::BEFORE THE DISTRICT CONSUMER DISPUTES  REDRESSAL FORUM, AT BIDAR::

                                                               C.C. No.15/2017.

                                                            Date of filing: 15.02.2017.

                                                                   Date of disposal: 17.02.2018.

P R E S E N T:-    

                              (1) Shri. Jagannath Prasad Udgata,                                                                                                                                                                                                                 B.A., LL.B.,

                                                                                                President

                             (2) Shri. Shankrappa (Halipurgi),

                                                                                 B.A.LL.B.,

                                                                                           Member.

COMPLAINANT/S:    1.   Shobha W/o Late Dhanraj Channamal,

                                             Age: 40 years, Occ: House hold,

                                             R/o Dongaon, Tq:Aurad, Dist: Bidar.

                                      (By Sri. D.M.Swamy, Adv.)

                                                                 VERSUS

OPPONENT/S:        1)         Senior Divisional Manager,

                                             Life Insurance Corporation of India,

                                             Jeevan Prakash Station Road, Raichur.

                                    2)        The Zonal Manager,

                                                Life Insurance Corporation of India

                                             South Central Zonal office,

                                             Saifabad, Hyderabad-500063.                                                                                                                                   

                                      (By R1.Sri. Basavaraj Udgir, Adv.)

::   J UD G M E N T  ::

By Shri. Jagannath Prasad Udgata, President.

      This is the complaint of a wife/nominee of deceased policy holder of the O.P.s u/s 12 of the C.P.Act,1986 alleging deficiency of service owing to non settlement of the death claim.

The gist of the complaint is as hereunder.

2.            That, the complainants husband by name Dhanraj Channamal, working as Asst. C.E.O. under D.C.C. Bank Bidar during his life time had obtained L.I.C. policy No.661749118 on 28.03.2013 by paying monthly premium and the premiums were being paid regularly till his death on 14.11.2013, (Ex.P.1 and P2).

3.          That, said Dhanraj died untimely due to jaundice.  The certificate of hospital treatment issued to the opponents vide Ex.P.4 pertains to one Biradar Dhanraj Vaijinath, aged 45 years and cause of death has been explained in col.6 of the certificate as “Sepsic C  Encephalopathy C cardiac a systole and Aspiration of Pneumous”.  The history of the patient at the time of admission incol.No.5 of the same certificate has been described as “Fever on and off sometimes unconsciousness”.  However there is no signature of any doctor of rubber stamp of the hospital on this document.

4.         It is the say of the complainant that, she raised a claim of death benefit before theO.P.No.1, but the same was rebutted with imaginary grounds vide Ex.P.3.  She then continued with pursuing the claim with the O.P.No.2 being higher in hierarchy but the matter is yet to be settled.  A legal notice was got issued vide Ex.P.5 to which the opponents have sent a reply on 28.04.2016 (Ex.P.6), justifying the rebuttal, stating that, on 04.01.2013, the deceased policy holder had undergone treatment at Udagiri Multispeciality and Accident hospital, had undergone various tests and was diagonised of “Mild hepatomegally, GB calculus and moderate Spleenomegally” prior to the commencement of the policy and the cause of death is correlated to the undisclosed ailment and the life assured had not disclosed these ailments while effecting the assurance and hence the claim was repudiated.  She was however advised to approach the Insurance Ombudsman.

5.         The opponents receiving the notice, have put up appearance through counsel and have raised the same grounds as stated in the previous Para.

6.         Both sides have filed documents as elucidated at the end of this order and have filed evidence affidavits trying to justify their respective contentions.

7.         Considering the rival contentions of both sides, the following points arise for our considerations.

1. Does the complainant prove that, there is a deficiency of service?
2. Do the opponents prove that, they were justified in rebutting the death claim?
3. What order?

 8.        Our answers to the points stated above are as follows:-

            Point No.1.       In the affirmative.

            Point No.2.       In the Negative.

            Point No.3.        As per final orders, owing to the following.

:: REASONS ::

9.         The answers to the points No.1 and 2 proceed side by side and to be answered commonly.

10.       It is on record that, the deceased policy holder was Dhanraj S/o Vaijinath Channamal and his admitted age was 42 years on the date of obtaining the policy as per Ex.P.1.  He being an employee in a Bank, there is no scope of any confusion regarding his age or date of birth.  As stated earlier, Ex.P.4 (certificate of hospital treatment) records the name of the patient as Biradar Dhanraj Vaijanath and his age as 45 years.  But the certificate is neither signed by any Medical practitioner nor the rubber stamp impression of any hospital/Medical institute is forth coming.  Hence, for all practical purposes, this document is irrelevant to the proceeding.  However, even if for a moment a little credibility is to be implied on this paper, it discloses.  The cause of death as sepsis C Enchaphalopathy (affiliction of brain) C cardiac asystole (disruption in rythms of heartbeat) C Aspiration of Pneumous (drainage of fluids from lungs).  This if the cause of death, the grounds of rebuttal by the opponents are hollow perse.

