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  1. #16
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    BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President, 2. M.N.MANOHARA, B.A., LLB., Member, 3. A.P.MAHADEVAMMA, B.Sc., LLB., Member,

    ORDER

    Complaint No.MDF/C.C.No.132/2008 Order dated this the 26th day of March 2009

    COMPLAINANT/S Sri.Anand Sericulture Extension Officer, Department of Sericulture, Doddagarudanahalli, Mandya Taluk & District. (By Sri.H.S.Lokapal Rao., Advocate)

    -Vs-

    LIC Of India/S

    1. The Divisional Manager, L.I.C. of India, Near Tippu Circle, Mysore.

    2. The Branch Manager, L.I.C. of India, Bandigowda Layout, Mandya. (By Sri.S.Sudarshan., Advocate)
    Date of complaint 11.12.2008
    Date of service of notice to LIC Of India 22.12.2008

    Date of order 26.03.2009 Total Period 3 Months 4 Days Result

    The complaint is allowed, directing the LIC Of India to pay compensation of Rs.5,000/- to the complainant within 2 months with cost of Rs.500/-. Sri.Siddegowda, President 1. This complaint is filed under section 12 of the Consumer Protection Act 1986, to direct the LIC Of India to waive off the interest and penal interest on loan amount subsequent to August 1996 and for payment of compensation of Rs.50,000/- with costs.

    2. The case of the complainant is that he availed loan on four L.I.C. polices in the month of March 1995, when he was working at Ramanagar. For the repayment of the said loan in the month of August 1996, he approached the LIC Of India Branch Office at K.R.Pet as he was transferred to that place. But, the officials of K.R.Pet Branch Office informed the complainant that there was no loan existing on the said policies and refused to receive the payment from him. Subsequently, at periodic intervals of time the complainant made sincere attempts for repayment of the loan by enquiring at different branches of the LIC Of India as in general, the policy profiles and loan dockets were being transferred to the places where the policy holder would be transferred. In the month of June 2005 again the complainant approached the LIC Of India Branch Office at K.R.Pet and requested to provide him the status report of all the said policies. The branch Manager orally informed that they have sent a letter to branch office at Mandya regarding the status report and directed the complainant to approach Mandya Branch Office and accordingly, he approached on 2nd LIC Of India and requested for status report of the said policies and 2nd LIC Of India issued 4 computer copies of the status report of the said policies which clearly state that there was no previous loan existing on all the 4 policies. But, to his surprise a loan repayment quotation slip dated 24.01.2008 was sent to the complainant by 2nd LIC Of India with a calculation of interest. As per the calculation made by the 2nd LIC Of India, the complainant required to repay a sum of Rs.52,507/-.

    Then, the complainant sent a letter on 22.05.2008 to 2nd LIC Of India to waive off the interest levied on the loan amount and copy to 1st LIC Of India, but the LIC Of India did not oblige the report. Then, the legal notice was sent to 1st & 2nd LIC Of India and they have not sent any reply. Due to the negligence and dereliction of duty on the part of the LIC Of India an interest of Rs.38,107/- is accumulated on principle amount of Rs.14,400/- which is almost 3 times the principle amount for which LIC Of India are responsible. The LIC Of India have committed deficiency in service in not rendering proper information and have caused mental agony and inconvenience. Therefore, the present complaint is filed.


    3. The LIC Of India have filed common version, admitting that the complainant has obtained loans on 4 policies on 07.03.1995and the total loan amount is Rs.18,600/- and the loan was sanctioned at Channapatna Branch Office. The Complainant has not approached any of the Branch Offices for repayment of the loan and interest, all the loan dockets were transferred from Channapatna to K.R.Pet Branch Office on 21.11.1995 itself. Had the complainant approached the branch, LIC Of India would have accepted the amount. The allegation that the LIC Of India refused to receive the payment is utterly false. As per the condition No.3of the policy loan application, the complainant has to pay half yearly compounded interest at 10.5%. The life assured should inform the LIC Of India in writing as to the actual place of his work and his intention to get the policy and loan records transferred. The averment that generally the records will be transferred to place to place of transfer of the life assured and the complainant made sincere attempt to repay the loan are all false.

    The complainant was not deligent in paying the half yearly loan interest and kept quiet for a long time. The complainant is bound to repay the loan amount demanded by the LIC Of India as per the conditions. Though the complainant requested to waive the interest, but reply was sent expressing the inability to waive the loan interest. All the policies are due to maturity within a short period. The complainant in order to make unlawful gain, but not paying the loan and interest, has approached this Hon’ble Forum with unclean hands, selfish motives. The question of waiver of loan interest is not possible. There is no cause of action and there is no deficiency in service and hence, the LIC Of India are not liable to pay any compensation and complaint is liable to be dismissed with costs.


    4. During trial, the complainant & 2nd LIC Of India are examined and produced documents Ex.C.1 to C.7. On behalf of the LIC Of India one witness is examined and documents Ex.R.1 to R.12 are marked.


    5. We have heard both sides.

    6. Now the points that arise for our considerations are:- 1. Whether the LIC Of India has committed deficiency in service by giving misleading information with regard to the loan? 2. Whether the complainant is entitled to waiver of the interest on the loan? 3. Whether the complainant is entitled to compensation?


    7. Our findings and reasons are as here under:-


    8. The undisputed facts are that the complainant being a Government Servant had obtained 4 L.I.C. policies from the LIC Of India as per Ex.R.1 to R.4 and he has availed the loan of Rs.5,500/- on Ex.R.1, Rs.6,000/- on Ex.R.2, Rs.2,000/- on Ex.R.3 and Rs.4,200/- on Ex.R.4 on 02.03.1995. The loan applications Ex.R.6 & R.8 are not disputed. Under this application, the condition is that the complainant has agreed to pay interest at compounding half yearly to the Corporation and the policies are assigned in favour of the LIC Of India and these documents revealed that the loan was disbursed at Channapatna Branch when the complainant was working in Ramanagar.

    The grievance of the complainant is that when he was transferred to K.R.Pet during 1996, he enquired in the Branch Office of the LIC Of India to pay the interest, but the Branch Office informed that there was no loan existing on the said policies and refused to receive the payment from him and at periodic intervals of time, he made sincere attempts for repayment of the loan by enquiring at different branches of the LIC Of India, but there is no material. It is admitted by him that he has not paid any amount towards the loan, though his duty is as to pay the loan with interest.

    According to him, loan amount was being deducted in his salary. But, no documents are produced at all. He has not sought for in writing about the loan particulars till 2005 and he kept quiet for 10 years. But the evidence of the complainant that he approached K.R.Pet branch in June 2005 requesting for status report of the policies and they directed him to approach the branch office at Mandya and then he approached the 2nd LIC Of India Branch and 2nd LIC Of India Branch issued 4 computer copies of the status report of the said policies. The complainant has produced Ex.C.3, C.4, C.5 and C.6 wherein policy particulars are mentioned, but with regard to the loan details, it is mentioned as “no previous loan exists”. 2nd LIC Of India has admitted that Ex.C.3 to C.6 have been issued from his branch office and except L.I.C. Office, those documents cannot be issued from anywhere.

    The contention of the advocate for the LIC Of India is that Ex.C.3 to C.6 though computerized they are not bearing the seal of the branch office and signature of the officer who issued, therefore they cannot be considered at all as evidence. Admittedly, Ex.C.3 to C.6 are computerized copies issued from the 2nd LIC Of India Branch Office on 09.03.2006 and hence they do not require the signature and seal of the officer who issued.

    The evidence of the complainant that he had obtained Ex.C.3 to C.6 from 2nd LIC Of India Office cannot be doubted at all, since they are generated by the computer. Nobody except, the official of L.I.C. can issue such documents and hence they are relevant for consideration. Of course, it is admitted fact that the complainant has not paid the interest and loan on the policy and he was aware that he was due of the loan and interest. But, when the complainant approached to know the details of the loan and interest, the LIC Of India should have furnished the proper information, but surprisingly they have issued wrong information in Ex.C.3 to C.6 stating no previous loan exists.

    Therefore, the 2nd LIC Of India Branch has committed deficiency in service in giving wrong information about the loan status to the complainant, because if the proper information had been given, the complainant would have made efforts to deposit the interest to the loan. Therefore, we hold that 2nd LIC Of India has committed deficiency in service by giving wrong information about the loan status.



    9. The complainant has sought for waiver of interest and penal interest charged on the loan, on the ground that would have paid the loan and interest if the information had been given. But, merely because the LIC Of India has not furnished the information the complainant cannot escape the liability of payment of interest and loan amount obtained on the policies admittedly. In fact, he has assigned the policies in favour of the LIC Of India for the loan security and the condition is that he is liable to pay interest 10.5% compounded half yearly. In spite of it, he has not made efforts to deposit the loan. Nothing prevented the complainant to deposit the interest or principle mentioning the policy number on which he has obtained the loan. Therefore, in view of the conditions of the loan sanctioned, the complainant is liable to pay interest as agreed upon as per the contract and the complainant is not entitled to waiver of the interest or compound interest.


    10. The complainant has sought for compensation of Rs.50,000/- for deficiency in service and mental agony. It cannot be said that all the policies are going to mature shortly and hence, the present complaint is filed, because only one policy i.e., Ex.R.2 is going to mature on 28.02.2009. It is expected that LIC Of India Branches should furnish proper information to the policy holder whenever they seek information. The LIC Of India Branch Offices should not furnish wrong information by dereliction of duty and it leads to loose good faith earned by the LIC Of India Corporation. Therefore, in the circumstances of the case for mental agony and deficiency in service, it is reasonable to award compensation of Rs.5,000/-, so that LIC Of India Corporation would issue instructions to all the branches to furnish correct information about the policy particulars and loan particulars.



    11. In the result, we proceed to pass the following order; ORDER The complaint is allowed, directing the LIC Of India to pay compensation of Rs.5,000/- to the complainant within 2 months with cost of Rs.500/-.

  2. #17
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    BEFORE THE MANDYA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANDYA PRESENT: 1. SIDDEGOWDA, B.Sc., LLB., President, 2. A.P.MAHADEVAMMA, B.Sc., LLB., Member, ORDER Complaint No.MDF/C.C.2/2009 Order dated this the 20th day of March 2009

    COMPLAINANT/S Smt.B.R.Vinutha W/o Late Ravikumar, R/at Bharathinagara, C.A.Kere Hobli, Maddur Taluk. (By Sri.B.Ramakrishne Gowda., Advocate)

    -Vs-

    LIC Of India/S 1. Senior Divisional Manager, LIC Of India, Divisional Office, Jeevan Prakash, P.b.No.37, Mysore – Bangalore Road, Bannimantap, Mysore.

    2. The Manager, LIC Of India, Maddur Branch, Maddur, Mandya District. (By Sri.B.A.Vijay., Advocate) Date of complaint 03.01.2009 Date of service of notice to LIC Of India 22.01.2009 Date of order 20.03.2009 Total Period 1 Month 28 Days Result


    The complaint is dismissed. However, there is no order as to costs. Sri.Siddegowda, President 1. This complaint is filed under section 12 of the Consumer Protection Act 1986, for settlement of insurance claim of Rs.3,00,000/-.


    2. The case of the complainant is that her husband Sri.Ravikumar S/o Boregowda had obtained Life Insurance from the LIC Of India for a sum of Rs.3,00,000/- vide Policy No.721196368 dated 15.10.2000. That policy had been lapsed for non-payment of premium from April 2001 and same has been revived on 19.05.2005 and when policy was in force death took place. The complainant filed claimant’s statement and other documents as a nominee. The LIC Of India Company repudiated the claim vide letter dated 28.05.2008 stating that deceased assured withheld material information with regard to his health at the time of getting the policy and the assured had suffered from T.B. since 2004 and took treatment in Asha Kiran Hospital. But, the ground of the LIC Of India has no basis at all. In spite of legal notice, the LIC Of India have failed to comply with the claim. Therefore, the present complaint is filed, for the insurance amount of Rs.3,00,000/- with interest and compensation of Rs.50,000/- for mental agony.


    3. The LIC Of India have filed version. Admitting that the policy was taken for Rs.3,00,000/- and also revival of the policy on 28.05.2005 and the complainant is the nominee, but pleaded that at the time of revival of the policy, the assured has submitted personal statement regarding his health dated 24.05.2005. Death was occurred within 5 months and 14 days from the date of revival. As it is early claim, investigation was conducted and it revealed that the life assured was a patient of Crypto Vollal Meningitis, Pulmonary T.B. and AIDS and had availed treatment from 2004 at Asha Kiran Hospital, Mysore and further, treated from 18.09.2005 to 11.11.2005. The fact of ill-health was not disclosed by the deceased while reviving the policy.

