Arunachal Pradesh

East Siang

CC/14/52

Ram sajjan Jha - Complainant(s)

Versus

LIC of India - Opp.Party(s)

nil

17 Dec 2014

ORDER

JUDGMENT & ORDER

This is a case under section 2 (1) of the Consumer Protection Act, 1986.

Ram Sajjan Jha, complainant present. Advocate Mr. Minli Riram present on behalf of LIC of India.

1) The Brief facts of the case are that wife of the complainant Lt. Audhaus Devi Jha , made an insurance policy for Rs. 1.00 lakh from the Opposite Party LIC of India vide Policy No. 443888374 Dated 31.8.2009. She suddenly died on 13.9.2009 at Raghunathpur, West Bengal. Shri Ram Sajjan Jha, husband cum nominee, approached opposite party, Pasighat Branch for payment of the assured sum but the claim was repudiated with the reason that DLA had been taking treatment for last six month which was not reflected in life history part of the proposal policy form. Aggrieved by non payment of assured sum, nominee Ram Sajjan Jha has filed this case.

2) Heard both the parties and also gone through the report submitted by the Medical Board constituted vice this Forum’s letter No. LMCA (Psg) – 77/2013 dated 14^th October, 2014 to ascertain proximate cause of the death of the deceased late Audhaus Devi Jha, Deceased Life Assured (in short DLA). As per report, the Board examined the case on the basis of the medical attendance certificate obtained by the LIC from the concerned Doctor and observed that “the disease stated in the certificate could be the proximate cause of the death of the deceased.”

3) As per (Annexure ‘A’), copy of proposal application bearing No. 210234, DLA was at Pasighat on 31.8.2009 who signed the Proposal Form in presence of a medical examiner and one LIC Agent named Miss Rashmi . In the column for Agent’s Confidential Report of the form, Miss Rashmi has noted that she knows DLA for last two years and remarked her health as ‘good’. Since DLA was examined  by the medical examiner on 31.8.2009 in presence of the Agent who also considered her case fit for granting policy by giving remark as “good health”, it is presumed that on 31.8.2009 she was in good heath.  LIC Agent Ms Rashmi’s reiteration of good health of DLA is in a way principles (LIC) statement.

4) The reason for repudiation of payment by the OP is for suppressing the material facts in Personal History part of the Proposal Form (Annexure-A) at Sl. No. 11. Information on personal history had been entered and signed on 31.8.2009 but as per First Premium Receipt bearing No. 2492823, DLA deposited the first premium amounting to Rs. 5,844/- on 28.08.2009 against the Policy No. 443888374.

5) As per First Premium Receipt bearing No. 2492823 (Annexure-2) the premium was deposited on 28.8.2009 (3 days ahead of the signing the proposal form /examined by the Medical Examiner on 31.8.2014) against the Policy No. 443888374. It is evident that her Policy was accepted on 28.8.2014 by assigning No 443888374.

6) As per Medical Attendance certificate obtained by the OP states that DLA had been taking treatment from 3.8.2009 to 11.9.2009 (more than one month) whereas as per statement made by the complainant, his wife (DLA) left Pasighat (exact date could not be confirmed but possibly on 1.9.2009 or 2.9.2009) in good health to visit her daughter in west Bengal who was studying there. She fell ill there itself and consulted doctor on 4.9.2009. It is confirmed that DLA was at Pasighat, Arunachal Pradesh on 28^th and 31^st August, 2009 as evident from the Annexure A and the First Premium Receipt as at point 3, 4, and 5 above. So, the Medical attendance certificate which states that DLA has taken treatment from 3.8.2009 to 11.9.2009 is not convincing.  Therefore, the same is to be set aside

7) With the aforementioned observations and findings, we are convinced that no material facts were suppressed by the deceased at the time of signing the contract with the LIC of India. And the facts were reiterated by LIC’s Agent in the form itself.

Therefore, the LIC of India has to pay the assured sum to the complainant with 12% interest till payment, along with compensation of Rs. 5000/- for physical harassment and mental agony suffered by the complainant. This order should be executed within 60 days from the date of judgment.

                     Copy of this order be served to both the parties.

                    

                                                            (Onam Moyong)                               (Nidhi Srivastava) IAS

                                                             Member                                                 President