FINAL ORDER/JUDGEMENT
Presented by:-
Shri Debasish Bandyopadhyay, President.
Brief fact of this case:- This case has been filed U/s. 35 of the Consumer Protection Act, 2019 by the complainant stating that the op -1 to 3 engaged agent for convincing the public at large to sale the policy of said insurance business and claiming the public at large like husband of this complainant, that its insurance policy, plan and other benefits, return are the far better than the other insurance company and the husband of the complainant agreed take insurance policy from the ops through op -4 an agent of the op -1 to 3 and took two policies in the name and style LIC’s JEEVAN LABH and ADHAAR STAMBH after submitting the requisite documents to the ops through their agent i.e. op-4, the husband of the complainant got two policy being no.403168490 sum assurance of the death benefit of the said policy was Rs.1000000/- only on monthly payment of the premium of Rs.4804/- and policy no.136288818 sum assurance of the death benefit of the said policy was Rs.300000/- on yearly payment of the premium of Rs.11251/- in respect of the aforesaid two policies the husband of the complainant made nominee to this complainant and during the continuance of the aforesaid policy the husband of the complainant suddenly on 09.8.2019 lost his life of heart failure due to hypertension as was reflected in the death certificate issued by Doctor concerned dated 9.8.2020 and when this complainant become little bit steady rushed to the op-4 and intimated the death news of her husband and requested to theop-4 to do the needful initially for death claim of the said policies and on good faith the complainant handed over all the necessary documents relating to this policies to the op-4 and theop-4 filed up the claim form and other documents of the said policies and said to the complainant to sign the said paper and as per direction of the op-4 being a layman and though she has no knowledge of the procedure the complaint sign the claim form and other documents and handed over to the op-4.
The complainant started waiting eagerly for the response from the ops but unfortunately none of the ops came forward with any communication keeping the complainant in darkness about the fate of her claim and theop-2 finally sent a letter repudiating the claim under policy no.403168490 of the complainant vide letter dated 9.6.2020 on the ground of the suppression of material fact of the previous policies and finding no other alternative on 3.10.2020 sent a legal notice addressing to the op-1 through her ld. Advocate stating all the facts and requesting for this claim and the complainant started waiting eagerly for the response from the ops did not came forward with any communication keeping the complainant in darkness about the fate of her claim.
Complainant filed the complaint petition praying direction upon the opposite party to pay a sum of Rs1300000/- for claim with interest @10% p.a. w.e.f. 9.8.2019 and to pay a sum of Rs.500000/- towards compensation for deficiency in service and causing harassment, mental agony and anxiety and to pay a sum of Rs.20000/- for litigation cost.
Defense Case:- The opposite party No.4 contested the case by filing written version denying inter-alia all the material allegation as leveled against him and stated that the husband of the complainant agreed to take Insurance policies from theop-4 on behalf of the LICI namely LIC’s JEEVAN LABH and ADHAR STAMBH after submitting the requisite documents except suppressing the details of his all previous policies taken through other agents. Non disclosure of his previous policies attracted repudiation action against policy no.403168490 (DOC-28-8-2018) by the LICI and premium was refunded to claimant during Oct 2020 amounting Rs.62452/- as per the policy terms and condition and so far the policy no.136288818 (Date of commencement 08 Jun 2018) death of the policy holder occurred even after the grace period from first unpaid premium and nothing is payable to the next of kin of deceased policy holder as per policy terms and conditions which were briefed firmly to the policy holder by op-4 before purchasing the policy in question. Despite, reminder from the op-4 the policy holder did not pay the unpaid premium Rs.11251/- for the policy no.136288818 which was due on 08 Jun 2019 and after getting information of the unfortunate and sudden death of the policy Holder, OP -4 immediately came forward to help the next of kin of the deceased by taking to heart, for utmost held by preparing all the documents for death claim and submitted to the branch, i.e. op-3 for onward transmission to higher authorities.
