West Bengal

Paschim Midnapore

CC/159/2014

Sabirannesa Bibi - Complainant(s)

Versus

The Division Manager, L.I.C. of India. - Opp.Party(s)

31 Mar 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

 

 Complaint case No.159/2014                                                                                             Date of disposal: 31/03/2015                               

 BEFORE : THE HON’BLE PRESIDENT :  Mr. Sujit Kumar Das.

                                                      MEMBER :  Mrs. Debi Sengupta.

                                                      MEMBER :  XXXXXXXXXXX

  

 For the Complainant/Petitioner/Plaintiff : Mr. G. Dey,  Advocate.

 For the Defendant/O.P.S.                       : Mr. D. Ghosh, Advocate.                                   

          

 Sabirannesa Bibi, W/o Late Sk. Mustakin of 4 No. Kalaikunda (Dhuliapata), P.O. Rakhajungle,

 P.S. Kharagpur (L), Dist. Paschim Medinipur, PIN.721301…………..Complainant

                                                           Vs.

1)The Division Manager, L.I.C. of India, Kharagpur (Division) near Lalbunglow, P.O. Nimpura, P.S. Kharagpur (T), Dist.Paschim Medinipur, PIN.721304;

2)The Branch Manager, L.I.C. of India, Kharagpur Branch, O.T. Road, India, P.O. Inda, P.S. Kharagpur (T), Dist.Paschim Medinipur, PIN.721305..……………Ops.

Mrs. Debi Sengupta, Member.

         The case of the complainant, in short, is that the complainant’s husband Late Sk. Mustakin gave proposal for endowment policy from the OP.  Accordingly, after fulfillment of all conditions the Ops accepted the proposal of Sk. Mustakin. The Ops received Rs.3732/- as premium from Sk. Mustakin.  The sum assured of the policy was Rs.2,00,000/-.  The Ops issued policy being No.499432139 dated 2/01/2012 and the date of maturity of the policy is on 2/01/2017.

            At the time of policy Sk. Mustakin nominated his wife Sabirannesa Bibi as his nominee who is the complainant of this case and after taking policy the complainant states that her husband deposited the premium of the policy and unfortunately died on 17/07/2012.

            The complainant states in her petition that after the demise of her husband the complainant applied for the death benefit and submitted her claim before the Insurance Co.  But the OP by a letter repudiate the claim and refused to pay the death claim to the complainant on the ground that at the time of taking policy the husband of the complainant Sk. Mustakin was not medically fit and he was under the treatment of the doctor.

            The complainant states that she went to the Insurance Co. for several times and requested

Contd……………P/2

 

- ( 2 ) -

 

them to pay the death claim of her husband but the Insurance Co. denied to pay the same.  Thereafter, the complainant send a registered notice on 8/11/2014 through her Ld. Lawyer

 but having received the notice of the Ld. Lawyer the LIC did not pay and heed to the request of the

 complainant.  As the Ops most illegally denied to pay the amount alleged by the complain so the complainant has been compelled to file this case and entitled to get order.

            The complainant as it states that there is deficiency on the service on the part of the Ops and

the complainant is entitled to get compensation due to deficiency in service.

            The complainant prayed before the Ld. Forum for compensation and other relief or reliefs.  

            The Ops contested the case by filling written statement challenging that the complainant has no cause of action for filing this case.  Ops denied the Para 7,8,9 & 10 of the petition filed by the complainant and states that all are false, concocted, motivated and malafide story.  The prayer of the complainant is vague, baseless and imaginary.  The complainant is not entitled to get any relief as the complainant prayed for.

            The Ops further beg to state that the husband of the complainant purchased one LICI policy being No.49943219 and the sum assured of Rs.2,00,000/- on 2/01/2012 and the mode of the premium was Rs.3732/- per month and the date of maturity of the said policy is 2/01/2017 from the OP NO.2 and said Sk. Mustakin nominated his wife Sabirannisa Bibi as his nominee.  In the proposal form, the husband of the complainant suppressed many material facts as alleged by the Ops.

            The Ld. Lawyer for the OP states that during filling of the proposal form the husband of the complainant Late Sk. Mustakin stated false information in the Column of No.11 of the said proposal form in respect of the health of said Sk. Mustakin, the husband of the present petitioner.