    The assured has given false statement and suppressed the material facts and hence, the LIC Of India repudiated the claim of the complainant. The revival policy is a new contract. Therefore, the LIC Of India has right to repudiate the claim and LIC Of India have not committed any deficiency in service and the complaint is liable to be dismissed with costs.


    4. The complainant has filed affidavit and is examined and produced the documents Ex.C.1 & C.2. On behalf of the LIC Of India one witness is examined and Ex.R.1 to R.12 are produced.


    5. We have heard both sides.

    6. Now the points that arise for our considerations are:- 1. Whether the deceased assured had suppressed the material facts at the time of revival of the police regarding health? 2. Whether the LIC Of India have committed deficiency in service by repudiating the claim? 3. Whether the complainant is entitled to the insurance amount with interest?


    7. Our findings and reasons are as here under:-


    8. The undisputed facts are that Ravikumar S/o Boregowda, the husband of the complainant had obtained L.I.C. policy on 15.10.2000 for Rs.3,00,000/- as per Ex.R.1 and the complainant is the nominee. It is also admitted fact that the policy was lapsed due to non-payment of premiums from April 2001 to April 2005 and the policy was revived on 19.05.2005 on paying the arrears of premiums, by giving personal statement regarding his health as per Ex.R.2. The complainant reported the death of her husband on 12.11.2005 due to heart-attack as per her letter dated 06.02.2006 as per Ex.R.5 and then submitted claim application Ex.R.7 with death certificate Ex.R.6. Then LIC Of India repudiated the claim, on the ground that deceased assured had suffered from T.B. since 2004 and took treatment from 18.09.2005 to 11.11.2005 at Asha Kiran Hospital, but he did not disclose these facts in his personal statement and hence withheld material information regarding health at the time of revival of the policy.



    9. So, the burden is on the LIC Of India to prove that the deceased assured had suppressed material facts with regard to his health at the time of revival of the policy. Admittedly, the policy had lapsed for nearly 4 years from April 2001 to April 2005 and on payment of arrears of premium, it was revived. At that time, the LIC Of India has taken personal statement regarding health of the deceased as per Ex.R.2 and it is not in dispute. He answered ‘No’ about the illness, treatment, operation or any test reporting good health. But according to the LIC Of India, the deceased had suppressed the material facts about his illness and treatment at the time of revival of the policy, though he was suffering from Crypto Vollal Meningitis, Pulmonary T.B. and AIDS and took treatment in Asha Kiran Hospital, Mysore from 2004.


    10. According to the complainant, the assured died due to heart-attack, but no document is produced. Though the complainant has denied that her husband Ravikumar was suffering from Pulmonary T.B., AIDS and Crypto Vollal Meningitis and took treatment at Asha Kiran Hospital, Mysore, but LIC Of India has examined R.W.2 Dr.Swamy, who is R.M.O. of Asha Kiran Hospital and he has produced the case sheet records Ex.R.12. In fact, the LIC Of India had written letter Ex.R.8 to Asha Kiran Hospital to furnish the documents and R.W.2 has sent reply Ex.R.9 stating that Ravikumar S/o Boregowda, residing at K.M.Doddi, Mandya got admitted to hospital on 18.09.2005 and discharged on 11.11.2005, he had taken treatment for Crypto Vollal Meningitis, Pulmonary T.B. and AIDS, he had taken out patient treatment since 2004. R.W.2 is the R.M.O. of this Asha Kiran Hospital has sent reply Ex.R.9. The evidence of R.W.2 Dr.Swamy is that Ravikumar S/o Boregowda, K.M.Doddi was referred by Dr.Poornima at Mandya for further treatment as he was diagnosed of having H.I.V. positive on 14.05.2004 and at every month he was treated as out patient and he was admitted on 18.09.2005 to 11.11.2005 with H.I.V. positive and he was also treated for Crypto Vollal Meningitis and Pulmonary T.B. (Brain infection).

    In fact, he was admitted on 04.07.2005 and discharged on request on 11.07.2005 and has produced the case sheet Ex.R.12, the case sheet records proves that Mandya Diagnostic Centre has diagnosed on reference by Dr.Poornima that Ravikumar is reactive for H.I.V I & II test and this report is dated 13.05.2004. On 14.05.2004 at Ashakiran Hospital, the complainant was examined and counseling was done and investigation revealed that he was H.I.V. positive and he was treated again on 17.05.2005, 17.06.2005 as a out-patient and he was admitted on 04.07.2005 and suspected tuberculosis and meningitis and discharged on request on 11.07.2005. Again he was admitted on 18.09.2005 and discharged on 11.11.2005 diagnosis was Crypto Vollal Meningitis, Pulmonary T.B.

    There is no reason to suspect this documents and the evidence of the doctor R.W.2. So, though he was positive to H.I.V. as on 13.05.2004 and diagnosed at Asha Kiran Hospital of having H.I.V. positive and took treatment as an out-patient, he did not disclose in his personal statement of regarding health on 24.05.2005 in Ex.R.2, but stated no hospitalization, no disease, but having good health at the time of revival of the policy. Of course, he was admitted to Asha Kiran Hospital on 04.07.2005 and suspected tubercular meningitis and C.T. Scan of the Brain was conducted and there was Meningitis with Diffuse Cerebral Oedema, and was in hospital up to 11.07.2005, but this treatment was before the giving declaration of health at the time of revival of the policy.


    Even though, the LIC Of India have produced the documents and evidence of the doctor he was suffering from Pulmonary T.B. and Crypto Vollal Meningitis, it is subsequent to the revival of the policy and it was not within the knowledge of the deceased assured, but it is proved that at the time of revival of the policy, he was positive H.I.V. and taking treatment.


    11. After the claim made by the complainant, investigation has been conducted and the LIC Of India have sent repudiation letter, stating that the assured had suffering from T.B. since 2004 for which he took medical treatment at Asha Kiran Hospital from 18.09.2005 to 11.11.2005 and he suppressed the material information deliberately in his personal statement. Admittedly, for the revived policy, personal statement of the assured was taken on 24th May 2005 as per Ex.R.2, thereafter he was admitted to hospital on 04.07.2005 and discharged on 11.07.2005 with diagnoses of tubercular meningitis. So, this disease was subsequent to the revival letter, but there is no evidence that he was suffering from T.B. at the time of revival of the letter. Of course, the LIC Of India has proved that the assured was positive to H.I.V. at the time of revival of the policy i.e., in May 2005 up to 24th May 2005 (date of personal statement) and had taken treatment visiting every month.


    12. The contention of the complainant side is that death is due to heart-attack and not for pulmonary tuberculosis or brain illness and there is no connection between the disease suppressed and the cause of death and hence, the repudiation is improper. The learned counsel for the complainant has relied upon the decision reported in 2006 (2) CPR page 195 of Rajasthan State Commission in the case of Mangej Kanwar –Vs- L.I.C. of India and 2008 (1) CPR page 299 of Punjab Chandigarh State Commission in the case of L.I.C. –Vs- Sukhpal Kaur. On the other hand, the learned counsel for the LIC Of India has relied upon the decision of the Hon’ble National Commission in Revision Petition No.2142/1999 in the case of L.I.C. of India –Vs- Smt.Savitri Devi and I (2009) CPJ page 231 of Hon’ble National Commission in the case of L.I.C. of India –Vs- M.Bhavani, we have perused those decisions.


    13. The decision cited by the learned counsel for the complainant which were rendered by the Hon’ble State Commissions are not applicable to the facts of the case and they are overruled by the Hon’ble National Commission decisions.


    14. It is settled law that revival of policy is a fresh contract. The Hon’ble National Commission in the case of L.I.C. of India –Vs- Bhavani referred above, has held that false declaration given at the time of revival of the policy leads to repudiation of the claim. Further, in the decision reported in II (2007) CPJ page 51 in the case of L.I.C. of India –Vs- Krishan Chandar Sharma, the Hon’ble National Commission has held that nexus between cause of death and illness with treatment is not material. So, applying the above position of law to the facts of the case, the evidence clearly proves that at the time of revival of the policy, the insured Ravikumar had given fresh declaration as per Ex.R.2, but he has failed to disclose the disease namely H.I.V. Positive, though he had the knowledge and he had taken treatment at Asha Kiran Hospital, Mysore. So, there is suppression of the disease H.I.V. by the insured and it is a material information, because H.I.B. Positive is a serious disease. So, it is established that the insured had given false declaration suppressing the fact of H.I.V. positive disease and treatment before the revival of the policy. Though in the repudiation letter, the LIC Of India have stated that assured had suffered from T.B. since 2004 and took treatment in Asha Kiran Hospital, but further pleaded that he had made deliberate mis-statements and withheld material information regarding his health at the time of getting the policy revival. The LIC Of India have taken specific contention in the version about the AIDS apart from pulmonary T.B. and Crypto Vollal Meningitis from 2004.

    Therefore, it is open to the LIC Of India to take the defence that the insured was suffering from H.I.V. Positive (AIDS) before the revival of the policy and he had the knowledge, but suppressed the same at the time of revival of the policy. Therefore, the repudiation of the claim of the insurance preferred by the complainant is justified.



    15. Hence, the complainant is not entitled to the insurance claim of Rs.3,00,000/- with benefits.

    16. In the result, we proceed to pass the following order; ORDER The complaint is dismissed. However, there is no order as to costs.

  3. #18
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    Smt.V.Porkodi,
    W/o.Late Varadarajan,
    96/157-Z/1, Rajapuram,
    Palaniappa Nagar, Salem 636 005 and two minors. --- Complainants
    Vs.
    1. The Senior Divisional Manager,
    Life Insurance Corporation of India,
    Trichy Road, Coimbatore – 641 018. 1st LIC Of India

    2. Tmt.R.Jayalakshmi,
    W/o.Ramkumar Nachimuthu,
    2/421, Teacher's colony,
    Senniampalayam,Coimbatore. ---
    (CMP 24/09 in CC 381/08 order dt.2.3.09) 2nd LIC Of India

    ---

    This case coming on for final hearing before us today in the presence of Mr.J.V.George, Authorised representative for complainant and the Senior Divisional Manager appeared for the LIC Of India No.1 and the 2nd LIC Of India appeared in person and upon perusing the case records and hearing the arguments and the case having stood over to this day for consideration, this Forum passed the following:
    ORDER
    Complaint under Section 12 of the Consumer Protection Act, 1986 seeking direction against the LIC Of India No.1 to disburse the terminal benefits and policy amount as per the accounts maintained by the LIC Of India, Rs.10,500/- towards compensation and Rs.2000 towards costs.
    The case of the complaint are as follows:
    1.The Complainant is the wife late Varadarajan who was employed as a Higher Grade Asst. in the LIC Of India's company. The deceased while he was a bachelor joined in the service, at the time he nominated his mother as a nominee. The nomination was changed immediately after marriage. But the LIC Of India has failed to record the nomination. The dispute arises as to whom the death benefit to be paid. The complainant with her minor children namely R.V.Kavin and R.V.Chathurbalu approached District Munsif's Court, Perundurai and filed O.S.595/04 and got an order on 28.8.06 as per the decree all the four claimants namely the mother of the deceased, the wife of the deceased, and two minor children should get the death benefits equally at the rate of 25% . The dispute is clear but the LIC Of India refused to settle the claim. There is no necessity to prolong the issue the LIC Of India also admitted the fact of dues to be paid to the legal heirs and a sum of Rs.9,72,574 as on 31.10.04. Even after nearly two years after the decree the LIC Of India has not sent any letter to the complainant. Hence this complaint.




    The case of the LIC Of India is as follows:

    2.The complainant is not a consumer as per the Consumer Protection
    Act, 1986. Late R.Varadarajan was employed with the oLIC Of India as a Higher Grade Asst. , while in service he met with an accident and died on 31.10.04. An amount of Rs.13,68,695 was due for settlement as terminal benefits. Late Varadarajan had nominated his mother as a nominee to receive the terminal benefits. But the complainants rights objection. Hence the LIC Of India was forced to withhold settlement. Complainants had filed a suit in O.S.No.595/04 before the District Munsif Court, Perundurai and got an order on 28.8.06. Since minors rights involved a specific order was asked for, but there was no reply from the complainant. Hence the settlement had to be kept in abeyance Smt.Jayalakshmi has later filed a Writ Petition claimed a ¼ settlement and is still pending.

