BEFORE THE PRESIDENT
DISTRICT CONSUMER DISPUTE REDRESSAL FORUM
GOMATI DISTRICT ::: UDAIPUR
CASE NO. C.C. 09 OF 2014
Petition filed U/S 12 of the Consumer Protection Act.
Shri Jiban Sutradhar-Complainant
Versus
- The Life Insurance Corporation of
India – represented by
- The Branch Manager, LICI,
Udaipur Branch &
- The Divisional Manager, LICI,
Silchar Division, Assam - Opposite Party
- Shri Tapan Sutradhar,
- Shri Dipak Sutradhar,
- Smti. Swapna Sutradhar &
- Smti. Jayasmita Sutradhar - Proforma- Opp. Parties
PRESENT
Shri Asish Pal,
PRESIDENT
Consumer Dispute Redressal Forum,
Gomati District, Udaipur
And
Shri Haridas Roy Barman
&
Smti. Runu Das (Roy Choudhuri)
MEMBERS
COUNSEL
For the Complainant - Smti. Sumanta Chakraborty,
Learned Advocate.
For the Opposite Party No.1(a)&(b) - Mr. Jhulan Ch. Das,
Learned Advocate.
For the Proforma-Opp. Parties - Miss Nandita Mascharak,
Learned Advocate.
Date of Delivery of Judgment - 20.03.2015
J U D G M E N T
This case arises on the Complaint filed by Shri Jiban Sutradhar under Section 12 of the Consumers Protection Act.
2. The complaint filed against the Branch Manager of LICI, Udaipur Branch & the Divisional Manager of LICI, silchar Division , Assam. Shri Tapan Sutradhar and 3 others legal heirs were made proforma opposite parties in this case. Being the legal heir and nominee of the two policies opened by deceased Tulshi Sutradhar, who was a Group-D employee of the Tribal Rehabilitation Division, Udaipur, the complainant claimed the sum assured of Rs. 75,000/- which she opened vide policy No.493333763 dated 21.05.2011 and for an amount of Rs. 2,00,000/- opened vide another policy No.492698579 dated 14.08.2010. the policy holder Tulshi Sutradhar died on 19.04.2012. Accordingly, being the nominee of the deceased, petitioner demanded the two assured sum but the respondent Life Insurance Corporation of India, repudiated the claim of the petitioner on 29th January, 2014. So, this case filed for direction of this Consumer Forum to the LICI to pay the two assured sum and interest thereon along with the compensation for deficiency of service.
3. Respondent Life Insurance Corporation of India appeared and filed written statement denying the claim. It is stated in the written statement that the deceased suppressed the material fact at the time of opening the policy. She was on leave on medical ground on various occasions since 2008 & 2009 as she was suffering from illness but she suppressed it. So, for suppressing the material fact, the nominee i.e. the petitioner is not entitled to get the two assured sum and the compensation.
4. The complainant’s side then produced two original Insurance policy certificates, original proposal forms, claimant’s statement, claim enquiry report, medical opinion, certificates of hospital treatment, certificate of employer of the deceased with leave application & sanction order, prescription of Dr. Dipen Roy, medical certificate of illness, discharge certificate of deceased and letter of Divisional Manager. Complainant’s side also examined one witness i.e. the complainant himself as PW-1.
Respondent Life Insurance Corporation of India, on the other hand, also produced one witness namely Shri Rahul Deb, Branch Manager, LICI, Udaipur Branch as DW-1.
5. On the basis of rival contention we, now, will decide the following points:
(1) Whether predecessor of the nominee was guilty for suppressing the material fact and not entitled to get the compensation amount?
(2) Whether the complainant being the nominee of the policy holder and others being the legal heirs are entitled to get the assured sum and also any other amount for deficiency of service?
6. On the basis of evidence, we shall now decide the above 2(two) points.
FINDINGS & DECISIONS AND REASONS FOR DECISION ON
POINT NOS. 1
7. We have gone through the evidence given by both the parties and also the terms & condition of the two policy certificates. It is found that at the time of opening the policy, personal history is to be given by person in whose name the policy was opened. There is item where it is written that during the last 5 years the policy holder suffered from any illness requiring treatment for more than a week or ever been admitted to any hospital or nursing home for general checkup, observation, treatment or operation, or remained absent from place of work on ground of health during the last 5 years, or suffering from or ever suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System, or suffering from or ever suffered from diabetes Tuberculosis, High blood pressure, low blood pressure, Cancer, Epilepsy, Hernia, Hydrocele, leprosy or any other diseases. Policy of sum assured of Rs. 2,00,000/- was opened on 14.08.2010 and at that time, the policy holder Tulshi Sutradhar was 49 years old. Another policy of sum assured Rs.75,000/- was opened on 21.05.2011 and at that time, she was 50 years old.
