Smt. Jyotsna Chakraborty,

wife of late Balai Chakrabroty,

Village – Ramanathpur, P.O. Kumirmora,

District – Hooghly,

PIN – 712704.--------------------------------------------------------------- COMPLAINANT.

-          Versus   -

1.      The Senior Divisional Manager,

Life Insurance Corporation of India,

Howrah Divisional Officer,

Rallis Building, 16, Hare Street,

Kolkata – 700 001.

2.      The Zonal Manager,

L.I.C.I., Eastern Zonal Office,

Hindusthan Building,

4, Chittaranjan Avenue,

Kolkata – 700 072.

3.      The Branch Manager,

L.I.C.I., Jangipara Branch, P.O. Jangipara,

District – Hooghly,

PIN  – 712 404.-----------------------------------------------------OPPOSITE PARTIES.

                                                P    R    E     S    E    N     T

President     :     Shri T.K. Bhattacharya, M.A. LL.B. WBHJS.

Member      :      Shri P.K. Chatterjee.

Member       :     Smt. Jhumki Saha.

                                                 F  I   N   A    L       O   R   D    E     R

1.                  The instant case was filed by complainant U/S 12 of the C.P. Act, 1986

wherein the complainant, Jyotsna Chakraborty  has   prayed for direction upon the o.p., Life Insurance Corporation of Indian  to pay the claim amount of Rs. 1 lac together with interest @ Rs. 18% p.a. and to pay Rs. 50,000/- as compensation for mental agony and harassment together with litigation costs as the O.P. L.I.C.I. in spite of submission of proper claim form did not release the amount against the policy no. 436523999 dated 28-03-2005 initiated by her husband, Balai  Chakraborty, since deceased. 

2.                  The o.ps. insurance company  in their  written version contended interalia that

the complaint is not maintainable for lack of jurisdiction ; that the original policy holder suppressed his preexisting disease ; that the claim upto the Ombudsman has been repudiated. So the complaint should be dismissed forthwith.   

3.         Upon pleadings of both parties three  points arose for determination :

i)                    Whether the complaint is maintainable ?

ii)                  Is there any deficiency in service on the part of the O.Ps.  ?

            iii)       Whether the complainant is entitled to get any relief as prayed for ? 

DECISION  WITH   REASONS      :

POINT NO. 1

4.      In fact the argument for lack of jurisdiction is just an argument for argument’s

sake. This is because the O.P. no. 1 runs his business in Howrah though the head office is at Kolkata. It is immaterial if the policy was initiated under Jangipara Branch, Hooghly. Therefore, the instant case is well inconformity as per clause ( b ) sub-section ( 2 ) of  Section 11 of the  C.P. Act, 1986. The point is accordingly disposed of. 

POINT NOS. 2 & 3

5.      Both the points are  taken up together for consideration. The Life Insurance

Policy being no. 436523999 commenced on 28-03-2005 and was due to mature on 26-03-2021. The sum assured Rs. 1 lac and the mode of payment was quarterly. The policy holder Balai Chakraborty since deceased made regular payments till March, 2006 and failed to pay premiums of June, September and December, 2006. So the policy lapsed. Thereafter the policy holder approached the O.P. authority to revive the same. On being asked by the LICI Authority, the policy holder submitted the medical check up and ECG Report. On the basis of the same together with his personal statement regarding his health the policy was revived on 12-03-2007 after accepting the three defaulted quarterly premiums. Unfortunately the policy holder expired on 14-03-2007 i.e. after only two days of the revival of his lapsed policy. The Sr. Divisional Manager, L.I.C.I., Howrah Division, repudiated the claim of the complainant, the widow of the policy holder. She approached the Zonal Manager, Eastern  Zone, who ratified the order of the Sr. Divisional Manager without giving any opportunity of hearing to the complainant. She then approached the Ombudsman. But the situation remained unaltered.

