Sri S.K.Sahoo,President.

            This is  a  complaint  filed  by  one  Sukanta Ranjan Mohapatra U/s. 12 of C.P.Act, 1986.

2.       The  case of the  complainant  is  that  deceased Mamata Kumari Devi  was   his  wife, who  was  serving  as  staff nurse  in the  govt. hospital. She had taken  New Endowment  Plan ( with profit)  bearing  policy No. 573941754 for  an  amount of  Rs. 10,00,000.00 .It  was  commenced  from 28.03.2014  and  the  half yearly premium was Rs. 24,468.00 (Annexure- 1 )  . She had   also taken one  Jeevan Anand ( with profit with accident  benefit)  from opp.party  No.2  bearing  policy No. 599841488  for  an  amount of  Rs. 3,00,000.00 , which was  commenced  from 28.01.2013  with  monthly  premium of Rs. Rs.1,756.00 (Annexure-2) . Mamata was  ill and admitted  to AIIMS, Bhubaneswar  , who  died  on  14.02.2015 due to   Cardio respiratory arrest. The  photo copy  of the  death  certificate  is Annexure-3. The  complainant  immediately intimated  the  death of   his  wife Mamata  to  all the opp.parties  and  submitted  his  claim for  the  sum assured  with  profit, bonus etc. Opp.party No.3  sent  a letter  to the  complainant  on 22.07.2015  and  asked  him to  submit the  necessary  documents  for the  claim relating  to   policy No. 599841488 . The  complainant  submitted  the  original policy bond,  death certificate and  all other  required documents to opp.party No.3   on 16.09.2015  and  Annexure- 4   is the  copy of the letter  received by the  complainant  and the  Annexure- 5  is  the  photo copy  of   letter  sent  by the  complainant  to opp.party No.3  on 16.09.2015. Surprisingly  after  nine  months  on 23.06.2016  opp.party No. 3   asked  the  complainant  to submit  the  original policy bond  along  with  other  documents  again for  his  claim. Regarding  policy No. 573941754  the  complainant   by  his  letter dtd. 07.03.2015  informed the opp.party No.4 regarding  the death of  his  wife Mamata and  claimed  for the insured amount. He  has  submitted  all the  documents,  policy bond  along  with the  said  letter and Annexure- 7  is the  photo copy of letter dtd. 07.03.2015 of the  complainant  sent to opp.party No.4. On 04.05.2015  opp.party No.4  sent  a letter to the  complainant  in which he  had  asked for  supply of  all the  necessary documents  for  his  claim. Annexure- 8   is the  photo  copy  of the letter  issued by  opp.party No.4  to the  complainant  on 04.05.2015 .The  complainant   submitted  the claim  form, original policy  bond  and  all other  required  documents to opp.party No.4  on 16.09.2015 and Annexure- 9 is the   photo copy  of  the letter  issued  by the  complainant   to opp.party No.4. On 03.11.2015  opp.party No.5 wrote a letter  to the  complainant, asking   him  to  submit  the   treatment particulars of the  insured  and  Annexure- 10  is  the   photo  copy  of the said letter. By  letter dtd. 16.11.2015   the complainant  has  shown his  inability  to  file the  treatment particulars of  his  wife  at AIIMS on the  ground  that the  hospital authority  refused  to supply  any documents  regarding  treatment  of  his  wife. Annexure- 11  is the   copy of the  letter issued to opp.party  No.5  by the  complainant  through  Regd.post   on 16.11.2015. Thereafter the  complainant  regularly  approached  opp.party No.2  to 6  and  requested them  to settle  the   claim  but no result. Finally  on 05.07.2016  the  complainant issued  a   legal  notice to the opp.parties  through  his  advocate for settlement  of  his  claim. Annexure- 12  if the  photo copy  of the  said  legal notice and Annexure- 13  is the  photo copy  of the  postal receipt . On 27.072016  the  opp.party No.5  sent  his  reply to the  complainant and Annexure- 14   is the   photo copy of the  said reply. Due  to the  inaction  of  the opp.parties  the  complainant  was subjected  to  mental agony and  harassment, for which they are liable  to pay  compensation.

