Before  the District Consumer Dispute Redressal Commission [Central]

5th Floor, ISBT Building, Kashmere Gate, Delhi

                               Complaint Case No. 257/04.12.2018

Priyanka Vikas Jaiswal

Widow of late Vikas Kumar Jaiswal

D/o Sh. Fulendra Choudhary                                 

R/o Ghoshi Tola, PS Kasim Bazar,

District Munger, Bihar                                                    ...Complainant

                                      Versus

OP1- Life Insurance Corporation of India

Through Branch Manager

Branch at:12/56 Deshbandhu Gupta Road,

(Branch Code: 11K), Karol Bagh,

Delhi- (110005), India.

OP2- Life Insurance Corporation of India

          Through Senior Divisional Manager,

Delhi Divisional Office-II, 9^th Floor,

Scope Minar, Laxmi Nagar.

Delhi- (110092), India.                                         ...Opposite Party

                                                                   Date of filing:             04.12.2018

                                                                   Date of Order:             14.08.2023

Coram: Shri Inder Jeet Singh, President

             Ms. Shahina, Member -Female

   Shri Vyas Muni Rai,    Member

Vyas Muni Rai

ORDER

1.1. The instant (amended) complaint has been filed by Ms Priyanka Vikas Jaiswal, nominee in the policy and widow of Lt. Sh. Vikas Kumar Jaiswal ( in short the complainant ) against 1. Life Insurance Corporation of India through its Branch Manager, Karol Bagh, Delhi ( in short the OP No. 1) and 2. LIC of India through its Sr. Divisional Manager, Laxmi Nagar, Delhi (in short the OP No.2) under section 12 of Consumer Protection Act 1986.

1.2. The complainant’s husband during his life time took following Life insurance policies from the OPs and details of the same are as under;

1. Policy no.126513731 dated 14.06.2012 for a sum of Inr 12,50,000/-   (twelve lakhs fifty thousand only) issued by the branch at karol bagh delhi  (branch code 11k). The present complaint pertains to the policy no.1.

2. Policy No. 117474988 dated 12.02.2013 for a sum of INR 7,50,000/-(Seven lakhs fifty Thousand Only) issued by the Branch at Connaught Circus, New Delhi (Branch Code 115)
3. Policy No. 9768995646 taken in the year 2008 for a sum of Rs. 5,00,000/- and other benefits of Policy arrayed in Table & Term No. 103-21 issued by the Branch at Nagpur, Maharashtra.

1.3. The present complaint pertains to policy no. (1) as detailed in para no. 1.2 of this order. Mr.Vikas Kumar Jaiswal (assured) took the policies to financially secure his family. The said policy was issued in favour of assured after proper verification, physical and medical check-ups by the OP No.1 for which assured made regular payments of the premiums.

1.4. The assured very first in the year 2008 took the policy No. 9768995646 for a sum of Rs.5,00,000/- and other benefits to be paid to the child of assured after attaining the age of majority. After the death of the assured on 13.02.2015 the representation was made to LIC for the settlement of the claim and the same was settled by the LIC/ OP.

1.5. All of sudden on 29.07.2014; the assured was admitted to Meditrina Institute of Medical Sciences, Nagpur with complaint of dry cough, low grade fever and diaspora and after treatment he was discharged on 06.08.2014 as per Doctors advice; thereafter, assured’s health was improved and he resumed his duties.

1.6. Again on 12.01.2015, the assured got admitted at CMC, Vellore with the same problem/ disease as mentioned in para No. 1.5 above and after proper check ups/ investigation, assured was diagnosed for mediastinal mass, Rfractory T. cell Lymphoblastic Lymphoma- Cardiac Tamponade and assured was medically advised for Hyper Card Chemotherapy. After 4 cycles of methotrexate-Based Chemotherapy; the assured could not survive and he expired on 13.02.2015.

1.7. Thereafter, after the death of assured/ Vikas Kumar Jaiswal, his widow/ the complainant, being nominee in the policy approached the OPs for the claim against the above mentioned policies and completed all necessary formalities/ documentation as required by the OPs. In the meantime due to financial constraints, complainant shifted to her parental home at Munger, Bihar and she is totally dependent upon her aged parents.

1.8. The OPs also conducted several investigations/ inquiries from the hospital and employer of the assured (LIC) regarding the claim raised by the complainant  qua the said policies. The complainant visited the office of  the OPs many a times but OPs didn’t clear the claim; OP2 vide its letter dated 04.03.2016 repudiated the claim, citing non- disclosure of the earlier policies; however, the complainant has pleaded that at the time taking the policy in question, no other policy was in existence and the ground of repudiation of claim is false and wrong.