The LICI produced the application for leave or for extension of leave on different dates from 2008 to 2009 filed by policy holder. It appears that on 2 dates i.e. on 12.07.2008 & 13.07.2008 she was on leave on the ground of family affairs. From 24.11.2008 to 12.12.2008 she was found on leave on the ground of marriage ceremony of her daughter. In the year, 2009 on different date she was found absent from duties on the ground of self illness. The type if illness not written in the application but it is found that commuted leave and earned leave was taken by her during that year. In the prescribed form, however, illness not mentioned by her. Whether the matter was brought before her knowledge at the time of opening the policy, not clear. She was a Group-‘D’ employee. The terms & condition of the policy not clarified to her. In the evidence, the complainant Jiban Sutradhar stated that he submitted all the necessary documents as required by the Insurance Co. but in spite of receipt of those documents, the assured sum of two polices were not released in his favour by them though his mother died on 19.04.2012.
Learned advocate for the complainant submitted that his mother was not aware about the type of disease and as usual, took the commuted leave and eared leave. The prescriptions produced by the complainant also disclosed nothing about any cardinal disease of lever disease or anything else.
Learned advocate for the Insurance Co., on the other hand, argued that as per decision of the National Consumer Dispute Redressal Commission published in R.P.No.4057/2006, R.P.No.1312/2006, F.A.No.242/2006, REVISION PETITION NO.2072 of 2008 in IV (2008) CPJ 109 (NC), Revision Petition No.692 of 2006 & Revision Petition No.982 of 2004, petitioner is not entitled to get any compensation for suppression of material fact and concealment to pre- diseases at the time of opening the policy.
8. We have gone through the decisions given by the National Commission. But in this case, there is nothing to show that the deceased willfully suppressed the material fact and given wrong information. The agent of the company did not clarify the questions to her. There is nothing to establish that the deceased Tulshi Sutradhar had willfully given wrong reply to the specific questions relating to her health. It is not established that she withheld the information willfully. After opening the policy also, she was not well aware about the type of disease which she had been suffering. Insurance policy is a contract the two parties. In such a case, the proposers are to clearly disclose all pros & cons to the party. It is to be proved that the declaration made is found to be false to the knowledge of the declarant. Only in such a case, the Insurance Co. can repudiate the claim of the petitioner. The deceased was on leave on many grounds. Sometimes on self illness, sometimes on family affairs and in one occasion on the ground of marriage ceremony of her daughter. When her serious illness was actually detected not clearly comes out. The Insurance Co. is to prove convincingly that she had been suffering from that illness before 2010. Only remaining absent from the duties is not sufficient to prove that she had been suffering from liver cerosis like disease before 2010. The Insurance Co. did not take step for examining the insured who was Group-D staff. So, we do not agree with the contention raised by the Learned Advocate for the Insurance Co.
The policy was opened in good faith. The policy holder was in firm behalf that she was well and good at the time of opening the policy. The serious illness was not detected at that time. Therefore, the policy certificates cannot be repudiated by the Insurance Co. on the ground of suppression of material fact. In this case, previous illness not proved by convincing evidence. Therefore, we all are of the opinion that the complainant being the nominee of two policy certificates of the deceased Tulshi Sutradhar is entitled to get the assured sum of Rs. 2,75,000/- (Rs. 2,00,000/- & Rs. 75,000/-).
9. The respondent Life Insurance Corporation of India, therefore, is directed to pay the assured sum of Rs. 2,75,000/- (Rs. 2,00,000/- & Rs. 75,000/-) of two polices to the nominee complainant who is to disburse the same to the other legal heirs. The Life Insurance Corporation of India is also directed to pay the interest over this amount from this date @ 9%, per annum, till payment is made. As there was some deficiency of service for late payment of the two assured sum, for that the complainant is entitled to get Rs.5,000/-, as compensation.
The Life Insurance Corporation of India Ltd. is directed to pay the amount to the petitioner nominee for disbursement of the same to other legal heirs equally.
10. The case stands disposed of accordingly.
11. Supply copy of this judgment to the parties at free of cost.
A N N O U N C E D
(Haridas Roy Barman) (Smti. Runu Das (Roy Choudhuri) (Asish Pal)
Member Member President
Consumer Dispute Redressal Consumer Dispute Redressal Consumer Dispute Redressal
Forum, Gomati District Forum, Gomati District Forum, Gomati District
Udaipur Udaipur Udaipur