6.      Now let us examine if the O.Ps. were justified in repudiating the claim of the

complainant. Keeping in our view that the cruel hands of death is always uncertain to human being, the death of the policy holder within two days of the revival of the lapsed policy, was just a normal incident to be an Act of  God. Not that the policy holder had any premonition of his death and so he ran from pillar to post to get his lapsed policy revived. If the O.Ps. are bent upon in repudiating the claim of the hapless widow on the plea that the policy holder suppressed his preexisting decease i.e., the heart problem, then we must hold that the L.I.C.I. Authority had the opportunity to get him medically checked- up by their own board of medical experts when the question of revival of his lapsed policy arose. On the contrary, they are putting blame on the deceased for alleged suppression of preexisting decease. How could we be unmindful that the purpose of insurance is to protect the insured against the losses resulting from the hazards beyond his control ?  

7.      Two pertinent anomalies are detected from the conduct of the O.P., L.I.C.I.

They are fixing their point of consideration from the date of revival of the lapsed policy i.e., 12-03-2007. This in fact makes no sense. As soon as the policy was revived by the O.P.  Authority, the policy gathered momentum and its force can be traced back since the date of its commencement i.e., 28-03-2005. To be precise, the policy was regularized enabling the policy holder to get the benefit of the contract entered upon.

8.      Secondly, the policy automatically lapsed for non-payment of three quarterly

premiums in a row. If the O.P. authority was to revive the policy condoning the delay and considering his financial stringency of the policy holder, the question of further medical check was just bogus and the conduct of the O.Ps. was definitely capricious. The Authority has the power to revive the policy of the willing policy holder by imposing a penalty. Order for further medical check-up was altogether redundant and harassing. 

9.      Arguably, if we assume that the policy holder never defaulted in paying the

premiums till his sudden death on 14-03-2007, what would have been the theory of repudiation ? Did the situation alter in favour of the nominees ? Should the O.P., L.I.C.I. Authority stick  to the same reasoning of preexisting decease ?  Or they would innovate a convenient theory which suits their purpose to repudiate. If the repudiation in identical cases is their predetermined view, the unfortunate nominees are helpless. They have no

where to go.   

10.    The O.P. Authority repudiated the claim on the ground of suppression of

material facts with respect to the health of the policy holder.  They attached much importance on the death certificate issued by Dr. Answar Ahmed Mallick who opined the cause of death was heart stroke. Though the  ECG report was normal, the doctor opined for definite disorder of heart.

11.   Now the question arises, his policy was revived on the basis of the ECG

report on 12-03-2007. Then how the same report stands in the way of clearance of the claim ? One cannot blow hot and cold in the same breath. All the excuses for repudiation are too fragile to merit acceptance. The policy holder was tolerably literate and did not have any understanding with the English language. The complainant is illiterate and put her L.T.I. in the claim form. It is, therefore, very easy to put a death nail in the coffin of the claim prayer. Had the  O.P.  Authority been a little bit sympathetic and considerate, the genuine claim of the complainant would not have been repudiated.

In the light of the above observations we arrive at the irresistible conclusion

that it is a fit case where the prayer of the complainant shall be allowed as we trace gross negligence and deficiency in service. Both the points are accordingly disposed of.  

      Hence,

O     R     D      E      R      E        D

      That the C. C. Case No. 41 of 2013 ( HDF 41 of 2013 )  be and the same is   allowed on contest with  costs  against  the O.Ps. 

      The O.Ps. be directed to pay the entire claim amount of Rs. 1 lac together with the interest @ Rs. 10% p.a. since January, 2011 till full payment against Policy no. 436523999 dated 28-03-2005  within 30 days from the date of this order.

      The o.ps. be further directed to pay compensation to the tune of Rs. 50,000/- for causing tremendous mental agony and unnecessary harassment to the complainant within 30 days from the date of this order

      The complainant is further entitled to a litigation cost of Rs. 10,000/- from the O.Ps. within 30 days from the date of this order.

      The complainant is  at liberty to put the decree into execution after expiry of the appeal period.

      Supply the copies of the order to the parties, as per rule.

DICTATED  &    CORRECTED

BY   ME.  

  (    T.K. Bhattacharya  )                                               (    T.K. Bhattacharya  )

  President,  C.D.R.F.,Howrah.                                   President, C.D.R.F.,Howrah.

 (  Jhumki Saha  )                                                              (  P. K. Chatterjee )

 Member, C.D.R.F.,Howrah.                                       Member,  C.D.R.F.,Howrah.