State Consumer Disputes Redressal Commission
Smt. Sarita Gupta vs The Branch Manager, Life Insurance ... on 28 August, 2018
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION WEST BENGAL 11A, Mirza Ghalib Street, Kolkata - 700087 Complaint Case No. CC/218/2016 ( Date of Filing : 13 May 2016 ) 1. Smt. Sarita Gupta W/o, Lt. Pradeep Gupta, 117, Raj Bhallav Saha Lane, 2nd Floor, Shibpur, P.S - Shibpur, Howrah - 71 101. ...........Complainant(s) Versus 1. The Branch Manager, Life Insurance Corporation of India, Kolkata Branch Office 10 Regd Office at 1 & 3 Ilaco House, 5th Floor, Brabourne Road, Kolkata - 700 001. 2. The Divisional Manager, Life Insurance Corporation of India Kolkata Metropolitan Divisional Office - 1 Regd office at Jeevan Prakash, 16, Chittaranjan Avenue, Kolkata - 700 072. 3. The Zonal Manager, Life Insurance Corporation of India, Eastern Zonal Office regd office at Ground Floor, Hindusthan Building, 4, Chittaranjan Avenue, Chandni Chowk, Pilkhana, Kolkata - 700 012. 4. The Branch Manager, Life Insurance Corporation of India, Mumbai Divisional Office III Regd Office at New India Building, Claims department, Ist Floor, Santa Cruz (W), Mumbai - 400 054. 5. The Chairman, Life Insurance Corporation of India, Mumbai (Central Office) Regd Office at Nariman Point, Mumbai, 5th Floor, West Wing, Yogakshema, P.B. No. 19953, Jiban Bima Marg, Mumbai - 400 021, Maharashtra. 6. Sri Rajesh Kumar Gupta S/o, Lt. Ram Prakash Gupta, Flat No. 1, Pratima Apartment, 5, Raj Bahadur Road, P.S - Behala, Kolkata - 700 034. ............Opp.Party(s) BEFORE: HON'BLE MR. SHYAMAL GUPTA PRESIDING MEMBER HON'BLE MR. UTPAL KUMAR BHATTACHARYA MEMBER For the Complainant: Ms. Binota Roy, Ms. Priyanka Das, Advocate For the Opp. Party: Mr. Abhik Das., Advocate Dated : 28 Aug 2018 Final Order / Judgement Sri Shyamal Gupta, Member
This complaint case is filed over non-settlement of Complainant's insurance claim in respect of 3 nos. insurance policies by the OP Insurance Company.
Brief facts of the complaint case are that her husband died in a road accident on 12-01-2014. Necessary FIR in this regard was lodged on the very same day. During his lifetime, Complainant's husband took 3 nos. insurance policies of which two were made in Kolkata and the rest in Mumbai. After performing religious rituals, Complainant wrote a letter to the OP No. 1 on 24-01-2014 informing it about the accidental death of her husband. After receiving claim forms, the same was deposited along with necessary documents. Further case of the Complainant is that, initially she was not aware about the existence of the policy, issued from Mumbai. However, as soon as she discovered its existence, she filed necessary claim in respect of the said policy too. However, as the OPs sat tight over her claims for long, and when complaints to different authorities did not yield any positive result, finding no other alternative, the compliant case was filed.
By filing WV, it is submitted by the OPs that one of the three policies was taken from Mumbai and all documents and file pertaining to the said policy was in the office of the Western Zonal office of the OPs and as such, clubbing the said policy with the other policies being issued from Kolkata was bad in law. It is stated the claim was duly processed but final decision could not be taken for want of certain documents called for ascertaining the nature of death which allegedly occurred under mysterious circumstances and not in any hospital and no doctor had given certificate as to the nature of death. Further, considering that in case of accidental claim, the total claim amount under the three policies taken together would be double the sum assured (approx. Rs. 71,00,000/-), necessary decision in this regard was to be taken by the higher office and was beyond the financial limit of the branch or divisional office of the OPs.
Decision with reasons Both parties were heard at length at the time of hearing; documents on record also carefully gone through.
Ld. Advocate appearing on behalf of the OPs contended that the Complainant's husband, since deceased, had taken three policies the cumulative sum assured of which was Rs. 35,50,000/-. According to the Ld. Advocate, the same was vitiated/void contract due to exceeding of the limit of eligible insurance on the life of deceased assured and also for intentional/material suppression of previous policy which could not be detected as was taken from a distant division/zone of the LICI.
In absence of copy of the relevant Section/Rules of the Insurance Act, we are unable to figure out the veracity of the allegation of the OPs in this regard. Though it is alleged that the Complainant's husband did not disclose the existence of Mumbai policy while taking the other policies, for some obscure reasons, the OPs have not placed on record the relevant documents to establish such allegation. Further, it is to be kept in mind that the proposal forms are filled up by the agents of the Insurance Companies. Accordingly, in absence of evidence from the concerned agent, it cannot be conclusively ascertained if the proposal forms were filled up strictly as per the instruction of the Insured, since deceased, and most importantly, whether the same was filled up in presence of the Complainant's husband before obtaining his signature on the same or not. It is an open secret that proposal forms are filled up by insurance agents behind the back of the proposers. That apart, non-disclosure of such information, under any circumstances, cannot be considered as material suppression. There was virtually no need for the Complainant's husband to hide the details of Mumbai policy while filling up the proposal forms in respect of other policies those were taken made in Kolkata. The objection of the OPs in this regard is, thus, not tenable.
Ld. Advocate for the OPs alleged that the Complainant did not file relevant documents as per their requirement. We, however, find no substance in such contention given that firstly, all accidents are not reported in newspapers. Therefore, if the present incident was not reported in the newspaper, as claimed by the Complainant, hardly any fault can be found with her.
Secondly, for the purpose of ascertaining the cause of death, PM report itself was suffice and the same has been submitted by the Complainant. Additionally, the Complainant also filed copy of the order passed by the Motor Accident Claims Tribunal. That apart, since necessary FIR was lodged and also the incident was duly enquired by the Surveyor deputed by the Insurance Company, in case of any adverse findings, the same would definitely get reported to the OPs. However, nothing of that sort is forthcoming before us.
As for the requirement of driving licence, it transpires from the copy of Complainant's letter to the OPs dated 23-12-2015 that at the material time of accident, one Sri Manoj Gupta was driving the two-wheeler and his driving licence bearing no. WB 012007534469 was seized by the police on 12-01-2014 which was duly mentioned in the charge sheet. Despite this, insistence of the OPs for the copy of driving licence of the Complaint's husband was indeed unfortunate.
It is clear that above impediments were created to frustrate the legitimate claim of the Complainant which clearly indicates gross deficiency in service on the part of the OPs. Whether on account of involvement of considerable sum of money, decision/approval from the higher echelon of the Management was necessary or not, it was certainly not the look out of the Complainant. She filed necessary claims along with relevant papers which, to our mind, if considered with an unbiased mindset, the matter would not come to a head causing unwarranted harassment/sufferings/mental pain and agony to the Complainant.
The Complainant, therefore, definitely deserves due relief.
Hence, O R D E R E D The case stands allowed on contest against the OPs with a cost of Rs. 20,000/- being payable by the OPs to the Complainant. The OPs shall settle all the claims by paying the contractual amount within 40 days from today along with simple interest @ 9% p.a. over the total amount payable in respect of the subject policies from 13-05-2016 till full and final payment is made. [HON'BLE MR. SHYAMAL GUPTA] PRESIDING MEMBER [HON'BLE MR. UTPAL KUMAR BHATTACHARYA] MEMBER