Orissa

Cuttak

CC/81/2014

Smt Mohini Nayak - Complainant(s)

Versus

The Zonal Manager,LIC of India - Opp.Party(s)

S K Mohanty

28 Nov 2015

ORDER

OFFICE OF DISTRICT CONSUMER DISPUTES REDRESAL FORUM:CUTTACK.

                                                                      C.C. No.81 of 2014

 

Present:               Sri B.K.Das,President.

 Sri Pitabas Mohanty,Member.

 

Smt. Mohini Nayak,

At:Padmapur,(Kiamundi), PO:Olara,

Via:Borikina,Dist:Jagatsinghpur.                                               … Complainant.

 

                                Vrs.

 

1. The Zonal Manager,

L.I.C of India,East Central Zonal Office,

Jeevan Deep Building,6^th Floor,

Exhibition Road, Patna-800001.

 

2. The Sr. Divisional Manager,

L.I.C of India,Cuttack Divisional Office,

“Jeevan Prakash”,Post Box No.36,Cuttack.

 

3. The Branch Manager,

L.I.C of India,Paradeep Branch Office,

At/PO/PS:Paradeep Port,

Dist:Jagatsinghpur.                                                       … Opp. Parties.

   

                                                                                                ORDER

Sri Pitabas Mohanty,Member.

                Deficiency in insurance service is the grievance of the petitioner.

                The facts as stated by the petitioner in the complaint petition shortly are that the petitioner is the legal married wife of Late Narayan Ch. Nayak who had availed a policy from the O.Ps bearing policy No.588378852 valid from 28.10.2009 to 28.10.2017.  During subsistence of the policy though the husband of the petitioner was paying the premium regularly through the L.I.C agent Tapan Kumar Samant but due to financial stringency the husband of petitioner became defaulter.  Subsequently after development of the financial position the husband of the petitioner not only had paid the defaulted premium amount along with interest on 15.5.2012 but also has submitted the declaration of good health through the L.I.C Agent Tapan Kumar Mohapatra for revival of the policy bearing No.588378852 In the mean time the husband of the petitioner faced an accident on 3.6.3012 and though admitted in the Aswini Hospital at Cuttack on 4.6.20132 for treatment but dies on 12.6.2012.  Owing to such unexpected situation the petitioner immediately informed the L.I.C agent as well as the Branch Manager (O.P No.3) and requested for payment of the full insured amount.  Due to non-receipt of the insurance claim the petitioner made a representation to Zonal Manager (O.P No.1) on 10.10.2013.  In the mean time as against the letter dt.5.11.2012 from the side of O.P No.3 the petitioner had submitted all relevant documents for settlement of Insurance claim.  Thereafter the petitioner received a letter dt.11.9.13 from the Divisional Manager, L.I.C, (O.P No.2) wherein it is stated that though the policy was revived on 11.6.12 but the life assured was not in good health on 11.6.2012 since due to road accident on 3.6.20-12 the life assured was admitted in Aswini Hospital from 4.6.12 to 12.6.12 which clearly go to establish that on 11.6.12 the life assured was not in good health.  As against the letter of O.P No.2, the petitioner sent legal notice on 23.12.13 to all the O.Ps stating that prior to death of her husband the defaulted amount along with interest has already been paid on 15.5.12 to the L.I.C. agent Tapan Ku. Mohapatra.  Hence, there was no suppression of material facts in the declaration.  Thereafter the petitioner received an A/C payee cheque amounting to Rs.6,60,091/- bearing No.173826 in favour of the petitioner drawn on IDVI,Paradeep towards settlement of insurance claim since the O.P No.2(Sr. Divisional Manager) in repudiating the whole insured value has allowed only paid up value along with bonus and refund of revival amount which has been intimated to the petitioner by O.P No.2 through R.P. letter dt.17.1.2014.  It is alleged by the petitioner that such settlement of insurance claim is illegal and arbitrary since the O.Ps have deducted Rs.7,00,000/- from the insured value.  Accordingly  finding no other way the petitioner has filed the present dispute against the O.Ps with the prayer to direct the O.Ps to pay Rs.7,00,000/- towards balance insurance amount along with Rs.50,000/- as interest along with Rs.5000/- as cost and Rs.5000/- as compensation.