1.9. The complainant has further pleaded that policy bearing No. 117474988 was taken on 12.02.2013 for a sum of Rs. 7,50,000/- by the assured from the OP and policy no. 126513731 in question was taken prior the policy No. 117474988, The complainant through her counsel issued legal notice dated 31.05.2016 to OP, with a request to settle the claim of the policy in question, however , OP vide letter dated 14.06.2016 acknowledged the legal notice of the complainant and OP vide letter dated 08.07.2016 upheld the repudiation of the claim.

1.10. The complainant alleged deficiency of service and unfair trade practices on the part of the OPs for repudiation of her claim, which caused mental agony, harassment & financial losses to the complainant.

1.11. The complainant has prayed for directions to OPs to pay the sum assured of Rs.12,50,000/-; Rs.4,13,321/- towards interest calculated @ 9% p.a. from the date of statement of claim made; Rs.1,00,000/- compensation for mental and physical harassment, and Rs. 50,000/- as cost of litigation.

1.12. The complaint is accompanied with copy of marriage certificate, copy of policy No. 126513731/dated 14.06.2012; premium receipt of policy; discharge summary of Sh. Vikas Kumar Jaiswal, death certificate of Sh. Vikas Kumar Jaiswal, representation made to the OP for settlement of claim along with other documents; repudiation letter dated 04.03.2016, copy of policy No 117474988 dated 12.02.2013; copy of legal notice dated 31.05.2016, copy of letter dated 14.06.2016, and 08.07.2016 issued by the OP,  copy of letter dated 02.12.2016 of the complainant etc.

2.1. The OPs have filed their composite reply under the signature of Ms Dipa Sinha, Manager (Legal and HPF), Delhi. The complainant took policy on 28.02.2013 from OP1 Karol Bagh Branch after gap of 16 days only from the taking of another policy (policy No. 117474988) for sum assured for Rs. 7,50,000/- from another Branch and assured did not disclose this, while proposing for Policy No.126513731.

2.2.  In the proposal form for policy No. 126513731, the assured (Mr. Vikas Kumar Jaiswal) did not disclose the previous policy No.117474988 in reply to Q. No 9 of the proposal form signed on 22.02.2023. Had the assured disclosed it in his previous policy, the OPs would have called full medical report & special medical reports viz. ECG, SBT-13, RUA, HB percentage, copy of self-attested ITR of last 03 years and the proposal would have been underwritten after the Divisional Medical referee at Divisional officer level instead of granting risk under Non-Medical Special Scheme at Branch level. The non- disclosure of previous policy has direct bearing on grant of risk under subsequent policy; the deceased/ assured did not disclose his previous policy solely with motive and intention to avoid and escape from medical examination & test reports. OPs denies that the policy was issued after proper verification, physical and medical check-ups by the OP1; the risk was covered under ‘Non-Medical Special Scheme’ without medical examination and physical check-ups by the OP. As per prevailing underwriting rules and the same was due to the age and occupation stated by the deceased /assured in his proposal form. Assured took the policy from the OPs by concealing the material facts about his health.

2.3. The assured died on 13.02.2015 before expiry of 03 yrs period from the date of commencement of risk w.e.f. 28.02.2013, hence death claim under policy was duly processed as per the provisions of section 45 of the Insurance (Amendment Laws) Act, 2015 including the complete investigation procedure.

2.4. Further, date of the commencement of risk cover under policy No 117474988 is w.e.f. 12.02.2013 and date of commencement of risk cover  under policy No126513731 is of date 28.02.2013; hence policy No. 117474988 was taken prior to the policy No 126513731. Policy No 126513731 was dates back to 14.06.2012 and date of proposal under policy 126513731 was of 22.02.2013; therefore, any financial loss or mental agony or harassment meted out to the complainant and deficiency of services; unfair trade practices on the part of the OPs are denied. The complainant is not entitled for any relief claimed and complaint deserves dismissal with costs.

3. The complainant has filed rejoinder. The OPs have tried to mislead the Hon’ble Forum by supressing material facts. The objection of non- disclosure of previous policy is not applicable in facts and circumstances, since the Insurance Co. has already admitted the claim on the same ground. It has been further submitted that non-disclosure of other policies, for the purpose of repudiation of claim is not burden solely on the complainant, but the OP is duly bound to verify the existence of the previous policies of the insured person, before issuance of policies; rest of the contents of the complaint have been reiterated and reaffirmed as correct.