    3. The LIC Of India was and is always ready to disburse the amount to the rightful claimants without getting entangled into another litigation. The dispute between the complainants and the nominee Smt.Jayalakshmi has disabled this LIC Of India from discharging their duties. Without prejudice to the defense raised, this LIC Of India is willing to deposit the entire amount of Rs.13,68,695 payable as a terminal benefit of late Varadarajan before this Forum and this Forum may kindly decide on terms of settlement and dispose of the matter. The settlement had to be postponed only because of the ongoing dispute between the claimants and not because of any deficiency in service on the part of this LIC Of India. Hence this complaint may be dismissed with costs.

    4. The complainant has filed Ex.A1 and A2 was marked on the side of the complainant and the opposite parties has not filed the proof affidavit and not filed documents.

    The point for consideration is
    1.Whether the opposite parties have committed deficiency in service?
    If so to what relief the complainant is entitled to?

    ISSUE 1:

    5. The only dispute is who are all the rightful claimants to receive the terminal benefits of Rs.13,68,695 of late Varadarajan. The present complainant V.Porkodi is the wife of Late Varadarajan and minor R.V.Kavin and R.V.Chathurbalu are the children and the 2nd LIC Of India Mrs.Jayalakshmi is a mother of deceased Varadarajan. As per Ex.A2 all the four legal heirs are entitled to get 25% each. Ex.A2 is the District Munsif Court order dated 28.8.06. As per counter the 2nd LIC Of India has filed a Writ Petition claiming 1/4th share. The above said facts are admitted by both parties.

    6. A joint memo is filed by the parties accepting 25% share each. Parties have also agreed to deposit minors share in Fixed Deposit in Canara Bank, Saramangalam branch, Salem till the minors attained majority. They also agreed for taking the interest by the mother of the minors once in 3 months. A memo was recorded.


    7. In the result, a) Smt.V.Porkodi, wife of Late Varadarajan, minor R.V.Kavin, minor R.V.Charthubalu children of late Varadarajan, and Mrs.R.Jayalakshmi, mother of late Varadarajan are entitled to get 25% of the amount out of Rs.13,68,695/- , b) the share of minor R.V. .V.Kavin, minor R.V.Charthubalu children of late Varadarajan, shall be deposited in Fixed Deposit at Canara Bank, Saramangalam branch, Salem till the minors attained the majority, c) the interest accrued in minors fixed deposit account can be taken by the mother namely Porkodi once in three months, d) the fixed deposit receipt will be given to the mother of the minors. With this direction the complaint is disposed of.

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    Smt. Sulochana Kamalakant Gaonkar,
    House No.603, Thorlem Bhat,
    Dongrim, Tiswadi, Goa. ……………….Complainant

    V

    Life Insurance Corporation of India,
    91F, Mapusa Branch Office,
    Rastroli Sadan, Near Cine Alankar,
    Mapusa, Bardez, Goa ......………...…..Opposite Party -1

    The Zonal Manager, Life Insurance
    Corporation of India,
    Western Zonal Office,
    “Yogakshema” Jeevan Bima Marg,
    Mumbai 400 021. ......………...…..Opposite Party -2



    Date: - 05 /03/2009



    O R D E R

    (Per Smt. Shanti Maria Fonseca, Sr. Member)

    Brief facts of the Complaint:-


    1.The case of the Complainant is that her husband Shri Kamlakant Gaonkar who expired on 8.3.06 at Goa Medical College & Hospital was insured with the Life Insurance Corporation of India under policy no.930783137 for Rs.30,000/- (Rupees thirty thousand only) for double accident benefit along with two other policies.

    2.It is her case that out of 3 policies held by her husband with the Life Insurance Corporation of India 2 have been honoured and that policy bearing No.9300000783137 for Rs.30,000/- (thirty thousand only) was repudiated by the Life Insurance Corporation on grounds of non-disclosure of material facts by the deceased pertaining to his health.


    3.According to the Complainant there is no basis for the Insurance Company to conclude that vomiting of blood by the deceased was solely due to the consumption of alcohol and that the said conclusions arrived at by them are hypothetical without any proof. In the light of the above, the Complainant has alleged that there has been a deficiency in service on the part of the Opposite Parties as they have failed to honour the 3rd policy No. 9300000783137 of the deceased.

    Case of the Opposite Parties:

    (i)The deceased policy holder had taken up the policy on 2-2-06 while he expired on 8-3-06 i.e. within a very short period of about 1 month & 5 days after taking up the policy.

    (ii)In the light of letter No:RHTC/GMC/2006-07, dated 13/10/06 from Dr. Seema Natekar it is on record that the deceased was a chronic alcoholic. There has also been an affidavit dated 18/4/08 filed by the said doctor in support of her letter dated 13-10-06.

    (iii)Letter dated 9/1/07 from Doctor Anant Halarnekar who was the regular doctor of the deceased for 20 years has been placed on record before this Court. The contents of the said letter states that the Complainant was a consumer of both alcohol and tobacco till March 2006.

    On perusal of all documents and evidence that has been placed before us we make the following

    OBSERVATIONS

    1.The Opposite Party has brought no specific medical record to show the connection between “hypovolemic shock due to upper G-I blood with hepatic Encepalopathy” and the alleged alcoholism addiction which the deceased suffered from.

    2.The regular doctor who treated the deceased has very clearly stated in his letter dated 9/1/07 to the Opposite Parties that in the 20 years prior to his death the deceased was never referred to by him to any consultant nor admitted to any hospital as he had no major illness.

    3.The defense taken up by the Opposite Parties in para 11 pag. 6 of their Written Arguments is not acceptable as `occasional’ gastritis is suffered by all normal human beings at some point of time or the other. The fact that the policy was accepted by the Opposite Parties is what makes them liable for payment.
    In the aforesaid circumstances we pass the following:

    ORDER

    1.Opposite Parties jointly and severally to pay to the Complainant a sum of Rs.30,000/- (Rupees thirty thousand) @ 12% p.a. from the date when Complainant made a claim to the Opposite Parties until the date of payment.

    2.Cost of Rs.15,000 (Rupees fifteen thousand) awarded to the Complainant towards mental torture and harassment and also the cost of legal expenses towards the filing of this suit.

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    (Super Market Complex, Block – 1, 1st Floor.)


    Consumer Case No.: 52 / 2006.
    Date of filing : 08.11.2006.
    Date of final order : 24.04.2009.
    Present:
    A) Sri Saurish Chakraborty President.

    B) Smt.Swapna Kar Member.

    C) Sri Swaraj Kumar Biswas Member.


    Subho Debnath,
    Son of Gopal Debnath,
    Milanpara, Raiganj, Uttar Dinajpur. Complainant.

    versus

    1. The Branch Manager,
    Life Insurance Corporation of India,
    Raiganj Branch, Uttar Dinajpur.

    2. The Manager (Claim),
    Jalpaiguri Divisional Office,
    Life Insurance Corporation of India,
    Jeevan Prakash, Jalpaiguri – 735 101. Opposite Parties.

    Judgment
    Date: 24.04.2009.

    Petitioner Sri Subho Debnath on 08.11.2006 by filing a petition of complaint Under Section 12 of the Consumer Protection Act, 1986 has prayed for an order for payment i) The double amount of sum assured that is Rs.40,000/- x 2 = 80,000/- along with 12% interest till payment, ii) For getting the cost of the complaint, iii) For paying Rs.10,000/- towards harassment, iv) Moreover the petitioner also prays to relinquish the untenable plea of denying payment of sum assured.

    The background facts in a nutshell are as follows: -

    The wife of the complainant Smt. Tagari Debnath, aged 18 executed a L.I.C. policy bearing No. 453321037 on 10.12.2003 as per table No. 93-25 and the sum assured is Rs.40,000/-. The premium is to be paid on 10th in quarterly basis and the amount of L.I.P. is Rs.555/-.

    The complainant paid quarterly premium of Rs.555/- to the O.P. 10.12.2003. However, the policy holder, Tagari Debnath inflected severe Burn Injury 100% on 19.01.2004 at her father’s residence and she was admitted in the Raiganj District Hospital forthwith.

    Immediately the attending doctor examined her and considering the serious condition of the patient referred the case to the North Bengal Medical College and Hospital, Siliguri. But she had succumbed to death on the way to Siliguri and as such her dead body taken back to Raiganj District Hospital. Co-incidentally the Hospital Authorities informed the Police and accordingly ‘Surathal’ was performed and they arranged post mortem of the dead body. Incidentally it is fit to be mentioned here that the cause of death as incorporated in the Post Mortem Report is “extensive Burn Injury about 95%”.

    Of late the petitioner furnished Death Certificate/ Surathal Report and FIR.

    Moreover, being the absolute claimant (husband of the deceased) the petitioner claimed the sum assured to the L.I.C. Authority.

    Never the less the L.I.C. Authorities vide their reference No. J.D.O./ Claims/ Mgr./ 53, dated 26.08.2006; refused to entertain the claim stating untenable plea, that the deceased had committed suicide and as the life assured committed suicide well within one year from the date of commencement of risk, nothing is payable under the policy.

    On the contrary O.P. L.I.C.I., contested the case and filed W.V. denying inter alia all the material allegations against them contending therein that the case is time barred by limitation as the complainant filed the case after period of limitation, because the cause of action arose form the date of death of the policy holder i.e. 19.01.2004 but the instant petition had been filed on 08.11.2006.

    They also contended that 100% Burn Injury can only possibly be sustained in case of suicide as she periled herself in some inflammable substance and kept herself in a confined place.

    In view of the above fact and circumstances O.P. prayed before the Forum to dismiss the case with cost.

    Decisions with reasons:

    The case has arisen out of a rejection of insurance claim of the petitioner by the O.P.

    Nevertheless the main question which arose for determination is whether Tagari Debnath committed suicide? OR expired due to accidental extensive Burn Injury (95%).

    However, we have carefully perused the records i.e. Post Mortem Report/ Inquest Report/ Surathal Report/ Deposition of the Witnesses/ Cross Examination thereof in view of the aforesaid complaints in the petition.


    The relevant reports i.e. Post Mortem Report/ Surathal Report could not confirmed that Tagari Debnath expired due to Accidental Burn Injury (95%). On the other hand such type of Burn Injury might have caused by suicide as opined by Dr. Guchait in his witness. So, there is every reason to believe due to that the death caused due to suicide.

    We have carefully considered the arguments advanced by the Ld. Counsels for the parties, we are of the view that the complainant is unable to prove his case that the death caused due to accident.

    Fees paid are correct.

    Hence it is ordered,

    That the complaint could not be entertained as the Policy Holder committed suicide within one year from the date of commencement of risk under the policy.

    The Complaint is dismissed on contest without cost against O.P.

    Let true photo copies of this final order be supplied to the parties free of cost.

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    CONSUMER COMPLAINT No. 75 OF 2004
    Date of filing: 18th October 2004
    Date of Order: 8th April 2009

    Complainant (s) Opposite Party (s)
    1.Rekharani Mahato, 1. Zonal Manager,LICI,
    W/o. Late Jagadish Chandra Mahato. Eastern Zonal Office,
    2.Tapati Mahato. Hindusthan Building,
    3.Usha Mahato. 4,Chittaranjan Avenue,
    4.Anupama Mahato. Calcutta.
    5.Banashree Mahato. 2.Branch Manager,LICI,
    All daughters of Late Jagadish Ch. Mahato, Jhalda Branch,
    6.Sandip Mahato, P.O. & P.S. Jhalda,
    S/o. Late Jagadish Ch. Mahato. District: Purulia.
    Resident of : Neemtar, Purulia,
    P.O., P.S. & Dist: Purulia


    Present: 1. Shri A.K.Sinha, President-in-Charge.
    2. Smt. S. Sengupta (Santra), Member.


    For the Complainant (s) : Sri S.K.Sarkar, Adv.
    For the O.P. No. 1 & 2 : Sri S. Patra, Adv.

