DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KANDHAMAL, PHULBANI
C.C.NO.36 OF 2016
Present: Sri Rabindranath Mishra - President.
Miss Sudhiralaxmi Pattanaik - Member.
Sri Purna Chandra Tripathy - Member.
Monoj Kumar Senapati, aged- 29 years
S/O: Prem Senapati Vill: Parubhata
PO: Khamankhol, PS: Baliguda Dist: kandhamal ……………………….. Complainant.
Versus.
1. The Branch Manager
L. I.C of India, Phulbani Branch.
At/PO/PS: Phulbani Dist: Kandhamal
2. The Sr. Divisional Manager,
L.I.C of India, Berhampur Division At: Khodasingi,
Main Road, Berhampur PO: Berhampur Dist: Ganjam.
3. The Zonal Manager, L.I.C of India, East Central Zonal Office
Jeevan Deep Building 6th Floor, Exhibition Road
PATANA- 800001. …………………………….. OPP. Parties.
For the Complainant: Sri Sidheswar Das, Advocate, Phulbani
For the OPP. Parties: Sri Bijay Kumar Mohanty, Advocate,Phulbani
Date of Order: 29-03-2017
O R D E R
The case of the Complainant in brief is that he is the nominee of his late Mother Ruta Senapati, who was the L.I.C policy holder under the O.Ps. The deceased policy holder Ruta Senapati died on 10-01-2015 at his residence at parubhata,Khamankhol under Baliguda PS of Kandhamal District. During her life time she started 2 numbers of L.I.C policies bearing No. 574136513 dated.28-10-2014 in which the sum assured to the tune of Rs. 1,00000/- and policy bearing
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No.573452789 dated. 12-03-2014 and the sum assured to the tune of Rs.1, 00000/-. The deceased deposited all the premiums prior to her death and both the policies are in force at the time of death of the policy holder. The Complainant being the son and nominee of the deceased applied for the death claim of his mother on 10-01-2015 along with necessary documents. The Complainant requested several times for settlement of the claim but the O.Ps threw a deaf ear to the approaches of the Complainant. On 07-02-2015 the O.P repudiated the claim of the Complainant on the ground that the Insured was suffering from Malaria and E .Fever prior to the commencement of the policy and the said fact was suppressed at the time of filling the proposal Form. Due to the non receipt of the death claim of the deceased the Complainant is suffering both mentally and financially. Hence, he has filed this complaint against that O.Ps to settle-up the policy of the deceased with proper interest and benefit admissible under the provision along with Rs. 20,000/- as compensation towards mental agony and harassment with Rs. 5,000/ towards cost of litigation.
The case of the O.Ps as per their joint version is that it is a fact that the policy holder expired on 10-01-2015 as per the death certificate submitted by the Complainant , but she was under treatment prior to the above policies and suppressed the material fact of her ill health in the proposal forms of the policy .As per the answers given by the Complainant in the proposal form she had not disclosed the material fact that she was suffering from malaria and E.Fever before acceptance of the above policy. The O.Ps have collected the evidence from Rogi kalyan Samiti, Sub Divisional Hospital, Balliguda vide O.P.D Regd. No. 54135 dated. 09-03-2014 wherein it is mentioned that the DLA was suffering from Malaria and E.Fever.Further, pathological investigation report dated 09-03-2014 of the same hospital also shows Malaria as positive. So the death claim of the Complainant rightly repudiated by O.P No.2 and the same has been communicated to the Complainant on 07-03-2016. Hence, the question of harassment and mental agony does not arise and they prayed to dismiss the complaint with cost.
During course of hearing we have heard the learned counsel appearing for both the parties. We have gone through the complaint petition, the joint version filed by O.Ps, the documents filed by both the parties in support of their case.
The sole point of consideration is that whether the deceased suppressed the material fact regarding her ill health at the time of answering the questions in the proposal form or not?
The allegations of the O.Ps as per their version are that the deceased mother of the Complainant was suffering from Malaria and E-Fever before acceptance of the above policy. They are collected the evidence from Rogi Kalyan Samiti SubDivisional Hospital, Balliguda vide O.P.D Regd. No. 54135 dated. 09-03-2014 wherein it is mentioned that the DLA was suffering from Malaria and E-Fever. Further the pathological Investigation report dated. 09-03-2014 of the same hospital also shows malaria as positive. So, she has suppressed this material fact and availed Insurance policy from the O.Ps. On perusal of the outdoor ticket vide No. 41175, it is seen that the concerned date was
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tempered and neither any doctor nor any staff on behalf of Rogi Kalyan Samiti Sub Divisional Hospital , Balliguda were examined by the O.Ps to prove the papers collected for the purpose by the O.ps. It is well settled that onus of proving the grounds for repudiation of Insurance claim lies heavily on the Insurance Company. The O.Ps have also not filed any affidavit in support of their evidence. The original documents of the concerned medical were also not called for by them to prove their stand. So, the O.Ps failed to produce any suitable evidence to establish the grounds for repudiation of the claim of the Complainant. Being malaria is a common fever in the locality, it cannot be said that the deceased mother of the Complainant was suffering from a serious pre-existing disease and she was aware about the seriousness of the disease at the time of filing of the proposal form in absence of any positive evidence to that effect .
In the above circumstances, the Complaint filed by the nominee of the deceased, the Complainant is allowed. The O.ps are directed to pay the death benefit to the Complainant, the nominee of his deceased mother in connection with L.I.C policy bearing No. 574136513 and 573452789 with 9% interest per annum from the date of death of the deceased i.e 10-01-2015 till the date of payment .
The said order be complied within 30 days from the date of receipt of this order by the O.Ps, failing which the same shall carry interest at the rate of 12% per annum till payment.
The C.C is disposed -of accordingly. Supply free copies of this order to both the parties at an early date.
MEMBER MEMBER PRESIDENT
