::BEFORE THE DISTRICT CONSUMER DISPUTES  REDRESSAL COMMISSION AT BIDAR::

                                                           C.C. No.53/2022.

                                                                                                                          Date of filing: 01.06.2022.

                                       Date of disposal: 15.05.2023.

P R E S E N Ts:-    

                                   (1) Shri. Mabu Saheb H.Chabbi,                                                                                                                                                                                                 B.Com.,LL.B.,(Spl.),

                                                                       President.,  

                                   (2) Kum. Kavita,

                                                       M.A.,LL.B.,(Spl.),  

                                                             Member. 

                                   (3) Shri.Thriyambakeshwara,

                                                                                   B.A.,LL.B.,(Spl.), 

                                                                                           Member.

COMPLAINANT/S                    1.    Reshma W/o Late Umesh,   

                                                             Age: 36 years,  Occ: Household,

                                                            R/o H.No.262 Chickpeth Bidar.                                                                                       

                                                    (By Sri.Mailare Mallikarjun Advocate.)    

                                                                                                           V/s

OPPONENT/S                          1.  Shriram Life Insurance Company Ltd.,
                                                       Plot No.31,32 5^th 6^th floor Ramky Sele nium
                                                       beside Andhra Ban k Training Centre
                                                       Financial District Gacchi Bowli
                                                        Hyderabad-500032.

                                                   2.  The Divisional Manager

                                                        Shriram Life Insurance Company Ltd.,   
                                                        Division office Chennai-600004 Tamil Nadu.

                                                   3.  The Branch Manager/Agent
                                                      Shriram Life Insurance company Ltd.,
                                                      Branch office Kalburgi-585102.                                                                                                            

                                                         (OP No.1 By.Smt.Padma M., Advocate.

                                                     And OP No.2&3 Ex-parte.)

                                                                                             ::  J U D G M E N T  ::

By. Shri.Thriyambakeshwara. Member

The complainant has been filed by complainant under section 35 of the Consumer Protection Act, 2019, against the opponents for the deficiency in service for not settling the Life insurance claim by Ops and for other reliefs.   Hence, passed the following judgement.

Brief facts of the complaint.

The brief facts of the complaint in nut-shell are summarized as follows: -

1.         The complainant is the legally wedded wife of one  late Umesh S/o Sharnappa/DLA, who was business by profession by carrying on the business of seizing and recovery of money from movable properties in the name of M/s Guru Krupa Seizing Agency at Chickpeth Bidar.  During his life time he insured his life with Ops in policy No.12008135953, for an assured sum of Rs.13,95,000/- commencing from 27.08.2020, with the yearly premium of Rs.1,49,978/- for a period of 10 years and appointed his legally wedded wife i.e.,  complainant as nominee to the said policy.  The said DLA fell ill due to high fever and undergone for treatment and despite that, he died on 29.06.2021, in his house at Chickpeth Bidar.  However, the Medical officer opined & certified that, DLA died due to Brain
Hammraze, which is evident from annexed documents on records.  The complainant being nominee of said DLA Umesh submitted claim to Ops along with requisite documents as directed by Ops, which was repudiated through Ops vide Repudiation letter dt:03.02.2022, on the self created and false imaginary grounds of alleged correct income and occupation and the same were not disclosed by DLA prior to proposal date, which is illegal, unlawful and invalid and hence filed this complaint within limitation from the date of repudiation of claim by Ops. 

Written Version of OP.

