IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,PURI

CONSUMER COMPLAINT NO. 270/2016

Present: Sri D.Moharana, President I/c

Ms. S.K.Rath, Member(W)

1- Santha Bahadur

2- Sukra Bahadur

3- Jaga Bahadur

4- Muna Bahadur

5- Tuna Bahadur

All are S/o. Late Man Bahadur

At- Kashiharipur, PO- Gopinathpur, PS- Puri Sadar, Dist-Puri ..Complainant

Vrs.

1- The Senior Divisional Manager,

L.I.C.Of India Ltd.,At- Surya Nagar, Bhubaneswar Dist-Khurda

2- The Branch Manager,

LIC of India Ltd.,Puri Branch,

At-Penthakata,PO-Shree Vihar,PS-Sea Beach,

Dist- Puri-752003 …Opp.Parties

For the Complainant-Sri Pradipta Kishore Mohapatra, Advocate.

For the Opp.Party- Sri Puskar Mohapatra, Advocate & Associates

DATE OF FILING- 17.12.2016

DATE OF DISPOSAL-19.03.2020

O R D E R

Sri D.Moharana, President I/C

The present complainants are the sons as well as legal heirs of Late Man Bahadur. Late Man Bahadur was working as a Watchman under O.S.E.B., Puri. During his life time, he had insured his life with the Opposite Parties. He had assured 3 numbers of polices bearing Nos. 581382753, 581380651 and 581381328 for the insured sum of Rs. 50,000/-, Rs.30,000/- and Rs.25,000/- respectively. . In all of the three policies, his wife viz. Kamal Bahadur was stood as nominee. He was paying the premiums regularly and during the policies were in force, the life assured Man Bahadur died on 4.4.1998. Subsequently, the nominee submitted the claims before the O.Ps. But to her unfortunate, the said nominee also died before settlement of claim. The legal heirs of the life assured wanted to know the position of the policies through R.T.I application. However, the Opposite Parties intimated vide its letter dated 30.11.2016 to the effect that claims of the above three policies have been repudiated on the grounds of withhold of material information in respect of disease being suffered by the life assured at the time of procuring three policies. Being aggrieved with the decisions of the O. Ps, the legal heirs have come up with this case claiming deficiency in service on the part of the O.Ps in considering the claims of the life assured and ,thus, prayed for release of claim amounts of the three policies together with interest and compensation for harassment caused due to delay in settlement of claim. Hence, this case.

2- The Opposite Parties appeared through its learned counsel and filed written version wherein it is admitted that Man Bahadur had three policies bearing No.581382753 of Rs.50,000/-, Policy No. 581380651 of Rs.30,000/-, and Policy No.581381328 of Rs.25,000/- respectively. It is also admitted that Kamal Bahadur was the nominee in the above policies. The life assured died on 4.4.1998 . It is stated that they have on different occasions followed up with the nominee vide their letters dated 15.7.99, 2.11.99, 20.1.2000 and 3.2. 2000, but there was no response from the claimant. However, the O.Ps repudiated the claim against the above three policies on the ground of suppression of material facts. In this regard, it is contended by the O.Ps that the life assured was suffering from cancer before the proposal of the policies and the fact of repudiation was informed to the nominee vide their letter dt. 17.3.2001. Thus, it is contended by the O.Ps that the claims of the above policies were rightly repudiated as per terms and conditions of the policies and there is no negligence or deficiency of service while dealing with the claims. However, it is raised objection regarding maintainability of the case on the ground of law of limitation as provided under Sec. 24(A) of the C. P. Act, as the repudiation of the claim was intimated by them on 17.3.2001 and the complainants have filed this case at belated stage . Hence, prayed for dismissal of the case with cost.

3- We have carefully perused the copies of documents filed by both the parties in their support and gone through it in details. Heard the learned counsels appearing for both the parties at length. Before averting to the merits of the case, it is to be clarified the objection raised by O.Ps regarding maintainability of the case.

4- It is admitted by both the parties that Man Bahadur had insured his life with the O.Ps and Kamal Bahadur was nominee in the said policies. The present complainants are the sons and legal heirs of both Man Bahadur and Kamal Bahadur. Man Bahadur died on 4.4.1998 and , subsequently, Kamal Bahadur also died . Therefore , there was no scope for the legal heirs to know about the above policies and any claime thereof. However, one of the legal heirs Tuna Bahadur wanted to know the fate of policies as insured with the O.Ps by his father and represented to O.Ps through R.T.I and got information about the policies on 30.11.2016. Therefore, the cause of action is deemed to be began` when the O.Ps intimated the facts of the policies from the date in reply i.e. 30.11.2016 and the instant case has been filed on 17.12.2016 which is within the limitation and this Forum has ample jurisdiction to try this case.