After appearance the O.Ps have filed the written version wherein the O.Ps have taken the following pleas:

Though the husband of the petitioner was a policy holder bearing policy No.588378852 for a sum assured of Rs.10,00,000/- with date of commencement dt.28.10.2009 and yearly premium of Rs.1,98,989/- but the policy was lapsed for non-payment of premium due on 10/2011 and revived on 11.6.2012 with payment of arrear premium with interest and personal statement regarding Health on form No.680.

Further the agent does not have authority to accept renewal premium for which the L.I.C of India is no way responsible to pay the claim in case it is proved that the premium was paid to agent in view of the observation of Hon’ble Supreme Court reported in AIR 1997-SC-2459(Harshad J Shah Vrs. L.I.C of India).

In addition to it the O.Ps have taken the stand wherein it is stated that the petitioner is no way entitled for full insured value since it is undisputedly established that on 11.6.2012 the life assured(husband of the petitioner) after accident on 3.6.2012 was admitted in the Aswini Hospital from 4..6.2012 to 12.6.2012 as well as died on 12..6.12.  Accordingly the O.Ps have decided to allow the insurance claim of the petitioner with paid up value as on or before revival of the policy plus guaranteed addition and refund of revival amount an ex-gratia basis which which comes to Rs.6,60,091/- on the ground of suppression of material information and the settlement amount has been paid to the petitioner vide cheque No.173826 dt.31.3.2014.  In this context the O.Ps have placed reliance on the observation of Hon’ble National Commission reported in 1(2006)CPJ-78 (N.C) 11(2006) CPJ-86N.C, R.P No.85/2007-N.C.  As such according to O.Ps the dispute is liable to be dismissed.

In view of the above observation and counter assertions we are inclined to decide the present dispute as per our observation below:

1. Admittedly the husband of the petitioner is a policy holder bearing policy No.588378852 which was lapsed due to non-payment of premium.  Subsequently the husband of the petitioner had paid the defaulted premium with interest to the agent Tapan Kumar Samanta along with declaration of good ohealth for revival of the lapsed policy on 15.5.2012.  In such situation we are constrained to hold that payment of defaulted premium to LIC Agent for revival of policy is not tenable in the eye of law in view of the observation of Hon’ble Supreme Court reported in 1997(20CLT-264(Harshad J Shah and another Vrs. L.I.C of India and others.).
2. Moreover though it is stated by the petitioner that the husband of the petitioner has paid the defaulted premium to the L.I.C agent on 15.5.2012 for revival of the lapsed policy but there is no documentary evidence to this effect to establish that the defaulted premium has been paid to the agent on 15.5.12.  Accordingly in absence of any evidence we are not inclined to accept such contention of the petitioner as per observation of Hon’ble National Commission reported in 2008(1) CPR-1-N.C(Mathura Mahto Mistry Vs. Dr. Binod Shwa Jha & another) wherein it is held that

1. “disposing of complaint simply on pleading without directing the parties to file evidence by way of affidavit is illegal on the face of it.”

                In view of the above observation from our side vide para-A & B we are bound to accept the stand taken by O.Ps. that though the lapsed has been revived on 11.6.2012 but on the alleged date, after accident on  3.6.2012 the husband of the petitioner was admitted in the Aswini Hospital from 4.6.2012 to 12.6.2012 and died on 12.6.2012.  As such the declaration regarding good health at the time of revival of policy which has been filed vide Annex-4/1 series is incorrect for which without allowing the full insured value the O.Ps have allowed as per provision contained section 45 of Insurance Act,1938 the insurance claim of the petitioner only the paid up value as on before revival of the policy plus guaranteed addition and refund of the revival amount on ex-gratia basis amounting to Rs.6,60,091/-

Accordingly for the reasons recorded above, it is clear that law on the point conclusively in O.Ps favour for which the present dispute merits dismissal.

                                                                                              ORDER

                                The dispute is dismissed on contest.  No cost.

Pronounced by the Hon’ble Member in open Court on this the 28^th day of November,2015 under the seal and signature of this Forum.

I agree

                                                                                                                       

(Sri Bijay Kumar Das)                                                                              (Sri Pitabas Mohanty)

        President.                                                                                               Member.