The Consumer Disputes Redressal Forum, Ahmedabad City,
has partly allowed a complaint filed by Consumer Education and Research
Society (CERS), Ahmedabad, and Rekhaben A. Patel, the widow of Alpesh
A. Patel, holding Life Insurance Corporation of India (LIC), Ahmedabad,
liable for deficiency in service.
The Forum has ordered the company to pay Rekha Rs. 5
lakh under one policy and Rs. 50,000 under another, with nine per
cent interest from 3 September 2004 till realisation, besides other
benefits as per the conditions under the two policies of her late
husband. It has also ordered the LIC to pay Rekha Rs. 5,000 for her
mental agony, besides Rs. 2,000 towards cost.
The late Alpesh A. Patel had taken two LIC policies,
both starting on 13 February 2003. The sum assured was Rs. 5 lakh
for the first policy and Rs. 50,000 for the second, with his wife
as the assignee. He had paid the premiums regularly.
On 5 January 2004, Alpesh died due to drowning into
the Narmada Canal at Jaspur, Tal. Kalol (Gandhinagar, Gujarat). The
LIC was informed on 11 February with duly filled-in claim form and
necessary documents. Rekha also provided a copy of the FIR, Panchnama,
post-mortem report, final police report, etc. when the LIC asked for
it.
Though more than six months had elapsed, the LIC did
not sanction the claim, stating that it was an early claim (before
the expiry of one year) and that it was being investigated. After
nine months, it repudiated the claim, arguing that Alpesh might have
committed suicide, having given in to the unbearable suffering from
kidney stone.
The Forum, based on the post-mortem report, concluded
that it was death due to shock followed by drowning. It cited the
divisional magistrate’s report that it was a clear case of accident
and there was no reason for Alpesh to commit suicide. Thus, the delay
on the part of the LIC to avoid the payment of the claim was a deficiency
in service and an unfair trade practice. The court, taking note of
the fact that the kidney stone trouble of Alpesh had started soon
after taking the policies, ruled out any suppression of material fact
as alleged by the LIC.
The Forum also concluded that the disease was not of
a serious nature that would compel Alpesh to commit suicide. Moreover,
he had not left any letter stating that due to kidney stone disease
he was committing suicide.
The court also emphasised that the burden of proof lies
upon the insurer to prove with documentary evidence that the insured
was suffering from any disease before taking the policy. In this case,
the LIC had failed to prove it. Rekha, the widow of Alpesh —
the insured — also had failed to prove that death had occurred
due to accident. Thus, the Forum did not allow the defence of accident.
Verdict :
The Forum partly allowed the complaint and directed
the LIC to pay Rs.5,50,000 towards the sum assured under the policies
and all eligible benefits along with 9 per cent interest from 3 September
2004 till realisation. The LIC was also directed to pay Rekha Rs.5,000
towards her mental agony and Rs. 2,000 towards cost.
The Forum ordered the LIC’s compliance with the
order within 30 days from the date of pronouncement.
The Forum comprised Mr. C.A. Sejpal, President, and
Mr. Bharatbhai H. Joshi, Member. Mr. H. P. Motiramani, Advocate, pleaded
for CERS and Rekha, and Mr. H. M. Bhagat, Advocate, for the LIC.
Date : 21/05/2007
Place : Ahmedabad
Pritee Shah
Senior Director - CERC
Editor, INSIGHT — The Consumer Magazine
Consumer
Education & Research Centre (CERC) - Copyrights Reserved 2003.