Date of filing:-05/07/2021.                                                                                Date of Order:-15/05/2023.

DISTRICT CONSUMER DISPUTE REDRESSAL COMMISSION,

B A R G A R H.

Consumer Complaint No. 34 of 2021

Kanchan Kumar Chakrabarty, S/o. Late Binay Chakrabarty resident of College Road W. No.12, P.s. Dist. Bargarh.

                                                                                                                                      Complainant.

V e r s u s

                                                                                                                                                                                          The Branch Manager LIC of India Bargarh, Branch Bargarh Po/Dist. Bargarh.

Opposite Party.

Counsel for the Parties:-

For the Complainant :-       :- Sri J.K. Padhan and  Associates.

For the Opposite Party :-    :- Sri A.B. Sahu with Associates.

                                                -: P  R  E  S  E  N  T :-

Smt. Jigeesha Mishra            .....       .....       .....       .....       .....       P r e s i d e n t.

Smt. Anju Agarwal             .....         .....       .....       .....       .....       M e m b e r (W).

Dt.15/05/2023.                                 -: J   U  D   G  E  M  E  N  T:-

Presented by Smt. Jigeesha Mishra, President :-

1. The Case of the Complainant is that the Complainant was a policy holder having policy namely LICs Jeevan Arogya vide its policy No. 594418479. The policy was not renewed as due to non payment of the premium in the month of  December, but the same policy was revived on 13/03/2018 after due receipt of the insurance premium. The previous policy issued on 06/06/2011 and continued as the same policy. So the age of the policy is about 9 years. The petitioner suddenly got some problem in his health and during his treatment in the month of August he was diagnosed as Renal failure patient (CKD) and was admitted in  Shree Balaji, institute of Science Pvt. Ltd Raipur for his treatment on 09/01/2019 to 22/01/2019. During that procedure of Renal Transplantation was done. The petitioner spent a sum of Rs. 19,00,000/-(Rupees Nineteen lakhs) for the purpose of treatment. The petitioner was a insured under Opposite party for a sum of Rs. 1,50,000/-(Rupees one lakh fifty thousand)only each of his family member. So he made a claim on 14/06/2019. On 07/01/2020 the claim was rejected with a reason that non disclosure of pre existing illness. Hence the Complainant filed this case before this Commission.
2. The Opposite Party the Branch Manager of LIC of India, Bargarh, filed its version and  admitted that the Complainant paid premium on 13/03/2018 and the policy was revived. Further the Opposite Party submitted that the claim of the Complainant was repudiated on ground of non disclosure of pre existing condition of health at the time of revival under consideration. The Complainant has violated the terms and conditions of the policy bond. The claim repudiation letter was communicated to the Complainant vide letter date 07/01/2020. Hence there is no deficiency on the part of the Opposite Party.
3. Perused the records and following issues are framed:-

1. Whether the Complainant is Consumer of the Opposite Party ?
2. Whether the Opposite Party is deficient in its service ?
3. What relief the Complainant is entitled to get ?

Issue No.1.

            The Opposite Party admitted that the policy was revived on 13/03/2018. The Complainant paid insurance premium to the Opposite Party. Accordingly the Complainant is a Consumer of the Opposite Party.

            The issue is answered accordingly.

Issue No.2.

            The Opposite Party admitted the fact. The Opposite party did not deny the insured amount. The only ground of rejection of claim was non-disclosure of pre-existing illness. It is the duty of Opposite Party to conduct medical check up at the time of giving health policy. As per document the Complainant has no pre-existing illness. Non settlement of claim by the Opposite party amounts to deficiency in service. The issue is answered accordingly.

Issue No.3.

            For deficiency in service of the Opposite Party the Complainant is entitled to get relief. The issue is answered accordingly.

            As per supra discussion the following order is passed.

                                                            O R D E R

The Complaint is allowed on contest. The Opposite Party is directed to pay Rs. 1,50,000/-(Rupees one lakh fifty thousand)only to the Complainant within one month of this order. Further the Opposite Party is directed to pay Rs. 40,000/-(Rupees forty thousand)only compensation for harassment and mental agony and Rs. 10,000/-(Rupees ten thousand)only for litigation expences. Failing which the entire amount will carry 12% interest P.A. till realization.

            Order pronounced in the open court on 15^th  day of May 2023.       

            Supply free copies to the parties.  

      Typed to my dictation

                                                                                            and corrected by me.                                                                                           

                   I  agree/-                                                                       

         ( Smt. Anju Agrawal )                                                                  ( Jigeesha Mishra )

              Dt.15/05/2023                                                                              Dt.15/05/2023

              M e m b e r  (w)                                                                          P r e s i d e n t.