The op-4 had nothing to do, rather approaching the higher authorities for necessary action at their end and steps were taken accordingly and terms and conditions the liabilities have been repudiated henceforth, by the Higher Authority with a view that the policy holder clearly deliberately and intentionally mislead compensation in terms of provision of section 45 of the Insurance Act 1938 and refunded the premium paid under the policy during Oct 2020 and theop-4 had maintained a constant touch with the complainant. The policy holder knowingly and deliberately suppressed the material facts and even did not disclose all about his previous policies with other agents, to op-4. It was evidenced that three other policies with sum assured Rs.1440000/- were in force on the life of the deceased before the captioned policy was taken. The total sum under consideration would have been Rs.2400000/- if those policies had been disclosed at the time of the proposal of policyno.403168490. That revised sum under consideration would have been attracted for special medical examination on the life concerned, and the underwriter would have taken a different call based on the risk assessed on the basis of all related report. Thus, suppression of previous insurance policies have seriously affected the decision making of the insurer, which was material in nature. The suppression of material facts which have had a impact on the granting of risk was intentionally done to mislead the insurer and thus repudiation action for all the liabilities decided in term of provision of section 45 of the insurance act 1938 for the policyno.403168490. However, a sum of Rs.62452 was refunded to the complainant during Oct 2020 which has been again suppressed by the complainant.
The opposite party Nos.1 to 3 contested the case by filing written version denying inter-alia all the material allegation as leveled against him and stated that instant complaint case is bad for mis-joinder of unnecessary party. The zonal Manager of Eastern Zonal office of the LIC of India has been made a party to this proceedings as theop-1 unnecessarily. The said authority is the internal administrative controlling authority over its subordinate offices of the op corporation throughout its eastern Zonal area. This authority has no concern in the matter of disposal of policy claim cases of policy holders. The zonal manager of Eastern zonal office of the LIC of India however acts as the Appellate Authority” if any aggrieved persons being dis-satisfied with any decision of the claim deciding authority appeals for review of such order. So the Zonal manager of any zonal appellate can not be a necessary party to such a proceeding. The op-1/ The Zonal manager Eastern Zonal office of LIC of India is therefore requires to be expunged from this proceedings.
The life assured the complainant since deceased, purchased two insurance policies on his life one of them by submitting the proposal form on 8.6.2017 bearing policyno.136288818 for a sum assured of Rs.300000/- only and its premium was payable yearly @Rs.11,251/- only. Monthly premium payable was @Rs.4804/- only for the other policy which was obtained by filing proposal form on 29.8.2018 in respect of policyno.403168490 for a sum assured amount of Rs.1000000/-only. The nomination in respect of both the aforesaid policies stand in the name of Smt. Tusi Dey, the wife of the Life Assured.
The complainant informed to the LIC’s Singur Branch by filing an application on 23.9.2019that since the life assured Gourhari Dey expired on 9.8.2019 so she applied for making payment of Death claim of 5 policies, in total of deceased person bearing policy no.401244291,403168490,400084394, 400083536 and 136288818. And out of the above five policies the op, LIC has duly made payment of the death claims of a net amount of Rs.420000/- for the policy no.400083536 a further net amount of Rs.1095872/- for the policy no.400084394 and a net amount of Rs.75000/- for the policy no.401244291. Al those payment were made on 28.5.2020 and so far as regards payment of death claims of the remaining two policies (out of the above five policies), nothing is payable under policy no.136288818 as risk cover ceased under the said policy due to non-payment of premium since it was the obligation on the part of the policy holder to keep the policy in force.
So far the claim under the remaining policy no.403168490 the same has been repudiated on the ground of “Suppression of Material Fact” as per provision of sec.45 of the Insurance Act, 1938, as amended in 2015. This decision has duly been communicated to the complainant by the present op-2. The Divisional Manager, LIC vide letter no.HDO/claims/Repdt/SING/20-21/3 dated.29.6.2020/ However, the premiums paid under this policy has been refunded for a net sum of Rs.62327/- by cheque no.0001255 dated.07.10.2020.
In connection with the above policy, the ops beg to draw the kind attention towards the answer given by the aforesaid proposer against question no.9 of the ‘Proposal Form’dated.29.8.018 which are described in the w/v.
The sum under consideration for Insurance on his life was Rs.1000000/- and accordingly only his medical report was called for as per rules of the underwriting whereas in the proposal Form dated.08.06.2017 in connection with the policy no.136288818 the proposer furnished particulars of his five policy numbers.