    Order No. 59 dated 08.04.2009/C.C.No. 75of 2004

    The fact of the case in brief is that Smt. Rekha Rani Mahato and on behalf of her three minor daughters and one son alleged that her husband was a teacher who died on 16.9.2001 following an unnatural death. Over such death Purulia (T) P.S. UD Case No. 178/2001 was started and P.M. was done at Purulia Sadar Hospital on 16.9.2001 The deceased during his life

    time subscribed LIC Policy Nos. 462067340, 462067378, 461027948, 461029198, 463551935, 463551467 and 463552623, 7 nos. in all. After the
    death of the insured the petitioner approached O.Ps. for payment of the claim covered in the aforesaid policies. The O.P. promptly considered and paid the claim amount in respect of four of the policies and repudiated the claim against Policy No. 463551935, 463551467 & 463552623 by a letter dt. 27.12.2006 on the ground that the deceased had been suffering from Epilepsy since long and had died due to fall in a well following a sudden attack by Epilepsy.

    The petitioner subsequently tendered her representation to the O.Ps. but till the date of filing the complaint the O.Ps. did not settle the claim on three of the policies noted above. This gives rise to the instant case for the reliefs as have been prayed for.

    The O.Ps. have filed joint Written Version admitting therein, that, the deceased insured purchased policy no. 461027948 on 28.10.2001, No. 461029198 on 28.2.1995, No. 462067740 on 27.12.1997 and No. 462067378 on 28.10.1996 and they have allowed the basic sum assured with Bonus against the aforesaid four policies as non-early death claim taking lenient view without conducting investigation as per usual Rules & Regulations and claim in respect of three policies in question was repudiated as per contractual obligation on the ground of suppression of material facts. The O.Ps. have however referred to death claim guide line in the policy servicing manual no. II Chapter 2 Clause 2 wherein it was explain “ (1) Claims arriving within two years of the date of risk……. as early claims/premature claims and (2) Claims arising more than two years after the death of such risk or revival/reinstatement termed as other/ordinary claims”. The O.Ps. subsequently decided to repudiate all liability under the three policies in question on account of the deceased having withheld material information regarding health of insured at the time of effecting assurance with the company.

    From the pleadings of both parties of above the following points are required to be scrutinize for effective disposal of the case.
    1)Whether the service of the O.Ps suffers from deficiency?
    2)Whether the petitioner is entitled to the reliefs as prayed for?
    -:Decision with reasons:-
    Point No. 1 & 2:

    Both the points are taken together as these are interlinked.

    The petitioner has filed photocopies of (1) Legal heir certificate issued by Pradhan of Uparkahan G.P. dt. 03.12.2002, (2) Receipts dt. 08.12.2001 issued by O.P. against surrender of eight nos. of policies, (3) Certificate of death issued by SDMO, Purulia, (4) Intimation to O.P. dt. 08.12.2001 about the death of deceased with prayer to release claim amounts against seven no. of policies and (5) Status report of policy nos. 463551935, 462551467 & 462552623.

    The petitioner has filed affidavit-in-chief and has been cross-examined by the O.P. The PW has identified the signature of her husband in the proposal form of the above three policies in question when shown to her and the documents have been marked Exbt. A, B & C respectively. She stated that her husband died on 16.9.2001 at about 11.30 a.m. at her residence due to fall in the well, she got senseless and afterwards she came to know that fire brigade rescued the dead body of her husband. She further stated that she made no statement before police, police did not interrogate her and only on the date of incident police came to spot and thereafter did not turn up. She also admitted that the prescription of her husband were made over to LIC when asked for. The PW denied the suggestions that her husband was a patient of Epilepsy and made statement before police regarding such disease of her husband.

    O.P.W 1 who has filed his examination-in-chief has identified letter dt. 19.11.2002 to O.P. by the petitioner along with the prescription received by O.P. on 22.11.2002 which have been marked Exbt. G and X respectively. He denied the suggestion of Ld. Counsel of complainant that all proposal forms were rooted through the agent and stated that suffering from Epilepsy is considered to be a bar for opening of a policy which is bar in under writing manual of LICI. OPW1 also admitted that they did not hold any enquiry as to whether the insured had been suffering from any ailment and their opinion as to the suffering of Epilepsy of insured was formed on the basis of final report of police in the U.D.Case. They never asked the beneficiary in respect of the policies of deceased insured against which the insured amount have already been paid and further stated that they had got paid up the amount of those policies by adopting fraudulent means.

    On scrutiny of records it appears that the O.Ps in the W/V as well as in the Written argument claimed that the deceased insured purchased the following policies from the O.Ps during his lifetime.
    1)Policy No. 461027948, sum assured – Rs. 30,000=00 dt. Of commencement 28.10.91.
    2)Policy No. 461029198, sum assured – Rs. 50,000=00 dt. Of commencement 28.2.95.
    3)Policy No. 462067740, sum assured – Rs. 1,00,000=00 dt. Of commencement 27.12.97.
    4)Policy No. 462067378, sum assured – Rs. 50,000=00 dt. of commencement 28.10.96.
    5)Policy No. 673551467, sum assured – Rs. 1,00,000=00 dt. Of commencement 28.6.99.
    6)Policy No. 463551935, sum assured – Rs. 50,000=00 dt. of commencement 28.2.2000.
    7)Policy No. 463552623, sum assured – Rs. 40,000=00 dt. of commencement 21.2.01.

    But the petition of the complainant clearly manifest that the deceased insured purchased eight policies in all including policy no. 460802314 besides the policy no. referred to by the O.Ps. Such statement of the complainant is also confirmed when we securitized Exbt C series being the proposal form of policy no. 463552623 wherein in column 9 specified for mentioning previous insurance policy no. 460802314, sum assured Rs. 10,000=00 year of issue 1988 is reflected. The complainant also claimed that claim form with relevant documents were submitted to the O.Ps after the death of her deceased husband and the O.Ps have paid the sum assured with bonus in respect of Policy No. 460802314, No. 461027948, No. 461029198, No. 462067740 and No. 462067378 but repudiated the claim against Policy No. 463551467, No. 463551935 and No. 463552623.

    Thus it appears that the O.Ps. have settled 5 policies of the deceased insured purchased during 1988 to 1996, out of eight nos. of policies referred to hereinabove considering non early death claim and without conducting investigation as per the usual Rules and Regulation of the corporation through strictly as per the contractual obligations all the claim for the policies were repudiated on the ground of suppression of material fact as referred in Para 7 of the written argument of the O.Ps.

    Now the O.Ps. by repudiating the claim against policy bearing no. 463551467 dt. 28.6.99, sum assured Rs. 1 lack, No. 463551935 dt. 28.2.06 with sum assured Rs. 50 thousand and No. 463552623 dt. 21.2.01 with sum assured of Rs. Forty thousand being early claims under norms and made detail enquiry which established that the deceased assured willfully suppress his illness and there was suppression of material facts at the time of submitting proposal forms. The O.Ps. have cited Sec 45 of Insurance Act 1938 Clause 4.1 and 13.1 of Policy Servicing manual No. 11 as sufficient ground to consider the claim application and repudiation of same.

    From the above discussion of evidence and material on record it has been evident that the O.P. had repudiated the claim of the complainant in respect of 3 policies being nos. 463551467, No. 463551935 and No. 463552623 purchased during the period from 28.6.99 to 21.2.01 on the ground of suppression of material fact in respect of health declared in the relevant column of the proposal form. It is also apparent that the ground of repudiation of the O.Ps based on 4 prescription of Dr. K.K.Sinha of Ranch, Bihar dt. 11.5.88, 23.11.88, 13.2.88, and 27.2.90 (marked Exbt. X), 3
    proposal form (marked Exbt. A,B,C), letter of the petitioner to O.P. dt. 19.11.02 regarding sending of prescription of Dr. K.K.Sinha (Exbt.G) and copy of final report of Police in C/W U.D.Case No. 178/2001 (Exbt. D).

    On scrutiny of Exbt. X series it appears that no where in the prescription the history of the patient nor the diagnosis has been noted by Dr. K.K.Sinha excepting advice of medicine. The doctor was not even examine in the witness dock to substantiate the contention of the O.P. that the insured got treatment of Epilepsy. On perusal of Exbt. D we find that the I.O. stated that “ in course of investigation it transpired that the deceased was a patient under Doctor K.K.Sinha, MD, FRCP, Ranchi since long and the diease was apparently one “Mrigi”. It appears from cross examination of PW1 that she clearly stated that police visited her house only on the date of incident, she was not even examined by the Police. Exbt. D is also not supported by any documents statement of witness and therefore, it is not substantiated that the deceased insured got treatment of Epilepsy by Dr. K.K.Sinha since long and apparently it was “Mrigi” . The evidence of OPW 1 clearly manifest that the O.P. did not hold any enquiry as to whether the deceased insured had been suffering from ant ailment of Epilepsy and the opinion to repudiate the claim was formed on the basis of Police Report in the U.D.Case. It is also stated that they never asked the beneficiary in respect of the policies against which the insured amount have already been paid.

    The O.Ps have referred Sec 45 of the Insurance Act 1938 which is on fair reading it is clear that it is restrictive in nature. It lays down 3 condition for applicability of the second part of sec namely a) the mis- statement must be on a material matter or must suppress facts which it was material to disclose, b) the suppression must be fraudulently made by the policy holder and c) the policy holder must have known at the time of making statement that it was false or that it suppressed facts which it was material to disclose. Mere inaccuracy of (or) falsity in respect of some recital or item in the proposal is not sufficient. The burden of proof is on the insurer to establishe the circumstances unless the insurer is able to do so there is no question of the policy being avoided on the ground of mis-statement of facts (LIC vs. Asha Goel AIR 2001 SC 549).

    In view of above observation of Hon’ble S.C. and the facts and circumstances discussed herein above it can safely be said that the insurer O.P. have failed to establish that deceased insured was suffering from epilepsy and there was misstatement and suppression of material facts in the proposal form in respect of three policies in question. Further it appears that all eight policies were purchased by the deceased insured during the period from 1988 to 2001 and the O.Ps. have considered the claim in respect of five policies amounting to Rs. 2,50,000=00 when Exbt. D and Exbt. X series were at hand and in repudiating the claim in respect of three other policies they have considered those two exhibits as vital documents for repudiation of the claim. Such plea of the O.Ps. appears arbitrary and does not find leg to stand on. In our opinion that the O.Ps. have scrutinized the above exhibits and other documents submitted to them by the complainant for her claim and the O.Ps. disburse the insured amount to his beneficiaries on application of mind about contractual obligation and the O.Ps. disbursed the insured amount to its beneficiaries.

    Having given anxious thought over the matter this Forum has come to the conclusion that the O.P. have failed to establish the fact of mis-statement and suppression of material facts in respect of health of the deceased insured at the time of purchase of policy No. 463551935, 463552623 & 463551467. From the facts and circumstances which came to light from the evidences of both sides it can also safely be said that neither the disease of epilepsy could be proved nor its nexus with the cause of death could be substantiated. Therefore, the case of the O.Ps. is patently misconceived, far-fletched and wrong amounting to delay in settlement thereof and denial of the claim which is determined to be a deficiency in service as enumerated in the provisions of C.P.Act. This Forum has gone through the rulings appearing in 1996 CCJ 1368, 1995 CCJ 963, 1995 CCJ 35, 2003 CCJ 295 & 1994 CCJ 276 filed by the Ld. Counsel for the O.Ps. and this Forum has considered and found that these are not similar to the facts and circumstances of the case.
    Both the points are thus disposed of in the affirmative.

    Proper fees have been paid. Accordingly, it is

    O r d e r e d

    That Purulia Consumer Complaint Case NO. 75 of 2004 is allowed on contest against O.P.No.1 (Zonal Manager, LICI, Eastern Zonal Office, Hindustan Building, 4 C.R. Avenue, Kolkata) and O.P.No.2 (Branch Manager, LICI, Jhalda Branch, P.O. & P.S. Jhalda, District Purulia). Both the O.P.No.1 & 2 jointly and severally do pay the sum assured of Rs. 50,000=00 + Rs. 1,00,000=00 + Rs. 40,000=00 against Policy No. 463551935, 463551467 & 463552623, a total of Rs. 1,90,000=00 (Rs. One lack Ninety Thousand) only, of which the complainant No. 1 do get Rs. 60,000=00 (Rs. Sixty Thousand) only and all five minors namely, (2) Tapati Mahato, (3) Usha Mahato, (4) Anupama Mahato, (5) Banashree Mahato and (6) Sandip Mahato do get Rs. 26,000=00 (Rs. Twenty Six Thousand) only each within thirty (30) days from date failing which the entire decreetal amount shall carry interest @9% per annum till its final realization.