2.         Subsequent to service of summons on Ops by this commission, the OP No.1, appeared before this commission on 20.09.2022, and OP No.2 despite service of notice remained absent on the date of appearance hence, he was placed ex-parte and claim against OP No.3 for dismissed by order dated 05.12.2022, for not taking steps against OP No.3.  OP No.1 submitted his written version by categorically denying all most all facts of the complaint by further submitting that, the deceased Umesh, during his life time had proposed for an insurance policy on his life by submitting a proposal form and by payment of the proposal deposit amount.  After underwriting the proposal, the Ops issued a policy bearing No. NN012008135953, under the plan "Shriram Life Assured Income Plan V02" covering the life of Mr. Umesh for a sum assured amount of Rs.13,95,000/- which was commenced from 27.08.2020 for a term of 10 years, with an annual renewal premium of 1,49,975/- (including riders and GST) payable for a period of 10 years and nominated his spouse Reshma as Nominee.  That, while taking the policy deceased Life assured mentioned his occupation as HDFC Bank Seizure Supervisor and income as Rs.8,00,000/- per annum in the proposal form. The complainant being the Nominee under the policy intimated to Ops that, the life assured Umesh died on 29.06.2021 due to Brain Hemorrhage. Since the death claim arose within a period of 1 year from the date of commencement of the policy, Ops entrusted the claim for investigation by assigning the same to one by name “Phoenix Investigation” in order to make discreet enquires and to submit the report.  The said investigation agency conducted discreet enquires into the death claim and submitted its report dated 13.12.2021 to the OPs. As per the investigation it was found that, the deceased Life assured does not have substantial income and Life assured found to be a Auto Driver and also understood that, at one point of time he worked as Recovery Agent with annual income of Rs.2,00,000/- only but life assured never worked as Supervisor in any company and never had income of around 8 lakhs per annum as declared in his proposal form. It is further submitted that, the investigation report revealed that, the life assured was suffering from Hypertension and brain related issues from few years. As per the medical records of Bidar Institute of Medical sciences, Life Assured was known case of Hypertension, which was also not disclosed at the time of proposal. Hence, based on the investigation conducted, it is clearly established that, the deceased Life assured had suppressed the material facts by not disclosing his correct income, occupation and health in the proposal form, which ought to have been disclosed. This act of suppression of income and occupation by life assured amounts to breach of the bounden duty of the proposer to furnish correct and complete details in response to the questions in the proposal form. As per the term and conditions Ops policy wherein Sec.45 of the Insurance Act 1938 states that, "Sec. 45. (1) No Policy of Life Insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the Policy, i.e. from the date of Insurance 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. (2) The Policy of Life Insurance may be called in question 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 of fraud: Provided that, the Insurer shall have to communicate in writing to the insured or the Legal Representative or nominee or Assignees of the Insured the ground and materials on which such decision is based.  Hence, in view of the above legal provision, facts and circumstances of the case in hand and in terms of the Policy contract and declarations contained in the proposal form, the respondent company rightly repudiated the claim of the petitioner under the Policy No.NN012008135953 vide Repudiation Letter dated 03.02.2022 held in the name of Late Umesh on the grounds of false as well as incorrect answers and non- discloser of materials facts with malafide intention by the Life assured in the Proposal Form for insurance with the respondent and accordingly this OP is not liable for payment of any benefit under the Policy.  It is submitted that, premium amount of Rs.1,43,100/- is already refunded to the nominee’s Bank Account maintained in State Bank of India on 04.02.2022 through NEFT vide UTR No.N03522181988703.  The Ops relied on number citations of Apex Court and commission, however the same were not produced on record in support of their defense.  Hence, prayed for the dismissal of the complaint. 

Evidence of complainant.

3.         The complainant is examined herself as P.W.1 and got marked   documents Ex.P.1 to Ex.P.24 which are as follows,

1. Ex.P.1-Copy of OP No.1 forwarding letter dt:27.08.2020.
2. Ex.P.2- T/c of non Ulip policy schedule.
3. Ex.P.3-T/c of 1^st premium receipt.
4. Ex.P.4- T/c proposal copy.
5. Ex.P.5- T/c X-ray report of DLA.
6. Ex.P.6- T/c of Lab investigation report.
7. Ex.P.7-T/c of City scan bill.
8. Ex.P.8-T/c of Lab investigation report.
9. Ex.P.9-T/c discharge voucher.
10. Ex.P.10-T/c death claim Form-“A”.
11. Ex.P.11-T/c declaration of claimant.
12. Ex.P.12-T/c Medical attendant certificate.
13. Ex.P.13-T/c certificate of identity and burial.
14. Ex.P.14-T/c of repudiation letter of OPs dt:03.02.2022.
15. Ex.P.15&21-T/c of Pan Card of DLA.
16. Ex.P.16&22-T/c Aadhar Card of DLA.
17. Ex.P.17-T/c Death certificate of DLA.
18. Ex.P.18-T/c Aadhar Card of complainant.
19. Ex.P.19-T/c Certificate of registration of firm of DLA.
20. Ex.P.20-T/c of firm registration receipt.
21. Ex.P.20(a)-T/c partnership deed.
22. Ex.P.23-T/c Chit fund pass book of DLA.
23. Ex.P.24-T/c of paper citation against OP No.3.

