IN THE COURT OF THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, DEOGARH.

C.C No-30/2017

Present-     Sri Dipak Kumar Mahapatra, President, Smt. Jayanti Pradhan, Member (W), Smt. Arati Das, Member.

Kshiti @ Kshitibala Pradhan, aged about 52 years,

W/O-Late Udaya Nath Pradhan,

R/O-vill-Sarankote,

P.O-Saida,P.S-Barkote,Dist-Deogarh.                        ...   Complainant.

Versus

1. The Branch Manager,

          LIC of India,

         Kuchinda Branch,

          P.O/P.S-Kuchinda,Dist-Sambalpur.  

2. The Divisional Manager,

            LIC of India,

            Jeevan Prakash,Sambalpur,

          Dist-Sambalpur-768004.                                              …    Opposite Parties.

For the Complainant:-Sri S.K Biswal, & Sri B. K Pradhan, Advocate.

For the Opp.Parties :-Sri P.Guru, Advocate.

DATE OF HEARING -11.07.2018, DATE OF ORDER -31.07.2018

SRI DIPAK KUMAR MAHAPATRA,PRESIDENT-Brief facts of the case are that the husband of the Complainant has availed a Insurance policy from the O.P on dtd.  28.03.2011 vide policy no-594393988 for a sum assured of Rs3,00,000/-As the policy holder(Insured) died on dtd. 08.06.2014 the present Complainant being the nominee filed a death claim with the O.P against the death of the Insured. The O.P directed to submit the treatment particulars of the life assured from dtd. 01.06.2011 to  dtd. 08.06.2011 but as the Insured was in a good health condition till his death the Complainant never filed any such documents. Later on the O.P repudiated her claim on the ground of suppression of material facts as to the pre-existing disease of Brain Tumor along with Hemiplegia since 2 ½ years. And received treatment from Dr. P.N Dash on dtd. 30.04.2013 and the Insured revived the Policy by giving false statements. Again it was alleged that due to Hemiplegia the Insured was not attending his job at +2Panchayat College, Kalla where was working as Clerk. Also copies of letters seeking explanation by Sub-Collector, Deogarh to the principal of the said College regarding the drawing & disbursing salary of the Insured during his absent in college has been furnished by the O.P to strengthen his defence.                                                                    

POINTS OF DETERMINATION:-

1. Whether the Complainant is comes under the purview of Consumer Protection Act.1986?
2. Whether the O.P has committed any Deficiency in Service to the Complainant?

From the above discussion and materials available in the case record we inferred that the Complainant is a Consumer of the O.P as her deceased husband has availed an Insurance policy from the O.P and being the legal heir & successor as well as the nominee she has filed this case.

On consideration of the evidence, according to Sec-45 of the Insurance Act, 1938, is in these terms: 

"No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policy-holder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose.”                          

In the case before us the policy was issued on 28^th March 2011 and the amount insured was payable after 28^th March 2022 or at the death of the insured, if earlier. The O.P repudiated the claim by its letter dated 9^th October 2015. Obviously, therefore, two years had expired from the date on which the policy was effected. We are clearly of the opinion that Sec-45 of the Insurance Act applies in the present case in view of the clear terms in which the section is worded, though learned counsel for the O.P sought, at one stage, to argue that the revival of the policy some time in 28^th may 2014 constituted in law a new contract between the parties and if two years were to be counted from March 2011, then the period of two years had not expired from the date of the revival. Whether the revival of a policy constitutes a new contract or not for other purposes, it is clear from the wording of the operative part of Sec. 45 that the period of two years for the purpose of the section has to be calculated from the date on which the policy was originally effected; in the present case, this can only mean the date on which the policy was effected. From that date a period of two years had clearly expired when the O.P repudiated the claim.

After hearing the counsel for the parties and having gone through the facts of the case, we hold that the main dispute in the present case is that whether the prescription of Dr. P.N. Dash (Physiotherapist) is positive proof that insured was old patient of Hemi paralysis and Hemiplegia  and was taking medicines from him for such disease before the start of original policy and neither he has mentioned the name of medicines given to such patient in his treatment nor he has mentioned that the Insured was coming to him for monthly check up. He has only mentioned that said patient was under his treatment as he was suffering for last two and half years before his death, which was occurred on dtd.04.06.2014. Apart from this prescription, there is no other evidence produced by the O.P (Insurance Company) nor it is evident that the Insured was ever outdoor patient and he coming per week or per month for check up. Dr. P.N Dash was merely Physiotherapist and was neither qualified to give Allopathic medicines nor has he mentioned any Allopathic or Ayurvedic medicines for the treatment of Hemi paralysis and Hemiplegia given by him to the life assured/insured. The matter has been well settled in the case of “Life Insurance Corporation Of India... vs Kulwant Kumari” decided by Hon’ble National Consumer Disputes Redressal Commission, New Delhi, on 1^st  May, 2009.

Again the information sought under R.T.I Act-2005 about the presence of the Insured on dtd. 30.04.2014 in the Panchayat College, Kalla under Deogarh dist. was confirmed by the P.I.O of that concerned College. Therefore all the allegations made against the deceased Insured have not been proved.

Hence for the reasons stated above, we found that the O.P has committed “Deficiency in service” U/S-2(1) (O) to the Complainant by repudiating the Death Claim.

ORDER

The Complaint petition is allowed and the O.P is directed to settle the Death Claim of the Complainant and pay the sum assured of Rs.3,00,000/-within 30 days of receiving this order. Further the O.P is directed to pay a sum of Rs.5,000/- towards compensation, Rs. 5,000/-towards cost of litigation to the Complainant within 30 days of receiving this order, failing which the O.P shall pay 9% interest on the above amount till the day of actual payment to the Complainant.

Office is directed to supply free copies of the Order to the parties free of costs receiving acknowledgement of the delivery thereof.

 Order is pronounced in the open Court today i.e 31^th day of July 2018 under my hand and seal of this Forum.

                                I agree                                                   I agree

                         MEMBER (W)                                           MEMBER                                   PRESIDENT

                              Dictated & Corrected by me

                                          PRESIDENT