 in which it was stated that “our competent authority has repudiated the claim as referred to above on the ground of suppression of material facts as regards his health at the time of effecting the assurance by the life assured and the decision of the repudiation action based on the documentary evidence of treatment particulars of the deceased life assured prior to taking the policy which is suppressed while taking the policy in his proposal for assurance and was very much material for accepting the policy.” The medical report of the deceased policy holder has shown that reason of death was excess of alcohol consumption. It is submitted that the policy issued to the complainant’s husband was a non medical policy and he said policy was issued on the information furnished in the proposal form. The claim was repudiated on the basis of brief clinical note issued from Assam Medical College and Hospital, Dibrugarh dated 26.07.2015 vide MR No.00000038014 OP No.OP1507168022 of late Sankar Bhattachrjee in which it was stated that as a patient the deceased life assured was a patient of alcoholic for 22 years and now not on alcoholic for last two months. He was also Distension of abdomen -1 year , swelling of limbs-1 year. The deceased life assured was having a habit of chronic alcoholic and was patient of CLD prior to the date of proposal even at the time of taking the insurance which were materials to disclose but the deceased life assured did not disclose these information rather concealed all the material information at the time of proposal. Replying to para-11 of the complaint petition it has been submitted by the opposite parties that it is the insured who has to provide all the material information either to the agent or to any officer of the opposite parties which he has in his personal knowledge, the claimant cannot put her burden of proof to the shoulders of opposite parties.
Admitting the fact that the husband of the complainant purchased the policy through agent of Life Insurance Company of India, they denied that the agent at the time of paper works neither intimated the terms and conditions nor advised about its consequences of breach to the complainant. It is the duty of the insured to place the entire real facts regarding his health before taking the policy as the policy is done on the statements furnished by the insured. The insured did not come with clean hands and by concealing material facts, the insured person somehow took the policy for his illegal gain knowing fully that he is furnishing the false statements which is crystal clear from the statement made in para of the petition. The O.Ps. have also denied that the opposite parties are duty-bound to provide safety and security to the nominee of the life assured after his death as they receive premiums paid by the insured during his lifetime. The O.Ps. have further denied that they failed to act in discharging their proper duty and acted in a casual manner at the time of affecting assurances to the life assured for which the complainant has to suffer both mentally and physically. They also denied the allegation of the complainant that their services were faulty, imperfect and inadequate in quality. The opposite parties have claimed that the complainant was not compelled to file the case against the opposite parties to pay sum assured of ₹ 1,00,000/- to the complainant but the O.Ps. are not liable to pay any compensation as per law and the opposite parties have denied immense physical, mental agony suffered for the opposite parties.
Denying their negligence and deficiency in service to the complainant the O.Ps. have submitted that the complainant is not entitled to any relief as prayed for by her in the complaint petition as the insured suppressed the material facts at the time taking the policy and hence the complaint of the complainant to be dismissed with cost.
In this case the complainant Smti. Milan Bhattacharjee has submitted her evidence in affidavit.
In her evidence she has stated that she is the complainant in the instant case and she is fully conversant with the facts of the case. Her husband Sankar Bhattacharjee (now deceased) was a priest during his lifetime and except that he had no other source of income. After death of her husband the complainant is living with her two children, one daughter and one son.
The complainant adduced that her husband purchased one Life Insurance policy named ‘Jeevan Prakash’ from Life Insurance Corporation of India (LICI), Dibrugarh Branch being policy No.445082562 on 28.11.2014. Exhibit No.-1 is the xerox copy of LIC policy as the original is kept in the custody of O.P. After proper verification the policy was approved in the name of the insured, Sankar Bhattacharjee. At the time of issuing the policy no question were asked to the deceased person about his health and all the formalities were done by the agent. The premium for the policy was ₹2331/- only to be paid quarterly and the insured paid the installments regularly.
The insured, Sankar Bhattacharjee died on 01.08.2015 living behind him the complainant, a son and a daughter. Exhibit No.2 is the original death certificate of the insured. After death of her husband the complainant claimed for the insurance sum assured ₹1,00,000/- before the Dibrugarh Branch of LICI.
The Jorhat Divisional Office of LICI vide their letter dtd. 24.08.2016 informed the complainant that LICI has decided to repudiate the liability under the above policy on account of deceased having suppressed some material information regarding his health. Exhibit No.3 is the letter of LICI dtd. 24.08.2016.
