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WEST BENGAL STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, KOLKATA
Hon’ble Mr. Justice S.C. Datta, President; Mr. D. Karforma &
Mrs. S. Majumder, Members
LIFE INSURANCE CORPORATION OF INDIA—Appellant
versus
MAHABIR PRASAD HANSARIA—Respondent
S.C. Case No. SC/03/A of 1999—Decided on 21.3.2003

The onus is on the insurer to establish the suppression of material facts by the insured at the time of submitting the proposal, and inordinate delay in settling the death claim indicates deficiency in service on the part of the insurer.

Headnote:

Insurance - Life Insurance Claim - Suppression of Material Fact

Fact of the Case:

The wife of the complainant was insured by the Life Insurance Corpn. of India. The insurance claim was repudiated by the LIC on the ground that the deceased had withheld material facts regarding her health. The Forum decreed the claim in favor of the complainant, together with interest.

Finding of the Court:

The court found that the LIC failed to establish that the deceased had suppressed material facts at the time of submitting the proposal. The court also noted the inordinate delay in settling the death claim, indicating deficiency in service on the part of the LIC. The court modified the interest rate granted by the Forum and directed the LIC to make the payment within a specified period.

Issues: Suppression of material facts by the deceased, inordinate delay in settling the death claim, and the grant of interest rate.

Ratio Decidendi: The onus is upon the LIC to establish the fact of suppression of material facts by the deceased at the time of submitting the proposal. Inordinate delay in settling the death claim indicates deficiency in service on the part of the LIC.

Final Decision: The court disposed of the appeal, setting aside the order of the Forum regarding payment of damages and modifying the interest rate granted by the Forum.

ORDER

Mr. Justice S.C. Datta, President—This is an appeal against the order of the Forum at Jalpaiguri decreeing the claim of the petitioner in toto together with interest. The wife of the complainant was insured by the Life Insurance Corpn. of India for the sums of Rs. 15,000/- and Rs. 25,000/-. Her husband was the nominee. Dr. K.S. Basak was the Medical Officer of the Insurance Company. He examined the wife of the complainant, namely Gayetri Devi but did not notice any ailment. She fell ill suddenly on 26.11.1994 and was shifted to North Bengal Medical Clinic where she expired on 29.11.1994. According to Dr. S. Banerjee, the attending physician, the cause of death was due to cardiac arrest, encephalitis and diabetes mellitus. On 22.3.1995 the complainant preferred claim but on 18.12.1996 the LIC repudiated it on the ground that the deceased has withheld material facts regarding her health. According to the LIC the deceased was suffering from vomiting and phileria from long time past and as such the repudiation was rightly done.

2. The Forum however negatived the contention of the LIC and passed the award in favour of the complainant.

3. It is not in dispute that two policies were taken out on the life of the deceased Gayetri Devi and while the policies were current, she expired. There is no paper to show that Gayetri Devi was suffering from vomiting and phileria for long. Incidentally it may be mentioned the onus is upon the LIC to establish the fact there had been suppression of material fact by the deceased at the time of submitting the proposal. The Medical Officer of the LIC examined the insured and found nothing wrong in the health of the deceased. The death certificate shows that she died of cardiac failure. The Forum noticed that the claim was repudiated after a long lapse of time. There was, therefore, inordinate delay in the matter of settlement of the death claim of the complainant. So there was deficiency in service on the part of the LICI. We have thoroughly gone through the judgment and find no reason to disagree with the views taken by the Forum.

4. Regarding the grant of interest @ 18% per annum we think that the Forum was not justified in granting interest at such a high rate. In our view it would be just and proper if the rate of interest is reduced to 10% per annum from the date of submission of the claim i.e. 22.3.1995 till the final payment is made of the assured sum of Rs. 25,000/- and Rs. 15,000/- in all Rs. 40,000/- together with bonus and other benefits accruing thereon which we hereby do. The LIC is directed to make payment of this amount within a period of 2 months from this date.

The order of the Forum regarding payment of damages is set aside. With this modification the appeal be disposed of.

Appeal disposed of.

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