Life Insurance Corporation of India vs Braj Kishore Singh

THIS appeal is directed against order dated 21st September, 1994 passed by the District Forum, Hazaribagh in Complaint Case No. 112 of 94 in which the appellant here was the opposite party and the respondent here was the complainant before the District Forum.

THE facts of the case as put in by the complainant may be briefly stated. Swarsati Devi (wife of the complainant Dr. Braj Kishore Singh) had taken three policies against her life and she paid the premium in respect thereof till her death. THE first policy was for Rs. 35,000.00. THE second policy dated 28.10.89 is for Rs. 65,000.00. THE third policy dated 27.3.91 is for Rs. 75,000.00. Swarsati Devi died on 28.8.91 due to cancer of stomach. Her death was reported to LIC, the opposite party and the opposite party L.I.C. thereupon supplied to the complainant a form which was to be filed by him with details of the three policies and other details which the complainant did. THEreafter the opposite party made payment with regard to the policy of Rs. 35,000.00 on 3.3.93. So far the second and third policies are concerned the complainant was informed by the opposite party L.I.C. that the claim in respect of these policies will be decided after inquiry. THE complainant waited for inquiry but no body came to inquire. THE complainant sent reminders, but in vain. He also met the Branch Manager of the L.I.C. but this also did not bring any fruit and the claim of the complainant under these two policies was not paid by the opposite party L.I.C. Hence the complainant had no alternative but to file the case before the District Forum. On being noticed the opposite party appeared and filed written version stating that the claims of the complainant under these two policies are with regard to an early claim they being of within two years of their commencement and according to the L.I.C. Manual in case of a policy which has been in force for a period of less than two years an inquiry has to be made with regard to the state of health of the proposer on the date of the proposal and that after inquiry it was found that the insured was suffering from cancer of stomach at the time of taking these two policies which was known to the insured complainant but this fact was suppressed by the proposer. It has been further averred by the L.I.C. that since the first policy was not an early claim the amount was paid to the complainant but since the remaining two policies are with regard to an early claim the inquiry has to be made and hence there has been delay and under the circumstances it is not deficiency in service on the part of the L.I.C. It has been further averred that since the case involves decision with regard to complicated facts an elaborate inquiry has to be made and detailed evidence - oral and documentary - " has to be adduced by the parties the case cannot be decided under the Consumer Protection Act (hereiafter called the Act) which envisages a summary proceeding and that the complainant ought to have filed a civil suit with regard to this dispute. On these grounds the opposite party has sought dismissal of the complaint.

The District Forum has held that there has been deficiency in service on the part of the opposite party inasmuch as there has been inordinate delay in deciding the claim under the two policies without there being any valid and justifiable ground for the same causing harassment and unnecessary expenses to the complainant and that the complainant is entitled to get the amount of the two policies with interest thereon from 28.12.91 till the date of its payment.

THE learned Counsel for the L.I.C. appellant has assailed the impugned order mainly on the ground that the District Forum has erred in holding that there is negligence and deficiency in service on the part of the opposite party - Insurance Company. Elucidating his submission the learned Counsel for the appellant has submitted that the two claims in question being early claims as the death of the policy holder - insured had taken place within two years of taking the two policies a detailed inquiry was required to be made with regard to the health of the proposer on the date of the proposal which is a time taking process and that the investigation was entrusted to Shri Y.M. Prasad, B.M. (S) and that during the course of investigation it was found that the complainant was treated at different places from Hazaribagh to Christan Medical College Hospital, Vellore sometimes in 1989-90 and therefore the Director, Christan Medical College Hospital had to be contacted which was not possible to do within a short period and therefore there has been delay in taking decision of these two claims. Now it may be mentioned that admittedly the information regarding the death of the insured had been given to the Senior Branch Manager, Hazaribagh Branch of the L.I.C. on 15.9.91 and on 18.9.91 the claim forms A, B & C were issued to the complainant by the L.I.C. with a request to submit those forms duly filled up which were submitted by the complainant and that the claim with regard to these policies had not been decided by the L.I.C. till the disposal of the case by the District Forum. The appellant has averred in his memo of appeal that the decision with regard to the Claim No. 510342984 secured in March, 1991 has been taken by the L.I.C. and the claim has been repudiated after the judgment of the District Forum in the instant case and that the decision with regard to Policy No. 510217527 is still under investigation. Thus even after more than three years the claim of the complainant under these two policies remained pending with the L.I.C.