Thereafter the complainant sent a legal notice to the Zonal Manager LICI, Jorhat Division through her advocate. In reply to this legal notice, O.P. No.1 vide letter dtd. 26.07.2018 informed the complainant that “our competent authority has repudiate the claim as referred to above on the ground of suppression of material facts as regards his health at the time of effecting the insurance by the life insured. The decision of the repudiation action based on the document/evidence of treatment particulars of the deceased life insured at the time of taking the policy, which he had suppressed while taking the policy in his proposal for insurance and was very much material for accepting the policy.” The complainant has stated that though O.P. No.1 stated that in the medical report the reason of death was shown as excess of alcohol consumption but it was the duty of the Opp. Party to prove that at the time of effecting the policy whether any medical examination was done to ensure that the insured was a heavy alcoholic and if medical examination was done then it cannot be said that the insured has suppressed some material facts. Exhibit No.4 is legal notice dtd. 18.07.2018 and Exhibit No.5 is reply of LICI dtd. 26.07.2018.
The complainant claim that it was the duty of the agent to take all relevant information from the insured and then it was the duty of the verification officer of the O.P. to verify all the relevant information. At the time of paper works the agent of Opp. Parties neither intimated the insured about the terms and conditions nor advised about its consequences of breach. No medical examination was also done by the O.P. so as to ensure whether the policy holder had been suffering from any disease or whether he had concealed some material facts.
It is also adduced by the complainant that her husband never suppressed nor concealed anything at the time of effecting the policy and it was the opposite parties who were very negligent and unprofessional at the time of effecting the policy. The complainant has prayed that the judgement and order may be passed in her favour as prayed for in her complaint.
At this stage on last 15.10.2019 the complainant filed petition No.94/19 under Order 6 Rule 17 r.w. section 151 of CPC for amendment of her claim petition as well as evidence in affidavit.
After hearing both sides this Commission allowed amendment of the complaint petition only to amend the name of the policy as “New Money Back Plan-20 years (with profit)” by substituting the name “Jeevan Prakash” in places wherever it appears in the original complaint petition with direction to furnish copy of the amended complaint to the O.P. vide order dated 12.01.2021. By the same order the complainant was allowed to file additional evidence in affidavit in this regard.
Lateron the complainant filed amended petition which was accepted and the O.P. prayed to treat their earlier W/S as the W/S with regard to the amended complaint petition. The complainant filed additional evidence in affidavit on 29.09.2021.
Closing the evidence of complainant the case was posted for evidence of O.P. and on 27.01.2022 the O.Ps. have filed their evidence in affidavit through one Nikhil Ch. Das, Senior Branch Manager, Life Insurance Corporation of India, Dibrugarh along with 5 Nos. of documents as exhibits.
In their evidence the O.Ps. have submitted that Sankar Bhattacharjee during his lifetime took the insurance policy “New Money Back Policy” being policy No.445082562 on 28.11.2014. He obtained the policy with malafide intention knowing fully that he is a patient of alcoholic for last 22 years. The O.Ps. have further deposed that the policy issued to Sankar Bhattacharjee was non-medical policy and the said policy was issued on the information furnished in the proposal form. The claim was repudiated on the basis of a brief clinical note issued from Assam Medical College and Hospital, Dibrugarh dtd. 26.07.2015 vide MR No.00000038014, O.P. No. OP1507168022 of late Sankar Bhattacharjee (DLA) in which it was stated that as a patient DLA was a patient of alcoholic for 22 years and now not as alcoholic for last 2 months. The DLA was also distension of abdomen -1 year, swelling of limbs – 1 year, DLA was a patient of chronic alcoholic and was a patient of CLD prior to taking the proposal. Even at the time of taking the insurance which were material to disclose but he did not disclose these information rather concealed all the material information at the time of taking the proposal.
Denying their negligency and lapses, the O.Ps. have submitted that there is no deficiency in service on the part of the opposite parties and have claimed to dismiss the case with cost. The exhibits submitted by the opposite parties in their support are as follows :
Ext.- A is the Medical Attendants Certificate.
Ext.- A(1) is the sign and seal of Dr. T.K. Das, asstt. Prof. of Medicine, Assam Medical College, Dibrugarh (Proved with original).
Ext. –B is the certificate of Hospital Treatment,
Ext –B(1) is the sign and seal of Asstt. Prof. of Medicine, Assam Medical College, Dibrugarh enclosed with Ext.-B(2) – Admission Record,
Ext. – B(3) Cadaver Report Form,
Ext.-B (4) is the Out Patient Department and
Ext.- B(5) is the Doctor’s order & Progress Note (containing 5 pages) (Proved with original).
Ext.-C is certified copy of Power of Attorney
Ext.-C(1) to Ext.-C(6) are the signatures of and seal of Nikhil Ch. Das, Senior Branch Manager, LICI, Dibrugarh Branch.
