PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SAMBALPUR

                                                              CONSUMER COMPLAINT NO.19/2017

Present-Dr. Ramakanta Satapathy, President,

  Sri. Sadananda Tripathy, Member,

Smt. Jhunu Sahoo,

W/O-Late Kishore Sahoo,

R/O-Samaleswari Colony, Po-Modipara, Ps-Town,

Dist-Sambalpur.                                                            .……….......Complainant.

Vrs.

1. Branch Manager, LIC of India, Sambalpur Branch Office-1,

Divisional officer Complex, Near Ainthapali, PO-Budharaja,

Dist-Sambalpur-768004.

2. Manager(Claims) , LIC of India, Divisional Office,

Divisional Office Complex, Near Ainthapali, PO-Budharaja,

Dist-Sambalpur-768004.

3. Sr. Divisional Manager, LIC of India, Divisional Office,

Divisional officer Complex, Near Ainthapali, PO-Budharaja,

Dist-Sambalpur-768004.                                               ...……….Opp. Parties

Counsels:-

1. For the Complainant                   :-         Sri. S. Patel, Advocate & Associates
2. For the O.P.s                                 :-         Sri. A.K.Sarma, Advocate & Associates

Date of Filing:21.02.2017,Date of Hearing :15.05.2023, Date of Judgement : 05.06.2023

  Presented by Dr. Ramakanta Satapathy, PRESIDENT

1. Husband of the Complainant purchased policy No. 594626047 and 593613404 for Rs. 1,05,000/- and Rs. 50,000/- respectively. During the subsistence of the policies assured Kishore Sahoo developed chest pain and consulted the doctor on 24.01.2015, admitted in Seva Nurshing Home, Sambalpur. On 11.02.2015 on the way to D.H.H., Sambalpur the assured died. The Complainant submitted relevant documents with the O.P. for claim. The O.P. No.3 vide letter dated 21.11.2015 repudiated the claim on the ground as follows:-

“ We, however, state that we have evidences and reasons to believe that before he revived the policies he was suffering from Type-2 Diabetic Mellitus for 06 years. Hypertension for 4 years and was a chronic smokers for 20 years which is evident from treatment paper dated 23.01.2015. He did not however disclose this fact in his personal statement regarding health dated 10.04.2013 submitted at the time of revival. Instead he gave false answers therein as stated above and induced us to revive the policies on the basis of the false statement. It is therefore evident that he had made deliberate misstatements and withheld material information from us regarding his health at the time of getting the policies revived and hence in terms declaration signed by him in the personal statement revival of the policies is hereby declared void. Hence, nothing is payable under the policies.

Being aggrieved the Complainant preferred appeal petition before Zonal Manager, Patna on 15.02.2016 and in reply the earlier order was upheld. The Complainant preferred appeal before Insurance “……….. A fair paid up value together with revival amount as indicated above is hereby awarded to be paid by the insurer to the Complainant, to-wards full and final settlement of the claim. Hence the complaint is treated as allowed to that extent only.”

Before granting the policies the O.Ps have examined the assured through their doctor and being aggrieved complaint has been filed for deficiency in service and unfair trade practice.

2. The O.Ps in their version submitted that the policies are admitted. The policies were repudiated as the deceased life assured(DLA) was suffering from Type-2 diabetic mellitus for Six years, hypertension for 4 years and was chronic smoker. As death of DLA took place within 3 years of the revival of the policy, due investigation was made by the O.P. The DLA deliberately withheld the material information regarding his health in personal history in the DGH form and accordingly the claim was repudiated. The Zonal Manager up held the decision. The order of Perused the documents filed by both the parties. In the present case the Complainant raised the question that in her appeal before the Zonal Manager, Patna she has specifically taken the ground that before repudiation core question whether the policies in questions are revived by either withholding the material information or by supressing the true facts fraudulently, this fact has not been decided by the appellate authority nor by the hon’ble                 Accordingly, it is ordered:

   ORDER

   The Complaint is dismissed on contest against the O.Ps. The O.Ps are directed to settle the claim of the Complainant as per terms of settlement fixed by the hon’ble insurance Order pronounced in the open Court on this 5^th day of June 2023.

   Supply free copies to the parties.