Evidence of Opponent.

4.         One Sridhar S/o Late E.J.Lingamm General Manager Legal department S.L.I.C Ltd. Hyderabad, is examined as R.W.1 on behalf of OP No.1 company, and got marked 37 documents as per Ex.R.1 to Ex.R.37 which are as below.

1. Ex.R.1-Copy of proposal Form of DLA.
2. Ex.R.2-Copy of Pan Card of DLA.
3. Ex.R.3-Copy of Aadhar Card of DLA.
4. Ex.R.4-Copy of 1^st premium receipt.
5. Ex.R.5-Copy of non Ulip policy schedule.
6. Ex.R.6-Copy of forwarding letter and policy schedule.
7. Ex.R.7-Copy of covering letter of OP.
8. Ex.R.8-Copy of terms and condition of policy.
9. Ex.R.9-Copy of details of amended section 38 and 39 of Insurance Act.
10. Ex.R.10&11-Copy of Annexure III of OP illustrating benefits.
11. Ex.R.112-Copy of renewal premium.
12. Ex.R.13-Copy of complainant representation dt:25.10.2021.
13. Ex.R.14-Copy of death certificate of DLA.
14. Ex.R.15-Copy of OP investigators report (death claim).
15. Ex.R.16-Copy of casualty slip of DLA issued by BRIMS.
16. Ex.R.17-Copy of inpatient hospital registration.
17. Ex.R.18-Copy of nurse note of BRIMS.
18. Ex.R.19-Copy of referral letter dt:27.06.2021 issued by BRIMS.
19. Ex.R.20-Copy of duty doctor notes.
20. Ex.R.20-Copy of nurse note.
21. Ex.R.21- Copy of city scan bill.
22. Ex.R.22-Copy of lab investigation report.
23. Ex.R.23&26-Copy of X-ray report.
24. Ex.R.24&27-Copy of Bio chemistry lab report.
25. Ex.R.25-Copy of lab investigation bill.
26. Ex.R.28- Copy of Driving License of DLA
27. Ex.R.29-Copy of family tree attestation by revenue department.
28. Ex.R.30-Copy of PHH Ration Card issued by food and civil supplies department.
29. Ex.r.31-Copy of extract of death registration of DLA.
30. Ex.R.32-Copy of complainant letter to investigator of OP.
31. Ex.R.33-Copy of death verification report.
32. Ex.R.34-Copy of OP No.1 letter to complainant.
33. Ex.R.35-Copy of OP claims documents requisition letter dt:08.12.2021.
34. Ex.R.36-Copy of repudiation letter.
35. Ex.R.37- Copy of Driving License of DLA

Points/Issues.

5.         On perusal of pleadings, evidence of the both parties and documents, this commission raised the points for discussion as below;

1. Whether the complainant proves that, she is consumer to Ops and further proves the deficiency in service by the Ops in not settling her insurance claim?  
2. Whether the OP.No.1 proves that, the DLA suppressed his correct income and occupation as per the repudiation letter dt:03.02.2022, prior to proposal made by DLA?
3. Whether the complainant is entitled for any relief sought in her complaint? What orders? 

6.         Our answers to the points raised above are as follows: -

1. In the affirmative.
2. In the negative,
3. In the affirmative and as per the final order.

Points No 1 to 3

7.         In order to decide the complaint issues, this commission discussed points/issues No.1 to 3 altogether for discussion as each points are inter related to each other- as follows.

8.         In order to prove the case of the complaint, the complainant lead her evidence as P.W.1 by way of reiterating the complaint facts and got marked Ex.P.1 to Ex.P.24 documents on her behalf, and in similar manner, OP No.1 also examined himself as per R.W.1 and in order to substantiate his case, he got marked 37 documents i.e., Ex.R.1 to Ex.R.37. On perusal of overall pleadings, evidence of both kinds of the parties, it is not in dispute that, the deceased Umesh S/o Sharnappa had purchased Ex.R.5 Insurance Policy in question from Ops company and the complainant is the nominee in the said policy as per proposal form Ex.P.4=Ex.R.1 and policy was in force as on the date of death 29.06.2021 of DLA as per Ex.P.12 medical attendant certificate, Ex.P.13 certificate of identity burial, and Ex.P.17=Ex.R.14 death certificate of DLA.  The complainant submitted claim as per Ex.P.10 to Ex.P.13 i.e. death claim Form-A and other documents and represented for the same for early settlement of her claim through Ex.R.13 dt:15.10.2021 to Ops Branch at Zaheerabad (Hyderabad) & Ex.R.32 dt:10.12.2021 to OP investigator.  But, the Ops repudiated the claim of complainant based on Ex.R.15-i.e., OP investigator’s report (death claim) in accordance with Ex.R.8 and 9, i.e., policy terms and conditions.