4. The complainant led evidence by filing her affidavit, which is on the lines of complaint. Sh. Ajay Tyagi, Manager, (Legal and HPF), Delhi has led evidence by filing affidavit on behalf of the OPs which is also on the lines of reply of the OPs; Exhibit RWI/1 (copy of proposal form) and Exhibit RWI/2 (copy of circular dated 24.10.2018 under the provisions of section 45 of the Insurance Amendment Law Act,2015) have been relied upon by the OPs.

5. The complainant and the OPs have filed their respective written final arguments and it was followed by oral submissions by Mr. Ganesh Kumar, Advocate for the complainant and on the other side by Mr. Rajiv, Advocate for OP1 and OP2.

6.  The details of policies taken by the complainant are given in para No. 1.2 above of this order. The complainant’s case has already been detailed and complainant fortifies her case, while relying upon the following cases.

(a) LIC of India V/s Smt Shahida Begum (without mentioning citation) decided by Hon’ble NCDRC,   held that by not disclosing earlier policies, the  contention regarding escaped special medical examination is not acceptable. It is fundamental principle of insurance law that utmost good faith must be observed by the contracting parties and good faith forbids either parties from non-disclosure of facts which the parties know. The assured has a duty to disclose and similarly it is the duty of the insurance company and its agent to disclose all material facts in their knowledge since obligation of good faith applies to both equally, as the law laid down by the Hon’ble Supreme Court of India in the matter of M/s Modern insulators Ltd. versus Oriental insurance Co. Ltd. reported in 1 (2000)CPJ1 SC.

(b) Hon’ble NCDRC in the matter of Asha Garg Vs United Insurance Co. Ltd. (without mentioning citation)held that:

1. If the details of earlier proposals and/ or policies taken with the Insurer are not disclosed in the new proposal, it would not amount to suppression as the information was not within the exclusive knowledge of the proposer / insured since the insurer had an opportunity to verify the statement;
2. However, if the proposals and/ or policies with other insurer/s is suppressed, that would be material suppression as such information would be in exclusive knowledge of the proposer/ insured.
3. If the relevant column is left blank, it would not amount to suppression; the insurer should have called for an explanation or rejected the proposal;
4. before accepting such proposals for huge amounts, it was the duty of the insurer to find out the status, income and the means of the income of the assured, if at all required.

(c) That the Hon’ble Supreme Court in the matter of Skandia Insurance Co. Ltd. (without mentioning citation) Versus Kokilaben Chandravadan & Ors. paved the way towards reading down the contractual clause by observing as follows:

……When the option is between opting for a view which will relieve the distress and misery of the victims of accidents or their dependents on the one hand and the equally plausible view which will reduce the profitability of the insurer in regard to the occupational hazard undertaken by him by way of business activity, there is hardly any choice. The court cannot but opt for the former view. Even if one were to make a strictly doctrinaire approach, the very same conclusion would emerge in obeisance to the doctrine of reading down the exclusion clause in the light of the ‘ main purpose of the provision so that the exclusion clause highlighted earlier. The efforts must be to harmonize the two instead of allowing the exclusion clause to snipe successfully at the main purpose. The theory which needs no support is supported by Carter’s “ Breach of Contract” vide paragraph 251.

7.1. The OPs have relied upon proposal form dated 28.02.2013 wherein complainant Ms. Priyanka Vikas Jaiswal widow of deceased/ assured is named as ‘nominee’ and in the column of person’s history it is answered by the assured in ‘negative’ as ‘No’ for which, the stand of Non- disclosure of material facts have been taken by the OPs. Secondly, OPs have also relied upon its circular  dated 24.10.2018 having refers section 45 of the Insurance Laws (Amendment) Act, 2015, its relevant parts are quoted as under:

1. No Policy can be repudiated on any ground whatsoever after the expiry of three years from the date of the policy i.e. from the date of issuance of policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later.
2. A policy may be repudiated at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date & revival of the policy or the date of the rider to the policy; whichever is later, on the ground of fraud as defined under amended section 45.

   A policy may also be repudiated at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy; whichever is later, on the ground that any statement of or suppression of fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of which the policy was issued or revived or rider issued.

     The decision of repudiation shall have to be communicated along with the grounds and the materials on which such decision is made in writing to the insured or the legal representatives or nominees or assignees of the insured.