3.       On the  other hand   the  case of the  opp.parties is that the  case is  not  maintainable  in  law or  facts . There is   no cause of action to  file  this  case against the opp.parties. The present  complaint  is   barred  for  non-joinder  of  necessary parties  and  mis-joinder  of  unnecessary  parties.  The opp.party No.1  is  neither  resident of  the place  where the  complaint is   filed nor  works  for the  gain at the said place. This  Forum has no territorial  jurisdiction to  decide the  issue raised by the  complainant  in his  complaint  petition. The  Branch Manager, Angul, Senior Divisional Manager, Cuttack  who are  added as opp.party No.2 &  6  respectively  in this  case, no way connected  with this case. The  policy  under  consideration was  initiated and  served at the   Carrier Agents Branch Office, Berhampur (opp.party No.3 )  and  Bhanjanagar (opp.party No.4). The  claim was repudiated at Berhampur  in the  office of opp.party No.5. Hence the  cause of  action  of the present  case  does not  arise  under the jurisdiction of this Forum. The  wife of the  complainant namely Mamata Kumari Devi  had  taken policy No.  573941754 from the  branch office Bhanjanagar and  policy No. 599841488 from CAB Berhampur.The   insured  died. It is not  correct, that  Mamata Kumari Devi fell ill after the  commencement  of the  policy and  got admitted AIIMS Bhubaneswar and  died  subsequently  on 14.02.2015.Much prior   to the   issuance of the  policy the  insured Mamata was under the  treatment  of Dr. Purusottam Pradhan  of Perfect Clinic ,Angul from 04.01.2012  to 31.01.2012  for  Pyrexia. Annexure- A  is the  photo   copy of the  medical certificate  issued by  Dr. Purusottam Pradhan. The  complainant has intimated  about the  death of  his  wife and  sent  information to the  opp.parties as   mentioned in paragraph- 4 & 5  of the  complaint petition. The  policy in  question was  accepted by the LIC  of  India  believing that the  informations  furnished  in the   proposal  are true. The LIC of India  while  issuing  a policy  underwrites  of risks  on the  basis  of the  statement made in the  proposal form and  personal statement  on the  presumption so made  are  true in all respect. The  Insurance contract  is based   upon the  principle of  Uberrima fides i.e  utmost good  faith  where  in   the  proposer  is   required to make  a   full and  fair  discloser  of the   material facts in the   proposal  form. As per section-45  of the   Insurance Act, 1938 , if  there  is  a  misstatement   of  facts  in the  proposal  form  with  regard to the  material facts and  the  same  have ben fraudulently  supressed the   corporation  is  at liberty  to repudiate the  claim. As the  insured Mamata Kumari Devi had  suppressed the  material facts relating to   her  medical treatment  prior  to  obtaining the  policy in question,  the opp.parties  repudiated the  claim. Hence there  is  no  deficiency in service and the  complaint petition  filed  by the  complainant  be dismissed.

4.         Neither of the  parties adduced  evidence   during  hearing  of  this  case. Admittedly  the  complaint petition  filed  by the  complainant is supported with affidavit.

           The   complainant is  the   husband   of  deceased   Mamata Kumari Devi  who had  taken  insurance  policy  of  New Endowment Plan ( with profit)  from  opp.party No.4 bearing  policy No. 573941754 which  commence  from  28.03.2014 for  a  sum assured  of Rs.10,00,000.00 and  Jeevan  Anand (with profit , with  accident benefit)  from opp.party No.2 ,  later  transfer  to opp.party No.3  bearing  policy No. 599841488  which  commence   on  28.01.2013 for  a sum  assured of Rs.3,00,000.00  from  Life Insurance  Corporation  of  India. Admittedly   Mamata Kumari Devi  was  serving  as  a staff nurse in the  Govt.  hospital  and  she  died on 14.02.2015  while  she    was  under  going  treatment  at  AIIMS, Bhubaneswar  due  to  Cardio Respiratory Arrest .It is  also  admitted  case of the opp.parties that the  claim of the  complainant  was  repudiated  as the   complainant  failed  to produce the  prescriptions , test  reports   etc. being   asked   to submit the  same  before the opp.parties.

