JUDGMENT

Shri A.K.Patra,President:

1. The captioned consumer complaint is filed by the complainant named above inter alia alleging deficiency in  service on the part of the Ops for  repudiation of  claim of  insurance benefit made on account of the premature death of her insured husband .
2. The complainant seeks for  an order directing the Ops to release the insurance benefits of Rs. 6,25,000/- with interest under  Policy No.573224977 and for award of compensation of Rs 5,00,000/- towards mental  agony & suffering along with cost of this litigation and all  other  reliefs as this  Hon’ble Commission may  deem fit & proper.
3. Brief facts of the case of the complainant  are that, her husband deceased  Sanjaya Kumar Joshi had availed a policy under “Jiban Saral Scheme” of LIC of India vide Policy No.573224977 on dt.17.08.2011 paying regular monthly premium to the Opp.Party No.1 through Opp.Party No.2. After paying the premium of five installments, the husband of the complainant died on 25.0.1.2012 . After the demise of her husband the complainant, being the nominee, made a communication to the ops verbally and than in writing with a request to settle the insurance claim. As per the policy bond, the death benefit amount payable  is Rs.6,25,000/-. Several approaches of the complainant for release of insurance benefit are not responded by the Ops lastly on dt. 28.11.2018 the Zonal Manager, LIC of India, East Central Zonal Office, rejected the claim of the complainant arbitrarily on a false ground of suppression of material facts   . Hence, this complaint.
4. This consumer complaint is contested through a written reply filed by the O.Ps. It is submitted by the Op No.1 that, the case is related to repudiation of death claim in Policy No.573224977 on the life of late Sanjaya Kumar Joshi under Jeevan Saral Plan with date of commencement 17.08.2011 for death sum assured of Rs.6,25,000/-  under plan No.165, Term 20 years, with monthly premium of Rs.2552.00(SSS) and the policy holder  died  on 25.0.1.2012 just after five month of taking policy and  his wife Smt. Kiranbala Joshi is the nominee  in the policy. After receiving of her death claim, the investigation was made by the Opp.Party No.1 and came to know that, the insured Sanjaya Kumar Joshi  was suffering from mouth cancer before taking the policy and he had intentionally suppressed such facts of suffering the disease. The deceased life assured died on 25.01.2012 but intimated to the Op No.1 after three years of death i.e. after the limitation period which is barred by limitation.  The claim of the complainant is just after five months of taking the policy and the claim was categorized under “early claim”.  The Opp.Party No.1, to pay the genuine claim, has issued necessary forms to the complainant and made correspondences  to submit the treatment papers for last five years and the complainant submitted the said claim forms and true copies  vide her letter dt.05.09.2018  and all these papers clearly revealed the fact that, policy holder deceased  Sanjay Kumar Joshi was suffering from mouth censer before taking the alleged this policy  and had intentionally suppressed material  information to grab the insurance money as such, the death claim was rightly repudiated  on 28.11.2018 and that there is no deficiency in service on the part of the Ops .  Hence, this complainant against the Ops is liable to be dismissed with cost.
5. Heard. Peruse the material on record. We have our thoughtful consideration to the submission of rival parties.
6. After perusal of the complaint petition, written version and all the documents relied on by both the parties placed in the record, the points for consideration before this Commission is whether the complainant is entitled for insurance benefits there under the  alleged insurance policy  vide policy No.573224977 of   LIC of India Ltd, on account of premature death of her insured husband Sanjaya Kumar Joshi    and whether the Ops/LIC of India  have deficient in service for repudiation of the  claim of the complainant?
7. Admitted facts of the case are that, the deceased husband of the complainant was insured with the OP/LIC of India vide Policy No vide policy No.573224977 under “Jeevan Saral Plan” with date of commencement 17.08.2011 for death sum assured of Rs.6,25,000/-  and that, the policy holder  died  on 25.0.1.2012 while policy was in force and that, his wife Smt. Kiranbala Joshi is the nominee  in the said policy to receive the death benefit under the policy and that , after receiving of her death claim, the investigation was made by the Opp.Party and that ,insurance claim is repudiated on dt. 28.11.2018
8. The Op/LIC of India has repudiated the claim on the ground of   “suppression of material facts, which have had bearing on the granting of risk”.