The complainant in this case has submitted her written argument on 23.05.2022. In her argument the complainant has stated that the deceased husband of the complainant Sankar Bhattacharjee purchased the LIC policy “New Money Back-plan-20 years (with profit)”. on the request of a policy agent of LICI. The agent somehow convinced her husband to purchase the policy and the policy agent did all the paper works which were verified by the concerned officials of O.Ps. and the policy was approved in the name of the insured Snkar Bhattacharjee. At that time no question was asked to the policy holder about his health and all the formalities were observed by the agent. During his lifetime the insured regularly paid the installment of premium @ ₹2331/- quarterly. Unfortunately Sankar Bhattacharjee died on 01.08.2015 leaving behind him, the complainant, one daughter and one daughter. After death of her husband the complainant applied for the sum assured ₹ 1,00,000/- against her husbands’ LIC policy at Dibrugarh Branch office, but vide letter dated 24.08.2016 the Jorhat Divisional office of O.P. informed the complainant that the corporation has decided to repudiate her claim on the ground of withholding some material information regarding his health. In reply to her legal notice sent through her advocate the O.P. No.1 vide letter dtd 26.07.2018 stated that their competent authority has repudiated the claim on the ground of suppression of material facts in regard to his health at the time of effecting the assurance by the O.P.
The complainant has further argued that it was the duty of the opposite parties to prove that at the time of effecting the policy whether any medical examination was done to ensure that the insured was a heavy alcoholic person and if no medical examination was done then it cannot be said that the insured had suppressed some material facts. The complainant has also stated in her argument that during continuance of the case it had come to her notice that due to oversight the name of the policy in question was wrongly wrote as “Jeeevan Prakash” in place of “New Money Back plan-20 years (with profit)” which was letter on corrected by amending the complaint petition.
In the written statement the opposite parties stated that insured has obtained the policy with a malafide intention knowing that he was a patient of alcoholic for 22 years and by suppressing the said fact obtained the policy; in support, O.Ps. have produced Medical Certificate issued from AMCH, Dibrugarh dated 26.07.2015 vide No.00000038014 OP No.OP1507168022 without supporting the affidavit of doctors who examined insured. Moreover, in the cadaver report Form being MRD No.80144, HOSP No.68022 issued by Assam Medical College & Hospital, Dibrugarh submitted by the Opposite Parrties, it is mentioned that the reason of death was ‘Cardio respiratory Failure.’ The opposite parties contented that policy issued to the complainant’s husband was a non medical policy and the said policy was issued on the basis of information in the proposal form. It was the duty of the O.Ps. to conduct the medical examination at the time of effecting the policy to assess the fitness and after complete satisfaction, the policy is issued, in both Medical as well as Non Medical policy; if no medical examination was done then it cannot be said that the insured had suppressed some material facts. The opposite parties just to shrug off their obligations, responsibilities and faults made such statements in those paragraphs of written statement and to cover up the deficiency and unfair trade practice of opposite parties. All allegations made in various paragraphs of the W/S made by the O.Ps. were not admitted and hence the written statement of the O.Ps. has got no legal force.
It is crystal clear that the repudiation of claim by the O.Ps. was not justified and thus O.Ps. are liable to pay sum assured amount of ₹ 1,00,000/- (Rupees one lakh)only of policy No.445082562 dated 28-11-2014 with interest till the date of actual payment along with ₹ 1,50,000/-(Rupees one lakh fifty thousand)only on account mental, physical agony suffered by the complainant due to negligent and unprofessional treatment by the opposite parties and also direct to pay the cost of litigation etc.