5- While going through the merits of the case , it is an admitted fact that Man Bahadur had availed three policies during his life time bearing No.581382753 of Rs.50,000/-, PolicyNo. 581380651 of Rs.30,000/-, and Policy No.581381328 of Rs.25,000/- respectively . The date of commencement of three policies were 28.5.1997, 15.12.1995 and 28.3.1996 respectively. Kamal Bahadur, his wife was the nominee in the said policies. The life assured had died on 4.4.1998 and leaving behind his wife and the present legal heirs(complainants). It is admitted by the complainants that the nominee also died just after the death of life assured. It is argued by the learned counsel for the complainant that there was no scope with the legal heirs to know about the policy positions of his father. However, they could know it through R.T.I wherein they came to know that the above three policies were arbitrarily repudiated by the LIC authorities. On the other hand, the learned counsel for the O.Ps contended that the claims of the policies were scrutinized by them before repudiation. It is stated that Man Bahadur did not disclose his suffering from cancer. He was detected cancer by A.H.R.C.C.,Cuttack on 26.12.95. He was also swelling on the chest prior to 3 years of dt. 26.12.1995. It is also stated that the Report of Dr. Krupasindhu Panda, Oncologist dt. 16.1.1996 disclosed that the life assured was suffering from breast cancer and Dr. Panda operated the swelling. All these facts are corroborated and proved in shape of relevant documents filed in record by the O.Ps. It is contended that due to suppression of material facts the claim was repudiated on 17.3.2001 and intimated to Kamala Bahadur , the nominee in the said policies.

6- While going through the medical documents filed by the O.Ps, we see that Dr. K.S Panda in his prescription dt.16.1.1996 has clearly mentioned that the life assured was suffering from breast cancer and under treatment on his advise and the same was operated by him successfully and advised the life assured to take rest from 2.1.1996 to 16.1.1996 and from 17.1.1996 to onwards, the life assured can resume his duties and needs prolonged treatment for his recovery. The prescription does not reveal that the cause of death of the life assured is due to cancer nor any fact to ascertain that the life assured has pre- existing disease of cancer and since long the life assured has been treated by the Dr. K.S Panda. The prescription which the O.Ps produce before this Forum is no relevant unless other vital evidence relating to prolonged treatment and knowledge of the life assured about the pre- existing disease before entering into the policies. The prescription of the treated doctor K.S. Panda can not be taken into consideration without submitting an affidavit regarding the pre- existing disease of the life assured. Therefore, documentary evidence is necessary to prove that this is a case of pre- existing disease. Merely filing a prescription does not ipso facto prove the case of pre- existing disease.

On the observation made by the O.P- Insurance Company, the policy dated 15.12.1995 vide policy NO.581380651 with sum assured of Rs.30,000/- was being admitted whereas the other two policies repudiated on the ground of detection of cancer.

The certificate issued by the Dr.K. S. Panda is very vital piece of evidence . It reveals from the certificate that even if the life assured had breast cancer but it had been successfully operated by him and can resume his duties but certainly the life assured died on 4.4.1998 not for the cancer but a natural death as claimed by the complainant. No certificate or document was produced by the O.Ps -Insurance company regarding the cause of death of life assured. The O. Ps -Insurance company had not done proper investigation regarding the suffering of breast cancer prior to enter into the policies nor any reports revealing the cause of disease to fall the death of life assured. The O. Ps failed to prove its case completely.

7- From the above assertions, we are clear that the O.Ps have repudiated the claims of the complainant without application of mind. There is nothing on record to disclose that the complainant was suffering from cancer three years prior to signing of proposal as pleaded by the O.Ps. Hence, the complainants are entitled to the benefits with regard to three policies bearing No.581380651, 581382753 and 581381328.

7- Now it is to be decided as to whether the above insured amount would carry interest for the relevant period under dispute or not?

It is clear that if the O.Ps would have been released the amount against the policy in question at that time, they would have been paid only the sum assured. In the meantime, several months and years have already been elapsed and it is justifiable to grant simple interest on the said insured amount . The rate of interest is, thus, assessed at 12 per cent per annum from the date of filing of the case before this Forum i.e. 17.12.2016 till the date of actual payment. Since the complainants have been well compensated in terms of granting interest on the insured amount, therefore, we are not inclined to grant any compensation separately as prayed by the complainants. Hence, it is ordered that:-

O R D E R

The case of the complainants are allowed against the O.Ps on contest. The Opposite Parties are directed to settle the claims against three policies No. 581380651, 581382753 and 581381328 respectively by paying the insured sum together with simple interest there of at the rate of 12 % per annum from 17.12.2016 till the date of actual payment within 30 days from the date of actual payment. The case is accordingly disposed of with an order of Rs.2000/- towards cost of litigation to be paid by the O.Ps to the complainants within the above period.

Dictated and corrected by me on this 19th day of March,2020

Sd/-S.K.Rath Sd/-D.Moharana

I AGREE(MEMBER) PRESIDENT I/C