DATE OF DISPOSAL: 03.08.2023

PER:   SRI SATISH KUMAR PANIGRAHI, PRESIDENT:

The fact of the case in brief is that the  complainant has filed this consumer complaint Under Section 12 of the Consumer Protection Act, 1986, alleging deficiency in service against the Opposite Parties  (in short the O.Ps ) and for redressal of her grievance before this Commission.

2. The complainant’s mother late Nirmala Kumari Sahu during her life time had insured here life before O.P.No.1 for assured sum of Rs.5,00,000/- (five Lakhs) vide policy No. 573606032 on 27.03.2012. Accordingly policy bond was issued in favour of complainant’s mother. As per the practice norms prevailed in the agency circle of the Insurance sector of O.P.No.1, the agents usually filled up the proposal forms at the time of submission and the applicants insured’s simply put signature on the proposal form as per instructions of agent. The O.P.No.2 filled up the proposal form and complainant’s mother simply put her signature and later the same was submitted in the office of O.P.No.1. The complainant’s mother suddenly expired on 14.03.2015. After her death complainant being her only daughter and successor submitted application claiming the sum assured. But the O.P.No.1 vide letter dated 30.08.2015 without assigning valid reasons repudiated their liability simply stating that the proposer had withheld material information regarding her death at the time of submission of proposal forms, which is not at all correct. Her mother (the insured) was working as a Government teacher and retired as Head Mistress of Govt. Girls High School. Although her life she was healthy and she had never suffered from any type of chronic disease, even the doctor of the O.P.No.1 had also opined that complainant’s mother was having good health and free from any chronic disease. So in view of the same question of suppression of material facts by the insured, does not arise. Even during the time of effecting policy, complainant’s mother had undergone medical check-up by the recognized doctor of O.P.No.1 and the said doctor had also opined that complainant’s mother was in good health. So repudiation of claim is nothing but illogical one basing on flimsy ground. The complainant in order to get back the assured sum, issued letter to O.P.No.1, so also to the Zonal Manager of LIC at Patna claiming the assured amount. The complainant also through his advocate issued notice on dated 01.12.2015 to O.P.No.1 claiming assured amount. But the said attempt did not yield any result.  The O.P. No.1 simply declined to consider the claim in proper perspective, rather only to harass and to cause prejudice to complainant, O.P. repudiated the claim of complainant. However, the O.P. refunded the premium amount of Rs.1,40,000/- already deposited. Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.P.No.1 to make payment of sum assured along with interest, compensation of Rs.20,000/- and litigation cost of Rs.10,000/- in the best interest of justice.   

3. The O.P. No.1 contended that the allegations made in the complaint petition against the O.Ps are baseless, illegal, not convinced and not sustainable in the eyes of law.  The present complaint is baseless and flagrant abuse of process of law aimed to harass and blackmail above answering O.Ps. The complaint is bad for non-joinder of necessary party and is liable to be dismissed. The complainants mother late Nirmala Kumari Sahu during her life time had insured her life before the LIC of India for an amount of Rs.5,00,000/- vide policy No. 573606032 and the said policy was issued for a sum assured of Rs.5,00,000/- on the life of late Nirmala Kumari Sahu from LIC of India C.B.O. II Branch. It is not a facet that proposal forms are being filled up by the agent and the insured only puts his/her signatures. The insured might have sought assistance in filling the proposal form and the agent must have extended his support. It is not true the mother of the complainant has expired suddenly on dated 14.03.2015. As per the treatment papers available with this O.P. No.1, she was under treatment for Hypertension, Type 2 DM and chronic liver disease since 10-15 years from her death. On the basis of suppression of material facts of her ill health, the claim under the aforesaid policy has been repudiated and the same was conveyed to the complainant on dated 30.08.2015. All the averments made therein the complaint are baseless, wrong and is emphatically denied. The complainant is not entitled to any relief whatsoever and is not entitled, to claim and recover anything from the answering O.P. in the light of what is stated above. The complaint is not maintainable and is beyond the jurisdiction of this Hon’ble court and is liable to be dismissed summarily. Hence the O.P.No.1 prayed to dismiss the complaint with exemplary cost in the interest of justice.