The opposite parties in this case submitted their written argument on 23.05.2022. In their argument the O.Ps. have stated that the complainant filed this case stating interalia that Sankar Bhattacharjee (since deceased) purchased a Life Insurance Policy “New Money Back Plan-20 years (with profit)” from Life Insurance Corporation of India, Dibrugarh Branch vide police No.445082562 on 28.11.2014. Said Sankar Bhattacharjee died on 01.08.2015 leaving behind him, the complainant, one son and one daughter and the complainant had applied to release the sum assured of ₹1,00,000/- lakh only at Dibrugarh office of the O.P. The O.Ps. vide letter dtd. 24.08.2016 repudiated the liability under the above policy on account of the deceased having withheld some material information regarding his health. In reply to legal notice served by the complainant upon the O.Ps., the opposite parties’ competent authority informed the complainant of repudiation of her claim. The O.Ps. have claimed that late Sankar Bhattacharjee took the insurance policy with malafide intention knowing fully that he had been a patient of alcoholic for last 22 years and suppressed the said fact while obtained the policy and the policy issued to the complainant’s husband was a “non-medical policy” and the said policy was issued on the information furnished in the proposal form. The claim was repudiated on the basis of a brief clinical note issued by Assam Medical College and Hospital, Dibrugarh dated 26.07.2015 vide MR No.00000038014 OP No.OP1507168022 of late Sankar Bhattacharjee in which it was stated that the DLA was a patient of alcoholic for 22 years and now not alcoholic for last two months. DLA was also suffering from distension of abdomen- one year, swelling of limbs- more than one year. He was a chronic alcoholic and was a patient of CLD prior to the date of proposal and this fact was not disclosed at the time of procuring the policy. They have further argued that the insured person did not come with clean hands and by concealing material fact, the insured person somehow took the policy for his illegal gain knowing fully that he is furnishing false statement which is crystal clear from the statement made in her claim petition. The death of the policy holder has taken place within first three years of the commencement of the policy and hence it is called an early death claim.
Section 45 of Insurance Act says “No policy of Life Insurance Corporation of India shall be called in question on any ground whatsoever after the expiry of three years from the date of policy, i.e. from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of rider to the policy whichever is later.” As such allows insurers for calling on policy in question on the ground of miss-representation or suppression of material facts not meaning to fraud only within initial three years of the policy. As the claim of the complainant was early claim hence the officials of LICI made an enquiry and on enquiry it is found that the life assured Sankar Bhattacharjee suppressed the material facts. After about eight months of the commencement of policy the life assured died. O.Ps. have argued that life assured Sankar Bhattacharjee in the proposal at the time of taking the policy replied “No” when he was asked - “Do you use or have used alcoholic drink, narcotics, any other drugs, tobacco in any form.” But from exhibit –B(4) it is crystal clear that he suppressed the material information that he used to drink alcohol for last 22 years, that means when he took the policy he used to drink alcohol. He also falsely replied “Good” when he was asked “what has been your usual status of health”. But in exhibit B(4) it has been mentioned that “distension of abdomen for more than one year, swelling of limbs for more than one year” which shows that the deceased, with ill-motive, had suppressed the real and true facts and took the policy for his illegal gain.
The O.Ps. in their written argument have submitted that the policy was a “non-medical policy” that means the policy issued on the statement furnished by the life assured in his proposal form and the opposite parties believing on the statements of the life assured issued the policy. As the policy is non-medical hence no medical test was done from the side of the opposite parties, the policy was issued on utmost good faith. They have claimed that the complainant admitted the statement of the O.P. in para-10 of her evidence in affidavit stating that “in the medical report it is shown that reason of death was excess of alcohol consumption.” Denying their liability of negligence and deficiency in service the O.Ps. have argued that they replied the legal notice of the complainant timely. The complainant neither denied the contents made in exhibit-B(4) nor did the complainant denied the statement made in the W/S and the documents exhibited.
The opposite parties have further argued that the complainant exhibited the xerox copy of the policy as exhibit-1 in her evidence in affidavit and stated therein that original is kept in the custody of the O.P. but no notice was issued to the opposite parties to produce the original nor filed any petition in the case for production of original by the opposite parties and as such exhibit-1 is not admissible in evidence as secondary evidence without issuing notice for production of the original. The complainant is not entitled to the relief/reliefs as prayed for in her complaint and the case is liable to be dismissed with cost.
Points for decision
- Whether the complainant is a consumer under Consumer Protection Act.
- Whether this Commission has proper jurisdiction to try the case.
- Whether the opposite parties are liable for deficient and negligent services.
- Whether the complainant is entitled to get the reliefs as prayed for.
Decisions and reasons thereof
- We have carefully gone through the complaint, W/S, evidence and documents annexed and we found that O.P.s have admitted that the insurance policy being policy No.445082562 (New Money Back plan-20 years) was purchased by the husband of the complainant from the O.P. Milan Bhattacharjee, the wife of the deceased Sankar Bhattacharjee was nominated as the nominee of that policy and Milan Bhattacharjee is the complainant in this case from which this Commission has held that the complainant is a consumer under O.Ps. under the Consumer Protection Act.
- The complainant is a permanent resident of Dibrugarh town and the O.Ps. have their Branch Office at Dibrugarh in Dibrugarh District of Assam. The amount claimed by the complainant is also within the pecuniary jurisdiction of this Commission and as such this Commission has proper territorial as well as pecuniary jurisdiction to try this case.
