RAM NARESH SINHA vs Divisional Manager L I C Of India

THIS First Appeal has been filed by the Complainant against the order dated 12th March, 1993 passed by the State Consumer Disputes Redressal Commission, Bihar in Complaint No. 26/90.

THE facts of the case as available from the records are as follows : Smt. Shanti Kumar, wife of the Complainant got herself insured with the Respondent (Life Insurance Corporation) with effect from 28th September, 1985 for rupee one lakh. She died on 7.10.1986 due to ruptured tubal pregnancy and thereafter the Complainant lodged his claim with the Respondent for the insured amount. But the Respondent refused to pay the amount claimed on the ground that they had accepted the policy subject to First Pregnancy Clause and contended that the Complainant was entitled only to the amount payable in terms of that Clause. According to the Complainant, this was a baseless ground not applicable as per the agreement between the insured and the Respondent. The Complainant, therefore, filed a complaint before the State Commission. The Respondent averred before the State Commission that in the policy bond, in the very first page in the column ''Special Provision'', there is a stamped print mentioning the words, ''See overleaf which referred to a separate leaf containing the special provision regarding the First Pregnancy Clause tagged with the policy bond which has been purposely suppressed by the Complainant. The State Commission opined that the very nature of the policy was in dispute and that the Consumer Protection Act and its machinery cannot be effectively utilised for determining complicated questions involving dispute regarding the fundamental facts of the case. The State Commission therefore held that this is a matter that can be suitably adjudicated before the Civil Court where the Complainant as well as the Opposite Party will have ample opportunity to adduce evidence, oral and documentary and to examine witnesses at length, and dismissed the complaint.

AGGRIEVED by this Order, the present Appeal has been filed by the Complainant. In his appeal, he has contended that the respondent took 15 months to repudiate the claim on the ground that the policy was covered under First Pregnancy Clause whereas according to the Appellant, the original policy bond does not contain such a clause. The appellant has pointed out that even according to the provisions of the LIC, the First Pregnancy Clause was not applicable to the deceased lady as she was a working woman and her husband (Appellant), a qualified doctor. He has further alleged that the repudiation of the claim was not made in good faith as the Respondent filed a policy document making interpolation in it and then cutting it themselves and that the Respondent had failed to prove their contention that the policy was covered under the First Pregnancy Clause.

WE have carefully gone through the records and have heard the Appellant in person and the Counsel for the Respondent. The main question for determination is whether the attachment regarding First Pregnancy Clause was in the original policy bond or not. It may be mentioned that the original Insurance Policy bond is not part of the record with us. The Appellant showed us in the Court the original Insurance Policy document with him; the said attachment was not in that document. The Counsel for the Respondent showed us the copy of the policy document which he contended to be the true copy of the original document, and this copy had the said attachment. Moreover, half imprint of the rubber stamp of LIC was seen each on the attachment and on the third page of this copy. If this copy were the true copy of the original policy document shown by the Appellant, the halfimprint of the rubber stamp found on the third page of the copy should have been found on the third page of the original policy document with the appellant. But the half -imprint of the rubber stamp of LIC was not found on the third page of the original policy document displayed before us by the Appellant in the Court. It emerges that the copy shown by the Respondent -Insurance Company was not the true copy of the original policy document shown to us by the Appellant. Based on the aforesaid proceedings in the Court, we conclude that the policy in the present case is not subject to First Pregnancy Clause and that the Appellant is entitled to the full amount assured under the policy. The Counsel for the Respondent pleaded that the tariff made applicable to the disputed policy pertained to a policy subject to the First Pregnancy Clause as otherwise, an additional premium of Rs. 5 per thousand would have been charged which was not done in the instant case. Notwithstanding these pleadings, the Counsel for the Respondent could not convince us that the policy in the case is one subject to First Pregnancy Clause. In the light of the material brought before us during the hearing and the circumstances of the case we direct the Respondent -Insurance Company to pay to the Appellant within a period of three months the full assured amount of Rs. 1,00,000/ - with interest at 18% per annum from 19.7.1990, the date of complaint, till the date of payment. We also order the Respondent to pay costs to the Complainant which we assess at Rs. 3,000/ -. Petition disposed of.