State Consumer Disputes Redressal Commission
The Branch Manager, Life Insurance ... vs Smt. Purnima Dhar on 18 March, 2015
Daily Order STATE CONSUMER DISPUTES REDRESSAL COMMISSION WEST BENGAL 11A, Mirza Ghalib Street, Kolkata - 700087 First Appeal No. FA/886/2012 (Arisen out of Order Dated 18/09/2012 in Case No. Complaint Case No. CC/44/2011 of District Uttar Dinajpur) 1. The Branch Manager, Life Insurance Corporation of India Islampur Branch, P.O. & P.S. - Islampur, Dist. Uttar Dinajpur, West Bengal. 2. Life Insurance Corporation of India. Represented by the Div. Manager, Jalpaiguri Division, 'Jeevan Prakash', Shintipara, P.O. & Dist. - Jalpaiguri, West Bengal. ...........Appellant(s) Versus 1. Smt. Purnima Dhar W/o Kalyan Kanti Dhar, Shib Dangipara, P.O. & P.S. - Islampur, Dist. Uttar Dinajpur, Pin - 733 202. ...........Respondent(s) BEFORE: HON'BLE MR. DEBASIS BHATTACHARYA PRESIDING MEMBER HON'BLE MR. JAGANNATH BAG MEMBER For the Appellant: Mr. Gopal Basu, Advocate For the Respondent: Mr. Ritobroto Banerjee., Advocate ORDER
Date: 18-03-2015 Sri Debasis Bhattacharya This appeal is directed against the order dt. 18-09-2012 in Case No. 44/2011, passed by the Ld. District Forum, Uttar Dinajpur, whereby the complaint case has been allowed on contest. Being aggrieved and dissatisfied with the same, the OPs thereof have preferred this appeal.
Case of the Complainant, in brief, is that her husband, Kalyan Kanti Dhar, during his lifetime, submitted two proposal forms on 05-11-2009 for a sum insured of Rs. 1,00,000/- each. The M.O. of the OP No. 1 examined the Complainant and on being satisfied about his state of health, directed him to deposit required money and subsequently Policy nos. 456144871 and 456144872 were issued on 05-11-2009. The Insured, all on a sudden, died on 24-12-2009 and after his death, the Complainant claimed the insurance money from the authority. But, the OP No. 2 repudiated her claim on 21-11-2010. Hence, the instant case for getting insurance benefit and other relief(s).
The OPs contested the case by filing WV whereby they stated that the deceased Insured submitted two proposals on the same day, but without giving information about each other. Besides, the said Insured informed the OP in writing that there was no other proposal under consideration in any office of the OPs and on the basis of such misrepresentation of fact, the proposals had been accepted, but the assurance of life can be made for once as it was a special policy under non-medical (general) scheme. As per question no. 9 of the proposal form, all particulars of previous policy(ies) are required to be mentioned, but fraudulently and mischievously, two separate proposals were submitted. Had the DLA disclosed about another policy in the proposal form, then medical reports would have been called for as in no way under non-medical (general) scheme, he could get more than Rs. 1,00,000/- sum policy on his life. The claim was repudiated owing to non-disclosure of material facts to contract of insurance.
Point for consideration in this appeal is whether there is any factual/legal infirmity in the impugned order or not.
Decision with reasons Ld. Advocate for the Appellants has submitted that the life assured purchased two policies on his own life on 05-11-2009 under Non-medical General Scheme for Rs. 1,00,000/- each from the OP No. 1 and he died on 24-12-2009, i.e., after a period of 1 month 19 days due to heart failure. On scrutiny of relevant documents it was revealed that the life assured submitted two separate proposals for Rs. 1,00,000/- each on the same day, but he did not disclose this fact in any of the proposal forms, rather gave false answers therein. As a result, the claim of the Respondent was repudiated by the Appellants vide its letter dated 29-11-2010 on the ground of non-disclosure of material information regarding his another proposal in either of the proposal forms. The Ld. District Forum failed and neglected to notice and examine the proposal form of both the policies obtained by the life assured in which it is clearly specified that all the particulars about the other policy must be mentioned by the insured in col. 7 of the proposal form, but the Respondent deliberately suppressed this information about other policy in either of the proposal forms. Hence, both the policies suffer from suppression of material facts. Ld. District Forum further failed to appreciate that the Appellants acted in accordance with law and therefore, no deficiency of service on the part of the LICI arose at all. Had the deceased policyholder declared about the other policy in either of the proposals, then both the proposals would have been taken together and considered collectively and jointly as 'one policy' for the purpose of risk assessment and medical report and special reports would have been called for in this case as per the rules of the Corporation. Ld. District Forum ought to have considered the fact that as per rules, the life assurred at the age of 49 years, was not entitled to get more than one policy as the maximum limit for non-medical general scheme at the age of 49 years is Rs. 1,00,000/-. Thereby, the Ld. District Forum erred in law in overlooking and ignoring the contractual obligations of both the Insurer and the life assured and as such, the impugned order be set aside. In support of his contention, the Ld. Advocate has referred to two decisions of the Hon'ble National Commission reported in 2012(1) CPR 245 (NC) and 2012 (1) CPR 48 (NC).