11.       Next, when we look at the documents produced as Ex.R.1 to R.5, we observe, the name of the patient as Biradar Dhanraj and age has been mentioned as 38 years.  Was this patient treated at Udayagiri Multispeciality and Accident hospital same person who had obtained policy?  A big doubt is cropping up regarding the identity.  Additionally, the opponents have not chosen to lead the evidence(s) of  the doctor or team of doctors involved in the treatment of Biradar Dhanraj.  The learned counsel for the complainant has submitted before us a judgement of the Hon’ble National Commission, reported in III (2009) CPJ (NC) Rasheeda Khatoon V/s L.I.C. of India, in which in Para o.5 and 6 it has been observed as follows:-

            ‘’ i.      As far as the merit is concerned, there s no disputing the fact that the State Commission has dismissed the complaint base on the report dated 23.02.1995 of Dr. B. I. Singh, Sr. Consultant, which a has been produced before us.  It is not in dispute, that no affidavit by the concerned Doctor was filed, whose report has been filed.  There is no other material to substantiate as to who is this Dr. B.I. Singh, as also, in what context did he go to him, as also where is the hospital record on which this report has been based? Had any affidavit been filed or original record of hospital/consultant filed/produced, that would have given an opportunity to the petitioner to cross-examine him.

            ii.         The legal position of thecae is, that this report remains unsubstantiated, unproven and, in our view, the State Commission fell in error in relying upon an unproven document, hence the order passed by the State Commission cannot be sustained, which is set aside and the order passed by the District Forum is restored.

12.       Further, the complainant side has produced before us a copy of an earlier order in C.C.No.53/2015, in which considering various case laws reported in:-

            1(2012) CPJ 378 (Rajsthan State Commission)

            L.I.C. v/s Dalikumar Devda.

            1(2013) CPR 150 (Delhi State Commission)

            Narayan Chimandas Bhambani V/s Oriental Insurance Co. Ltd.

            IV (2008) CPJ 89 (NC)

            And also

            2013 (1) CPR 604 (S.C.).

            We have ruled in favour of the complainant, setting aside the opponent L.I.C.s, contention of concealment of material facts.

13.       It is further the mandate of the Hon’ble Apex Court in III (2007) CPJ 3 (S.C.)- united India Insurance Co. Ltd. V/s Great Eastern Shipping Co. Ltd that, where two views are possible, the one which favours the consumer should be accepted.

14.       The analysis (s) supra, prove beyond doubt that, the opponents have failed to substantiate their contention of concealment of material facts, have denied the genuine claim of the complainant mindlessly and hence we proceed to pass the following:-

                                                    ::ORDER:: 

1. The complaint is allowed in part.
2. The opponents are jointly and severally directed to pay the complainant the sum assured of Rs.2,50,000/- (two lakh fifty thousand) in policy No.661749118 obtained by her late husband Dhanraj together with interest @ 10% p.a., calculated from the date of rebuttal i.e., 28.02.2015 till date of realisation;
3. A compensation of Rs.20,000/- (twenty thousand) be payable and litigation expenses of Rs.5,000/- (five thousand) additionally bytheopponents;
4. Four weeks time is granted to comply this order.   

(Typed to our dictation then corrected, signed by us and then pronounced in the open Forum on this 17^th  day of February 2018).

   Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                  

Member.                                                                President.                                                                                      

Documents produced by the complainant

1. Ex.P.1-  Copy ofL.I.C. Policy No.661749118.
2. Ex.P.2– Copy ofdeath certificate of Dhanaraj.
3. Ex.P.3– Copy of repudiation oetter date: 28.02.2015.
4. Ex.P.4—Copy of certificate of hospital treatment (Irrelevant as  
                   unsigned and no seal).
5. Ex.P.5 – Copy of legal notice date:  11.04.2016.
6. Ex.P.6- Reply to legal notice date: 28.04.2016.        

 Document produced by the Opponents. (O.P.NO.1 only).

1. Ex.R.1- Copy case sheet of Udayagiri Multi speciality and Accident    
                  hospital date: 04.01.2013 pertaining to Biradar Dhanraj.
2. Ex.R.2- Copy of negative result of H.I.V. date: 04.01.2012 of the same 
                 hospital.
3. Ex.R.3- Copy of the pathology report date: 04.01.2012 of the same 
                 Hospital.
4. Ex.R.4- Copy of Songraphy report date: 04.01.2013 of Varad
                  Sonography and X-ray clinic.
5. Ex.R.5- Copy of bleed examination report date: 25.12.2012 of Sanjeev
                 clinical Laboratory.

NIl

Witness examined.

Complainant.

1. P.W.1- Smt.Shobha W/o Late Dhanraj (Complainant).

Opponent No.1

1. R.W.1- Sri K. Parashurama S/o K.Bharamappa authorised signatory of L.I.C. of India.

Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                  

       Member.                                                                      President.