The complainant Ramila Devi  has filed this complaint petition against Branch Manager, Federal Life  Insurance Company Ltd. and one another (o.ps) for realization of Rs. 8,50,000/- as ( sum assured),  Rs. 50,000/-  for mental agony  and physical harassment and Rs. 21,000/- as litigation cost with 18 % p.a. interest on the total amount since the date of death of life insured person till date of final payment.

The brief facts, of the case are that the complainant Ramila Devi is wife and nominee of L.A. namely Lakho Sao. The further case is that husband of the complainant  purchased a policy in his name for Rs. 8,50,000/-, bearing policy no.- 4000651001 on 16-01-2014 after paying the premium amount Rs. 43,077.19/-. The Further case is that the entire proposal form was filled up by company’s  agent and the complainant’s husband only put his signature wherever agent told him to do so.  The further case is that the o.p company issued premium receipt Saw, and bond in the name of L.A. person namely Lakho Saw, and as such risk coverage of life of Lakho Saw started from 23-01-2014. Further case is that on the fatal day dated 12-03-2014 the aforesaid policy holder namely Lakho Saw, complained about sudden chest pain, to family members. The family Members and neighbors consulted Dr. B.K.Jha (M.D.) a deputed doctor of district but after continue efforts he could not save the life of Lakho Saw, on the next day Lakho Saw, expired. The further case is that Dr. Jha asked to the family members that death happens due cardio respiratory failure. The further case is that thereafter complainant Ramila Devi filed death claim against aforesaid policy to the aforesaid company with all relevant documents but the company repudiated her  claim on the ground that the assured person was   T.B. Patient.

The complainant  has filed the following documents with the complaint petition -  photocopy of  premium receipt  annexure-1-, photocopy of  death certificate of late Lakho Saw annexure-2-, photocopy  of prescription report of Dr. B.K.Jha about treatment of Lakho Saw,  annexure-3-, photocopy of    death certificate of late Lakh Saw, granted by Dr. B.K.Jha  annexure-4, photocopy  of  I.T. return for the assessment year 2012-2013  annexure-5, photocopy of    I.T. return for the year 2013-2014  annexure-6 and photocopy of repudiation letter annexure-7.

On issuance of notices o.ps appeared on 18-05-2016 and filed their w.s. with prayer to dismiss the complaint petition with exemplary cost.  The o.ps has asserted in their w.s.  that the complaint does not raise any  “Consumer Dispute” as defined u/s 2 (e) of Consumer Protection Act. They have further asserted that the complainant has not come with clean hands and suppressed the material facts about his medical history in the proposal form. It has been further mentioned in the w.s. that the complaint does not disclose any cause of action.  It has been further mentioned that after investigation it was found that L.A. was suffering from T.B. It has been further mentioned that the complainant didn’t disclosed the pre-existing policy of Rs. 10,lacs/-. It has been further motioned that the complainant suppressed the material fact with respect to medical condition, occupation, income, non disclosure of existing insurance policy.

O.ps has admitted in the w.s. that the L.A. Lakho Saw,was insured  with his company and the company issued the policy bond in his name. O.ps  has annexed the copy of  proposal form and policy terms and condition as annexure-A, They have  further  annexed photocopy of investigation  report as annexure- B and C. They have further  annexed photocopy of   repudiation letter as annexure-D and copy of affidavit dated 16-05-2015 annexure-E.

On behalf of complainant the deposition of Ramila Devi has been filed on affidavit. She has exhibited the documents annexed with complaint as exhibit -1 to 8 in her deposition.

On behalf of o.ps, o.p w-1 Soni Jha has filed his  deposition on affidavit.

The complainant has filed repudiation letter as annexure-7 whereas the o.p has filed the same documents as annexure-D.  The repudiation letter shows that the claim of the complainant has been repudiated on the ground that late Mr. Lakho saw had not disclosed the fact concerning his previous medical history, at the time of applying for insurance coverage vide proposal form dated 16-01-2017.

The o.ps has repudiated the claim of the  complainant  on the above ground and  has raised the above  matter in his w.s. So, as per section 102 of the evidence Act, the burden of proof lies on him to prove the fact. On behalf of o.ps Dr. Manoj Kumar who treated the L.A for Tuberculosis has not been examined. No reason has been assigned for the above reason.

Learned lawyer for the complainant has relied on the observations of National Consumer Dispute Redressal Commission New Delhi  given in the case of PNB Met Life Insurance Company Ltd. V/s Vineeta Devi, FA- 1045/2017 on 24-09-2018.  Learned lawyer for the complainant also filed the confonet case history with affidavit of Ramila Devi (complainant). The facts of this case correlate with the case of PNB Met Life Insurance Company. In the above case Hon’ble N.C. has relied on the Judgment of the Commission in the case of Sushil Kumar Jain / Vs United India Insurance company Ltd. I (2012) CPJ 204 (N.C). In the above case Hon’ble N.C. has observed that the Dr’s prescriptions have to be substantiated   by an affidavit of the said Dr, especially in the light of the fact that it is being disputed by the complainant. In the case of PNB Met Life Insurance Company Hon’ble N.C has further observed that the insurance company has not produced an affidavit of the concerned Dr. nor did the said Dr. answer any interrogatory by way of evidence before the fora below. On the above grounds Hon’ble N.C. was pleased to reject plea to insurance company and allowed the claim of the complainant. In this case the o.p company has also not examined the Dr. to prove the fact that the L.A. was suffering from T.B. He has only filed evidence of one Soni Georage authorized person of the company, on affidavit who is neither expert witness nor investigated the matter. On the basis of above discussion we are of the considered opinion that the insurance company wrongly repudiated the claim of the complainant on the ground of previous disease that is T.B. and as such there is deficiency on the part of o.ps company.

Accordingly, the claim petition is allowed and the o.ps company are directed to pay Rs. 8,50,000/-, sum assured to the complainant  with 7 % interest p.a from the date of the filing of complaint, Rs. 20,000/-  for compensation of mental agony and physical harassment and Rs. 10000/-as litigation cost to the complainant within  2 months from the date of order, on failure he shall be liable to pay aforesaid amount with 9 % interest p.a.  till realization. Let a copy of this order be furnished to both the parties as per rule.