1. The brief history of the case of the complainant is that her husband Satadal Mandal during his life time had obtained an LIC Policy Vide No.573962181 commencing from 17.12.2013 for a sum assured (SA) of Rs.4.00 lacs with monthly premium of Rs.1633/- under which the complainant was the nominee and the LA died in a road accident on 03.1.2014. It is submitted that the fact was intimated to the OP.1 and the complainant being the nominee filed claim form along with required documents with the OP.1 but after a long silence the OP.2 on 24.3.2015 repudiated the claim stating that the LA had with held the details of his previous policy No.573799002 to avoid special report. It is further submitted that the deceased had taken other policies from the OP.1 duly mentioned in the proposal form but inadvertently the Policy No.573799002 could not be available in the proposal form which is a bona fide mistake but the Ops could have ascertained the previous policy details of the LA from their computer system easily before granting the policy in question as the Policy No.573799002 belongs to his branch. The complainant further submitted that after repudiation of the claim she wrote to OP.3 for reconsideration of claim on 18.5.2015 but the Ops remained silent. Thus alleging deficiency in service on the part of the Ops she has filed this case praying the Forum to direct the Ops to settle the death claim under policy No.573962181 at Rs.4.00 lacs with interest @ 12% p.a. along with accidental benefits from 24.3.2015 and to pay Rs.50, 000/- towards compensation besides Rs.10, 000/- towards cost of litigation to the complainant.
2. The Ops filed counter in joint admitting the Policy No.573962181 commencing from 17.12.2013 issued in favour of Satadal Mandal, who died on 03.01.2014 and the claim under the said policy was repudiated on the ground of suppression of material information. It is contended that before issue of above policy, the OP.1 had already issued another policy No.573799002 in the name of said LA but he had deliberately avoided to mention the previous policy details in the proposal form and the omission of the same is a material suppression of the fact. It is further contended that the claim under the Policy No.573799002 has already been settled in favour of the complainant on 31.3.2015. The Ops submitted that the policies are issued basing on the paying capacity of the LA and had the life assured disclosed about the existing policy, he had not been entitled for issuance of the present policy in dispute. Thus denying any fault on their part, the Ops prayed to dismiss the case of the complainant.
3. The complainant has filed certain documents in support of her case. Both the parties have filed affidavits. Heard from the parties through their respective A/Rs and perused the materials available on record.
4. In this case Policy No.573962181 with DOC from 17.12.2013 for a sum assured of Rs.4.00 lacs on monthly mode of premium of Rs.1633/- issued in favour of Satadal Mandal by OP.1 in which Smt. Sulekha Mandal, the wife of the LA is nominee are all admitted facts. The other admitted facts are that the LA died on 03.01.2014 in a road accident and filing of claim application by the nominee under the policy. The case of the complainant is that he submitted claim application for settlement of insurance claim of her late husband in her favour but the OP.2 after a long delay i.e. on 24.3.15 repudiated the claim with reason that in the proposal for assurance dt.17.12.2013, in response to Question No.9, the LA had not mentioned about his previous policy No.573799002 to avoid special report.
5. Perused the repudiation letter dt.24.3.2015 as well as the copy of proposal form available on record. At Qn. No.9 of the proposal form the Ops have advised the LA to give details of previous insurance (including policies surrendered/lapsed during last 3 years). It is found in the footnote of the said question written by the Ops that, Corporation does not entertain any fresh proposal for insurance where a policy was lapsed or has been converted paid up policy within last 3 years. There is no mention about ascertaining any special report as has been stated in the repudiation letter. Therefore, the Ops have laid special emphasis on the lapsed policy or converted paid up policy within 3 years before accepting the fresh proposal but not on the special report.
6. The Ops stated that by the time of issuing the disputed policy No.573962181, the OP.1 had already issued Policy No.573799002 in favour of the LA and the LA has deliberately avoided mentioning the said policy in Qn. No.9 of the proposal for which the Ops could not ascertain the paying capacity of the proposer. From the above discussions it was ascertained that, non mentioning of policy number inadvertently is not important in this case. What is important is that, whether the LA had paying capacity for the existing policies. If the LA had no paying capacity, this would entitle the Ops to repudiate the claim.
7. It is seen that the LA was a bank employee. The complainant has filed copy of salary statement of her late husband as well as details of insurance policies obtained from which it was ascertained that the deceased LA had 3 previous policies before obtaining the present one in dispute. All the policies were under Salary Saving Scheme and the premiums were duly deducted from the salary of the LA every month and a sum of Rs.2545/- (Rs.1633/- + Rs.429/- + Rs.483/-) was deducting towards premium in respect of 3 policies. Hence all the 3 policies were alive. It is seen from the salary statement issued by the employer of deceased LA that his total salary as on Dec.’13 was Rs.46, 858/- and net salary was Rs.24, 353/- and hence the LA had enough paying capacity to pay the premiums of the policies obtaining by him as noticed from his home take salary.
8. Further the OPs say that by the time of issuing the present policy, the OP.1 had already issued another policy in favour of the LA which fact was deliberately avoided to mention in Qn. No.9 of the proposal. It was not understood as to how the OP.1 failed to know about the previous policy in this computer age. Each and every data regarding issue of any policy by them are available in their computer. The name and date of birth of the LA were available in the proposal form and the OP.1 could have easily ascertained any previous policy obtained by the LA. Agent’s Code and D.O. Code could have been checked by the OP.1 before granting a new policy in order to know antecedent of the proposer but the Ops in this case accepted the proposal to achieve their goal but at the time of their liability they are raising finger towards the LA. The Ops cannot cover up their own faults by saying this and that and also they cannot repudiate a bona fide claim in this manner.
9. From the above discussions, it can be clearly concluded that the intention of Qn. No.9 of the proposal form was different as that the Ops hold and the LA was enough paying capability towards the premiums of insurance policies that he obtained. Further non putting of exact policy number in the proposal form is not fatal to settle the claim as the said policy has been issued by the OP.1 branch itself. As such we hold that the repudiation in this case is unjustified and unjustified repudiation of claim was clearly a deficiency in service on the part of the Ops. Therefore, the complainant being the nominee under the policy is entitled for death claim of her late husband. In the peculiar circumstances of the case we are not inclined to grant any compensation in favour of the complainant as prayed for except a sum of Rs.2000/- towards cost of this litigation.
10. Hence ordered that the complaint petition is allowed in part and the Ops 1 & 2 being jointly and severally liable are directed to pay the sum assured of Rs.4, 00,000/- with other death benefits if any with interest @ 9% p.a. from the date of repudiation i.e. 24.3.2015 and to pay Rs.2000/- towards costs to the complainant-nominee within 30 days from the date of communication of this order.
(to dict.)