9. It is the contention of the Op that, claim of the complainant is just after five months of taking the policy and the claim was categorized under “early claim”. Accordingly, the investigation was made by the Opp.Party No.1 and came to know that, the husband of the complainant was suffering from mouth cancer before taking the policy and he had intentionally suppressed such facts of suffering of the disease only to grab the insurance money as such, the death claim has been rightly repudiated.   Thus, onus is there   on the part of OPs to prove their contention.
10. It is found that ,the  Op/LIC of India  in  their repudiation letter dt.28.11.2018 has relied on the following documents :- (a) Medical Treatment Papers of D.H.H., Bhawanipatna, Laxmis’s Diagnostic & Research Centre, ChitanyaMedical Centre,K.G.H. Visakhapatnam, Santi Memorial Hospital Pvt.Ltd and (b) Claim Form A & C . But no where it is proved that, such documents have served to the complainant for her perusal.
11. During hearing of this case the O.P/LIC of India has relied on the self attested copies of documents as per the list of documents filed on dt.08.05.2023 (i) proposal Form,(ii)Policy Bond ,(iii) Prescription of the Dist Head Quarter Hospital, Bhawanipatna dt.28.06.2011 & 29.06.2011,(iv) Report of Laxmi Diagnostic & Reserch Centre-Bhawanipatna Dt.28.06.2011,(v) Report of Chaitanya Medical Centre dt.04.08.2011,(vi) Report of prescription of Dr.Manmadha Rao –Visakhapatnam dt.10.08.2011,(vii) Report  of  CITI C.T.SCANS-Visakhapatnam (viii) Discharge Summary of Shanti Memorial Hospital Pvt. Ltd- Cuttack dt.10.11.2011,(ix)  letter of Mrs.Joshi that her husband expired on 25.01.2012 due to long illness,(x)  Certificate by employer,(xi) certificate of identity & Burial or Cremation,(xii)  certificate of Hospital Treatment,(xiii)  medical Attendant’s certificate,(xiv)  claimant’s statement ,(xv) Repudiation Letter dt.28.11.2018 which are said to have obtained during investigation of the claim. However, the person investigated the matter has not been examined and above referred documents filed as per the list of documents dt.08.05.2023 have not been proved in accordance with law, since neither the person who wrote the facts that, insured was suffering of the disease nor any one conversant with his handwriting and their signature was produce before this Commission for examination. It is necessary to proof the handwriting and signature of the person who had purportedly recorded the facts of suffering of the disease of deceased insured Sanjaya Kumar Joshi  . So also, no documents relied upon by the Op in their repudiation letter are proved.  In these circumstances it becomes necessary to examine the author of aforesaid history/past history i.e. the facts of suffering of the disease alleged to have their with the insured prior to obtaining of the insurance Policy or in case, he/she is not available to examine, some other person who is conversant with the handwriting of the author of the said history/past history i.e. the facts of suffering of the disease of insured is to be examined. Only thereafter it can be decided as to whether the facts of suffering of the disease as recorded on the above referred documents are true or false.
12. Law is well settled that, placing documents in the case record or marking of the document as exhibits are mere reference and convenience of Commission and it has nothing to do with its evidentiary value. Even just because a documents is marked without objection will not dispense with the proved of the said documents in accordance with law.
13. The Learned council for the Ops during his argument referred to some orders passed by the Hon’ble National Commission in Appeal No.242/2006.”Dineshbhi G Chandrana vs. LIC of India decided on 27.07.2010 that, in the event of non discloser of material fact the LIC was within the right to repudiate the claim. We found that  those are not applicable in the fact & circumstances of the case in hand  as it is not proved anywhere that, the policy holder was ever suffering from any disease and that, he has not disclose any material fact regarding his health condition. Repudiation of claim cannot be accepted merely on placing contention without proof. Held, in Manik Chandra Pahari vrs LIC of India reported in 2017 ,NCJ ,378 (NC).