9.         On perusal of the W.V. filed by OP No.1, he raised number defences stating that, as per the investigation, it was found that, DLA did not have substantial income and he found to be a auto driver and also under stood that, at one time he worked as recovery agent with annual income of Rs.2,0,000/- and he never worked as supervisor in any company and did not had income of Rs.8,00,000/- p.a. as declared in his proposal form and as per investigation report, it is revealed that, DLA was suffering from hyper tension and brain related issues since many years which is evident from the medical records of BRIMS Bidar, where DLA had treatment and the said material  facts were suppressed by him and hence, non disclosing of correct income, occupation and health issues in the proposal form by DLA amounts to breach of the bounden duty of assured and it was his duty to disclose the same in the proposal form, whereby insurer had been able to decide whether policy deserves to be issued or not to DLA.  The same breach of duty on the part of DLA amounts to violation of the terms and conditions of Sec.45 of Insurance Act 1938 and thereby Ops are not liable for payment of any benefits under the policy as sought by complainant.   If we compare the same with repudiation letter Ex.P.14=Ex.R.36 of OPs dt:03.02.2022, absolutely nothing is whispered about the alleged
pre-existence of diseases i.e., Hypertension, Brain related issues as contended in the W.V. for repudiation of claim and thereby except the alleged correct income, occupation, no other grounds have been raised by OP No.1 as contended in detail in his W.V. about other allegations as urged in W.V.  Therefore, this commission is not supposed to look into the grounds other than urged in the repudiation letter Ex.P.14=Ex.R.36.  In this regard this commission gains support of judgment of Hon’ble Supreme Court reported in

2016(14) SCC 161, Galada Power and Telecommunication V/s United India Insurance Co. and another.  Which has been up held the said principle again by the Hon’ble Supreme Court in reported decision 2019 part 4 CPR 654(Supreme Court) i.e., Saurashtra Chemicals Ltd. V/s National Insurance Company, wherein the Hon’ble Supreme Court held that, , “an insurance company cannot travel beyond the grounds mentioned in the letter of repudiation”.

            Therefore, except the grounds urged in repudiation letter, no other grounds to be entertained by commissions for deciding the claim/s. Accordingly, no other grounds to be looked into by this commissions as Ops  urged in Para No.4 of further facts in Page No.3 of W.V. and the same are ignored by this commission. 

            Therefore, this commission ignores the additional grounds than repudiation letter urged in the W.V. by OP No.1. Hence, now this commission left with the option of scrutinizing only grounds urged in the repudiation letter Ex.P.14=Ex.R.36 in respect of correct income and occupation of DLA declared by him at the time of proposal. 

10.       On perusal of Ex.P.14=Ex.R.36 repudiation letter at Para No.1 & 2, it is urged that,

deceased life assured mentioned his occupation as HDFC bank supervisor and income as Rs.8,00,000/- per annum in the proposal Form.  But as per the investigation report it was found that, deceased life assured does not have substantial income and Life assured is an auto driver and also as per information, he worked as a recovery agent reportedly with annual income of 2 Lakhs only. 

8.         The deceased life assured had suppressed the material fact by not disclosing his correct income, occupation in the Proposal form which ought to have been disclosed.  This was in breach of the bounden duty of the proposer to furnish correct and complete details in response to the queries contained in the proposal form.

