MR. PRAVAT KUMAR PADHI, PRESIDENT:-
Complainant has filed the C.C.Case No. 32/2023 U/s-35 of C.P.Act, 2019 seeking following relief:-
Hon’ble Commission after hearing direct the Ops to disburse the death benefits of deceased husband of the complainant along with litigation expenses and compensation.
Complainant being aggrieved by repudiation of claim in respect of LIC Policy No. 597049927 has filed the present C.C.Case. The main contention of the Complainant is that her husband had taken 3 nos. of LIC policies bearing No. 586114357, 588696203 and 597049927. The 1st two policies were settled and there is no dispute. The only disputed relates to the 3rd policy as mentioned above. The Ops have stated that the Complainant has obtained the 3rd Policy by suppressing the material facts regarding the disease, illness and treatment. The Complainant vide her letter dt. 12.03.18 denied having any past treatment particulars of D.L.A. The Policy was obtained by suppressing the fact and being an early claim, the matter was investigated as per the Provision of Sec-45 of Insurance Act, 1938.The husband of the Complainant expired on dt. 24.07.2016 as per discharge certificate of Dayananda Medical College & Hospital, Ludhiana dt. 21.07.2016, the DLA Sesadev Samal was admitted there from dt. 14.07.2016 to dt. 21.07.2016 for treatment of Cirrhosis and acute Hepatitis-B with history of DM, HTN with occasional Alcohol intake since 10 years. As per medical Attendant’s certificate of Sadguru Hospital, Cuttack the primary cause of death was Cirrhosis in liver and the DLA was suffering from cirrhosis in liver deceased since long and was addicted to alcohol. As per Hospital treatment certificate of the said Hospital, the DLA had a history of HBSAG positive and Alcoholic Heapatic Encephalopathy. Though such facts and documents were within the knowledge and custody of the complainant, but she suppressed and did not submit any previous treatment data before coming to that Hospital.
The averments of the complaint petition is that the complainant’s husband all of a sudden fall ill in hepatitis (Jaundice) and was in good condition as stated in Para-5 appears to be false in view of the materials available on record regarding treatment of her husband.
The claim being a early claim and policy obtained by suppressing fact for which we find no deficiency on part of the Ops particularly when the Ops have refunded total premium paid less extra premium amounting Rs. 9,608/- towards final settlement under claim dt. 22.12.2022. Thus we find no merit in the consumer complaint & accordingly the C.C.Case No. 32/2023 is hereby dismissed. No order as to cost.
Issue extract of the order to the parties concerned.
Pronounced in the open Commission, on this the 16th day of January,2024.
I, agree.
Sd/- Sd/-
MEMBER PRESIDENT