           The  complainant  has  filed Annexure- 1 & 2   which   proved that the deceased Mamata Kumari Devi    had  taken   life insurance  policies  from  opp.parties and  she died  during the  period  covered  under the insurance policy. Annexure- 3 is  the  death certificate   of  Mamata Kumari Devi   which  shows that  she  died  on 14.02.2015  in AIIMS Hospital, Bhubaneswar . It is  also clear  from the  documents  filed  by both the parties  that there was  correspondence   in between the  complainant  and the opp.parties and  the  complainant  failed  to  file  the   prescriptions and the  documents  relating to the  treatment  of  Mamata Kumari Devi   at  AIIMS Hospital ,Bhubaneswar on the   ground that the hospital   refused to  supply those  documents.  From  the  photo  copy   of  claim statement, photo copy of medical attendant certificate, photo copy  of   medical treatment  certificate   of  identity and  photo copy of  burial/ cremation ceremony, it  appears   that Mamata Kumari Devi   died  due  to  cardio respiratory  arrest. Admittedly the  complainant failed  to file  the  prescription  and  other  documents  relating  to treatment  of the  deceased Mamata Kumari Devi   at AIIMS Hospital, Bhubaneswar. However,  the  fact  that  Mamata Kumari Devi    died  due  to  Cardio  Respiratory Arrest   on 14.02.2015  during  treatment  at AIIMS Hospital,Bhubaneswar  is  not  disputed. So   the   non-production of  prescription  and  the  documents  relating  to treatment of  Mamata Kumari Devi at AIIMS Hospital, Bhubaneswar   by the  complainant   will  no way   affect the  claim of the  complainant. The onus is  on the opp.parties to  prove that Mamata  Kumari Devi was  suffering  earlier to the policy  taken by her. 

5.       It  is  argued by  the Learned Counsel for  the opp.parties  that this Forum (at present Commission)  has no  territorial jurisdiction    over the  present  complaint filed  by  the  complainant. On  perusal of the  documents filed  by the  opp.parties  vide Annexure-C1  it is  clear that the  said  document is  of Angul Branch office and the declaration  by the  proposer  at Angul. On perusal of Annexure-C2  it  appears that the  policy  under policy  No. 573941754 was  proposed  at Bhanjanagar. The policy bearing No. 599841488 has been  issued in favour of the wife of the complainant  by LIC of India Angul Branch. Admittedly the LIC of India  is  carrying its  business through  out India  , having a  branch office at Angul.  So it is   clear  that the   opp.parties  being  the  officials’ of LIC of India  carries  their  business through  out  India  including   at Angul. So this  Forum(at  present Commission)  is  competent  to entertain the  complaint  filed  by the  complainant i.e  the  husband  of the deceased Mamata Kumari Devi. Although  the opp.parties  on the  show cause  challenged  the  maintainability of the  present  proceeding  on the  ground  of   no cause  of action, non-joinder and  mis-joinder of  necessary parties, no specific  evidence  led  by  them to  prove such allegations made  in their  show cause.

          The  Learned  Counsel for the opp.parties  vehemently  argued that the  deceased Mamata Kumari Devi   suppressed the  material  facts in  his   proposal form   submitted   to the opp.parties. He   further  argued that  she  was   under  treatment  by Dr. Purusottam Pradhan   of    Perfect Clinic, Angul  for  Pyrexia which was suppressed  by her. He  further argued that  Mamata Kumari Devi    was on leave   on  medical  ground during  her  service  which  appears  from the  certificate issued  by the   employer  in  favour  of the opp.parties. On perusal  of Annexure- B1  the  photo  copy of the said  certificate  issued by the  employer  , it  appears that  the  deceased Mamata Kumari Devi    was  on  leave  for  some  period  during  her  service  carrier  on medical ground. On perusal of the  said  Annexure- B1 it  appears that the  deceased  had  produced  the medical certificate  for  such  leave before the  employer. The opp.parties have  not  produced  the copy of  those   medical certificates    alleged   to have been  produced   by  deceased  Mamata Kumari Devi   before  her  employer  for the   leave period. The non-production of  those  medical  certificate  submitted by Mamata Kumari Devi    before  her  employer  by the opp.parties creates  doubt  on the  plea  of the  opp.parties  that  she  was  on medical leave for  treatment of diseases . The  photo copy   of  certificate   by the  employer  produced  by the opp.parties is  also  not legible.