11.       The OP No.1, in order to repudiate the claim of complainant, he relied upon the investigator report submitted by his investigator at Ex.R.15, who in-turn prepared in the said report based on his investigation and medical records said to have been collected by him as per Ex.R.16 to Ex.R.27 in accordance with Ex.R.8 and 9, i.e., policy terms and conditions.  On perusal of the Ex.P.4 =Ex.R.1 i.e., the proposal Form, which is evident from page No.4 that, one Sheelavathi R/o Zaheerabad (Hyderabad) i.e., authorized agent of Ops had certified that, she had satisfied as to the personal information received through DLA and same was reported to Ops for issuance of policy.  By considering the residences of DLA at Chickpeth Bidar (Karnataka) and the place of residence of authorized agent of Ops at Zaheerabad(Hyderabad), it is not explained by Ops that, how and in what mode the proposal Form was received from DLA by Ops authorized agent at Zaheerabad (Hyderabad).  Apart from OP No.1 evidence, absolutely there is no evidence of said investigator before this commission to verify the very authenticity/veracity of the said investigator report Ex.R.15.  Even, on the perusal of Page No.3 of the proposal  Form the signatures of attesting witness on proposal form, it is shown the place of attesting at Bidar, and they are also not examined by Ops in order to clarify that, the DLA was asked about his health issues or other details as found in the proposal Form Ex.P.4=Ex.R.1.  Therefore, when such being the things, the investigator report do not create any confidence or credit worthiness report to be looked into by this Commission for accepting, as it is a true version in the absence of his and other attesting witnesses evidence before this commission.  The Ops ought to have explained how and in what manner proposal Form was received from DLA as the authorized agent who had policy from DLA is resident of Zaheerabad (Hyderabad), where as the DLA was resident of Bidar(Karnataka).  Apart from the above the OP No.1 also not examined even the said authorized agent in order to substantiate in accordance with his defense in respect of queries asked by them were falsely answered by DLA as found in Ex.P.4 =Ex.R.1.  The investigator report Ex.R.15 is not trust worthy, as he has not placed his evidence affidavit along with his report and hence this commission is of the opinion that, the said investigator report Ex.R.15 has got no any evidentiary value in eyes of law, which is based for repudiation of complainant’s claim as per repudiation letter Ex.R.36 issued by Ops. The OP No.1 though strongly contended in his W.V. stating that, the DLA had misrepresented about health issues along with income and occupation, but in order to substantiate the same about suppressed health issues, the Ops neither examined the treating doctor nor proved in accordance with law the said medical records produced on record.  All the medical records are photo copies of alleged as DLA treatment records, which does not bear any seal and signature of the authority from whom those were collected.  Therefore, the photo copies produced on record with self attestation of OP No.1insurance Company seal & sign and got marked under Exhibit series from Ex.R.16 to Ex.R.27 are itself not a proof of documents by producing on record in accordance with law. In this regard this commission gains the judgment of Hon’ble National Commission reported in III-2011 CPJ 418 (NC) by holding that, “Production of document is different from proof of document”.  

12.       Further the OP No.1 also not proved those alleged treatment documents by examining the treated doctor who said to have treated for alleged diseases to DLA in the Hospital.  Non examination of treating doctor is fatal to the case of Ops.  In this regard this commission gains the judgment of Hon’ble NCDRC reported in (2020) CJ 110(NC) between SBI Life insurance Co.Ltd Vs Laxmi Ben Nagin Bhai Chavan and ors, the ratio lead down by their lordship,

“Insurance –SBI home loan Master policy-repudiation of death claim on ground of concealment of pre-existing disease –complaint allowed by For a below-both District Forum and state Commission had reached to conclusion after going through all documents that, medical papers have not been properly proved since neither Doctor has been duly examined nor his affidavit has been furnished- National Commission is not expected and required to re-appreciate and re-assess evidences- where on the basis of evidences Fora below have reached to a conclusion which is a possible conclusion, then such conclusion need not be disturbed in revision petition- revision petition dismissed”.   

The OP further instead of raising this type of objections for repudiating the claim of complainant, they ought to had subjected   the DLA for medical examination prior to issuance of policy through their authorized medical practitioner and got it rectified the suitability to issuance of policy to the DLA. In this case instead of taking such precautions while selling the product to the DLA, the OP company kept silent at the initial stage of selling the product, and not done in the instant case as the authorized agent for Ops had the policy from DLA just by getting signature of DLA on proposal, which is evident from the Page No.4 of Ex.R.1 wherein the place of her certification and signing the said proposal by her is at Zaheerabad (Hyderabad) and now after lapse of 18 months of collecting the premium from the insured, raising subsequent to DLA death on 29.06.2021, thereby Ops trying to escape from the clutches of liability to settle the claim of the complainant, on untenable grounds without there being cogent evidence in support of the repudiation of claim, which cannot be sustained under law. The DLA or the complainant is not supposed to put under the loss of benefits of policy just because of the omissions and commissions of authorized agent of Ops or by Ops themselves. 

