The Complainant has filed this case alleging deficiency-in-service by the O.Ps, where O.P No.1 is the Branch Manager of Life Insurance Office, Balasore, O.P No.2 is the Divisional Manager, LIC, Cuttack, O.P No.3 is the Zonal Manager, LIC of India, East Central Zonal Office, Patna and O.P No.4 is Sanjay Kumar Singh, LIC Agent, Jaleswar Branch, Balasore.

                    1. Factual matrix of the dispute is that the Complainant is the legal married wife of deceased Kamal Lochan Acharya and also nominee of the deceased life insurance policy No.583669686. But, Kamal Lochan Acharya died on 01.11.2012 due to heart attack and the Complainant had applied for settlement of death claim of her husband along with the documents before O.P No.1, but the O.Ps didn't settle the claim of the Complainant. Thus, the Complainant through her Advocate served legal notices to the O.Ps through registered Post with AD on 20.03.2014. On receipt of legal notice, the O.Ps intimated to the Complainant vide letter dt.24.03.2014 with an observation "he was operated for hernia on 08.06.2010 as per treatment particular for which repudiate the claim for full sum assured and nothing is payable under Policy". And as per advice of the O.P No.2, the Complainant issued a legal notice through her Advocate to O.P No.3 through registered Post with AD on 16.04.2014, but the O.Ps did not settle claim of the Complainant, thus showing deficiency-in-service by the O.Ps. The O.P No.4 has not asked any question to the Complainant, but the Complainant has only signed in some blank papers as per his advice. Moreover, hernia operation is a minor operation and it may be operated without any risks. Prayer for settlement of death claim of the Complainant bearing Policy No.583669686 along with compensation for mental agony and litigation cost.

                    2. Written version filed by the O.Ps No.1 to 3 through their Advocate, where they have denied on the ground of maintainability as well as its cause of action. They have further submitted that the deceased life assured (in short DLA) has suppressed the material fact by not disclosing the treatment and he was undergoing prior to taking of the Policy and thereby has committed gross breach of good faith, for which the contract of insurance has become void ab-initio. Moreover, the DLA had availed 25 days leave on medical ground for his hernia operation on 08.06.2010, which he had not disclosed in the proposed form while taking Policy on 28.08.2010. Accordingly, the DLA was guilty of suppression of material fact and basing on this mis-statement the repudiation of claim has been rightly done and legally justified. The DLA had mentioned 'No' to the question No.6(a) while filing of the proposal form at the time of taking Policy regarding medical treatment if any. But, the treatment particular available shows that the DLA was admitted and operated for hernia on 08.06.2010 and discharged on 17.06.2010. Accordingly, the O.P considering the terms and conditions of the Policy especially U/s.45 of the Insurance Act, 1938 has repudiated the claim of the Complainant and the said decision of repudiation has been duly communicated to the Complainant on 24.03.2014. So, there is no deficiency of service on the part of the O.Ps No.1 to 3 in any manner whatsoever with regard to the repudiation of claim.

                    3. The O.P No.4 appeared through his Advocate and filed written objection, but he did not take part in hearing as his Advocate remained absent on the date of hearing. Written objection filed by O.P No.4 through his Advocate, where he has denied about maintainability as well as its cause of action and jurisdiction. The O.P No.4 has further submitted that the Complainant has not mentioned the name of her two minor sons as Complainant, who are Class-I heir of the DLA. The DLA knowing the very fact of each ingredient put his signature suppressing about his surgical operation with a malafide intention. As per Provisions of L.I.C Act, suppression of material fact regarding disease, no claim is payable against the Policy of DLA. Moreover, the O.P No.4 at the time of filing of the prescribed form for execution of L.I.C Policy duly asked about existence of any disease and the DLA gave negative reply, accordingly that point was filled up. So, no deficiency of service has been committed by O.P No.4.

                    4. In view of the above averments of both the Parties, the points for determinations of this case are as follows:-

(i) Whether this Consumer case is maintainable in the eye of Law.

(ii) Whether there is any cause of action to file this case by the Complainant.