4. The O.P.No.2 stated that the allegations and averments made in the complaint petition are not all true and correct as such denied therein. The complainant is required to strict proof of those allegations which are not specifically admitted herein and deemed to have been denied. The complainant’s mother Nirmala Kumari Sahu during her life time had insured here life before the O.P.No.1 vide policy No. 573606032 is true and correct and is admitted by the O.P.No.2 but the allegation that the O.P.No.2 as the agent to the aforesaid policy has filled up the proposal form and thereby simply put the signature of the policy holder is false and this complainant has unnecessary dragged this O.P.No.2 to this case. The agent of the insurance company has been appointed in order to inform the customers regarding various proposals and schemes of the insurance company and after satisfaction with the proposals, the customer with fulfilling all the necessary formalities can have the insurance policy and will be insured accordingly. The O.P.No.2 as an agent has filled all the information as per the saying of the insured and accordingly has submitted the proposal form with the Insurance Company i.e. O.P.No.1. Therefore, this O.P.No.2 has no role to play herewith this case. The complainant has submitted all the papers and documents by collecting all the papers and documents by collecting all the material information received from the insured policy holder at the time of the opening of the policy. Therefore this O.P.No.2 denied all those allegations and the complainant is to put to strict proof of the same. Regarding medical checkup of the insured policy holder and as per the report of the Doctor’s of the O.P.No.1 the policy has been opened, thereby the O.P.No.2 is no way relates in the same allegation. The O.P.No.2 as the agent of the O.P.No.1 is no way related to disburse of the claim amount as claimed by the complainant, as because he as per the principles and provision of Insurance law has filled up all the information by gathering the information from the insured and medical checkup report and after fulfilling all the necessary formalities have putted the signature of the insured and accordingly the policy has been issued in here favour and hence it is not the duty of the O.P;No.2 to disburse the insurance claim and thereby he is not liable for the same in any corner. Hence the O.P.No.2 prays to reject the complaint petition of the complainant by dismissing the proceeding in the interest of justice.  

5. Since long time both the parties are not attending the Commission and also not taken any steps to proceed in the case. Hence the Commission in view of the statutory provision of the Consumer Protection Act wishes to dispose of the instant case on Merit. We perused the complaint petition, written version and written argument and the materials placed on it and have also thoughtfully considered the same in interest of the justice.

6. In view of the above circumstances, the issues pertaining to the case is whether the complainant is entitled to get sum insured? The op no.1 admitted in its written version that, they have already returned all the premiums of the policy no.: 573606032 to the claimant. The op no.1 is also admitted the fact submitted by the complainant in his complaint regarding the medical check-up conducted by their Medical Examiner and as per medical examiner confidential report, the Op no.1 have considered the proposal issued the policy in favour of the complainant. The other questions raised by the Op no.1 in his written version are not relevant and also not mentioned in the proposal form. The questions in the proposal form under the Personal History clause are very limited.  The LA has provided all information as questioned by the Medical Examiner of the op no.1 which was also recorded under the ‘Personal History’ clause and question no.10 onwards of the Proposal Form which was sealed and signed by the Medical Examiner. Further, the op no.1 has not filed any corroborative documents in support of the evidence on affidavit adduced at para 10 by the representative of the OP no.1. The op no.2 corroborated the complaint and admitted in his written version that, he has filled up the proposal form and thereafter the policy was issued by the op no.1 in favour of the complainant.

6. On foregoing discussion, in our considered view the op no.1 has issued the policy in favour of the LA after getting confirmation from all corners and assured the LA in terms of policy contract. It tantamount that, the op no.1 has issued said policy after full and final satisfaction of clauses required to issue a life insurance policy to the LA Nirmala Kumari Sahu. Therefore, the OP no.1 is liable to pay the life assured amount to the nominee. Hence there is deficiency in service rendered by the op no.1 by repudiating the claim made by the nominee violating their own assured contract policy. The O.P.No.2 is acting as an agent and done on behest of the OP no.1’s interest. As such we are fixing the liability against O.P.No.1 only.

              7.  We rely the principles laid down by the Hon’ble National Commission that “Once proposal is accepted and policy is issued LIC is liable for payment of claim” 2011 (4) C.P.R LIC of India verses Prabhasa Ranjan Nayak. Further Hon’ble National Commission, New Delhi in Life Insurance Corporation of India versus Pariapally Sujatha & ors 2009 (4) CPR 326 held that, “Death claim cannot be repudiated by LIC without any tangible evidence”.

            In the light of the above principles of law, we allow the case on contest in the interest of the justice.

            In the result, the complainants’ case is allowed against O.P.No.1 and dismissed against O.P.No.2. The O.P.No.1 is directed to pay the sum assured of DLA Nirmala Kumari Sahu in Policy No. 573606032 with interest at the rate of 6% per annum from the date of filling of the case i.e., 15.12.2016 to the nominee/complainant together with pay litigation cost of Rs.10,000/- to the complainant within 45 days of receipt of this order. In the event of non-compliance of the Order, the Complainant is at liberty to recover the entire dues at the rate of 12% interest per annum till its actual date of realisation and rights to take appropriate steps in accordance to the Consumer Protection Act, 2019.

This case is disposed of accordingly.

 The Judgment be uploaded on the www.confonet.nic.in for the perusal of the parties.

A certified copy of this Judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986. A copy of this order be also sent to the Secretary, State Consumer Disputes Redressal Commission, Odisha, Cuttack for information.

The file is to be consigned to the record room along with a copy of this Judgment.

Pronounced on 03.08.2023