3. If the policy is repudiated, then the Accident Benefit, Critical illness Rider, Term Assurance Rider or any other rider shall not be payable.
4.  Where policy is repudiated on the grounds of fraud, then nothing is payable to the insured or nominee or assignee or legal representatives of the insured or legal representatives of the nominees, as the case may be. Even in case of single Premium Policies, where policy is repudiated on the grounds of fraud, nothing is payable on ex-gratia basis.

 However, where the policy is repudiated within three years from the date of revival of the policy on the grounds of fraud, then paid-up value plus bonus acquired and vested before revival, if any, is payable to the insured or nominee or assignee or legal representatives of the insured or legal representatives of the nominee, as the case may be. The amount paid for revival of the policy and thereafter is not payable. If the policy had not acquired any paid – up value before revival, then nothing is payable.

7.2. Further, OPs also fortifies its contentions while referring the following cases;

1. Satwant Kaur Sandhu V/s New India Assurance Co. Ltd. IV (2009) CPJ 8 (SC):

14. MacGillivrary on Insurance Law (Tenth Edition) has summarized the assured’s duty to disclose as under:

“…. The assured must disclose to the insurer all facts material to an insurer’s appraisal of the risk which are known or deemed to be known by the assured but neither known nor deemed to be known by the insurer. Breach of this duty by the assured entitles the insurer to avoid the contract of insurance so long as he can show that the non- disclosure induced the making of contract on the relevant terms.”

15. Over three centuries ago, in Carter Vs. Boehm 4 (1766) 3 Burr, 1905 Lord Mansfield had succinctly summarized the principles necessitating a duty of disclosure by the assured, in the following words:

    “Insurance is a contract of speculation. The special facts upon which the contingent chance is to be computed lie most commonly in the knowledge of the assured only; the underwriter trust to his representation, and proceeds upon confidence that he does not keep back any circumstances in his knowledge to mislead the underwriter into  a belief that the circumstances does not exist. The keeping back such circumstances is a fraud, and therefore, the policy is void. Although the suppression should happen through mistake, without any fraudulent intention, yet till the underwriter is deceived and the policy is void; because the risqui run is really different from the risqui understood and intended to be run at the time of the agreement… The policy would be equally void against the underwriter if he concealed…Good faith forbids either party, by concealing what he privately knows, to draw the other into a bargain from his ignorance of the fact, and his believing the contrary”

The upshot of the entire discussion is that in a contract of insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not to accept the risk is a ‘material fact.’ If the proposed has knowledge of such fact, he is obliged to disclose it particularly while answering in the proposal form. Needless to emphasise that any inaccurate answer will entitle the insurer to repudiate his liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a Contract of Insurance.”

2. Reliance Insurance Co. Ltd and another V/s Rekhaben Naresh bhai Rathod, Civil appeal No. 4261 of 2019 ( Arising out of SLP (C) No. 14312 of 2015), D/ 24.04.2019).  

    Contacts of insurance are governed by the principle of utmost good faith. The duty of mutual fair dealing requires all parties to a contract to be fair and open with each other, create and maintain trust between them. In a contract of insurance, the insured can be expected to have information of which she/ he has knowledge. This justifies a duty of good faith, leading to a positive duty of disclosure. In the present case, the insurer had sought information with respect to previous insurance policies obtained by the assured. The duty of full disclosure required that no information of substance or of interest to the insurer be omitted or concealed. Whether or not the insurer would have issued a life insurance cover despite the earlier cover of insurance is a decision which was required to be taken by the insurer after duly considering all relevant facts and circumstances. The disclosure of the earlier cover was material to an assessment of the risk which was being undertaken by the insurer. Prior to undertaking the risk, this information could potentially allow the insurer to question as to why the insured had in such a short span of time obtained two different life insurance policies,. Such a fact is sufficient to put the insurer to enquiry. In the present facts that the information which was sought by the insurer was indeed material to its decision as to whether or not to undertake a risk. The proposer was aware of the fact, while making a declaration, that if any statement were untrue or inaccurate or if any matter material to the proposal was not disclosed, the insurer may cancel the contract and forfeit the premium. The proposer duly appended his signature to the proposal form and the grant of insurance cover was on the basis of the statements contained in the proposal form. Barely two months before the contract of insurance was entered into with the appellant, the insured had obtained another insurance cover for his life in the sum of Rs. 11 lakhs. Failure of the insured to disclose the policy of insurance obtained earlier in the proposal form entitled the insurer to repudiate the claim under the policy.

( Paras 26,27,28).

8.1. (Findings)- The rival contentions of both the sides are considered, keeping in view the material on record, which is oral narration of events and of documentary record as mentioned in affidavits of parties followed by oral submission.

