Pravinchandra Shantilal Piyara - Appellant
Versus
Life Insurance Corporation of India & Anr. - Respondent
Decided On : 10/12/1992
Original Complaint No. 9 of 1992
Advocates Appeared :
Mr. A.I. Surti,Mr. H.M. Bhagat
Held: To our opinion, therefore, if a person makes an application and if the Corporation does not decide his case immediately and unfortunately if the person dies by accident or by cardiac failure which is not anticipated it is the legal as well as moral duty of the insurance company either to process the application and if the proposal was such which ought to have been accepted, the Corporation should accept the proposal with retrospective effect and should give all benefits available to the applicant as if the policy has been accepted, particularly when the Corporation is a State and holding monopoly. (para 9)
(ii) Consumer Protection Act, 1986 - Sections 2 & 14 - Deceased filed proposal to insure his life for Rs. 50,000/- Disclosing that his one kidney was removed & paid enhanced premium, 1.5 times more than normal premium Opp. party did not take decision for 7 months & meanwhile insured dead - No case of opp. party that it was possible for it to reject the proposal - Proposal made by insured satisfied all the requirements and on account of gross delay and negligence policy could not be issued - Opp. party is liable for damages - Damages assessed at Rs.50,000/- -Interest at 12% also awarded. (Paras 11 to 15)
Result: Complaint allowed.
IMPORTANT POINT
It will be a deficiency in service if the proposal of a consumer for insurance policy is not processed with utmost expediency.
S.A. Shah, President. The complainant is the nominee of the deceased-insured Himatlal Shantilal Pujara who died on 17.8.1989 owing to cardiac trouble. There is no dispute that the deceased has filed a proposal to insure his life to get the life insurance policy for Rs. 50,000/- on 12.3.1989 and on the advice of the local agent of the Life Insurance Corporation(LIC) he paid a cheque dated 13.3.1989 for the premium. It is also not denied that the deceased disclosed that his one kidney was removed and, therefore, he was required to pay enhanced premium of Rs. 2,400/- instead of Rs. 1,600/- which is exactly 1.5 times more than the normal premium payable. The premium was alleged to have been accepted by the Insurance office at Dhrangadhra and it has been alleged that the policy was already prepared and issued but the same was not received by the complainant The fact regarding the issuance of the policy has been denied by the Insurance Company and there being no direct evidence, we will proceed on the basis that the deceased has made a proposal, has given a cheque for Rs. 2,400/ - as per the advice of the insurance agent of the LIC, has also disclosed that his one kidney was removed and hence there is no question as to whether there was any mis-representation or fraud played upon the Insurance Company. The insured was straight forward person and has made true disclosure and he having only one kidney was worried and therefore he filled up the proposal form and paid higher premium which is payable by the person who has a physical defect.
2. Unfortunately, it is further alleged that the Insurance Company neither cared to send the policy immediately nor any letter was sent to the complainant. It appears that since the deceased kidney was removed, they have made a private enquiry with Dr. Dastur who had operated the insured. It appears that this operation was performed in the year 1985 i.e. 5 years prior to the date of proposal.
3. Unfortunately the insured expired on 17.8.1989 i.e. after more than 5 months from the date of proposal and that the information of the death of the insured was communicated by the complainant on 17.10.1989. The opponent came to know for the first time that the insured has expired and thereafter the insurance company repudiated the claim on 28.10.1989 and offered to refund the deposit amount of Rs. 2,400/-. Being aggrieved by the said repudiation the nominee of the insured has filed this complaint.
4. It is no doubt true that the policy has not been issued by the opponent, and according to Mr. Trivedi, the learned advocate appearing on behalf of the LIC even the decision to grant the policy was not taken by the LIC. Therefore the fundamental questions arise for our consideration are as to whether:-
1) there was any deficiency in service to the potential consumer i.e. the complainant and insured.
2) that the proposal having not been accepted whether the complainant is entitled to any amount.
3) if there is any deficiency in service, whether the complainant is entitled for any amount. If yes, what should be the amount.
5. Before-we answer all these three issues, it will be necessary to take into consideration the following circumstances:
a) that the LIC is a state within the meaning of article 12 of the Constitution of India.
b) that the LIC has the monopoly throughout the country to undertake the business of life insurance.
c) that every citizen of this country has a right to be insured, if he satisfies the necessary conditions of insurance.
d) that the Insurance Company has been nationalised for better services to the policy holders.
In this connection we may reproduce the speech of the then Finance Minister, Shri C.D. Deshmukh, from his broadcast to the nation on the eve of the promulgation of the Life Insurance(Emergency Provision) Ordinance, 1956(reproduced by the Corporation in its Manual to the Agents). The Finance Minister stated that:
"the nationalisation of Life Insurance will be another milestone on the
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