            Op states that said Sk. Mustakin was suffering from low back pain with right leg radiation including other diseases and also his operation was done on 29/09/2011.  That from treatment papers discharge summary issued by doctors and other relevant documents of hospitals and others it is seen that the said Sk. Mustaking was suffering from various ailments since long back and that  fact has been deliberately suppressed long time and thereby  misguided and misrepresented the Ops.

            The Ld. Lawyer for the OP argued that if the proposer disclosed about his treatment etc. as per requirement then LICI might have not issued the policy in his favour.  The Ops state that the nominee of the aforesaid policy holder was aware about the above mentioned facts as she accompanied Sk. Mustaking at the time of his treatment she also made  false statement during her claim as well as she suppressed, all relevant facts and misrepresented LICI /OP under the above

 

Contd……………P/3

 

- ( 3 ) -

 

 facts and circumstances LICI repudiated the claim by a letter dated 2/01/2013, the LICI authority further intimated the complainant that if she is not satisfied she may send her representation within three months for consideration her claim to the Zonal Manager of LICI Authority.  But inspite of approaching to the Zonal Manager of LICI through a Advocate’s letter sent to the complainant dated 5/11/2014 by stating that complainant has made complete false, baseless, irrelevant allegation against the LICI.

            The Ld. Advocate argued that it is clearly evident that there is no deficiency in service on the point of the Ops/LICI and prays for dismissal of the above instant case.

          Upon the case of both parties the following issues are framed.

Issues:

1)Whether the case is maintainable in its present from?

2)Whether there is deficiency of service?

3)Whether the complainant is entitled for getting relief as prayed for.?

 

Decision with reasons

Issue Nos.1 to 3:

              All the issues are taken up together for discussion as those are interlinked each other for the purpose of arriving at a correct decision in the dispute.

              Ld. Advocate for the complainant made his argument that the case is maintainable under the statutory provisions of the Consumer Protection Act.

        The husband of the complainant gave proposal for endowment policy of from the LICI.  Accordingly after fulfillment of the condition and after satisfied the OP accepted the proposal of Sk. Mustakin and received Rs.3732/- as premium from him and issued a policy certificate being NO.499432139 dated 2/01/2012.  The sum assured of the policy was Rs.2,00.000/- and the date of maturity is on 2/01/2012.  The Advocate for the complainant argued that the LICI could not repudiate the death claim of the complainant and Ld. Advocate states that the OP with false averment repudiate the death claim of the complainant and at the time of taking policy Sk. Mustaking was  medically checked by the Dr. of the OP/LICI so the case is maintainable in its present form.

The Ld. Advocate for the OP/LICI made his reply that there is strong evidence to establish that the case is not maintainable in this Forum.

Ld. Advocate further argued that there is strong evidence to establish that there is no deficiency of service against the OP.  That from the medical documents treatment papers and others surrounding circumstances, it is clearly evident that the proposer of the said policy namely Sk. Mustaking was admitted many times in Nursing home and Hospital.  The treatment papers,

Contd……………P/4

 

- ( 4 ) -

 

discharge summary issued by doctor of policy claim and other relevant documents of the hospital and others it is seen that said Sk Mustakin was suffering from various ailments since long back and that fact has been deliberately suppressed by the Sk. Mustaking and thereby misrepresented the Ops/LICI.  As a result, it is to be decided that there is no deficiency of service on the part of the OP as alleged by the complainant.

            We have carefully considered the case of both parties including these documentary evidence admitting each other and it appears particularly in the fact of the proposal form that the complainant has deliberately suppressed the facts of in the policy form.

            In view of the facts and circumstance, we do not find any scope to accept the plea of the complainant.  As a result, it is held that there is no scope to file this case in this form.  Therefore, the prayers made by the complainant cannot be granted in her favour.

 

               Hence,

                           It is Ordered,    

                                                    that the case be and the same is dismissed  on contest  without cost.

Dictated & Corrected by me

              

                Member                                                                                                  President

                                                                                                                           District Forum

                                                                                                                       Paschim Medinipur.