8.2. Since some legal issues and other issues have emerged from the rival contentions of the parties, therefore, they are taken.

8.3. The complainant purchased three life insurance policies which are described in para 1.2 of this order. The OP has raised the issue that in the proposal form for assurance under policy no. 126513731, the life assured i.e. Mr. Vikas Kumar Jaiswal did not disclose his previous policy no. 117474988 in question no. 9 of the proposal form signed on 22.02.2013. Had deceased life assured disclosed his previous policy, the OPs would have called full Medical Report, Special Medical Reports viz. ECG, SBT-13, RUA, HB percentage and copy of self-attested ITR for last 3 years and proposal would have been underwritten after the Divisional Medical Referee at Divisional Office Level instead of granting risk under Non- Medical Special Scheme at Branch level. Non-disclosure of previous policy solely with the motive and intention to avoid and escape from medical examination reports has direct bearing on grant of risk under subsequent policy. It is the case of OPs that the policy was taken on 28.02.2013 from the Karol Bagh Brnach (B.O.-11-K) under Delhi Division Office -2 of LIC of India with a gap of 16 days only from the taking of another policy no. 117474988 for sum assured of Rs. 7,50,000/- from another Branch (Branch unit-115) and the life assured did not disclose this while proposing for the policy no. 126513731. It is also the case of OPs that policy no. 126513731 was dates back to 14.06.2012 (from the back date) and date of proposal under this policy is 12.02.2013.

8.4. OPs have relied upon its Circular dated 24.10.2018 referring section 45 of the Insurance Laws (Amendment) Act, 2015 which, inter alia, depicts that “a policy may be repudiated at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of rider to the policy; whichever is later, on the ground of fraud as defined under amended section 45.

     A policy may be repudiated at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of rider to the policy; whichever is later, on the ground that any statement of or suppression of fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other documents on the basis of which the policy was issued or revived or rider issued.

     The decision of repudiation shall have to be communicated along with grounds and the materials on which such decision is made in writing to the insured or the legal representatives or nominees or assignees of the insured.

8.5. Therefore, in the present case Mr. Vikas Kumar Jaiswal (husband of the complainant)/ life assured died on 13.02.2015 before expiry of 3 years from the date of commencement of risk i.e. 28.02.2013, based on this factor, death claim under policy was duly processed in pursuance with the provisions of section 45 of the Insurance Amendment Laws Act, 2015 including the complete investigation procedure. This submission of the OPs have force in their defence. Relevant details of provision of section 45 of the Insurance Laws (Amendment) Act, 2015, its relevant parts issued vide Circular dated 14.10.2018 relied by OPs and exhibit R-1/2 with its affidavit are already detailed in para no. 7.1 of this order stands proved by OPs.

8.6. The OPs have also fortified its contentions while relying upon the case law which are detailed in para no. 7.2 of this order which manifestly establishes the case of OPs that Mr. Vikas Kumar Jaiswal/ (since deceased) life assured and husband of the complainant did not disclose the material fact of taking another policy from the OPs’ different Branch is suppression, although, it may be by mistake, bona fide, omission, without any fraudulent intention, yet underwriter is induced to issue policy, the policy is void. The upshot of the entire discussion is that in a contract of insurance, any fact which would influence the mind of a prudent insurer in deciding whether or not to accept the risk is a ‘material fact’. The ratio of case law titled Reliance Insurance Company Ltd. and another vs. Rekha Ben Naresh Bhai Rathod (para 7.2 of this order) entirely favours the OPs and strengthens its case for repudiation of claim of the complainant.

8.7. However, OPs vide its letter dated 04.03.2016 repudiated the death claim under policy no. 126513731 of the life assured of deceased (Sh. Vikash Kumar Jaiswal) for the sum assured Rs. 12,50,000/- advising the servicing Branch Office to refund the premiums collected till the date of repudiation to the nominee/ complainant. The contents of the repudiation letter dated 04.03.2016 are reproduced as under:-

“REF.: Claims/Repudiation/107/11K                                  March 4, 2016

REGISTERED

Smt. Priyanka Vikas Jaiswal,

w/o Late Sh. Vikas Kumar Jaiswal,

c/o Fulendra Chaudhary,

Ghosi Tula Munger, Bihar,

Madam,

Re: Death Claim under Policy no. 126513731 on the life of

Late Sh. Vikash Kumar Jaiswal

Sum Assured Rs. 12,50,000/- P/T. 165-10

     With reference to your claim under the above policy on the life of your Husband late Shri Vikas Kumar Jaiswal we have to inform you that we have decided to repudiate all liability under the policy on account of the deceased having withheld material information regarding his previous insurance at the time of effecting the assurance with us.