    The complainant No. 1 do deposit the amount of each minor in the nearest Post Office/Nationalized Bank. Minor daughters may withdraw the amount in deposit in their respective names at the time of attainment of majority /marriage whichever is earlier, similarly, complainant No. 6 will withdraw the amount in deposit on attainment of majority.

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    Consumer complaint No 122/07
    Date of presentation: 27.4.2007
    Date of decision: 2.4.2009

    Raj Kaur wife of late Sh. Tilak Singh resident of village Raju Bela, Post Office Chak Sharif, Tehsil and District Gurdaspur (Pb) at present resident of C/O Sh. Harnam Singh, village Bakan, Post Office Deol, Tehsil Jawali, District Kangra (HP)

    Complainant Versus

    1. Life Insurance Corporation of India, Amritsar Division, “Jeevan Jyoti” Building, G.T. Road, Gurdaspur (Pb) through its Branch Manager
    2. Life Insurance Corporation of India, Amritsar Division, Jeevan Prakash, 4-5 District Shopping Complex, Ranjit Avenue, Amritsar (Pb) through its Divisional Manager


    Opposite parties
    Complaint under section 12 of the Consumer
    Protection Act, 1986

    PRESIDENT: A.S.JASWAL
    MEMBERS: PABNA SHARMA & PARDEEP DOGRA

    For the complainant: Sh. Gaggan Guleria, Advocate.
    For O.Ps: Sh.Rajeshwar Sapeya, Advocate.

    ORDER
    A.S.JASWAL, PRESIDENT (ORAL)

    In nut-shell, the case of the complainant is that her husband, during his life time, had taken New Janaraksha Insurance Policy bearing 471216052 in the sum of Rs.50,000/- on dated 13.3.2003 from the opposite parties. The date of maturity was 15.3.2019. It is asserted that during the subsistence of the Policy, her husband expired and that she, being his nominee, had filed her claim before the opposite parties, but they repudiated the same in illegal manner and thus committed deficiency in service.
    2. The claim of the complainant has been resisted and contested by the opposite parties by taking various preliminary objections, including that the deceased, while filling in the proposal form, had suppressed material facts regarding his health. On merits, it is asserted that the claim of the complainant was duly investigated and that during investigation, it was revealed that the life assured had made false statements in the proposal form and got the policy issued in his favour on false statements. It is asserted that the life assured was a chronic alcoholic and this fact has been concealed by the life assured at the time of proposal. Therefore, the opposite parties are not liable to indemnify the complainant.
    3. This Forum on 5.10.2007 framed the following points for determination:-
    1. Whether O.Ps committed deficiency in service, as alleged? OPC
    2. Whether the complaint is not maintainable, as alleged? OPOPs
    3. Relief

    4. For the reasons to be recorded hereinafter while discussing points for determination, our findings on the aforesaid points are as under:-
    Point no.1: Yes
    Point no.2: No
    Relief: The complaint is partly allowed as per operative part of the order

    REASONS FOR FINDINGS
    POINTS No.1 & 2

    5. Both these points are inter connected and inter linked, hence are taken up together for determination, in order to avoid repetition in discussion. The learned counsel for the complainant has argued that the action of the opposite parties in not paying the insured amount to the complainant is nothing but deficiency in service.
    6. On the other hand, the learned counsel for the opposite parties has argued that the deceased, life assured, had suppressed material facts regarding her ailment prior to obtaining the Policy and the claim of the complainant has been rightly repudiated by the opposite parties and that there is no deficiency in service on their part.
    7. To appreciate the arguments of the learned counsel for the parties, the entire record available on the file was gone into in detail. From the record it stands proved that the deceased/life assured had obtained Janaraksha Insurance Policy from the opposite parties and that he had also paid the premium amount to them. There is no dispute regarding these facts. The death of the deceased has also been admitted.
    8. The only basis for the rejection of the claim of the complainant is that the deceased, life assured, had suppressed material facts regarding his ailment as during investigation, it was found that the life assured was a chronic alcoholic. This plea of the opposite parties has no force and is rejected being devoid of any force. The onus to prove their such defence was upon the opposite party, but they have failed to bring on record, medical expert opinion to prove that the life assured was a chronic alcoholic. Further more taking of liquor is not a material fact and that it is also not a disease. We would like to observe that almost every body takes liquor with few exceptions Furthermore; the opposite parties have failed to prove, by way of expert evidence that the life assured had died due to taking of excessive liquor by him. We are of the view that consumption of liquor by the life assured is not a material fact, the suppression of which will entitle the opposite parties to repudiate the claim of the complainant. Thus, the action of the opposite parties in repudiating the genuine claim of the complainant is nothing but great deficiency in service.
    09. In view of the discussion made hereinabove, we hold that the opposite parties have not applied their mind to the facts of the present case, and illegally and arbitrarily repudiated the genuine claim of the complainant.
    10. Now, how this deficiency can be cured. We are of the view that the ends of justice will be met in case the opposite parties are directed to pay the insured amount alongwith all accrued policy benefits to the complainant. Due to deficiency in service, the complainant has suffered mental pain, agony and inconvenience and the ends of justice will be met in case the opposite parties are directed to pay compensation, which is quantified at Rs.5000/-. Hence, point No.1 is answered in affirmative and point no.2 in negative.
    11. No other point argued or urge before us.
    Relief
    12. In view of our findings on points No.1 and 2 above, the complaint is partly allowed and we order the opposite parties jointly and severally to pay the insured amount alongwith all accrued policy benefits to the complainant within 30 days after the receipt of copy of this order, failing which it will carry interest @ 9% per annum from the date of complaint, till its realization. The opposite parties are also directed to pay compensation to the complainants to the tune of Rs.5000/-. The complaint is allowed alongwith litigation costs of Rs.2000/-.

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    C.C.No: 251/2008
    BETWEEN:
    Daruvuri Surendra Babu,
    S/o. Nageswara Rao, Hindu,
    Aged about 30 years, Unemployee,
    R/o Punur Village,
    Yaddanapudi Mandal,
    Prakasam District. ... Complainant.

    Vs.
    Life Insurance Corporation of India,
    Chirala Branch represented by its
    Manager …Opposite party.

    COUNSEL FOR COMPLAINANT: SRI B.L. NARAYANA RAO,
    ADVOCATE, ONGOLE.

    COUNSEL FOR OPPOSITE PARTY: SRI O.N. SASTRY,
    ADVOCATE, ONGOLE.

    This complaint is coming on 17.04.2009 for final hearing before us and having stood over this day for consideration this Forum delivered the following:
    ORDER:
    1. This is a complaint filed by the complainant under Section 12 of Consumer Protection Act, 1986 against the opposite party.

    2. The averments in the complaint are as fallows: The complainant has obtained Asha Deep Insurance Policy bearing No.841158003 for an assured sum of Rs.1,50,000/- commencing from June’2003 ending by June 2028. The policy was renewed in the year 2005 by charging late fee of Rs.1055/-. Subsequently, the complainant is paying premiums regularly. Unfortunately, the complainant fell ill in November’2006 and after diagnosis, it was revealed that his kidneys are not functioning properly. He was treated at Aswini Hospital, Guntur with medicines and also with dialysis. As there was no improvement in the health of the complainant he went to Mahaveer Hospital at Hyderabad for treatment. Finally in the month of October’2007 the doctors came to conclusion that both the kidneys totally failed. Since, October’2007 the complainant was on dialysis regularly for survival. On 10.11.2007 both the kidneys are transplanted with a kidney donated by his mother. Since then, the complainant is surviving with One kidney. He incurred Rs.4,00,000/- for transplantation of kidneys and after that he is incurring Rs.25,000/- every month for medicines. The complainant submitted claim forms before the opposite party by submitting of original documents pertaining to his treatment. Unfortunately, his claim was rejected by the opposite party in October’2008. The claim was repudiated on the ground that the complainant was undergoing dialysis since March’2006. The complainant never had dialysis in March’2006 and it was for the first time in November’2006 he had dialysis. The repudiation of the claim is totally illegal. The complainant is entitled to 50% of the policy amount immediately after transplantation of kidney. Thereafter, after surgery is entitled for 10% of the total policy amount deliver the maturity date. Because of the attitude of the opposite party the complainant was put to serious mental agony and physical sufferance. Hence, the complaint.

    3. The opposite party filed his counter contending as fallows: It is true that the complainant had taken Asha Deep Policy on 26.06.2003 for a sum assured of Rs.1,50,000/-. The policy was under lapsed condition for non-payment of premiums from June’2004 to June’2005. Later, the policy was survived on 30th January’2006. As per the terms and conditions of the policy the sickness benefits under the policy will not be entertained up to the expiry of One year period from the date of revival of the policy i.e., lien clause is applicable as per condition No.11 of the policy bond. The date of revival was 31.01.2006 and the date of 1st admission for treatment was during the lien period of One year i.e., in March 2006. The same is admitted by the complainant and hence nothing is payable under the sickness benefits and the same was communicated to the complainant on 13.10.2008. As per the terms and conditions of the policy the complainant is not entitled to any amount and the complainant is liable to be dismissed with costs.

    4. On behalf of the complainant Exs.A1 to Ex.A5 were marked. The Ex.A1 is the Bunch of medical bills. Ex.A2 is the Premium Receipt. Ex.A3 is the Premium Receipt. Ex.A4 is the Patients Hand Book. Ex.A5 is the Medical Certificate dated 14.01.2009.

    5. On behalf of the opposite party Exs.B1 to Ex.B6 were marked. The Ex.B1 is the Letter of the opposite party addressed to the complainant dated 13.10.2008 and acknowledgement of receipt of the letter by the complainant. Ex.B2 is the Claim Form AD (KF) – 3 submitted by the complainant dated 10.11.2007. Ex.B3 is the Claim Form AD (KF) – 1 submitted by the complainant. Ex.B4 is the Policy Bond dated 04.07.2003. Ex.B5 is the Proposal Form dated 26.06.2003. Ex.B6 is the Addendum to Proposal under Asha Deep Plan.

    6. The point for consideration is whether the complainant is entitled for the reliefs in the complaint.

    7. It is not in dispute that the complainant has obtained Asha Deep Insurance Policy for an assured sum of Rs.1,50,000/- commencing from June’2003. For non-payment of premium from June’2004 to June’2005 the policy was under lapsed condition and it was revived on 30th January, 2006.

    8. The case of the complainant is he fell sick in November’2006 and the doctors diagnosed that his kidneys are not functioning properly and he took treatment in Aswini Hospital, Guntur and Mahaveer Hospital, Hyderabad. It is further case that since October’2007 he was undergoing dialysis and on 10.11.2006 kidneys are transplanted with the kidney donated by his mother it is his further case that when he submitted claim form for claiming sick benefits under the policy his claim was repudiated on the ground that he was undergoing dialysis since March, 2006 in the lien period from revival of the policy. It is his further case that he never had dialysis in March’2006 and for the 1st time he had dialysis in November’2006 and the repudiated of his claim is illegal.

    9. On the other hand the opposite party contended that in the present case the policy was revived on 30th January, 2006 and he was undergoing dialysis since March’2006 within lien period from revival and as per policy condition he is not entitled for sick benefits and his claim is rightly repudiated.

    10. Policy condition 11 reads as fallows: a) “Benefit (B) of the Policy Schedule is not applicable if any of the contingencies mentioned in Para 11. b) occurs (i) at any time on or after the date of which the risk under this Poicy is commenced but before the expiry of one year reckoned from the date of this Policy or (ii) one year from the date of revival”.

    11. As per Ex.B2, Hospital report date of 1st Renal dialysis was in March’2006. In the claim form Ex.B3 submitted by the complainant himself he stated that he was undergoing dialysis since March’2006. It falsifies his case that he was undergoing dialysis since November’2006 and he never had dialysis in March’2006. The documents Ex.B2 and Ex.B3 shown that, he was undergoing dialysis since March’2006 i.e., within one year from the date of revival of the policy. As per condition No.11 of the policy he is not entitled to claim the sick benefits and his claim was rightly repudiated by the opposite party.

  9. #24
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    CC.No:209/2008
    BETWEEN:
    1. Khatiza Begum,
    W/o Mahaboob Khan, aged 42 years.

    2. P. Mahasin Idad Alikhan,
    S/o Mahaboob khan, aged 6 years,
    2nd complainant being minor represented
    by his mother 1st complainant

    Both are residents of Akaveedu village,
    Racharla Mandal, prakasam District. ... Complainants.

