On 15/03/2019 the complainant (Ashraful Haque) lodged the complaint U/s 12 of the Consumer Protection Act,1986.
The case of the complainant, in brief, is that the Golapjam Khatun, the mother of the complainant purchased some insurance policy during her life time from the O.Ps on payment of premium and the policy Number is 456951385. The O.P collected all information from the insured person and after being satisfied they issued policies in favour of Golapjam Khatun. She paid premium of Rs.5752/- and after receipt of the same the O.Ps issued the said policy amounting to Rs.10,00,000/- in her name. During the life time of her she paid premium regularly, but due to financial crises she was unable to pay the premium and subsequently she renewed the policy by paying all outstanding premium to the O.P concern in the year 2016. Suddenly she died due to cardiac respiratory failure on 25/05/2017 when the said policy was in force. After her death the complainant being a nominee and legal heirs of her claimed the insured amount of the said policy by filing all necessary documents before the O.Ps. After received of all documents as well as claim form, the O.P issued a letter dated.11/09/2018 repudiated the claim pointing out that “aforestated policy has not completed 3 years from the date of death revival which was only 11 months 16 days from revival to date of death (25/05/2017) of the life assured and they have examined the claim keeping in view of provisions of Section 45 of Insurance Act,1938. They also informed the claimant that in the Agent’s confidential report (Form No:-380) proposal for assurance signed by him on 30/10/2013 in the question No:-1:-B where he answered that he was not a relative of that policy holder which was totally false statement because the life assured was his mother and as an agent of LICI he should have known that being the son of the policy holder cannot be a party of the Agent and this was done intentionally to defraud Corporation. The complainant on several times requested the O.P for payment of the sum assured, but the O.Ps whimsically repudiated the claim by adducing a minor mistake of information which cannot affect the claim. The complainant suffers irreparable loss and injury due to negligent and whimsical act of the O.Ps.
Upon this background the complainant prayed that the O.Ps be directed to pay the assured amount of Rs.10,00,000/- along with interest @ 9% PA from the date of death of insured and to give direction the O.Ps to pay the compensation of Rs.1,00,000/- and litigation cost of Rs.15,000/-.
The O.P/ LIC of India has contested the case by filing W.V denying all the material allegations contending inter alia that the case is not maintainable in its present form and that the instant complaint is made with “Suppressio- Veri Suggestio-Falsi”. But the O.P admitted the fact that Gulabjam Khatun the mother of the complainant purchased the said insurance policy from Raiganj Branch and the code number is 3662458. Though he registered himself as the nominee in the said policy, the purpose of the insurance contract may be termed as commercial. Therefore, according to Section 2(1) (d) of C P Act, 1986 the complainant cannot be a consumer and the case is liable to be dismissed. On perusal and detailed serutiny it was found that the agent himself was the nominee who has denied being the relative of the deceased while he submitted the form of proposal and Moral Hazard Report in form no:-3251. The principle intention in this case is seen to be an attempt to defraud the corporation with misleading answer. It is also a fact that in the revival paper, the declaration dated.09/06/2016 of good health was also witnessed by the said agent (complainant) and the policy holder had an another policy bearing no:-456918945 at Raiganj Branch for a sum assured of Rs.500000/- on 28/11/2011.This fact was intentionally suppressed in the proposal by declaring that the proposal for policy no:-459951385 was her first insurance. But she disclosed the fact that the under writing would have been decided differently before issuing the policy. It is further stated that the complainant being a regular agent of LIC must have known the fact that the MHR which is a part and parcel of contract of insurance cannot be signed by an agent if he /she is a relative of the proposed of the Life Insurance Policy and the complainant admitted it in the complaint by saying a “Minor Mistake” on his part. After query some other astonishing facts came to light which amply proves that the complainant had an ulterior motive to make money out of his ailing mother’s life and he acted as visiting agent of LIC Chanchal Branch and affected an insurance on 26/05/2016 for a sum assured of Rs.2000000/- on his mother’s life (Policy No 458150494 status report enclosed) again in Raiganj Branch Office Policy No:-998981311 on 28/10/2016 for a sum assured of Rs.900000/-. His malafide intention of defrauding the corporation is amply proved with these facts that he over insured his mother with full knowledge of the technicality of insurance and his mother’s ill health and therefore, he changed the branches and time frame very frequently their by avoiding strict medical and other underwriting barriers. Agents are considered to be the first line underwriter. In this case the agent cum complainant has intentionally misled the corporation by giving wrong information with unclean mind for making quick money out of insurance contract. It is further stated that the LIC has settled the death claim of Golapjam Bibi against policy No:-456918945 DOC 28/11/2011 for Rs.500000/- which is duly payable as per rule of guidelines of the LIC. The allegation of deficiency in service does not hold good. The complainant is trying to make intention of defrauding the company by taking shelter of the learned forum and mis utilizing the provisions of the CP Act.
Upon this background the O.Ps prays for dismissal of the case with a prayer to impose penalty U/s 27 of CP Act upon the complainant.
P o i n t s f o r d e c i s i o n-
- Is the case maintainable in its present form and prayer?
- Is the complainant entitled to get relief as prayed for?
