DISTRICT CONSUMER DISPUTES REDRESSAL FORUM. BOLANGIR

                                  ………………

Presents:-

1. Sri A.K.Purohit, President.
2. Smt. S.Rath, Member.

                     Dated, Bolangir the 5^th day of February 2018.

                     C.C.No.45 of 2017.

Baidyanath Agrawal, aged- 49 years son of Chandi Agrawal.

Village/P.O- Bhaler, P.S.Puintala, Dist- Bolangir.

                                                   ..                   ..                      Complainant.

                         -Versus-

1.L.I.C.of India, Titilagarh Branch Office,

   At/P.O/P.S-Titilagarh, Dist- Bolangir, represented

   Through it’s Branch Manager.

2,L.I.C.of India,Divisional Office, At-Jerevan Prakash,

   Ainthapali, P.S.Ainthapali, Dist-Sambalpur

   Represented through its Divisional Manager.

3.Zonal Manager, L.I.C of India, East Central Zonal Office,

   “Jeevan Deep” 6^th Floor, Exhibition Road, Patna-800001.

                                                ..                ..                           Opp.Parties.

Adv. for the complainant-  Sri T.K.Mohapatra.

Adv. for the O.Ps            -  Sri G.C.Behera.

                                                           Date of filing of the case-18.09.2017

                                                           Date of order                   - 5.02.2018.

JUDGMENT.

Sri A.K.Purohit, President.

1              The complainant being the nominee of deceased policy holder Bishnulal Agrawal, has preferred this complaint against the O.Ps alleging deficiency in insurance policy.

2             The case of the complainant is that his deceased brother Bishnulal Agrawal had taken three insurance policies in the name and style ”Endowment Assurance with profit DAB”,”LIC’s Jeevan Saguna” and “LIC’s New Endowment Plan with profit” vide policy No.594932423,594938279 and 594944509 respectively. The policies commenced from  23.12.2013,28.10.2014 and 21.11.2015 respectively. After the death of his brother the complainant collected all the documents like death certificate, claim form and other relevant papers and submitted his claim before the O.Ps on dated  24.01.2017. Although the complainant has submitted his claim since 24.1.2017, he did not receive any settlement of his claim for some months and suddenly he received a letter of repudiation. The complainant alleged that the repudiation of his claim is  unjust and he being the nominee is entitled to the assured amount. Hence the complaint.

3           The O.Ps have contested the case by filing their written version jointly. The O.Ps have denied all the allegations of the complainant and submitted that since there is suppression of material facts regarding the health of the deceased life assured the claim has bee repudiated. The deceased life assured was an old Cardiac RHD patient and since the death is not after two years of the insurance policy the case of the complainant is hit u/s.45 of the Insurance Act. Hence the O.Ps claim for dismissal of the case.

4              Heard both the parties. Perused the documentary evidence  available on record. Relying on a decision of the Hon’ble Supreme Court in P.C.Chacko And Another –versus- Chairman, Life Insurance, the learned Advocate for the O.Ps submitted that the case is not  maintainable in view of Sec.45 of the Insurance Act. It is seen from the repudiation letter dated 25.3.2017 issued by the O.Ps that the claim of the complainant has been repudiated on the ground of suppression of material facts regarding the health of the Policy Holder. It is an admitted fact  that the deceased brother of the complainant had taken three L.I.C. policies vide numbers referred above, It is also an admitted fact  that the complainant is the nominee in all the three policies. Now the only point for consideration is whether the O.Ps are liable to pay the assured amount or not.

5             In support of his case, the O.Ps have filed a Xerox copy of medical certificate of their own doctor wherein the doctor has simply mentioned that the deceased policy holder was an old Cardiac RHD patient. He has not mentioned when he has examined the policy holder. He has also not mentioned how he has come to such a conclusion that the policy holder is an old Cardiac patient. Therefore from this documentary evidence, it reveals that on the request of the O.Ps the doctor has simply written a certificate without any diagnosis without any record of disease. To corroborate this evidence, the O.Ps have not filed any affidavit evidence of the doctor nor have filed the affidavit of the person who has obtained the certificate. Therefore this forum can not believe the evidence of the O.Ps.

6              The decision cited by the O.Ps is different from the facts and circumstances of the present case. On the other hand when the policy is admitted, and when the death of the policy holder is admitted, the O.Ps are under obligation to pay the assured amount.

7             Under the aforesaid facts, circumstances and discussion, this forum has come to a conclusion that repudiation of the claim on the ground of suppression of material facts, can not be believed. Hence ordered.

                                          ORDER.

               The O.Ps are directed to pay Rs 5,00,000/-,Rs 5,50,550/- and Rs 5.00.000/- vide Policy No.594943423,  594936279 and 594944509 respectively, totaling a sum of Rs 15,50,550/-( Rupees Fifteen Lakhs fifty thousand five hundred fifty) to the complainant within one month from the date of receipt of this order along with interest @ 10% P.A. from the date of repudiation i.e 25.03.2017 till payment. The O.Ps are further directed to pay Rs 5,000/- (Rupees Five thousand) only towards litigation expenses to the complainant within the aforesaid period.

               Accordingly the case is disposed off.

Order pronounced in open forum today this the 5^th day of February 2018.

                        (S.Rath)                                         (A.K.Purohit)

                        MEMBER.                                     PRESIDENT.