Bihar

Muzaffarpur

CC/90/2015

Sammi Sinha, - Complainant(s)

Versus

Branch Manager, Life Insurance Corporation Of India & Ors. - Opp.Party(s)

Sri Amaresh Kumar, Smt. Poornima Kumari & Vinod Kumar Jha

20 Jan 2016

ORDER

                                               District Consumer Forum, Muzaffarpur

          Complain Case No. –90/2015

  Sammi Sinha,   W/o Late -  Jayant Kumar  Shrivastav R/o- Village- Dumari,  East of   Mahavir Sthan Chowk   , Gobarsahi Road, P.S- Sadar, Distsrict-       Muzaffarpur  ……………………………………………………….Complainants 

V/s

1. Branch Manager,  Life Insurance Corporation of India, Branch Office Jivan Jyoti Building , Umashankar Prasad Marg,  in front of Devi Madir , P.S- Mithanpura, district Muzaffapur
2.  Senior  Divisional Manager, LIC Ltd. Regional Office Jeevan Prakash Building , Umashankar Prasad Marg, Devi Mandir in front , P.S- Mithanpura, District- Muzaffarpur  
3. Area Manager, Life Insurance Corporation Ltd.  Jivandip Building, Middle East Area Office, Exhibition Road  Patna- 800001………………………………….................…opposite parties.

Date of order- 20-01-2016

                                                                                                  Present.

1. Shri Govind Prasad Singh

                                                                                                                        President,

       Consumer Forum Muzaffarpur

2.  Smt. Archana Singh

      Member

       Consumer Forum Muzaffarpur

For complainants-  Sri Amaresh Kumar,  Smt.  Pornima Kumari  and Vinod Kumar 

   Jha – advocates

For opposite party-   Sri- Dinesh Kumar  Tripathi

Order

           

            The complainant has filed her case of claim of Rs. 2,85,000/- on 14-05-2015 against  the opposite party arises from the policy purchased  in the name of her husband  who is no more.    

            The case of complainant appears from his complaint petition supported with an affidavit that her husband purchased insurance policy from the opposite party at the instant of LIC agent Bearing no.- 539771768 for Rs. 1,25,000/- the period was up to 28-03-2011. The husband of the complainant  has deposited the policy premium in time all of a sudden on 20-08-2012 he feels  pain in his chest, he was hospitalized  and during  treatment  he was died  on 23-08-2012 in Bhawani Hospital research  institute,  power house chowk, Muzaffarpur as such the opposite party was informed and submitted  the claim she was dragged for payment of claim under the assurance that it will be paid  at the earliest but on 20-02-2014 her claim was refused. Her husband has never suppressed  any fact at the time of taking policy the agent of opposite party has  got his signature at the policy  application. The opposite party has not taken any age proof certificate at the time of issue the policy because  it was found  mention in his previous  policy. As such the husband of complainant has no any malice intension to not give age proof. He had never suppressed any material fact. By not paying the claim of complainant  the discrepancy arises against  the opposite party as such she has filed her case of claim of Rs. 2,85,000/- including the policy sum Rs. 1,25,000/- and damages Rs. 50,000/- physical, mental, harassment  Rs. 50,000/- and other financial harassment  Rs. 50,000/- with litigation cost.

             

            The complainant  has filed letter dated 17-02-2014 issued by Divisional Office of opposite party at Muzaffarpur and the status report of policy NO.- 53971768 June-2014 from which it appears that age proof mention as  previous policy.

            In this case opposite party appeared and has filed written statement supported with an affidavit on 08-10-2015 alleging therein that the complainant has got no cause of action or right to sue to file this case against this opposite parties. He has further alleged that the said policy was taken by the her husband with ill motive and mala fide intention  by suppressing the current  previous policy in proposal form and  there is no comment against the other  allegations of these paragraphs. The husband of the complainant  had 4 policies in which the claim was paid on 22-05-2013 against the policy No.- 535340992 and the claim of policy No.- 534778271 was admitted (payable at maturity)  on 07-05-2013 plan 90.  Further the claim of policy No.- 538498499 was paid of 26-03-2014 and further the claim of policy No.- 537482740 was admitted (payable at maturity) on 07-05-2013 plan 90  and although the claim were settled in May, 2013 except policy No.- 538498499 since present  policy was under investigation  decision has taken and repudiated the claim on 17-02-2014. The claim of this policy was repudiated as the disease has not mentioned the mandatory provision of column – 9 of proposal form and has suppressed the previous policies and it  had already intimated to the claimant in the repudiation letter that  if the claimant is not satisfied with the decision of repudiation, she May  file appeal to Zonal office of LIC Patna. Being   educated persons he had must would be  read and convinced with the full question of proposal. He has further alleged if the policy holder had declared the previous policy, the  medical report was required and proposal was under the  jurisdiction of divisional office claim  section where after proper verification decision would have to be taken, therefore it is a matter of total concealment. He has further alleged that it is necessary to mention that it is mandatory rule of LIC India that if any person  purchased a new policy and he also purchased  earlier policy within 2 years then the recent proposal  will be  accepted after submission of required documents and medical  report as demanded  by the branch, concerned as such the diseased  did not mention in claim proposal form  under column -9 and the claim of complainant was repudiated on the basis of concealment of previous policy and she was intimated if not satisfied then she may have filed before Zonal office but she has not filed any appeal to Zonal Office hence on the aforesaid  ground the claim of complainant  is liable to be dismissed.

            The opposite party has filed certified plain copy of application form for purchase of new policy endorsed the para-9 of the form which was mandatory.

            Considering the facts, circumstances, material available with the record as well as allegation of the respective parties all facts is admitted by the opposite party. The policy is also admitted  only the claim was repudiated  on the ground of concealment of fact regarding the previous policy as  he had previous four policies,  out of whom claim two policy were settled. Now the question only arises before us for adjudication  that whether the mandatory provision  alleged by the opposite party connected with para-9 of proposal form is mandatory for all or only for claimant?  in this regard in our believe it is sufficient to say as per natural justice in our believe  the alleged mandatory provision  if available will be effective to all concerned. When the opposite party has accepted his proposal form and issued the new policy no. after taking the premium, hence the mandatory provision may have not considered by the opposite party itself, how he is claiming that it is mandatory for the claimant,  the reason best known to them, as such in our believe if the mandatory  provision  was surpassed by the opposite party itself then it has no matter of any objection and repudiation of claim of complainant on this ground is baseless, malafide and with ulterior motive, as such the objection raised by the  opposite party has no effect  in eye of law as well as fact, accordingly  considered the all facts and scrutiny   the material we are of the opinion that the complainant is found able to prove  that case and is entitle to get her claim as prayed for.

            Accordingly  the case is allowed and the opposite party directed to pay  insured sum Rs. 1,25,000/- with interest @ 8% from the  death of  her husband of the complainant  insurer  opposite party is further directed to pay Rs. 30,000/- for mental, physical, harassment   and Rs. 10,000/-for  litigation cost. Total payment   should be made within 30 days of the order otherwise the complainant is entitle to get it recover from the process of law. 

 

Member                                                                                 President