    Vs.
    1. The Branch Manager,
    L.I.C. of India, Khammam,
    Khammam District.

    2. The Regional Manager,
    L.I.C. of India, Dargamitta,
    Bhakthavatchala Nagar,
    Nellore.

    3. The Branch Manager,
    L.I.C. of India,
    Ramnagar 1st line, Ongole. …Opposite parties.


    COUNSEL FOR COMPLAINANT: SRI M. MALLIKHARJUNA REDDY,
    ADVOCATE, ONGOLE.

    COUNSEL FOR OPPOSITE PARTY: SRI Y. RAMESH,
    ADVOCATE, ONGOLE.

    This complaint is coming on 08.04.2009 for final hearing before us and having stood over this day for consideration this Forum delivered the following:
    ORDER:
    1. This is a complaint filed by the complainant under Section 12 of Consumer Protection Act, 1986 against the opposite parties.

    2. The averments in the complaint are as fallows: The 1st complainant is the wife and the 2nd complainant is the son of the deceased policy holder P. Mahaboob Khan. Said P. Mahaboob Khan worked as a mechanic in Telephone Department. He obtained insurance policy on 15.12.2004 and authorized his drawing officer to deduct the premium amount from his salary and remit the same to the L.I.C of India. The L.I.C. also accepted this proposal and issued endowment assurance with profit and with double accident benefits. Accordingly, premium was paid up to 14.05.2007. The deceased went to Akaveedu which is his native place on leave. while he was in Akaveedu he fell ill and died on 19.05.2007. Immediately, after the death of the deceased the complainant informed the same to the department people as well as to L.I.C. people to settle the insurance claim. The L.I.C received the documents and kept silent without settling the claim. There after she issued legal notice through her counsel on 14.05.2008. The L.I.C. gave reply on 23.05.2008 with false averments. In the above circumstances there is no other go for the complainant except to file the present complaint. Hence, the complaint.

    3. The 2nd opposite party filed his counter and the opposite parties 1 and 3 filed Memo adopting the counter filed by the 2nd opposite party. In their counter the opposite parties are contending as fallows: It is true that husband of the 1st complainant took a policy for the sum assured of Rs.2,00,000/- showing the 2nd complainant as his nominee. The policy is an endowment policy and it covers with profit and with double accident benefit. Double accident benefit applies when the death caused is due to physical injury i.e., accidental injury to the policy holder. In the present case the policy holder did not die due to any physical injury and therefore, the complainants are not entitled for double accident benefit. The deceased paid the premium through his employer by attaching the salary every month. The employer did not pay 2nd, 3rd, 4th, 5th premiums of the year 2005 and 2nd and 3rd premiums of the year 2007 during his life time. After the death of the deceased the complainant sent claim application along with some documents and the L.I.C. requested the complainant to fulfill the requirements mentioned in the letter dated 26.05.2008. The L.I.C issued reply notice dated 23.05.2008 stating that the policy was in lapsed condition on the date of death without acquiring paid up values, dues of non receipt of premiums for 2,3,4,5 for the year 2005 and 2,3 of 2007. However, the claim is under consideration on exgretia basis and as it is an early claim the opposite parties are arranging for claim enquiry. There is no deficiency in service on the part of the opposite parties. Any how, the opposite parties are ready to pay Rs.1,89,949/- as per the terms and conditions of the policy, requirements of the corporation and insurance act. For the foregoing reasons the opposite parties prays the forum to dismiss the complaint.

    4. On behalf of the complainant Exs.A1 to Ex.A5 were marked. The Ex.A1 is the Xerox copy of the Endowment assurance dated 29.01.2005. Ex.A2 is the Death Certificate. Ex.A3 is the Legal Notice to the Chief Branch Manager, L.i.C of India, Khammam, Khammam District. Ex.A4 is the Letter dated 23.05.2008. Ex.A5 is the Letter dated 26.05.2008 to the Smt. Katiza Begum, Akaveedu Village, Prakasam District. No documents are marked on behalf of the opposite parties.

    5. The point for consideration is whether the complainant is entitled for the reliefs in the complaint.

    6. It is an admitted case that the husband of the 1st complainant P. Mahaboob Khan had taken endowment policy and it covers with profit and double accident benefit. The case of the complainant is that the death of the insured was accidental death and that she is entitled to receive the amount under double accident benefit. Whereas the opposite parties contented that the death of the insured was natural death and it is not an accidental death and therefore the complainants are not entitled to claim amount under double accident benefit.

    7. Now, the point for consideration is whether the death of the policy holder was accidental or natural.

    8. No evidence is produced by the complainant to show that the death of the policy holder was an accidental death. The averments in the complaint goes to show that the policy holder went to his native place on leave and died due to illness on 19.05.2007. From the reading of the complaint it is clear that the death was not due to any bodily injury solely or directly caused by external, violent and visible means and the death is natural death due to illness. Therefore, the complainants are not entitled to claim amount under double accidental policy.

    9. It is not in dispute that the deceased had taken insurance policy for Rs.2,00,000/- under salary saving scheme. An authorization was given to the employer to deduct premium every month from his salary and remit the same to the LIC.

    10. In the instant case the L.I.C contented that the employer did not remit the premium to the L.I.C for 4 months in the year 2005 and 2 months in the year 2007 and the policy was in lapsed condition and however they are considering the claim on exgretia basis and arranged for claim enquiry. The L.I.C further contented that after deducting 6 months premium which was not paid from the sum assured of Rs.2,00,000/- ready to pay the balance with bonus which works out to Rs.1,89,949/- to the complainants. Complainants did not agree for it and filed the present complaint for the policy amount.

    11. It is not in dispute that the deceased has taken policy under salary savings scheme. As per salary savings scheme the amount of premium was to be deducted every month from the salary of the policy holder. If premium was not deducted for any particular month it is the duty of the employer to inform the L.I.C. regarding non-payment of premium giving reason as to why premium was not remitted. Then a duty is caste on the LIC to inform the insured that his premium had not been remitted. In the present case no notice was issued to the insured about non deduction or non remittance of premium. Insured may not be aware of the fact that the premium was not paid. Therefore, unless a notice is issued the insured could not be held responsible for the consequence of non payment of premium under the policy.

    12. In a case reported in 1999 (3) CPR at page 91 (Supreme Court) in Delhi Electric Supply Undertaking Vs. Basanti Devi & Another. It was held that “Insurance – Life Insurance – LIC Agent – Authority of LIC agent to collect premium from policy holders – Liability of LIC – Salary Savings Scheme Policy – Employer collecting premium by deducting from salary and paying it to LIC – So for as employee was concerned employer was agent of LIC to collect premium on its behalf – Employers had implied authority as an agent of LIC to collect premium – General principles of agency attracted – LIC liable for default of employer’s failure to deduct premium from salary of employee resulting in lapse of policy – LIC bound to pay assured sum”.

    13. In another case reported in 1(2009) CPJ, Page 266 (National Commission) in LIC of India Vs. Gousabi it was held that “Consumer Protection Act, 1986 – Section 2(1) (g) – Life Insurance – Salary Saving Scheme – Policy lapsed due to non-payment of premium – Payment of premium after deducting from salary, between employer and LIC – Non-remittance of premium not to be intimated to LIC by employee – Deceased employee proceeded on leave without pay – Duty caste on employer to inform LIC that premium from deceased’s salary not being deducted and remitted – Deceased kept ignorant about non-deduction of premium from salary, not responsible for consequence of non-payment of premium – LIC held liable to pay sum assured to wife of deceased”.

    14. In view of the decisions sited above I am of the opinion that the LIC is liable to pay the insurance amount of Rs.2,00,000/- to the complainants.

    15. In the result, petition is allowed and the opposite parties are directed to pay policy amount of Rs.2,00,000/- to the complainants together with interest @ 9% p.a., from the date of the petition till realization and also to pay Rs.1,000/- towards costs of litigation. The complainants are entitled to receive the amount in equal shares. The share of the minor 2nd complainant shall be kept in fixed deposit in any Nationalized Bank till he attains majority.

  10. #25
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    C.C. No. 20 /2009


    Between


    D.C.Geethanjali W/o Late J.B.Jayasankara Raju,
    Hindu, aged 34 years, residing at Raja Street,
    Bangarupalyam Town & Mandal, Chittoor Dist.,
    … Complainant.

    And

    1.The Life Insurance Corporation of India,
    Divisional Office, rep., by its Divisional
    Manager, office at Dharga Mitta, Nellore
    Town & District.

    2.The Life Insurance Corporation of India,
    Rep., by its Branch Manager, Puttur,
    Puttur Mandal, Chittoor District.
    … Opposite Parties.

    This complaint coming on before us for final hearing on 20.04.2009 and upon perusing the complaint, written versions, affidavits, material documents and on hearing Smt P. Madhusudhan, counsel for the complainant, and Sri P.Dayasekhar counsel for opposite parties 1 & 2 and having stood over till this day for consideration, the Forum made the following:-

    ORDER

    DELIVERED BY Sri.K.Subramanyam Reddy, B.A., B.L.,Male Member
    ON BEHALF OF THE BENCH


    1) This is a complaint filed by the complainant U/Sec. 12 of C.P.Act, 1986 for directing the opposite parties to pay Rs. 50,000/- with interest at 18% p.a being policy amount; Rs. 30,000/- towards compensation and Rs. 10,000/- towards litigation expenses to the complainant.

    2) The material averments in the complaint dt. 31.01.2009 in brief are as follows :-
    The complainant is the legally wedded wife of J.B.Jayasankara Raju, The husband of the complainant died on 03.02.2004 due to Heart Attack. During the life time of deceased had taken L.I.C policies in his name by mentioning the complainant as nominee in one policy and remaining two policies nominee was his mother J.Thulasamma. The deceased was paid the premium amounts regularly till his death without any default. The complainant obtained policy No. 840157274 for a sum of Rs. 50,000/- payable on quarterly rests of Rs.460/- through the 2nd opposite party. After death of the deceased J.B.Yasankara Raju the complainant has submitted claim form to the 2nd opposite party for settlement of the claim. Later the complainant submitted requisitions and made several requests personally, but the opposite parties have not choosen to settle the claim of the complainant. Due to the acts of the opposite parties the complainant suffered a lot both mentally, physically and financially for non settlement of the policy amount. Hence there is clear deficiency of service on the part of opposite parties.
    Hence the complainant approached this Forum for redressal of her grievances. Under the above said circumstances the complainant prayed this forum to
    a) Direct the opposite parties 1 & 2 to pay Rs. 50,000/- with interest at 18% p.a from the date of complaint till the date of realization to the complainant towards policy amount;
    b) direct the opposite parties 1 & 2 to pay Rs. 30,000/- towards compensation for mental agony; and
    c) to pay an amount of Rs. 10,000/- as costs of litigation.

    3) The 1st opposite party filed his Written Version on 24.03.2009 and admitted that on 28.03.1996 the husband of the complainant obtained JEEVAN MITRA DOUBLE COVER ENDOWMENT PLAN with Profits policy No.840157274 for Rs.50,000/-. The deceased/ life assured has nominated the complainant as his nominee in the said policy. This opposite party further submits that the said policy was lapsed due to non-payment of premiums from 3/1997. The said policy was revived on 26.02.2001 by paying 16 quarterly premiums due from 3/1997 to 12/2000. At the time of reviving the policy the deceased/ life assured has given self declaration by mentioning that he was hale and healthy.

    This opposite party further submits that after death of the deceased/ life assured this opposite party conducted investigation and found that the deceased was not in a good condition of his health, at the time of revival of the policy the deceased/ life assured withhold material information regarding to his health in the declaration give by him had given false answers.

    This opposite party further submits that the deceased/ life assured has suppressed his ailment at the time of reviving policy. The death of the deceased is 03.02.2004 and the claim of the complainant is repudiated by the complainant on 03.01.2005. The complaint filed by the complainant on 10.02.2009. Hence the complaint is barred by limitation. The SVIMS Hospital Tirupathi has issued Medical attendants certificate, which shows that the deceased/ life assured is a known smoker and alcoholic patient and he had taken treatment since 3 to 4 years for hyper tension. Hence there is no deficiency of service on the part of this opposite party. Hence the complaint may be dismissed with costs.

    The 2nd opposite party filed Memo adopting the Written Version filed by the 1st opposite party.

