West Bengal

Paschim Midnapore

CC/5/2012

Sri Haradhan Bhowmik - Complainant(s)

Versus

The Manager, LICI - Opp.Party(s)

31 Jul 2012

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

 

 Complaint case No.05/2012                                                         Date of disposal: 31/07/2012                               

 BEFORE : THE HON’BLE PRESIDENT :  Mr. K. S. Samajder.

                                                      MEMBER :  Mrs. Debi Sengupta.

                                                      MEMBER :  Mr. Kapot Chattopadhyay.

 

    For the Complainant/Petitioner/Plaintiff: Mr. B. Das.

    For the Defendant/O.P.S.                          : Mr. D.  Ghosh.

             Sri Haradhan Bhowmik, S/o-Late Shyamapada Bhowmik of Vill-Singerpur, P.O.-

             Saintal, P.S.-Debra, Dist-Paschim Medinipur………Complainant.

                                                              Vs.

1. The  Manager, LICI, Kharagpur Branch at Inda, P.O.-Kharagpur, Dist-Paschim Medinipur
2. The Sr. Div. Manager, LICI, at Inda, P.O.-Kharagpur, Dist-Paschim Medinipur ………………Ops.

The case of the complainant, in brief, is as follows:-

On 28/2/2009 the insured Barnali Bhunia purchased a policy from the LICI bearing policy No.498730878.  The sum assured was Rs.1, 50,000/-.  The said Barnali died on 29/12/2009.  The policy was for life coverage of the insured.  The present complainant Haradhan Bhowmik is the nominee of Barnali. After she died, the complainant made claim of policy amount of the insured amount to the Ops but the Ops repudiated the claim of the complainant on the ground of furnishing false information regarding educational qualification of the insured in the application for policy.  Therefore, the complainant stated that the services of the Ops are deficient and the complainant is entitled to get the sum assured alongwith other claims.

    The Ops contested the case by filing a W/O. The Ops admitted the purchase of insurance policy by the insured covering life and that the sum assured was Rs.1, 50,000/-.  But the Ops contended that in the application for proposal for policy the insured mentioned her qualification to the effect that she read up to class-VIII although, the qualification of the insured was up to Class VII standard.  The Ops further contended that as per guide line of the LICI on life coverage policy, self-employed married woman not filing income tax return is entitled to

Contd…………..P/2

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policy for a maximum sum of  Rs.1,00,000/- if illiterate or educated up to viii standard.  Since the insured Barnali read up to Class vii, there was suppression of material fact for the purpose of obtaining policy for a higher amount and if the actual qualification was mentioned in the proposal form the Ops would not have accepted the proposal and issued the policy for a sum assured for Rs.1,50,000/-.  Therefore, the Ops repudiated the claim and as such the complainant is not entitled to get the relief.

It is now for our consideration as to whether the complainant is entitled to get the relief.

Decisions with reasons:

Admittedly, the insured Barnali, since deceased, purchased a policy of Rs.1, 50,000/- on 28/2/2009.  It is also admitted in this case that the educational qualification of Barnali who was a self-employed woman having annual income of Rs.50, 000/- as per her information furnished in the proposal form, was up to Class vii standard.  But the case record shows that in the school certificate the qualification of Barnali has been mentioned as that she was reading in Class viiii.  The Ops have filed the copy of the said certificate.  It shows therefrom that by way of interpolation in the school certificate the qualification of Barnali has been written as viiii whereas the admitted position is that the insured read up to Class vii.  The guidelines relating to policy of LICI have been filed by the Ops and from those guidelines under Clause-B i.e. with own income of married woman under category iii, the maximum sum assured may cover equal to seven times of average annual income subject to an upper ceiling of Rs.1,000,00/- if illiterate or educated up to 8^th standard.

  Therefore, in the present case the maximum coverage that was allowable to the insured was Rs.1,00,000/-.  But showing the qualification as was reading in Class VIII, the insured purchased the policy for Rs.1, 50,000/- whereas she was allowed to a maximum amount of Rs.1, 00,000/- because of the admitted fact that she read up to Class vii.

      In this case, the Ops have clearly stated in their W/O that they would not have accepted the proposal and issued policy for a sum assured of Rs.1,50,000/- had the insured properly disclosed her actual qualification.  The Ops contended that the suppression was regarding the material fact touching the entitlement of maximum amount of insurance.

      In this case, it is not disputed that in very quick succession the insured Barnali purchased three policies including the present policy and after some months of such purchase she died.  In fact, from 28/02/2009 to 13/04/2009 Barnali purchased three policies.  The said Barnali died on 29/12/2009.  This fact is quite suspicious in nature as within a few months of such purchase Barnali died.  If we keep side by side this fact alongwith the fact of showing higher qualification in the school certificate by of interpolation, there should not be any least hesitation to say that the higher qualification was shown with a view to have a policy of an

Contd…………..P/3

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amount which is quite higher than the entitlement.  We find that the suppression of qualification was a material fact and the Ops would not have issued the policy for an amount of Rs.1, 50,000/- had the actual qualification would nave been mentioned.  Therefore, we do not find anything wrong in the act of repudiation of claim by the Ops and we are constrained to hold that the claim of the complainant is not sustainable. Accordingly the claim case filed by the complainant be dismissed.

Dic. & Corrected by me

                                                         I agree               I agree                      

              

         President                                Member             Member                      President

                                                                                                                 District Forum

                                                                                                              Paschim Medinipur.