This case has arisen out of an application U/s 35 of the Consumer Protection Act, 2019.
The case of the complainant is that her mother Bibi Jarina was the holder of LIC policy No:998983611 commenced from 28.01.2017, yearly premium Rs.9,187/- and basic sum assured Rs.1,00,000/-. O.P.No:4 was the agent of LIC. She had deposited premium of 03 consecutive year (out of lock period) on 11.03.2017, 28.02.2018 & 31.03.2019. Thereafter, she became seriously ill, undergone treatment & died on 25.06.2020 & the complainant is the nominee of said policy.
That after death of policy holder the complainant several times visited the office of LICI, Raiganj Branch, contacted agent but the officials of said office did not give positive response & they harassed the complainant in several way or form.
Thereafter, she sent written application to O.Ps as well Regional Manager, LICI, Kolkata but did not get any response. Then she sent a legal notice to O.P.No:1 and copy forwarded to O.P.No:3 on 29.04.2022 but all attempts gone in vain. For deficiency in service of the O.Ps the complainant has been suffering mental pain and agony and sustained financial loss. Hence, this complaint with prayer for payment of 03 yearly premium Rs.9,187/- each i.e Rs.27,561/- + sum assured Rs.1,00,000/-, Rs.1,00,000/- for harassment, mental pain and agony, litigation cost of Rs.20,000/- & miscellaneous cost Rs.15,000/-.
O.P.No:4 submits written version stating that he is acted as a facilitator and he is not privy to the contract of insurance between the parties & settlement of insurance claim does not fall within the domain of O.P.No:4. He is praying for dismissal of the case.
O.P.No:1 to 3 contested the case by filing written version stating that the case as made out in Para-7-13 is totally false as immediately on receiving the death intimation from the complainant vide her letter dated 23.09.2020, O.P/LIC issued necessary discharge voucher, forms and asked for some other documents required for processing the claim vide letter dated 12.10.2020, on scrutiny of the documents it is found that as per Discharge Certificate issued by Chitaranjan National Cancer Institute the age of the Life Assured as on death is 64 years, from Voter identity card the age of the Life Assured is 47 years as on 01.01.2020 and also from claimant’s statement submitted by the complainant herself the age of Life Assured at death is 65 years.
That at the time of taking the policy in the year 2017 the age of Life Assured declared 47 years as her birth date 2.6.1969 (as per Rasakhowa High School), from the above it is clear that there is huge difference of ages about 14/15 years between the ages that was stated at the time of taking policy and at the time of the death of Life Assured. Due to that LIC asked for clarification from the complainant but she instead of giving any response knocked the door of the Forum. Moreover, LIC wrote a letter to the Head Master of Rasakhowa High School for verification of school certificate dated 26.11.2021 but no reply is received till date.
That complainant tried to perpetrate fraud on the LICI by suppressing material facts, there exists no deficiency in service or unfair trade practice on the part of LICI, so it prays for dismissal of the case.
Point for consideration is:-
- Whether there was any deficiency in service & unfair trade practice on the part of the O.Ps which gives rise cause of action to file the complaint and the complainant is entitled to get the claim?
D e c i s i o n w i t h r e a s o n s
At the outset it is noted that O.P.No:4 was acted as a facilitator and he was not privy to the contract of insurance between Life Assured & LICI, & settlement of insurance claim does not fall within the domain of O.P.No:4, thus no deficiency of service can be attributed on the part of O.P.No:4, in fact the complainant has no specific allegation against him, but against LICI.
The particulars of First Premium Receipt dated 11.03.2017 are as follows:Name of Life Assured: Bibi Jarina, Policy No:998983611, DOC (Date of Commencement):28.01.2017, T & T(Table/Plan & Term):814-12-12, S-A (Sum Assured):1,00,000, DOM (Date of Maturity):28.01.2029, Prem (Premium):9187.00, Mode:YLY (Yearly), DOB (Date of Birth):02.06.1969, Age:48, Age ADMTD (Age Admitted):Yes, DLP (Date of last premium/payment):28.01.2028, Prop (Proposal):No/DT:9993/11/03/2017.
Policy document reflects it LIC’s New Endowment Plan (With profits), Plan/Table No:814, name and address of Proposer/Life Assured Bibi Jarina W/o:Lt. Sirajul Islam, Vill:Rudel, P.O:Rasakhowa, P.S:Karandighi, Dt:U/D, 733212, Nominee:Rehena Khatun (Complainant).