(iii) Whether the husband of the Complainant (the deceased) had suppressed the material facts regarding existence of disease of hernia at the time of filing of proposal form of the Policy knowingly.

(iv) Whether the O.Ps-Insurance Company has rightly repudiated the claim of the Complainant for suppression of material facts by the husband of the Complainant.

(v) To what relief the Complainant is entitled for ? 

                    5. In order to substantiate their pleas, both the Parties have filed certain documents in their support as per list. Perused the same.  It is admitted fact that the husband of the Complainant was the Policy holder of LIC bearing Policy No.583669686 and the Complainant is the nominee of the said Policy. The husband of the Complainant died on 01.11.2012. It has been argued on behalf of the Complainant that after filing of death claim application after lapse of long period when the O.Ps-Insurance Company did not settle the claim, the Complainant was compelled to issue Advocate notice and when it was in vain also, then the O.Ps informed her about repudiation of her claim on the ground of suppression of material facts regarding existence of disease of hernia at the time of filing of proposal form of the Policy. For this reason, the Complainant was compelled to take shelter in this Forum for the claim amount of Rs.2,00,000/- with compensation of Rs.30,000/- and litigation cost of Rs.30,000/- in total Rs.2,60,000/-. It has been argued on behalf of the O.P No.1 to 3 that after filing of the claim form by the Complainant, on enquiry when it came to light that the husband of the Complainant was suffering from disease of hernia and operated at Chandi Nursing Home on 08.06.2010 and availed 25 days leave on the medical ground from 18.06.2010 to 12.07.2010. When he suppressed the material facts as per existing rules and terms and Condition of the Policy, the O.Ps-Insurance Company was compelled to repudiate the claim and informed the Complainant accordingly. In the repudiation letter of the O.Ps, it has been clearly disclosed that in the question Serial 11(v) of the proposal form, it has been mentioned as “Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other diseases ?” and the answer is ‘No’. Thus, it clearly amounts to giving of false material evidence and had made incorrect statement by withholding the correct information at the time of commencement of the Insurance Policy, for which the O.Ps have no other alternative and compelled to repudiate the claim. Though O.P No.4 is the Agent of the LIC of India has filed his written version, but he has not taken part in the hearing and according to him, at the time of filing of proposal form of the Policy, the husband of the Complainant was knowingly the very fact of each ingredient put his signature suppressing about his surgical operation with a malafide intention and also at the time of filing of the prescribed form for execution of L.I.C Policy duly asked about existence of any disease and the husband of the Complainant gave negative reply accordingly. In support of their arguments, the O.Ps No.1 to 3 have relied upon the Authority reported in I (1994) CPJ-3 (N.C) in the case of Divisional Manager, L.I.C of India & Ors. (Vrs.) Sunita Sharma, where the Hon’ble National Commission, New Delhi has held that Insurance claim not paid on the ground that insured suppressed material facts relating to his state of health. Similarly, they have also relied upon the Authority reported in AIR 1962 SC-814 in the case of Mithoolal Nayak (Vrs.) LIC of India, where the Hon’ble Apex Court has held that the deliberate concealment of fact by the Proposer, that he/she had been treated by the Doctor before the Policy was effected/ revived, the Policy is vitiated and cannot claim the benefit of a Contract which has been entered into as a result of fraudulent suppression of facts. It has further held that all moneys that have been paid in consequence of the Policy would belong to the Company, if the Policy was vitiated by reason of fraudulent suppression of material facts by the insured.       

                    6. So, now on careful consideration of all the materials available in the case record and on the basis of principles laid down by the above authorities as discussed earlier, this Forum come to the conclusion that the O.Ps have rightly repudiated the claim of the Complainant due to suppression of material facts by the husband of the Complainant, for which the Complainant is not entitled to get any relief as prayed for. Accordingly, this Consumer case is liable to be dismissed. Hence, Ordered:-        

                                                     O R D E R

                         The Consumer case is dismissed on contest against the O.Ps, but in the peculiar circumstances without cost.

                         Pronounced in the open Forum on this day i.e. the 3rd day of July, 2017 given under my Signature & Seal of the Forum.