            The  opp.parties  have  not settled  the  claim , even  though  the  present  complaint  was filed   in the  year  2016  before  this Forum (  now Commission). However the  sole  plea  of the  opp.parties  is that Mamata Kumari Devi   the  insured  has  suppressed the   material  facts  that  is   about her  treatment and   leave , for  which the  complainant  is  not  entitled  for the  insured amount. The  photo  copy  of the  medical  certificate issued by Dr. Purusottam Pradhan  does  not  bear  the  signature  of the  patient  Mamata Kumari Devi, so   it  needs  no consideration  in absence   the  examination  of  Dr.  Purusottam Pradhan to   prove the    fact of treatment or the  original certificate. The  proposal  form Annexure- C1   submitted  by  Mamata Kumari Devi    before the   opp.parties, consists  of  four pages. Page No.3  & 4  bears the signature of the  deceased Mamata Kumari Devi   .Page- 4   of the  said  proposal form is the  declaration  by the  proposer. The letters of the  proposal form of the opp.parties   are  very small and  not  readable  with normal  vision. It  appears that it  was signed  on 13.01.2013  at Angul. On close  scrutiny of the  said declaration of the   proposer  it  is  clear  that  if the  answers   and / or  signature  herein  above  are/ is   in vernacular  than  he/she should  declare  above  his/ her  signature in own  handwriting  that the replies  were  given after fully and  properly  understanding the  questions.   It is  clear  from the said  declaration  form by  the  said  proposer  that  Mamata Kumari Devi   has not made  any  specific  endorsement  by  her   own hand writing  that the  reply  was  given by her  after fully and   properly  understanding the  questions, above  her  signature on the  proposal  form. The declaration  by the  person filing  the  form , declarants name and address are blank in the  proposal  form. It  appears that the  insured Mamata Kumari Devi  only  put  her signature  near the  mark  “  X  ”.The  certificate   to be  given by the  insured  in the   proposal  form is  also  not  filled up. Mamata Kumari Devi should  have given the  certificate that “ I certify that the  contents of the  form and  documents have  been fully explained to me by  (Name, Designation, Occupation) Mrs/Mr__________________________  and  I  have  understood  the   significance  of the   proposed  contract”. In absence of such  evidence  the   proposal  form relied  on  by the  opp.parties losses its importance. So the  argument  of the  Learned  counsel for the opp.parties that the  Mamata Kumari Devi    has  suppressed the material facts  at the time of  submission  of   proposal  form  is  not  at all  reliable  and  trust worthy, in absence of  such endorsement   by herself  on the   proposal  form  above   her  signature. There  is  deficiency  in the  service  provided by the opp.parties to the  complainant .The opp.parties  have also adopted unfair  trade practice  by repudiating the  claim of the  complainant  without  reasonable ground.   So  after  analysing the material    facts  produced by   both the parties  , it is  clear  that the  complainant  is  entitled for the  insured amount.

6.       Hence  ordered :-

: O R D E R :

          The  case be  and the same  is allowed in part , on contest against  all the opp.parties. The opp.parties  are  jointly and severally  liable to pay for the claim  of  the  complainant. The opp.parties are  directed  to pay the sum assured  in  both the  policy  along with  interest @ 6% per annum  from the  date of 31.08.2016  till payment  is made. They are  further directed to pay  compensation of Rs.20,000.00 (Rupees Twenty Thousand) only  and  litigation expenses of Rs.10,000.00 (Rupees Ten Thousand) only  to the   complainant. The opp.parties  are directed to pay all the  amount  within one  month   from  the date of  receipt  of this  order, failing which the  amount  ordered to be  paid  will carry penal interest @ 12%  per annum  till payment  is made.