- Regarding deficiency in service of the opposite parties we have minutely examined the complaint petition, W/S filed by the O.Ps. evidence in affidavit along with exhibits filed by both the parties. Seen that Shri Sankar Bhattacharjee (now deceased) purchased the life insurance policy from O.P. No.1 on 28.11.2014 being the policy No.445082562 under the policy caption “New Money Back Plan-20 years”. Sum assured of the policy was ₹ 1,00,000/- and present complainant was shown as the nominee in the policy. The accidental benefit sum assured was shown as ₹ 1,00,000/- and the premium was fixed at ₹ 2331/- quarterly and the maturity date was shown as 28.11.2034. Surprisingly the complainant did not submit the original policy along with her complaint or evidence in affidavit. But in her evidence she has stated that the original LIC policy was kept under custody of O.Ps. From perusal of case record and order sheets we have seen that the complainant neither prayed before the Commission to direct the O.P. to produce the original LIC policy in question which was reportedly under the possession of O.Ps. nor prayed to treat the xerox copy of the policy as secondary evidence under Evidence Act. It is also seen that the O.Ps. had also not furnished the original LIC policy along with their W/S or evidence. But interestingly O.Ps. have not challenged the validity/existence of the policy in whatever form it has been placed by the complainant. Held that the policy was purchased by the deceased policy holder and as such the nominee/complainant is entitled to claim the death benefit sum assured of the above policy.
The opposite parties, it is seen, repudiated the claim of the complainant on the ground of concealment of material fact at the time of procuring the policy. They have nowhere denied that the complainant’s husband purchased the policy from the O.P. In question No.11 of the proposal form all the answers given by the DLA were in negative as claimed by the O.P. in their repudiation letter. But we find it difficult to understand whether the DLA was asked the question in reality or it was just a mere formality. From our experiences for last few years in like cases we have observed that the corporation has given more importance in the number of policies to attain their desired target than in providing required services to the policy holders and/or their nominees etc. It should be the duty of the O.Ps. to explain the terms and conditions concerning any policy to its valued customers before selling any policy to them. But in practical field the corporation/O.P. is not seen playing such role. Avoiding of medical examination prior to sale/purchase of a policy as per our previous experiences were not done properly, for which at the time of death claim/injury claim etc. the policy holders/nominees have to face problems beyond imagination. In most of the cases we have seen that the corporation adopts a plea of repudiation as concealment of material facts.
In this particular case also we have seen that the O.Ps have repudiated the claim of the complainant on the ground of concealment of material facts at the time of procuring of the policy. It is true that the medical reports exhibited by the O.Ps. have suggested that the DLA was a patient of alcoholic for last 22 years. But the cause of death was shown as “Cardiorespiratory Failure” in the cadaver report of the DLA issued by AMCH, Dibrugarh which has been exhibited as O.Ps. exhibit No.B(3). The O.Ps. have stated in their W/S as well as evidence in affidavit that the agreement between the insurer and insured is a contract based on utmost good faith. But we consider that the corporation like the O.Ps. should be cautious in issuing policies based on that utmost good faith.
In this case we have seen that the complainant has failed to exhibit the policy in original and except death certificate she has produced no original documents along with her evidence.
Consumer Protection Act is a welfare legislation enacted by the Government for the welfare and redressal of the grievances of victimized consumers. To give relief to the consumers the Commission is not to be strict in toto in complying with all the formalities of CPC, evidence etc.
Under all our above discussions and observations we may come to a conclusion that as the cause of death of the DLA was Cardiorespiratory Failure, other factors like chronic alcoholic, CLD etc. are not material in deciding the claim of the complainant.
We found the opposite parties are liable for repudiating the claim of the complainant on the basis of concealment of material facts. We found no reason to disbelieve the complaint of the complainant and as such we have unanimously decided to allow the complaint of the complainant and we direct the O.P., Life Insurance Corporation of India to pay to the complainant :
- The sum assured death claim of the complainant amounting to ₹ 1,00,000/- (Rupees one lakh)only against the policy No.445082562 under policy name “New Money Back Plan-20 years (with profits).
- A sum of ₹ 20,000/- (Rupees twenty thousand)only on account of physical and mental agony suffered by the complainant and on account of cost of litigation.
All the above amounts be deposited into the credit of this Commission by the Opposite Parties within 30 (thirty) days from the date of receipt of this judgement and order.
This instant C.C. No. 18/2018 is accordingly disposed of on contest.
Send copy of this judgement and order to the Opposite Parties for compliance. Complainant is to take step.
Next date fixed 30.01.2025 for compliance of order and judgement.