13.       The Ops also raised major grounds in Ex.R.36 regarding the
mis-representation of his actual income and occupation by holding that, he was not a proprietor of any seizing agency and not having Rs.8,00,000/- income p.a. by contending that, he was just auto Driver and had only Rs.2,00,000/- income p.a. by such profession.  In this regard though the OP No.1, produced a document i.e., Ex.R.28=Ex.R.37, the Driving License of DLA having Badge No.8593AR, does itself not proves that, by holding such DL, the DLA was not proprietor of M/s Gurukrupa Seizing Agency as per Ex.P.19 certificate of registration of firm, and Ex.P.20(a) partnership deed, Ex.P.21 Pan Card, Ex.P.23 Chit fund pass book, which are produced by complainant for showing that, her husband had sufficient income from above source, which is in rebuttal of the grounds urged in Ex.R.36 repudiation letter by Ops.  Those documents stand undisturbed by Ops by producing any rebuttal evidence for discarding their authenticity.  Therefore, mere by producing Ex.R.28=Ex.R.37 and Copy of PHH Ration Card issued by food and civil supplies department, it cannot be presumed that, OP No.1 has proved the defence in accordance with repudiation letter, as the OP No.1 did not lead evidence of said investigator who said to have collected such documents and submitted along with his investigation report. Under the said circumstances, this commission not inclined to accept such documents which are not proved in accordance with law by examining            investigator/concerned authority.

 In this regard, this commission gains judgment of Hon’ble National commission reported in 2021(1) CPR 441(NC) Bajaj Allianz Life Insurance Company Limited Vs Sukhjit Kaur,

Consumer Protection Act, 1986 –Section 19:(Consumer Protection Act,2019- Section 41)-Life Insurance-Death claim-Proof of income-Scope-Husband of complainant obtained an insurance policy from appellant- In proposal form he claimed his income at Rs.2.5 lacs p.a.- He having died, complainant filed claim, which was rejected-Misrepresentation of facts of Policy of Rs.19.80 lacs would not have been granted to deceased since the extent of insurance coverage depends upon the income of the insured-Whether deceased had inflated his income while submitting the proposal?-Onus was on insurer to prove that the deceased had made a misrepresentation in the proposal form with respect to his income-Allegedly deceased was a BPL Card holder-Nothing brought on record in proof of income of deceased- Interference with impugned order of State commission declined. 

Even in the instant case also the OP No.1 did not prove through any authenticated document in order to substantiate his defence about
mis-representation of actual income by DLA. Under the said circumstances this commission is of the considered opinion that, the Ops have utterly failed in their case of repudiating the claim of complainant on the ground that, the Ops authorized agent did not get policy from DLA by explaining the terms and conditions as which is evident from Ex.R.1 Page No.4, wherein she signed and certified to Ops about said proposal at Zaherabad (Hyderabad) contrary to the place of residence of DLA at Chikpeth Bidar (Karnataka) and further they have not examined the concerned treating doctor on DLA prior to date of proposal as per Ex.P.16 to Ex.P.27 treatment records of DLA and the investigator who said to have collected those documents under his investigation at Ex.R.15-Copy of OP investigator’s report, was not examined by producing his evidence affidavit and further Ops are also not examined the said authorized agent Smt. Sheelavathi Zaheerabad, who received policy from DLA to speak about the queries posed to said DLA as shown by Ops in their repudiation letter Ex.P-36 and to speak under what mode she received said policy from DLA in view of place of residence of DLA and said agent  differs (inter-state)each other as found in Ex.R.1as discussed above. 

14.       Hence, we are of the considered view that, the complainant has proved her case for claim and whereas the OP. No 1 utterly failed to prove  his case as per Ex.R.36 repudiation letter.  Therefore, we answered the point No 1 and 3 in the affirmative in favor of complainant and point No. 2 in negative against to Ops and proceed to pass the following order.

::ORDER::

        The complaint u/s 35 of CP Act 2019, filed by the complainant is hereby allowed in part along with costs and compensation.

            The OP NO.1 to 3 are hereby directed to pay complainant/nominee in policy No.12008135953, for an assured sum of Rs.13,95,000/- along with interest 6% p.a. from the date of repudiation as per Ex.R.36 dt:03.02.2022 till realisation along with compensation of Rs.10,000/- for having suffered mentally and inconvenience, and Rs.5,000/- as litigation expense within 45 days from the date of this order. 