     In this connection we have to inform you that in the Proposal for Assurance dated 22.02.2013 and personal statement thereof signed by the deceased assured on 22.02.2013 at the time of taking this policy he had answered the following questions in negative as under:

Q. No.9

Please give details of your previous insurance: (including Policies Surrender/ Lapsed during last 3 years)

     We may, however, state that the above answer was false as we have evidence and reason to believe that deceased life assured has not disclosed all previous policies. Had he disclosed the previous policy no. 117474988. We would have called for the special medial reports i.e. FMR, ECG, SBT-13, RUA, HB%, copy of self-attested ITR for last three years and underwriting decision would have been taken at the level of Divisional Office. We would have called further medical requirement and the case would have been decided/ underwritten accordingly.

     It is therefore evident that he had made incorrect statements and withheld correct information from us regarding his previous insurance at the time of effecting the assurance. Hence in terms of the policy contract and declarations contained in the form of proposal for assurance, we hereby repudiate the claim and we are advising the servicing Branch Office to refund the premiums collected till the date of repudiation to the Nominee/ Claimant.

     In case you disagree with our decision and feel that we have not considered any particular facts and circumstances in support of your claims, you may send your representation within three months for re-consideration of your claim to our Zonal Office at the following address:

The Zonal Manager,

L.I.C. of India,

Northern Zonal Office,

Connaught Circus,

New Delhi-110001

Yours faithfully

Sr. Divisional Manager”

9. Thereafter, the complainant has also submitted a letter dated 14.06.2016 issued by OPs (in response to the complainant’s letter dated 31.05.2016) stating therein, that  we may inform you that relevant papers under above claim are being called from Divisional Office: Delhi II so as to place your appeal along with the facts before “ Zonal office claims  Dispute Redressal Committee”.

     Further, OPs wrote letter dated 08.07.2016 addressed to the complainant as under:

“Ref: Your appeal to ZO CRC in respect of policy no. 126513731 fvg. Lt. Sh. Vikas Kumar Jaiswal

     With reference to your appeal, the matter regarding repudiation of claim under the above policy was place before the Zonal Office Claims Reviews Committee.

     The Zonal Office Claim Review Committee has examined the facts of the case and it has been decided to uphold the repudiation decision of the Divisional Office. However, you may refer your appeal before the CO-CRC at the following address.

     Claims Dispute Redressal Commission[CO-CDRC]

     LIC of India, Central Office, CRM Deptt.

     5^th floor (Link), Yogakshema Building

     Jeevan Bima Marg, Mumbai-400021”

(the aforesaid two letters of OPs have been mentioned at Serial no. 13 and 14 of the list of documents filed on behalf of the complainant)

But there is nothing on record whether any appeal was filed by the complainant before CO-CDRC at its Mumbai address. Therefore, conclusion is drawn that OPs took all necessary steps to this effect.

10. Since it stand proved that the complainant didn’t disclose the material facts of having other policies from the OPs in his proposal form; thus ratio of the case law cited by OPs are applicable to the case in hand.

11. From the aforesaid discussion; analysis & conclusion, the complainant failed to prove that OPs have acted contrary to its rules / policy/ circular dated 24.10.2018 with regard to Amendment in section 45 as per the Insurance Laws (Amendment) Act, 2015. There is no evidence to conclude that OPs have repudiated the claim of the complainant on erroneous and unjustified grounds contrary to Law.

However, the complainant is held entitled to have the refund of the premiums collected by OPs till the date of repudiation i.e. 04.03.2016 in her favour being the nominee/complainant.

12. Thus, it is concluded that complainant has failed to establish her case based on the available material and by cogent evidence, For want of establishing the case against OPs; the complaint fails. It is dismissed, however, it is without prejudice to the rights of the complainant to receive the refund from the OPs the premium amount collected till date of repudiation i.e. 04.03.2016 in her favour being nominee/ complainant, since the said refund amount of premium is already undertaken by the OPs in its repudiation letter dated 04.03.2016, which OPs shall comply (its undertaking of refund of premium amount taken till dates of repudiation) within 35 days from the date of receipt of this order.

13. Announced on 14^th August, 2023.

[Vyas Muni Rai]                      [ Shahina]                              [Inder Jeet Singh]

Member                               Member (Female)                              President