D e c i s i o n w i t h r e a s o n s:-
Both the above points are taken up together for discussion and consideration as they are related to each other. The complainant has filed examination-in-chief on affidavit as PW1 and he is also cross examined in full. The complainant also filed xerox copy of status report of policy, death certificate of Golapjan Khatun, buried certificate of Golapjan Khatun, letter dated.15/11/2017 issued by the LICI, letter dated 01/01/2018 issued by LICI, Pan Card of Golapjan Khatun, legal notice dated 18.08.2018, letter dated 11.09.2018 issued by LICI and letter dated. 13.09.2018 issued by LICI.
No oral evidence is adduced by the O.P /Insurance Co. but the Ld. Advocate for the O.P has filed letter /reply of O.P /LIC of India dated 11.09.2018, Annexure – A Claim Format, underwriting manual, and proposal form of policy Number. 458150494, proposal form of Policy Number 998981311, proposal form of Policy Number 456951385, proposal statement regarding health and certificate of Policy Number 456918945. The OP also filed written argument.
It is an admitted fact that the deceased Golapjam Khatun was the policy holder and insured person. The present complainant Ashraful Hoque is the agent and her son. It is the case of the complainant that the insured Golapjam Khatun is the holder of policy being Number 456951385 and the sum assured of Rs. 10,00,000/- in her name. From the status report of policy filed by the complainant and from the document filed by the O.P showed that the policy being Number 456951385, sum assured of Rs.10,00,000/- is in the name of Golapjam Khatun and the premium was Rs. 5752/- per year. The deceased Golapjam Khatun has paid premium regularly and subsequently due to financial crisis she was unable to pay the premium, but after the renewal of the policy she paid all outstanding premium to the O.P. Thereafter, on 25.05.2017 she died while the policy was in force and the buried certificate, death certificate of Golapjam Khatun confirmed her death. The O.P/Insurance Company admitted that the policy was revived by paying arrear premium and after 11 months 16 days the policy holder died. Therefore it can be said that the deceased Golapjam Khatun took LIC policy being Number 456951385 amounting to Rs.10,00,000/- assured by the LICI. It is the case of the O.P that the complainant is the agent of the O.P and he is also the nominee being the son of the insured person and for that he is not the Consumer U/s 2(1)(d) of C.P. Act.,1986. It is also the case of the O.P that he did many act fraudulently with suppression of the relationship as mother and son with the policy holder and the O.P tried to showing him as quick money making person out of insurance contract and in this regard he filed some proposal form of policy. The deceased Golapjam Khatun was a consumer and the present complainant is his only son and only legal heirs of her. According to section 2(b) of the Consumer protection Act, 1986 in case of death of a consumer, his legal heirs or representatives; who or which makes a complaint. Therefore, the present complainant being the legal heirs of his mother has filed this complaint as a consumer. Therefore, the points has raised by the O.P that the complainant is not the consumer U/s 2(d)of Consumer Protection Act, 1986 cannot be accepted. The facts of other LIC policy as mentioned in the WV is not the case of the complainant. The case is involved with the claim of LIC policy being number 456951385, amounting to Rs.10,00,000/- only. According to Sec.45 of the Insurance Act., 1938 the O.P has to prove the fraudulent intention strictly by showing that their agent has deliberately suppressed the true fact. But the O.P has issued the LIC policy Number in question after considering the form submitted by the deceased Golapjam Khatun and the finance (premium) which was paid by the deceased has been accepted by the O.P. It is not to be considered here as to whether what has been done by their agent and it is the case of the Company and its agent and not the case of the Insured deceased and due to any fault of the agent the insured person cannot be affected specially due to the internal matter of the LIC being a legal heir the complainant is entitled to get the assured money mentioned in the policy in question. There is no iota of evidence to show that the deceased Golapjam Khatun who was the insured person intentionally defrauded the LIC. The fact of intentional defraud upon the corporation is in between the LIC and its agent and what step should be taken by the Company for its employee agent that is up to the LICI in another form / way and not against the Insured person.
Under the above facts and circumstances and considering the evidence on record of both sides we are of the view that the case is maintainable in its present form and prayer and the complainant is entitled to get relief as prayed for.
Considering the whole aspects of this case we think that the complainant is also entitled to get interest from the date of death of the deceased insured @ 6% per annum and the complainant is also entitled to get a compensation of Rs.25,000/- for his mental pain and agony and Rs.5,000/- as litigation cost.
Hence,
O r d e r e d
that this case be and the same is allowed on contest against the O.Ps but without any cost. The complainant is entitled to get assured amount of Rs.10,00,000/- along with interest @ 6% per annum from the date of death of insured, i.e, on and from 25/05/2017 and Rs.25,000/- as compensation and Rs.5,000/- as litigation cost. The O.Ps are directed to pay the assured amount of Rs.10,00,000/- along with interest @ 6% per annum from the date of death of the insured, i.e, on and from 25/05/2017 to the complainant by an account payee cheque. The O.Ps are also directed to pay Rs.25,000/- as compensation and Rs.5,000/- as litigation cost to the complainant by an account payee cheque.
The O.Ps are also directed to pay those amounts to the complainant within two months from the date of this order failing which those amounts shall carry further interest @ 6% per annum till realization.
Let a copy of this order be given to the parties on free of cost.