            Intimate the parties accordingly.                         

 (Typed to our dictation then corrected, signed by us and then pronounced in the open Commission on this   15^th day of May-2023).

Documents produced by the complainant.

1. Ex.P.1-Copy of OP No.1 forwarding letter dt:27.08.2020.
2. Ex.P.2- T/c of non Ulip policy schedule.
3. Ex.P.3-T/c of 1^st premium receipt.
4. Ex.P.4- T/c proposal copy.
5. Ex.P.5- T/c X-ray report of DLA.
6. Ex.P.6- T/c of Lab investigation report.
7. Ex.P.7-T/c of City scan bill.
8. Ex.P.8-T/c of Lab investigation report.
9. Ex.P.9-T/c discharge voucher.
10. Ex.P.10-T/c death claim Form-“A”.
11. Ex.P.11-T/c declaration of claimant.
12. Ex.P.12-T/c Medical attendant certificate.
13. Ex.P.13-T/c certificate of identity and burial.
14. Ex.P.14-T/c of repudiation letter of OPs dt:03.02.2022.
15. Ex.P.15&21-T/c of Pan Card of DLA.
16. Ex.P.16&22-T/c Aadhar Card of DLA.
17. Ex.P.17-T/c Death certificate of DLA.
18. Ex.P.18-T/c Aadhar Card of complainant.
19. Ex.P.19-T/c Certificate of registration of firm of DLA.
20. Ex.P.20-T/c of firm registration receipt.
21. Ex.P.20(a)-T/c partnership deed.
22. Ex.P.23-T/c Chit fund pass book of DLA.
23. Ex.P.24-T/c of paper citation against OP No.3.

Document produced by the Opponent.

1. Ex.R.1-Copy of proposal Form of DLA.
2. Ex.R.2-Copy of Pan Card of DLA.
3. Ex.R.3-Copy of Aadhar Card of DLA.
4. Ex.R.4-Copy of 1^st premium receipt.
5. Ex.R.5-Copy of non Ulip policy schedule.
6. Ex.R.6-Copy of forwarding letter and policy schedule.
7. Ex.R.7-Copy of covering letter of OP.
8. Ex.R.8-Copy of terms and condition of policy.
9. Ex.R.9-Copy of details of amended section 38 and 39 of Insurance Act.
10. Ex.R.10&11-Copy of Annexure III of OP illustrating benefits.
11. Ex.R.112-Copy of renewal premium.
12. Ex.R.13-Copy of complainant representation dt:25.10.2021.
13. Ex.R.14-Copy of death certificate of DLA.
14. Ex.R.15-Copy of OP investigators report (death claim).
15. Ex.R.16-Copy of casualty slip of DLA issued by BRIMS.
16. Ex.R.17-Copy of inpatient hospital registration.
17. Ex.R.18-Copy of nurse note of BRIMS.
18. Ex.R.19-Copy of referral letter dt:27.06.2021 issued by BRIMS.
19. Ex.R.20-Copy of duty doctor notes.
20. Ex.R.20-Copy of nurse note.
21. Ex.R.21- Copy of city scan bill.
22. Ex.R.22-Copy of lab investigation report.
23. Ex.R.23&26-Copy of X-ray report.
24. Ex.R.24&27-Copy of Bio chemistry lab report.
25. Ex.R.25-Copy of lab investigation bill.
26. Ex.R.28- Copy of Driving License of DLA
27. Ex.R.29-Copy of family tree attestation by revenue department.
28. Ex.R.30-Copy of PHH Ration Card issued by food and civil supplies dept.
29. Ex.r.31-Copy of extract of death registration of DLA.
30. Ex.R.32-Copy of complainant letter to investigator of OP.
31. Ex.R.33-Copy of death verification report.
32. Ex.R.34-Copy of OP No.1 letter to complainant.
33. Ex.R.35-Copy of OP claims documents requisition letter dt:08.12.2021.
34. Ex.R.36-Copy of repudiation letter.
35. Ex.R.37- Copy of Driving License of DLA

Witness examined.

Complainant.:-P.W.1- Reshma W/o Late Umesh,  (complainant).                  

Opponent:-  R.W.1- Shree Chidananda Chief Manager Legal, HDFC L.I.C