The Complainant has filed this case alleging deficiency-in-service by the O.Ps, where O.P No.1 is the Sr. Divisional Manager, LIC of India, Bhubaneswar Divisional Office, Bhubaneswar and O.P No.2 is the Branch Manager, LIC of India, Balasore Branch, Balasore.

                    2. The case of the Complainant in brief is that the husband of the Complainant is a L.I.C Policy holder vide Policy No.598310876 for Sum Assured Rs.1.00 Lakh (Rupees One Lakh) only covering from 28.10.2011 to 28.10.2021 under Jeevan Sathi (Death cover Joint Life plan) with profits, where the Complainant is the nominee. The said Policy was issued by the O.Ps as per medical examination of the Policy holder by the doctor of O.Ps. But, on 23.11.2012, the husband of the Complainant suddenly became seriously ill, thereby the doctor referred to Acharya Harihar Cancer Hospital, Cuttack for treatment and after treatment, he died on 07.12.2012. Immediately, the Complainant informed the O.Ps about death of her husband and submitted claim form along with necessary documents and medical certificate before the O.Ps, but the O.Ps remained silent in the matter. But, on several request made by the Complainant, the O.Ps vide their letter dt.14.05.2014 intimated the Complainant to submit all treatment papers and pathological reports for consideration of claim. But, on 22.08.2014, the O.P No.1 intimated the Complainant about repudiation of death claim vide Policy No.598310876 on the life of Late Ram Chandra Sethi for the reason “In proposal for assurance dt.28.10.2011, proposal and statement signed by the deceased assured had answered the following:-

Question: 11 (viii) Do you have ever used Alcoholic Drink, Narcotics, any other   

                                Drugs, Tobacco in any form ?   

                                Answer- No.

                        (ix)  What has been your usual state of health ?   

                                Answer- Good.

All these answers were false”. Thus, O.Ps letter of repudiation is illegal, arbitrary, imaginary and after thought in order to avoid the claim of the Complainant, which amounts to deficiency of service by the O.Ps, causing mental agony to the Complainant. The Complainant has prayed for payment of sum assured amount along with compensation for mental agony and litigation cost.

                    3. Though the O.Ps appeared through their Advocate, but could not file their written version within the statutory period. So, the O.Ps are set ex-parte. But, the Advocate for O.Ps was present at the time of hearing.

                    4. In order to substantiate her claim, the Complainant has filed certain documents as per list. Similarly though the O.Ps set ex-parte filed certain documents in their support. Perused the documents filed by both the Parties including written Argument filed by the O.Ps. It has been argued on behalf of the Complainant that the husband of the Complainant was a valid Life Insurance Policy holder which was commenced on 28.10.2011 and he died on 07.12.2012 after treatment at Acharya Harihar Cancer Hospital, Cuttack. The repudiation of death claim by the O.Ps to the Complainant as a nominee is arbitrary, illegal, whimsical, imaginary, which amounts to deficiency of service on the part of the O.Ps. The Annexure-A filed by the O.Ps in this case discloses that the Patient (husband of the Complainant) was admitted to Acharya Harihar Regional Cancer Centre, Cuttack on 23.11.2012, where he was treated as indoor patient. The Annexure-B filed in this case discloses that he died on 07.12.2012 and he was under treatment for 6 months. In Annexure-A regarding history of the Patient, endorsement of the doctor is as follows:- “Married, habituated to Gutkha and smoking since last 5 years”. But, in the proposal form filed by the O.Ps in Sl. No.11 the questions asked to the Complainant are:- Do you have ever used Alcoholic Drink, Narcotics, any other drugs, Tobacco in any form ? and What has been your usual state of health ? and it discloses that the Answer was "No" and "Good" respectively. So, basing on these documents, the Complainant is claiming that there is deficiency of service on the part of the O.Ps and repudiation was not genuine and proper. On the other hand, the O.Ps have taken the plea in his written Argument that the repudiation of the claim is proper and genuine basing on the procedure of Law. The Advocate for the Complainant has relied upon the Authority of the Hon’ble National Commission, New Delhi reported in the case of L.I.C of India (Vrs.) Promila Malhotra in F.A No.146 of 1995 decided on 04.03.2002, it has been held that when deceased concealed vital facts and L.I.C fails badly to adduce evidence and is unable to discharge onus, their plea of wrong statement cannot be delivered. But, in the instant case, the death was within 2 years of commencement of the Policy i.e. on 07.12.2012, but the repudiation letter was issued on 22.08.2014 as available in the case record. In this connection, Section-45 of the Insurance Act is relevant, which reads as follows:- “Policy not to be called in question on ground of mis-statement after two years- No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy holder and that the policy‑holder knew at the time of making it that the statement was false (or that it suppressed facts which it was material to disclose).” So, when the repudiation is after 2 years of commencement of the Policy, the Insurance company has no right to repudiate the claim on the ground of making false statement by the Complainant by suppressing material facts in his proposal form. Furthermore, in the Authority relied upon by the Complainant as mentioned earlier, it has been held that in that case the insured was hospitalized and the documents of the Hospital Authorities discloses that the Patient had suffered from hypertension for 14 years, but no attempt was made to summon any evidence for any the Hospitals or examine by one who might have seen the history sheet recorded at the time of admission of such Patient. However, in the instant case, the Hospital documents are available in the case record. In support of his written Argument, the Advocate for O.Ps has relied upon the Authority reported in 1962 AIR 814 in the case of Mithoolal Nayak (Vrs.) Life Insurance Corporation of India, where the Hon’ble Supreme Court of India held that all moneys that had been paid in consequence of the Policy would belong to the Company if the Policy was vitiated by reason of a fraudulent suppression of material facts by the insured. However, the fact of the case decided in the similar Authority is not similar to the present case and the Insurance company has violated the Section-45 of the Insurance Act and more than 2 years have been passed from the date of commencement of the Policy and repudiation of the claim.

                    5. So, now on careful consideration of all the materials available in the case record and on the basis of principles laid down by the above Authorities as discussed earlier, now this Forum come to the conclusion that it is a fit case to allow this Consumer case and the Complainant is entitled to get the death claim of her husband for the Sum Assured of Rs.1.00 Lakh (Rupees One Lakh) only and ancillary benefits like vested bonus, if any along with compensation of Rs.5,000/- (Rupees Five Thousand) only and litigation cost of Rs.1,000/- (Rupees One Thousand) only and the O.Ps are jointly or severally liable to pay the same to the Complainant within 60 days of receipt of this order and failure to comply the same will carry interest @ 10% per annum, which will meet the ends of Justice in this case. Hence, Ordered:-

                                                     O R D E R

                         The Consumer case is allowed on ex-parte against the O.Ps with cost. The O.Ps are jointly or severally liable to pay the death claim of the husband of the Complainant for Sum Assured of Rs.1.00 Lakh (Rupees One Lakh) only and ancillary benefits like vested bonus, if any along with compensation of Rs.5,000/- (Rupees Five Thousand) only and litigation cost of Rs.1,000/- (Rupees One Thousand) only to the Complainant within 60 days of receipt of this order, failing which it will carry interest @ 10% per annum from the date of order till realization. The Complainant is also at liberty to realize the same from the O.Ps as per Law, in case of failure by the O.Ps to comply the Order.

                         Pronounced in the open Forum on this day i.e. the 25th day of September, 2017 given under my Signature & Seal of the Forum.