Nagaland

StateCommission

CC/2/2015

Smti. Shweta Jain & 3 ors - Complainant(s)

Versus

Life Insurance Corporation of India & 3 ors - Opp.Party(s)

PB Paul, Pfosekho

17 Nov 2016

ORDER

This complaint under Sec 17 of the Consumer Protection Act, 1986 has been filed by the wife, son, unmarried daughter and father of the deceased.

The claimants are seeking compensation of Rs. 27,70,000/-, which includes the insured  sum of the Insurance Policy of Rs. 25 Lacs. The rest of the claim amount are basically general damages for mental sufferings and pain and deficiency in service and cost of the litigation. The claimants are also seeking interest @ 14 % per annum on the entire compensation amount.

Heard Shri P.B Paul, the learned counsel for the claimants. The opposite parties have not appeared to contest the case despite notices by registered post as well as ‘Dasti Service’. Due to non-appearance of the opposite parties after repeated notices this Commission ordered for ex-parte hearing vide order dated 03/05/2016.

The claimants’ case is that their husband/father/son, namely Sunil Kumar Jain, was 44 yrs old person. Being a business man the deceased had taken Insurance Policies of small amounts covering sum of Rs. 1 lac and 3 lacs in the year 2010 and 2011. The first LIC Policy No. 443501319 was taken on 09/03/2010. Second LIC Policy No. 443509522 was taken on the same day for the same value of 1 Lac. Third LIC Policy No. 443509522 for a sum of Rs. 3 Lacs was taken on 10/03/2011. The Fourth (Disputed Policy No. 444602367) for a sum of Rs. 25,00,000/- (twenty five lakhs)  was taken on 28/04/2012. After about four months of taking the last policy the insured/deceased felt loss of appetite, weakness and swelling on legs.

Accordingly, the deceased went for medical checkup at Dimapur. Thereafter, the deceased went for medical checkup in different hospitals at Dibrugarh, Delhi and finally at Asian Institute of Gastroenterology at Hyderabad. Unfortunately, the deceased did not survive long and died at Hyderabad on 04/12/2012.

fter the death of the Insured person his wife submitted the claim application in the office of Life Insurance Corporation of India at Dimapur. It was followed by submitting all the relevant documents in the Divisional office of LIC at Jorhat. The complainants have annexed one copy each of the claimants’ statement, medical attendant certificate, death certificate, repudiation letter etc. As noted earlier, there is no counter from the side of the opposite parties.

It appears from the repudiation letter dated 26/11/2014 that the claim has been denied on the ground that the deceased had suppressed his old ailments and he died of hepatic encephalopathy. However, this ground of repudiation has not been substantiated by the opposite parties by filing any counter or any medical certificate. On the other hand, the medical certificates of Asian Institute of Gastroenterology, Hyderabad reflects that the deceased was suffering from jaundice and distension of abdomen and hyper Gastroenteritis. In this way the hospital record does not disclose that the deceased was suffering from any serious ailment relating to heart, lungs, liver, kidney, brain etc. We also notice that the deceased was only under conservative treatment and he was not required to undergo any surgery. Hence, we hold that the grounds of repudiation taken by LIC in their letter dated 26/11/2014 are based on surmises, assumptions and hypothesis. It amounts to deficiency in service and also unfair trade practice within the meaning of Sec 2(1) (g) and (r) of the Consumer Protection Act.

The above apart, it is also worth mentioning that the LIC has entertained the claim of the beneficiaries of the deceased Sunil Kumar Jain by settling the claim of the remaining 3 (three) insurance policies, which were taken in the year 2010 & 2011. However, without any sound and established fact of suppression of any previous ailment of the deceased the genuine claim of the complainants’ against the Fourth Insurance Policy has been repudiated.

For the foregoing reasons, we allow the complaint petition. It is awarded that the claimants are entitled to the insured amount of the disputed policy i.e. Rs 25 Lacs. In addition to that we are also awarding a sum of Rs.20,000/- (twenty thousand) as general damages, which includes mental sufferings for illegal repudiation of the claim and deficiency in service. This amount includes the cost of the litigation. The entire amount of Rs. 25,20,000/- (Twenty five lacs twenty thousand) shall carry interest @ 7% per annum from the date of the filing of the complaint petition, i.e. 11/09/2015 till the date of the payment.

 

President, Mr. Justice BD Agarwal, Rtd. Judge

Member  Mr. Phushika Awomi

Member, Miss, Eyingbeni. Shitiri