    4) On behalf of complainant the complainant filed his Chief Affidavit in support of pleas raised in the complaint and same is marked as deposition of PW-1 and he also relied upon 3 documents and same are marked as Ex.A1 to A3. Ex.A1 is Xerox copy of first premium receipt issued by 2nd opposite party in favour of complainant’s husband. Ex.A2 is the Copies of requisitions dt. 24.08.2005, 14.11.2006 & 13.04.2007 issued by the complainant to the 2nd opposite party. Ex.A3 is the office copy of legal notice dt. 26.06.2008 with postal receipts and acknowledgements issued to the opposite parties.

    On behalf of opposite parties the 1st opposite party filed his Chief Affidavit in support of pleas raised in the Written Version and same is marked as deposition of RW-1 and he also relied upon 5 documents and same are marked as Ex.B1 to B5. Ex.B1 is the Xerox copy of policy of the deceased/ life assured. Ex.B2 is the original personal statement regarding health of the deceased/ life assured. Ex.B3 is the certificate issued by Cardiology, SVIMS, Hospital relating to the deceased/ life assured. Ex.B4 is the Xerox copy of repudiation of claim dt. 03.01.2005 issued by the opposite party. Ex.B5 is the Medical attendant certificate of deceased/ life assured issued by SVIMS, Hospital, Tirupathi.

    5) On the pleadings and on consideration of the material available and upon hearing the parties, the points that arise for consideration are :
    1) Whether the complaint is barred by limitation U/Sec. 24(a) of C.P.Act?

    2) Whether the insured suppressed his pre-existing disease at the time of revival of his policy?

    3) whether the complainant is entitled for the policy amount ? If so, whether there is any deficiency of service on the part of opposite parties in settling the claim of the complainant?

    4) Whether the complainant is entitled for Rs. 30,000/- towards compensation for deficiency of service on the part of opposite parties ?
    And
    5) to what result ?

    6) Both sides filed Written Arguments.

    7) Point No. 1 :-
    It is the case of the complainant that the insured/ deceased J.B.Jayasankara Raju is the husband of the complainant. During his life time the insured obtained JEEVAN MITRA DOUBLE COVER ENDOWMENT PLAN with Profits policy for Rs. 50,000/- from the 2nd opposite parties. In that policy the insured nominated his wife i.e complainant as nominee. The said policy was lapsed due to non payment of premiums from March-1997 to December-2000. But the said policy was revived on 26.02.2001 by paying 16 quarterly payments due from March-1997 to December-2000. The insured died on 03.02.2004 due to Heart Attack. The policy was in force at the time of death of the insured. After death of the insured the complainant submitted the claim form to the 2nd opposite party for settlement of the claim. But the opposite parties have not settled the claim in spite of her representations and legal notice.
    8) It is the case of the opposite parties that the insured has suppressed his health condition at the time of revival of policy, though he was taken treatment for his ailment. The opposite parties further stated that the insured was not in a good condition of his health at the time of revival of his policy and insured suppressed pre-existing disease and given false answers for Question No. 2, a, b & c and for question No. 4. Hence the opposite parties repudiated the policy on 03.01.2005 stating that the insured had made deliberate mis-statement and withhold material information regarding his health condition at the time of getting policy revived and hence in terms of policy of contract the revival policy is void.
    9) Further the opposite parties stated in their Written Version that the complaint is barred by limitation U/Sec. 24(a) of C.P.Act, since the life assured died on 03.02.2004 and the claim of the complainant is repudiated by the opposite parties on 03.01.2005. The complaint filed by the complainant in this Forum on 31.01.2009, after lapse of 4 years i.e from the date of repudiation of the claim.
    10) Sec. 24(a) of C.P.Act deals with the period of limitation. For the convenience sake and for ready reference Sec. 24(a) of C.P.Act is here under incorporate:-
    “[24-A. Limitation Period] :--(1) The District Forum, the Station Commission or the National Commission shall not admit a complaint unless it is filed within two years from the date of which the cause of action has arisen.

    (2) Notwithstanding anything contained in sub-section(1), a complaint may be entertained after the period specified in sub-section(1), If the complainant satisfies the District Forum, the State Commission, as the case may be, that he had sufficient cause for not filing the complaint within such period:

    Provided that no such complaint shall be entertained unless the National Commission or the District Forum, as the case may be, records its reasons for condoning such delay.”

    In the Insurance cases the limitation in filing of the complaint before Consumer Fora will start from the date when the insured’s claim was repudiated by the insurer. In this case the insurance claim was repudiated by the opposite parties on 31.01.2005 whereas the complaint filed by the complainant in this Forum on 31.01.2009 i.e after more than 4 years. In view of the above discussion I am of the view that the complaint filed by the complainant is barred by limitation U/Sec. 24(a) of C.P.Act.
    The Point is answered accordingly.
    11) Points No. 2 to 4 :-
    In view of my finding on Point No.1 the question of discussion of the points 2 to 4 does not arise.
    12) Point No. 5:-
    In the result the complaint is dismissed as barred by limitation. In the circumstances of the case each party will bare its own costs.

  11. #26
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    CONSUMER complaint NO. 96 OF 2008

    Between:
    Mattepaly Laxmi, W/o. Late Sambaiah, age 42 years, Occ: Vegetable Vendor, R/o. Pothkapally (v), Odela (m), Karimnagar district.
    …Complainant
    AND
    The Branch Manager, LIC of India, Karimnagar division, Near Ambedkar Stadium, Karimnagar.
    …Opposite Party

    This complaint is coming up before us for final hearing on8-4-2009, in the presence of Sri A. Venkateshwar Rao and A. Niranjan and G. Venkat Rao and SK. A. Nabi Advocates for complainant and Sri P. Ashok, Advocate for opposite party, and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following:
    ::ORDER::


    1. This complaint is filed under Section 12 of C.P. Act, 1986 seeking direction to the opposite party to pay a sum of Rs.50,000/- towards sum assured along with Rs.30,000/- towards damages and expenses.

    2. The brief averments of the complaint are that the husband of the complainant by name Mattepally Sambaiah obtained Endowment Insurance Policy for a sum of Rs.50,000/- from the opposite party bearing policy no.683928047 commencing from 15.12.2004. Under the said policy the complainant is named as the nominee of the policy holder. As per the terms of the policy the opposite party undertook to pay an assured sum of Rs.50,000/- with bonus in case of death of the policy holder and further undertook to pay Rs.50,000/- in case of policy holder dies accidentally, As per the terms of the policy the policy holder has to pay yearly premium of Rs.1,824/-. It is submitted that the policy holder died on 26.6.2006 in a train accident at Bijjigiri Sharief when he was crossing the railway track. On his death the Railway Police, Bellampally registered a case in Crime No.131/2006 U/s. 174 of Cr.P.C. After the death of her husband the complainant filed claim to the opposite party requesting him to pay an amount of Rs.1,00,000/- towards the sum assured as the policy holder died accidentally. But the opposite party paid an amount of Rs.50,000/- towards sum assured with bonus treating the death of the deceased as suicide. Along with the said claim form the complainant submitted copies of FIR, Panchanama, Postmortem Report, Death Certificate and other documents. In the Final Report it is mentioned that the deceased died in an accident but the opposite party relied on the typographical mistake that the death of deceased is a case of suicide and closed the investigation and on that ground the accident benefit coverage was not given by the opposite party. It is further submitted that when the complainant came to know about the mistake she requested the Railway Police to correct the mistake as her husband died in an accident and the same was corrected by the Police in the Final Report. The complainant requested the opposite party to pay the accidental benefit assured sum of Ra.50,000/- in view of the correction in the Final Report, but the opposite party failed to pay the same. The complainant submits that the opposite party is bound to pay the amount of Rs.50,000/- towards accident benefit coverage and non-payment of the same constitutes deficiency of service on their part. Hence sought direction for payment of the said amount with damages and costs.

    3. The opposite party filed counter stating that the husband of the complainant obtained Endowment Assurance Policy for Rs.50,000/- having a term of sixteen years. On 24.8.2006 opposite party received death intimation of the policy holder from the complainant as she being the nominee under the policy. On receipt of the said claim papers the opposite party admitted the claim for Basic sum assured and eligible Bonus which comes to Rs.50,000/- towards assured sum and Rs.4,500/- towards Bonus and paid the said amount of Rs.54,500/- on 23.11.2006. It is further submitted that the claim of the complainant for payment of Rs.50,000/- towards double accident benefit coverage was not considered as the policy holder committed suicide. It is submitted that as per the Final Report submitted by Railway Police the cause of death is shown as suicide. Again the complainant submitted another Final Report submitted by the Railway Police to the Executive Magistrate showing the death of the policy holder as a case of accidental death. On receipt of the same the opposite party referred the same to the Zonal Office and the claim of the complainant for payment of double accident benefit is rejected. There is no deficiency of service on their part as they have already paid the assure sum, hence opposite party prayed for dismissal of the complaint.

    4. The complainant filed Proof Affidavit reiterating the contents of the complaint and filed the documents which are marked as Ex.A1 to A9. Ex.A1 is the copy of Policy Bond bearing no. 683928047. Ex.A2 to A5 are the premium receipts issued by opposite party. Ex.A6 is the attested copy of F.I.R. in Crime No.131/2006 Dt: 26.6.2006. Ex.A7 is the attested copy of Inquest Report in Crime No.131/2006 issued by Station House Office, Govt Railway Police, ROP, Ramagundam, RPS, Bellampally (in 3 sheets). Ex.A8 is the attested copy of Report of Postmortem Examination Dt: 26.6.2006 (in 3 sheets). Ex.A9 is the attested copy of Charge Sheet filed by Sub Inspector of Police, Bellamplly Dt: 6.8.2006.

    5. On behalf of opposite party, the Proof Affidavit of its Administrative Officer is filed and got marked documents as Ex.B1 to B3. Ex.B1 is the original copy of Ex.A1. Ex.B2 is the original copy of Charge Sheet Dt: 6.8.2006 (in 2 sheets). Ex.B3 & A9 are one and the same documents.

    6. The points for consideration are:
    (1) Whether there is any deficiency of service on the part of opposite party?
    (2) If so, to what relief the complainant is entitled?

    7. The case of the complainant is that the husband of the complainant obtained Insurance Policy from the opposite party under Ex.A1 with double accident benefit coverage for basic sum of Rs.50,000/- and nominated the complainant as his nominee enabling her to receive the assured sum after his death. It is contended that the policy holder met with an accident on 26.6.2006 as he was hit by a goods train while crossing the Railway Track between Bijjigiri Sharief and Potkapally and he died on the spot. The Railway Police registered a case by issuing FIR under Ex.A6. After his death Police conducted Inquest over the dead body and sent it for Postmortem to Govt. Hospital, Sultanabad. It is contended that the Railway Police filed Final Report before the Executive Magistrate, Odela Mandal on 6.8.2006 under Ex.A9 reporting that the deceased while crossing the Railway Track to answer the calls of nature was hit by a train and sustained injuries and died on the spot. Further reported that there is no Foul Play suspected in his death. After the death of policy holder the complainant submitted claim for payment of double accident benefit assured sum of Rs.1,00,000/- with bonus, but the opposite party paid an amount of Rs.50,000/- towards basic sum with bonus of Rs.4,500/- treating the death of the policy holder as a case of suicide. Infact it is a case of accidental death and the opposite party ought to have paid the sum under double accident coverage. Therefore, the complainant sought direction for the said amount.

    8. It is contended by the opposite party that the deceased policy holder committed suicide and as per the terms of the policy the complainant is entitled to receive Rs.50,000/- towards basic sum assured with bonus. Along with her claim she submitted copy of Final Report under Ex.B2 in which it is stated that the death of the deceased as suicide. But another report is filed by the complainant under Ex.B3 in which it is stated that the death of the policy holder is an accidental while crossing the Railway Track. As per the terms of the policy the opposite party paid basic sum of Rs.50,000/- with bonus of Rs.4,500/- on 23.11.2006. As the policy holder committed suicide, the complainant is not entitled to receive double accident benefit coverage. Therefore, the opposite party prayed for dismissal of the complaint.