The prospectus shows age at entry from 8 yrs to 55 yrs, policy term and premium paying term from 12 yrs to 35 yrs, minimum sum assured Rs.1,00,000/-. Instant policy was issued to Bibi Jarina on minimum sum assured Rs.1,00,000/-, policy paying term & minimum premium paying term 12 yrs. It is evident that yearly premium of Rs.9,187/- + applicable taxes were paid in subsequent 02 years 2018 & 2019 too.
Complainant Rehena Khatun in cross-examination stated that her mother’s name is somewhere mentioned as Bibi Jarina or Jarina Bibi & that she was present when her mother Jarina Bibi purchased said LIC policy & she was present when the documents were signed before her for this policy.
Defence case is that as per certificate of Rasakhowa High School (H.S) as submitted by Bibi Jarina in presence of her daughter Rehena (Complainant) the policy was issued in the year 2017 entering Bibi Jarina’s date of birth 02.06.1969 & age 48 yrs, falls within the purview of age criteria of above mentioned policy.
Whatever complainant alleges that date of birth was mistakenly supplied by O.P.No:4/LIC Agent Sanjib Basak cannot & do not get any support. If it was so the insured has got 15 days “free look period” to verify the entries but she accepts the policy as correctly entered, issued on 13.04.2017. On the other hand we have no hesitation to hold the complainant’s claim false as Bibi Jarina herself supplied the certificate of Rasakhowa High School and accordingly & correctly her date of birth was recorded in the policy.
The complainant by suppressing said certificate of Rasakhowa High School tried to bank upon a. Transfer Certificate dated 02.01.1995 which certified that MST Zorina Khatun Son/Daughter of Kamaluddin Biswas, Vill:Kismattola, P.O-Panchanandapur, P.S-Kaliyachak, District-Malda & date of her birth as recorded in the admission register was 07.12.1969. It bears seal of the school & initial of Head Master/ Head Mistress with seal of that school which are illegible. Complainant also bank upon Identity Card of Employment Exchange, Islampur, U/D of MST Zorina Khatun W/o-Sirajul Islam where her date of birth has been recorded 07.12.1969. Apparently both the documents were subsequently procured. Be that as it may, at the time of purchase of policy in the year 2017 her age was 48 years or 48 years 06 months (say 49 years), which also mitigate the age criteria of the policy.
It is not disputed that the insured policy holder Bibi Jarina @ Jorina Bibi had died on 25.06.2020 & complainant being daughter nominee raised claim and on receipt of intimation from the complainant vide her letter dated 23.09.2020, O.P/LIC issued necessary Discharge Voucher, Forms and asked for documents required for processing the claim vide letter dated 12.10.2020 and on scrutiny of the documents submitted by complainant it is found that as per Death Certificate the age of life assured is 65 years, whereas in Voter Identity card her age found 47 years as on 01.01.2000 i.e 65 years (approx), showing huge difference of ages about 14/15 years between the ages that was stated at the time of taking policy & at the time of death of the Life Assured. Had her age been 65 years or 65 years (approx) at the time of taking the policy she would have been ousted from the prescribed age as entry, would not have been allowed to purchase said policy.
Legal maxim is he/she who seeks equity must come with clean hand. The complainant herself saw her mother sign the documents at the time of purchase of policy, now cannot escape from her personal liability. Since the complainant has played dubious role regarding the actual age of her mother she cannot get equitous relief(s) i.e the sum assured of the policy, any sum towards harassment, mental pain & agony, litigation cost and/or miscellaneous cost, as O.P/LICI on good faith acted upon the documents as submitted by Bibi Jarina in presence of complainant and also after her demise.
Under above facts and discussion, we are of the opinion that there exists no deficiency in service or unfair trade practice on the part of O.P/LICI, consequently the complainant is not entitled to get relief as prayed for. However, we opined that for ends of justice the complainant may get Rs.27,561/- i.e amount of 03 yearly premium of Rs.9,187/- each.
Hence, it is
O R D E R E D
that the C.C-03/2023 be and the same is allowed in part on contest but without any cost.
We do direct the O.P.No:1 to 3 to jointly & severally pay Rs.27,561/- i.e 03 yearly premium of Rs.9,187/- each, with simple interest @4% p.a w.e.f 11.03.2017 upon premium Rs.9187/-, 28.02.2018 upon premium Rs.9187/- & 31.01.2019 upon premium Rs.9187/- respectively, to the complainant within 30 days from the date of the order, failing which the complainant is at liberty to recover the same through execution and O.Ps are liable to pay interest @6% p.a after lapse of 30 days till final realization.
Let a copy of this order be given to the parties free of cost.