IT has been submitted on behalf of the appellant that during investigation it was found that the insured has been last treated by Dr. H.L. Saha of Hazaribagh of Carcinoma (cancer) stomach and Dr. H.L. Saha has first examined her on 10.5.91 and before that she was treated at Shailya Niketan, Kadamkuan, Patna and according to Medical Attendance Certificate she was discharged from Shailya Niketan on 31.5.91. IT has been further submitted on behalf of the appellant that during investigation the Investigating Officer collected certificate dated 27.6.94 from one Dr. Ganesh Shankar a Homeopathic Practitioner at Hazaribagh from which it appears that the insured was under his treatment from January, 1991 to 28.8.91 for cancer and thus the insured was already suffering from cancer when she had taken the Insurance Policy No. 510342984. But it may be noticed that according to this assertion of the L.I.C. in the memo of appeal the Investigating Officer has collected the certificate from the said Dr. Ganesh Shankar, Homeopath on 27.6.94 and reference was also made to the Director, Christan Medical College Hospital, Vellore on 6.7.94 for treatment particulars of me insured as during investigation the Investigating Officer gathered that some information that the insured had been treated in this hospital also But these facts are conspicuously absent from the written version filed by the opposite party filed thereafter on 18.8.94 and in that written version it has been simply mentioned that the insured had suppressed the fact that she was suffering from cancer at the time of the taking policy and she may die at any time and that this fact was known to the complainant also- But the opposite party have not said even a single word in his written version as to on what basis it was concluded that there was suppression of facts regarding her health by the insured at the time of the proposal for the two policies. The opposite party did not produce the single chit of paper before the District Forum in support of their this assertion. Of course the certificate issued by Dr. Ganesh Shankar is concerned, it has been produced before us. But we fail to understand as to why the opposite party did not mention about this certificate dated 27.6.94 in the written version filed on 18.8.94. Hence this certificate appears to be an after-thought. Moreover, the complainant had produced a photo-stat copy of a certificate dated 24.12.94 purporting to be of that Dr. Ganesh Shankar stating that he does not maintain any register/ records and that it appears that some L.I.C. officials/staff on false representation impressed upon him to issue a certificate which he issued on their request and the time was given by them. Dr. Ganesh Shankar has issued this certificate supported by sworn affidavit. That apart, in the memo of appeal supported by a sworn affidavit the appellant has averred that the insured was treated at Shailya Niketan, Kadamkuan, Patna and according to the medical attendance certificates she was discharged from that Shailya Niketan on 31.5.91. But according to the certificate dated 27 6.94 purporting to be that of the said Dr. Ganesh Shankar, the insured was under his treatment from January, 1991 to 28.8.91.

FOR these reasons we are not inclined to place reliance on the certificate dated 27.6.94 - the only paper that the opposite party has been able to produce to support his assertion. Hence the ground being taken by the opposite party appellant to justify the delay in the settlement of the claim of the complainant under the two policies cannot be accepted. Under these circumstances we find that the District FORum has rightly held that opposite party L.I.C. failed to produce a single chit of paper in support of their case and the plea being taken by the opposite party cannot be accepted and that there has been negligence and deficiency in service on the part of the opposite party in settlement of the claim of the complainant under the two policies.

THE appellants have tried to assail the impugned order on the ground that the case of the complainant was time-barred on the date it was presented before the District Forum. It has been also asserted by them that the District Forum has not given its finding on this issue though this ground was taken by the opposite party in their written version. But we find that no such plea was taken by the opposite party in this written version before the District Forum. Moreover, it is evident from the facts stated above that the claim of the complainant under these policies were pending for decision before the L.I.C. - opposite party and hence the question of limitation does not arise and we find no substance in this objection taken by the opposite party. It is evident from the discussions made above that the instant case does not involve adjudication of such questions which require elaborate evidence and which cannot be done in a summary proceeding under the Act. The simple question to be decided is if the L.I.C. opposite party has given valid and justifiable reasons for delay on their part to decide the claim of the complainant, which issue on our findings is decided against the L.I.C.

Thus we find that the appellants have not been able to make out any ground for interfering with the finding of the District Forum.

IN the result, the appeal is dismissed and the findings of the District Forum are hereby confirmed. The District Forum has awarded interest on the amount under the two policies from 12.12,91 till the date of their payment but the District Forum has, it appears, inadvertently omitted to mention the rate of interest payable on the amount under the two policies. Under the circumstances the case is being sent back for that limited purpose to the District Forum. The District Forum will decide the rate of interest to be paid by the opposite party after hearing both the parties.

THE appellant is directed to pay Rs. 500/- (Five hundred) only as cost to the respondent. Appeal dismissed with costs.