Orissa

Jharsuguda

cc/46/2014

Mrs.Thankamani Mathai,W/O- Late P.A. Mathai - Complainant(s)

Versus

BM LIC OF India - Opp.Party(s)

P.R.Singh Deo

28 Apr 2015

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, JHARSUGUDA

 

CONSUMER COMPLAINT CASE NO. 46 OF 2014

 

Thankamna Mathai,

W/O- Late P.A. Mathai,

R/O: Kalimandir Road, 

Dist:Jharsuguda,Odisha…………………………….………..…………Complainant.

     

                                           

Versus

 

1. The Branch Manager,

LIC of India, Collectorate Road,Jharsuguda Branch,

Dist: Jharsuguda, Odisha.

 

2. Divisional Manager, LIC of India, Sambalpur Branch,

PO/PS: Ainthapali Road, 

Dist: Sambalpur, Odisha..…………………………..….…...Opp. Parties.

 

Counsel for the Parties:-

For the Complainant                          Shri P.R.Singhdeo, Adv. & Associates.

For the Opp. Party                             Shri B.N.Dutta, Adv. Associates.

 

Date of Order: 28.04.2015

 

Present

                                                  1. Shri S.L.Behera, President.

                                                  2. Shri S.K. Ojha, Sr. Member.

                                                  3. Smt. A. Nanda, Member.

 

Shri S. L. Behera, President: - The brief facts of the complainant’s case is that, the complainant’s deceased husband  had insured himself during his lifetime with the O.Ps. under Jeevan Mitra (Double Cover Endowment Plan) having sum assured of Rs.2,00,000/- commenced on dtd. 25.03.1996, date of maturity 25.03.2016 bearing LIC Policy No.90826544. The life assured was paying the premiums of Rs.7,908/- only regularly till his death without fail and he has mentioned the complainant as 100% nominee in the said policy.  After being death of the complainant’s husband the complainant claim before the O.ps. but till date the O.Ps. neither accepted the death claim nor denied, hence this case.

 

Being noticed, the O.Ps. appeared and filed written version through their  counsel admitting the fact of insurance but denied the allegations. The O.Ps. submitted that the complainant has defaulted two times in payment of premium and both the times the policy was revived.  The claim has been repudiated due to the insured was suffering from Diabetes Mellitus (type02) and Hypertension at the time of revival of policy.

 

In their repudiation letter wherein it was categorically stated that the deceased policy holder had  answered the following question-2 since the date of your proposal form for the above mentioned policy : (a) have your ever suffered from or are your suffering from (ii) High Blood Pressure or any diseases of the heart ? No (V) Diabetics, Hernia, Hydrocele , Cancer or Leprosy ? No (c) Have you had a Electrocardiogram, X-ray or Screening, Blood, Urine or Stool examination? No. (iv)  Are you at present in sound health? Yes.    The deceased life assured replied in negative. According to the O.Ps. due to the suppression of above information by the deceased life assured (DLA),  as the life assured died on 18.07.2009 due to diabetes,  having breach of the policy condition,  the repudiation is legal and proper.  Denying any deficiency in service in respect to the complaint, the O.Ps prayed for dismissal of the complaint.

 

            The O.Ps. in order to prove their contentions have produced Photostat copies of death certificate, repudiation letter , medical certificate of Dr. R.K.Joshi Xerox copy of medical bill, medical attendance certificate, certificate of hospital treatment, medical examiner confidential report. 

 

3.         We have gone through the complaint petition and the written statement as well as materials, documents available on record.  We have also heard the learned counsel argued on behalf of the parties. 

 

4.         The complainant claim the repudiation of her claim to be arbitrary and without any justified reason, whereas the O.Ps. claims the same is right and proper.  Now we have to decide whether the repudiation the insurance claim of the complainant was justified or not? If justified what relief the complaint entitled for?  We have to go through the document produced by the O.Ps. to substantiate their pleas  taken in their written statement.  It is not disputed that the husband of the complainant, deceased life assured had obtained a policy assuring his life  which was commence from dtd. 25.03.1996 and the death of the life assured was on dt.18.07.2009. It is not disputed that the sum assured of the policy is Rs.2,00,000/- only and the half yearly premium of  Rs.7,908/- only was paid.

 

5.         All the documents filed by the O.Ps are Xerox copies. It is to be noted that all the documents above stated have been made on the printed form of the O.Ps.,Insurance company.  The original of the said medical certificate, death certificate etc. were not produced before this Forum.  Neither there is evidence in the form of affidavit in support of the version / statement of the LIC ( O.Ps) nor any document have been proved required under the law.  We do not find any material on record to show that the document produced on record by the O.Ps., Insurance company have been admitted by the complainant.

 

6.         Furthermore, there is absolutely no evidence whatsoever in the form of affidavit or otherwise to demonstrate the version of the O.Ps. LIC. The O.Ps. have only filed reply but not produced any evidence  in spite of that we have go into the document produced by the IO.Ps. LIC  i.e. death certificate, repudiation letter , medical certificate of Dr. R.K.Joshi Xerox copy of medical bill, medical attendance certificate, certificate of hospital treatment, medical examiner confidential report.  Those documents are not supported by any evidence, whatsoever, not even by a simple affidavit by the manager of the O.Ps. LIC or any officer authorized by the said corporation.   Furthermore these documents have simply been placed on record and even if for the sake of argument , these documents are prove on record, their truth or correctness  or otherwise has to be ascertained from the evidence as a whole  and the contents thereof cannot accepted , as it is .  Furthermore, even the original have not

 

been shown that those documents are be proved copies of the original.   It is settled law that the opinion of the doctor- and expert – unless he is subjected to the test of examination and cross examination in a court, such evidence cannot be considered as authentic and such evidence cannot be relied upon and form the basis of a finding.

 

7.         As per the above discussion and observation made us, we are of considered opinion that the O.Ps. LIC fails to proof the grounds of the repudiation of the insurance claim of the complainant to be proper and justified and we hold the said repudiation of her claim to be an arbitrary and unjustified act on the part of O.Ps.LIC, In other words the complainant claim the repudiation of her claim to be illegal and arbitrarily can be taken as proved.

 

8.         Accordingly, we hold the O.Ps. LIC is guilty of deficiency of service in respect to the complainant due to the said illegal repudiation of the claim. In view of the above discussion and observation made by us we allowed the complaint, hence order; 

           

                                                               ORDER

 

            The O.Ps. LIC , are directed to settled the claim of the complainant within one month from the receipt of this order.  The O.Ps. LIC are also directed to pay a sum of Rs.5,000 ( Rupees five thousand) only as compensation including the cost to the complainant on account of sufferance of her mental agony and harassment  caused by the O.Ps. LIC.

 

            The above stated directions are to be complied within the time specified as stated above.

 

Accordingly the case is disposed of.

Order pronounced in the open court today the 28^th day of April’ 2015 and copy of this order shall be supplied to the parties as per rule.    

           I Agree.                          I Agree,                                                                                                        

                                         

S.K.Ojha, Sr.Member                  A.Nanda, Member (W)                      S. L. Behera President                 

 

Dictated and corrected by me

 

      S. L. Behera, President.