Ld. Advocate for the Respondent, on the other hand, vehemently opposed the contention of the Appellants and stated that the deceased insured was a semi-literate person, who only read up to class VIII. As a layman, it was not possible for him to understand the niceties of rules and regulations of the Appellants. Moreover, the proposal forms were filled up by the agent himself who did not disclose anything to her husband at the time of signing the proposal forms or afterwards. Moreover, the empanelled Medical Officer of the Appellants himself thoroughly checked the physical condition of her husband and did not find anything wrong with his health. The unfortunate death occurred to the Insured all on a sudden and before his death, he was leading a normal life. The objections raised by the Appellants have no basis at all and although the Ld. District Forum passed a well reasoned order, just to compound her misery, the Appellants have intentionally filed the instant appeal, which be dismissed with exemplary costs.
Before proceeding with the issue at stake, we note down the undisputed facts of this case - (1) Ms. Mridula Sikdar acted as agent in respect of both the polices, (2) both the proposal forms were filled up by the deceased insured on the very same day, (3) both the proposal forms were filled up by the agent of the Appellants, (4) both the proposal forms were deposited to the same branch and the policies were issued on 05-11-2009, and (5) nowhere in the proposal form was there any mention of the fact that maximum limit of non-medical general scheme at the age of 49 age is Rs. 1,00,000/-.
Since Insurance Companies recruit/engage agents to act as an interface between an Insurer and Insured, the primary responsibility of apprising a proposer about the salient features of a policy rests with the agent. Since there was no mention of any upper ceiling of insurance in respect of non-medical general scheme in the proposal form, as a layman there was no scope for the deceased Insured to be aware of it and against such backdrop, it was incumbent upon the Agent of the Insurance Company to apprise him about such clause. Although it is reported in the Agents Confidential Report that the agent explained fully the terms and conditions of the plan to the proposer, she cannot disown her responsibility in the matter given the fact that while she was aware of the so-called rule that prohibits a person from having insurance coverage of more than Rs. 1,00,000/- in case of non-medical general scheme at the age of 49 years, it was the first and foremost responsibility of the said Agent to refuse accepting more than one proposal from the proposer. Neither the Agent nor the Doctor was de-empanelled. Then, the buck laid on the said branch of LICI.
Similarly, insofar as both the proposal forms were submitted at the same branch and as an Insurance Policy is issued after a proposal form is routed through a chain of officials at the concerned branch and especially both the policies being issued on the same day by the same branch office of the Appellants, it is hard to believe that the concerned officials of the branch were totally in the dark that the proposer submitted two proposal forms in contravention of the so-called rule (which has not been placed before us by the Appellants). The Appellants cannot abdicate its responsibility for the lapses on the part of its officials and that of its authorized agent who are supposed to thoroughly examine a proposal form before issuing a policy.
It is argued by the Appellants that they repudiated the claim of the Respondent owing to suppression of material fact, i.e., suppressing information about other policies as laid down in column no. 7 of the proposal form. It is nobody's case that on the date of signing the proposal forms, any policy was running in the name of the deceased Insured. Therefore, there was no question of mentioning details of other policy(ies) by the deceased Insured as pointed out by the Appellants.
Further, mere execution of a proposal form does not entitle a proposer to get an Insurance Policy. As stated above, an Insurance Policy is issued subject to fulfillment of each and every criterion of policy terms and conditions by a proposer and duly accepted as such by the Insurer. That being the position, while the proposer was not at all sure as to whether or not the Insurance Company would accept his proposals, and most importantly, as he was not aware of the policy details, it was totally unfair on the part of the Insurance Company to accuse the deceased Insured of suppression of material fact. Clearly, bereft of any plausible ground, the Appellants went into a huddle and resorted to witch-hunt and repudiated the claim on a totally hypothetical ground. There is nothing wrong with the impugned order and as such, the same is upheld in toto.
In the result, the appeal fails.
Hence, ORDERED that the appeal be and the same is dismissed on contest against the Respondent, but without any order as to costs. The impugned order is hereby affirmed. [HON'BLE MR. DEBASIS BHATTACHARYA] PRESIDING MEMBER [HON'BLE MR. JAGANNATH BAG] MEMBER