The instant case was instituted on the basis of a petition under Section 12 of Consumer Protection Act, 1986 filed by one Gita Roy, Wife of Late Pampu Roy, resident of Ukilpara, P.O. & P.S.- Raiganj, Dist.- Uttar Dinajpur which was registered as Consumer Case No. 31/18 in this Forum.

The fact of the case as revealed from the petition of complaint as well as from the evidence is that the husband of the complaint No-1 and the father of complainant Nos-2 & 3 Late Pampu Roy purchased one LIC New Endowment Plan on 28/12/2017 and the said policy bearing No-445963821 and the annual premium was Rs.4712/-.

The value of the assured sum was Rs.200000/- and Rs.200000/- for accidental benefit. It has been mentioned in the petition that during the life time Late Pampu Roy paid the premium of the policy but due to his physical weakness he was admitted to Madan Ganga Nursing Home on 08/07/2016 where the doctor diagnosis that Pampu Roy was suffering with the disease CVA with right sided ICH and on 21/07/2016 the said Pampu Roy died.

It has been further stated in the petition of complaint that the complainant No-1 Smt. Gita Roy was the nominee of that policy and after death of Pampu Roy the complainant No-1 filed a claim petition before the O.P/ LIC but on 16/03/2016 the O.P/LIC repudiated her claim. Thereafter, again on 21/04/2017 the complainant No-1 filed an another petition for re consideration of claim before the Zonal Office Claim Dispute Redressal Committee of LIC and that policy duly acknowledged by the O.P.No-1 but till today the LIC did not take any step of that application.

As such the complainant has filed the case for claiming of Rs.200000/- as per policy, Rs.50,000/- for compensations, Rs.20,000/- for litigation cost and Rs.30,000/- for mental pain and agony.

The petition has been contested by the LIC by filing the written objection denying all the material allegations as labeled against the LIC contending inter alia that the instant case is not maintainable and the case is also barred by law of limitation and the complainant has not come to this forum with a clean hand.

The definite defence case is that at the time of execution of the policy the deceased Pampu Roy suppressed the fact that he was suffering from different ailments and by suppressing the fact the policy was obtained. As such the complainants are not entitled to get any relief as prayed for.

The further defence case is that the LIC collected the documents from the employer of Pampu Roy who is the employee of Food Corporation of India and the documents collected by the LIC authority which is found that Pampu Roy was suffering from various diseases and he applied for leave from his employer and leave was granted. The contact between the Pampu Roy and LIC is a null and void contact as he has suppressed the fact that he was suffering from different ailments, so considering such facts and circumstances the instant case is liable to be dismissed.

 In order to prove the case the complainant Gita Roy was herself examined as PW1 and she was cross examined.  On the other hand no witness was examined on behalf of the O.P/LIC. During trial both parties filed the documents as per firisti.

Now the point for determination as to whether the complainant is entitled to get any relief from this forum or not?

             D E C I S I O N  W I T H  R E A S O N S:

At the time of argument the Ld. Lawyer of the L.I.C argued that repudiation of the claim was on the ground that the insurer Late Pampu Roy suppressed the material facts and obtained the policy, as such rightly the Insurance Company repudiated the claim. According to the argument as advanced by the Ld lawyer of the Insurance Company is that the deceased was suffering from various deceases including Entric fever for 7 days from 02/11/2013 to 08/11/2013, Hepatitis for 22 days from 27/04/2014 to 19/05/2014 and Viral fever for 11 days from 06/08/2015 to 16/08/2015, as such the complainant was not in good health or sound health for entering into a contract and it is a clear suppression from material allegations as per conditions of the proposal form. It is to be mentioned that the deceased Pampu Roy was an employee of Food Corporation of India and such fact of illness was collected by the L.I.C from the office of the employer of the insurer.

On the other hand the Ld. Lawyer of the complainant argued that the deceased died at Madan Ganga Nursing Home due to CVA with right sided ICH on 21/07/2016. The Ld. Lawyer of the complainant wants to argue that the cause of death has no relation with the deceased for which the insurer took leave. According to his argument at the time of execution of the contact there was no decease and the complainant was in good health as such the complainant is entitled to get relief as prayed for. Now the main point is to be considered whether the disease CVA with right sided ICH has any relation to the deceased as mentioned by the O.P in the W.V in Para 7. On perusal of the W.V it is found that the deceased was suffering from Viral fever, Hepatitis and Entric fever. In the opinion of this forum these diseases have no nexus with the CVA with right sided ICH. The terms CVA means Cerebral Vascular Accident where as from the W.V it is found that the deceased was suffering from Entric fever, Hepatities and Viral fever. These diseases have no relation with the disease by which the deceased died. In a normal human life fever is the common disease and that cannot be said that the deceased was suffering from various diseases. Moreover, suffering from Hepatitis has no nexus with the cause of death with the insurer. Moreover, at the time of execution of the contract no where it has found that the deceased before execution of the contract was suffering from hard disease. So, considering such facts and circumstances the complainant is entitled to get compensations as prayer for.

C.F. paid is correct,

Hence, it is,

                                O R D E R E D:

 That the complainant case being No. CC-31/18 be and the   same is allowed on contest against the O.P with cost.

The complainant gets Rs.200000/-(Two lakh only) as the sum assured for accidental benefit as per policy. Besides that the complainant is entitled to get Rs.10,000/-(Ten thousand) for compensations and Rs.5000/-(Five thousand) for litigation cost. The O.P is directed to make the payment of Rs.215000/-(Two lakh and fifteen thousand) within 45 days from the date of order failing which it will carry interest @ 5% per annum form the date of filing of this case. In case of default in making payment the complainant is at liberty to execute the order as per provision of law.

Let a copy of this order be given to the parties free of cost on proper application.