14. We found much weight on the submission of the learned counsel for the complainant that, the documents filed by the Ops as per their list of document in this case are nothing but self –serving documents may not be hold trust worthy. The learned counsel for the complainant further drew our attention on the judgment passed in M.Chandra Vrs. M. Thangamuthu & another reported in 2010(ii) CLR (SC) 746 :(2010) 9 SCC 712. The  self attested photo copy of documents filed by the Ops as per list of documents during hearing of this case without authenticated by fundamental evidence that, the photo copy is in fact a true copy of the original may not be accepted as evidence. Admittedly, here in this case, no evidence on affidavit as prescribed in C.P.Act 2019 is adduced by the OPs to substantiate their claim. The  Ops have failed to prove their contentions.
15. Here in the present case  , keeping in view of the admission of fact that, deceased husband of the complainant was insured with the Op/LIC of India vide Policy No vide policy No.573224977 under Jeevan Saral Plan with date of commencement 17.08.2011 for death sum assured of Rs.6,25,000/-  and that , the policy holder  died  on 25.0.1.2012 while policy was in force and that, his wife Smt. Kiranbala Joshi/here the complainant  is the nominee  to receive the death benefit under the policy does not seem to be any justification for nonpayment of claim under this policy in question to the complainant but insurance claim is repudiated by the O.Ps is not justified , hence we are of the opinion that , there is sufficient cause to file this complaint.
16. As per Section 69 of C.P.Act ,2019, Consumer complaint is to be filed within two years from the date of  cause of action arose .Law is well settled that cause of action states on the date of repudiation of insurance claim but not from the date death of the insured. As such here in this case cause of action for this complaint arose on 28.11.2018 when the claim of the complainant is repudiated by the OP/LIC of India .Accordingly this complaint ought to have filed within two years i.e. within 27.11.2020 but admittedly complaint is filed on 20.05.2022 is too late. However, Hon’ble Supreme Court of India in Misc. Case No.21 & 29 of 2022 in the matter of extension of limitation due to Covid -19 situation on 10.01.2022 has directed in continuation of earlier order dt.08.03.21, 27.04.21 and 23.09.21 that, the period from 15.03.20 till 28.02.2022 shall be excluded for the purpose of limitation as may be prescribed under any law – General Laws or Special Laws in respect of judicial or quasi judicial proceeding.(2022) 1 TMI 385(SC).
17.  In view of above said order of the Hon’ble Apex Court, we found that, this complaint is well within the Limitation period as prescribed under C.P.Act 2019 . Hence, we do not found any merit on the objection raised by the Ops that, complaint is barred by limitation is hereby rejected, rather complaint is found to be in time and well within the jurisdiction of this  Hon’ble Commission.
18. Based on the above discussion and settled principle of law, we are of the considered view that, the complainant is entitled for insurance benefit under the said insurance policy vide No.573224977 but the Opposite Parties have arbitrarily repudiated the claim for which, the Ops are deficient in service certainly caused financial loss & mental agony to complainant .As such the Op 1 (one) /LIC  of India liable to  compensate the injuries of  the complainant. We found nothing proved against the OP 2(one). Hence it is ordered.

                                                                                                  ORDER

This consumer complaint is allowed in part against the Op 1(one) and dismissed against the Op 2(two)  on contest with the following direction:-

1. The Op 1(one)/LIC of India is here by  directed to pay the insurance benefit of Rs 6,25,000/-  under said insurance policy vide No.573224977  on the life of insured deceased Sanjaya Kumar Joshi  with interest @ 9% per annum since the date of filling of this complainant i.e. 20.05.2022 till its realization and further directed to pay Rs 10,000/- only towards litigation expenses to the complainant.  
2. This order be complied within four weeks from the date of received of this order failing which the Op 1(one) is  liable to pay interest @18 % p.a. over the awarded amount till its realization to the complainant.

Dictated and corrected by me.

  Sd/-  

  President     

  I   agree.

                                       Sd/-

                                     Member   

         Pronounced,  in the open Commission today on this 31^st August 2023 under the seal and signature of this Commission. The pending application if any is also stands disposed off accordingly. Judgment could not be pronounced on time in want of quorum.  

The judgment be uploaded forthwith in the website of the Commission and free copy of this order be supplied to the respective parties or they may download the same from the Confonet  to treat the same as copy of the order received from this Commission .Ordered accordingly.