The ops beg to submit here that the ‘Sum under consideration has given great bearing on the granting of Insurance. Had he disclosed his other policies against question no.9 in the proposal form, the sum under consideration would have increased to Rs.2440000/-. And in that case other special reports would have been called for. It has therefore affected the underwriting. In support of the above submissions, the ops beg to refer the verdict of the Hon’ble Supreme Court passed on April 24, 2019 in Civil Appeal No.4261 of 2019 between “Reliance life Insurance Co. Ltd, Vs. Rekhaben Nareshbhai Rathod.”
Issues/points for consideration
On the basis of the pleading of the parties, the District Commission for the interest of proper and complete adjudication of this case is going to adopt the following points for consideration:-
- Whether the complainant is the consumer of the opposite parties or not?
- Whether this Forum/ Commission has territorial/pecuniary jurisdiction to entertain and try the case?
- Is there any cause of action for filing this case by the complainant?
- Whether there is any deficiency of service on the part of the opposite parties?
- Whether the complainant is entitled to get relief which has been prayed by the complainant in this case or not?
Evidence on record
The complainant filed evidence on affidavit which is nothing but replica of complaint petition and supports the averments of the complainant in the complaint petition and denial of the written version of the opposite parties.
The answering opposite party filed evidence on affidavit which transpires the averments of the written version and so it is needless to discuss.
Argument highlighted by the ld. Lawyers of the parties
Complainant and opposite party filed written notes of argument. As per BNA the evidence on affidavit and written notes of argument of both sides are to be taken into consideration for passing final order.
Argument as advanced by the agents of the complainant and the opposite party heard in full. In course of argument ld. Lawyers of both sides have given emphasis on evidence and document produced by parties.
DECISIONS WITH REASONS
All the issues/ points of consideration adopted in this case are clubbed together and taken up for consideration jointly as because the questions involved in these points of consideration are interlinked and/ or interconnected with one another.
For the purpose of arriving at just and proper decision in respect of the above noted points of consideration this District Commission after going through the evidence on affidavit filed by both sides along with interrogatories and their reply submitted by the parties and also after examining the documents filed by the both sides finds that the complainant has submitted her claim in respect of two policies in the matter of death benefits of her husband Late Gourhari Dey but after going through the evidence on record it is revealed that the husband of complainant had more than two LIC policies before the op nos. 1 to 3 but it has been totally suppressed by the complainant before the District Commission. More so op nos. 1 to 3 also have disbursed the claim of other four policies in favour of the complainant. This suppressing of vital fact is clearly indicating that the complainant has not come before this District Commission in clean hand and this factor is clearly depicting that the complainant is not entitled to get any equitable relief from this case.
Moreover, the complainant has also suppressed the fact that the ops have returned the premium of above noted two policies amounting to Rs. 62,452/-. This fact has also been suppressed by the complainant before this District Commission. This matter is also highlighting that the complainant is violated the rule of equity and so she is not entitled to get any equitable relief in this case.
Moreso, in this case the complainant has impleaded the Zonal Manager of Eastern Zonal office of LIC of India as a party in this case but the Zonal Manager of Eastern Zonal office of LIC of India is not a necessary party as because this Zonal Manager used to look after the administrative functions of the LIC of India and the Zonal Manager also equipped with the power of “Appellant Authority”. As the Zonal Manager of Eastern Zonal office of LIC of India is not a necessary party, this instant case is also bad for defect of parties.
Moreover, the provision of Section 45 of the Insurance Act, 1938 is clearly indicating that the claim of the claimant is also barred by law. As per order of Hon’ble Apex Court passed in Civil Appeal No.4261 of 2019 in the case of “Reliance life Insurance Co. Ltd, Vs. Rekhaben Nareshbhai Rathod” this case is also not maintainable.
A cumulative consideration of the above noted discussion goes to show that this case is not maintainable and it is bad in law and it is against the principle of equity and law of equity. So, all the points of consideration adopted in this case are decided against the complainant.
In the result it is accordingly
ordered
that the complaint case being no. 84 of 2020 be and the same is dismissed on contest.
Let a plain copy of this order be supplied free of cost to the parties/their ld. Advocates/Agents on record by hand under proper acknowledgement/ sent by ordinary post for information and necessary action.
The Final Order will be available in the following website www.confonet.nic.in.