    9. The case of the complainant is that the opposite party failed to pay the accidental benefit coverage even though the policy holder died in train accident while crossing the Railway Track. The complainant relied on the Criminal Case records under Ex.A6 to A9. A perusal of Ex.A6 F.I.R. reveals that the Railway Station Incharge filed a complaint with Railway Police that the dead body of the Male person is found on the Railway Track. On receipt of the same a case was registered and the Railway Police conducted Inquest over the dead body of Mattepally Sambaiah on 26.6.2006 in the presence of panchas and witnesses and the dead body was referred for postmortem examination to Govt. Hospital, Sultanabad. A perusal of contents of Column NO.9, 15 and 22 of Inquest Report under Ex.A7 reveals that the deceased was crossing the Railway Track at 4.30A.M. to attend calls of natures without observing the Goods Train and he was hit by it due to which he died on the spot. The said incident was witnessed by one Gare Yakub who is working as Gateman at Gate No.28. The doctor who conducted PME reported that the deceased died due to multiple injuries received on the head. Subsequently the Police filed Charge Sheet/Final Report before the M.R.O., Odela. A perusal of the said report under Ex.A9, the Investigating Officer reported that,

    "From the evidence collected so far revealed that the deceased Mattepalli Sambaiah R/o. Potkapalli of Karimnagar district while crossing the railway track at KM No.315/5-7 between Bisugirsharief and Potkapalli railway stations to answer the calls of nature he was hit by TKD up train, resulting which he sustained injuries and died on the sport. There is no foul play suspected in his death.
    As such the case has been referred as Accidental death and the Hon'ble Court may kindly be referred the case accordingly after due enquiry and issue further proceedings".

    10. On receipt of the claim from the complainant the opposite party paid Basic Assured sum of Rs.50,000/- with bonus of Rs.4,500/- on 23.11.2006 treating the death of the deceased as a case of suicide by relying on the copy of the Charge Sheet, Final Report under Ex.B2 in which in the last para it is stated that the death of the deceased is a suicidal. A perusal of the contents of Ex.B2 reveals that the Investigating Officer has conducted Investigation in which it is revealed that the deceased was hit by a train when he was crossing the Railway Track to attend calls of nature and he died on the spot due to the said injuries. In the last para it is stated that the case has been referred as suicidal death. Relying on the said report the opposite party treated the death of the policy holder as suicidal and paid basic sum.

    11. The opposite party filed 2 reports Ex.B2 & B3 copies of 2 Charge Sheets. In Ex.B2 it is referred at last para as follows, "As such the case has been referred as suicidal death and the Hon'ble Court may kindly be referred the case accordingly after due enquiry and issue further proceedings." In Ex.B3 it is referred as follows "As such the case has been referred as Accidental death and the Hon'ble Court may kindly be referred the case accordingly after due enquiry and issue further proceedings." But the facts gathered as referred above it is clear the deceased while crossing the track to attend the natural calls hit by Goods Train. As such it cannot be said that he intentionally made any attempt to commit suicide. Hence the reference of suicidal death in Ex.B2 might be a mistake of typing as contended by the counsel for petitioner. But perusal of another Final Report filed by the opposite party under Ex.B3 reveals that the deceased died due to train accident. When the opposite party received 2 different reports regarding the death of the policy holder the opposite party ought to have made their own enquiry to know the cause of death of the deceased.

    12. Further as per Ex.A7 Inquest Report Dt: 26.6.2006 conducted on the same day by SHO Railway, ROP, Ramagundam at Co.No.4 it is stated that the Panch witnesses Sl.No.3 to 6 who are the wife and children of deceased have stated that they have seen him lastly while on 26.6.2006 at 4.30 A.M., while he was leaving the house along with water bottle. Thus it is clear at that time deceased left the house only to attend the natural calls and not with any intention to commit suicide. After considering the case record it is established that death of deceased met with an accident as referred supra and rejecting the claim by the opposite party on the ground that it is a suicidal death is unjust and amounts to deficiency of service.

    13. In the result the complaint is partly allowed directing the opposite party to pay an amount of Rs.50,000/- with interest @ 7.5% per annum from the date of filing of the complaint i.e. 14.7.2008 till the date of realization along with costs of Rs.500/- within a period of one month from the date of receipt of this order.

  12. #27
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    C.C.No.50 / 2008


    BETWEEN:

    Konari Simhachalam, S/o.Ramayya, aged 33 years, H/o.of late Mahalakshmi,
    Madanapuram Village, Kottapalli Post, Saravakota Mandal, Srikakulam District. ...Complainant.

    AND:

    01) Life Insurance Corporation of India, rep.by its Branch Manager,
    Palasa, Kasibugga, Main Road, Srikakulam District.

    02) Life Insurance Corporation of India, rep.by its Senior Divisional Manager,
    Divisional Office, Dabagardens, Visakhapatnam. …opposite parties.

    This complaint coming on 06-04-2009 for final hearing before us in the presence of Sri T.Khagendranadh, Advocate for complainant and Sri Y.Murali Mohana Rao, Advocate for opposite party Nos. 1 and 2 and having stood over to this day for consideration, this Forum made the following:

    O R D E R

    (By Sri K.Sivaramakrishna, Male Member)

    This is a complaint filed under Section 12 of the Consumer Protection Act, 1986 and facts of the case briefly are as follows:
    Wife of the complainant by name Konari Mahalakshmi obtained LIC Policy for Rs.50,000/- on 30-3-2005. She died on 4-7-2005. Complainant is nominee under the policy. Complainant submitted original policy, death certificate of the deceased and claimed the insurance amount, but the opposite parties did not settle the claim. Complainant issued notice dated 7-4-2008 to opposite party Nos.1 and 2 claming the insurance amount. There was no settlement of the claim. Hence complaint is filed for a direction to the opposite parties to pay the insurance amount of Rs.50,000/- and premium of Rs.3,311/- and compensation of Rs.20,000/- and costs.
    2) Opposite party No.2 filed counter stating that the insured had died by committing suicide and hence the claim is rejected.
    Opposite party No.1 filed memo adopting the counter filed by opposite party NO.2.
    3) Both parties filed affidavits. Exs.A1 to A6 are marked on behalf of the complainant. Ex.B1 is marked on behalf of the opposite parties.
    Heard both parties.
    Point for consideration is:
    Whether there is deficiency in service on the part of the opposite parties.

    4) Point:
    Ex.A3 is copy of letter dated 25-5-2007 issued by opposite parties to the complainant stating that the insured committed suicide within one year from the date of the policy. Hence the policy has become null and void and nothing is payable under the policy. Opposite parties filed two letters given by Surpanch of Madanapuram Panchayat and another person by name P.Lingamurthy stating that the insured Konari Mahalakshmi died by committing suicide. These letters are not marked, because the letters are not evidence. Opposite parties ought to have examined the persons who gave the letters. Opposite parties ought to have filed affidavits of those persons to support their defence that the insured died by committing suicide. Complainant may have got opportunity to cross-examine those persons. By filing letters given by some persons, opposite parties cannot prove their defence. The letters cannot be relied on. The letters are not evidence.
    5) There is no proof that the insured died by committing suicide. The burden is on the opposite parties to prove that the insured died by committing suicide. Opposite parties have not discharged their burden of proof of their defence. Hence the defence is not accepted.
    6) Ex.A2 is certificate of death extract of the insured Konari Mahalakshmi. There is no denial of the fact of the death of the insured Konari Mahalakshmi on 4-7-2005. Opposite parties have failed to prove that the insured died by committing suicide. They have to pay the insurance amount to the complainant. We therefore hold that there is deficiency in service on the part of the opposite parties. Hence, we answer the point accordingly.
    In the result, complaint is allowed. Opposite parties are directed to pay Rs.50,000/- (Rupees fifty thousand only) to the complainant with interest at the rate of 12% per annum from the date of filing the complaint i.e., 22-4-2008 till the date of payment and costs of Rs.500/- (Rupees five hundred only). Advocate’s fee is fixed at Rs.500/- (Rupees five hundred only).

  13. #28
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    C.C.No.142/2007
    Between:

    Dharmala Sugana, W/o Nageswara Rao, Hindu, Aged 42 years,
    R/o D.No.2-7-2, Kannamathalli Temple Street, Alcot Gardens,
    Rajahmundry. ..Complainant.
    A N D

    1.The Zonal Manager, L I C of India, Zonal Office/ Central Office,
    South Central Zonal Office, Saifabad, Hyderabad, 500 463.
    2.The Divisional Manager, Divisional Office, L I C of India,
    Morampudi Road, Rajahmundry.
    Opposite parties.
    This case is coming on 20.3.2009 .for final hearing before this Forum and upon perusing the complaint, and other material papers on hand and upon hearing the arguments of Sri T V Satyanarayana Reddy, Advocate for the complainant and Sri M Siva Subbarao, Advocate for the opposite parties and having stood over for consideration till this day, this Forum has pronounced the following.

    O R D E R
    (By Smt.H V Ramana, Member)
    This is a complaint filed under section.12 of the Consumer Protection Act, 1986 by the Complainant to direct the opposite parties to pay an amount of Rs.5,68,527/and to award costs.


    2. The case of the Complainant as set out in the complaint in brief is that, the complainant’s husband obtained policy from the opposite party under Jeevan Anand in the month of September, 2003 and paid necessary premium. The opposite parties issued policy bearing No.802921246, Dt.19.12.2003 assuring a sum of Rs.4,00,000/- under the said policy. The complainant’s husband died intestate on 2.6.2005 leaving behind the complainant and his only daughter. In the above said policy the complainant was made a nominee and she filed all the necessary papers before the opposite parties for settlement of claim, for which the 2nd opposite party passed an order under his letter Dt.18.4.2006 LIC of India, Divisional Office, Rajahmundry, addressing the complainant that the policy of Dharmala Nageswara Rao, SA.Rs.4,00,000/--Plan and term of 149-50 with A B stating that the 2nd opposite party repudiated the claim on the basis of suppression of material facts. The complainant several times approached the opposite parties for settlement of claim, but in vein. Hence, the complaint.



    3. The 2nd opposite party filed written version and the same was adopted by the 1stopposite party. This opposite parties denied all the material allegations made by the Complainant. The opposite parties submits that there is no previty of contract between the complainant and the opposite parties and there is no service under taken for consideration by the opposite parties infavour of the complainant. The claim of the complainant repudiated by the opposite parties after thorough investigation and realizing the fact that the policy in question was secured by suppressing the material information by the life assured. With a dishonest intention the LA obtained the policy. The opposite parties requested the complainant to give all the requisite information and fill the claim forms. In spite of several reminders the complainant failed to furnish the required information. When this opposite parties received reliable information from various sources, it is came to known that the life assured was a known case of stage.II Non-Hodgkin’s Lymphoma with multiple relapses on savage Chemotherapy and he is also a diabetic since two years prior to death and was taking treatment at South Central Railway Hospital, Rajahmundry as outpatient. It is further realized that the life assured was on sick leave for more than 7 days on many occasions prior to commencement of policy and the same was not disclosed in the proposal form purposefully. The enquiries have also revealed that the life assured took treatment from Dr N Rama Krishna E N T and Dr B Thrinadha Rao, Rajahmundry for cancer. As per the report given by the Jagruthi Laboratory, Rajahmundry the Life assured was diagnosed to be suffering non-specific lymphadenitis and this clearly shows that the life assured was a diabetic and also at the primary stage of cancer at the time of taking the policy and the same was not disclosed and intentionally suppressed the same in the proposal form. With reliable evidence only, the opposite parties repudiated the claim and the complainant is not entitled for any relief and the complaint may be dismissed with costs.



    4. Exs.A.1 to A.11 has been marked on behalf of the complainant and Exs.B.1 to B.21 on behalf of the opposite parties and no oral evidence has been adduced on either side.



    5. Heard both sides. The complainant filed written arguments.


    • The points that arise for consideration are:


    1) Whether there is any deficiency in service on the part of the opposite
    parties?
    2) Whether the complainant is entitled for any relief, If so, to what
    relief?

    7.POINT NO.1: The Admitted facts in the case are that the complainant’s husband obtained LIC policy bearing No.802921246 on 20.11.2003 by paying a premium amount of Rs.34,384/-. The opposite parties issued Jevan Anand Policy to the Life Assured vide Ex.A.2 = Ex.B.2 and he also paid premium in the month of September, 2004. The complainant’s husband died on 2.6.2005 due to cancer vide Ex.A.1 and the same was intimated to the opposite parties for claim and the opposite parties repudiated the same for suppression of material facts under Ex.A.3=Ex.B.10. The complainant is a nominee to the policy and the same is reflected in Ex.B.2. The complainant gave a reply to the 2nd opposite party by narrating the health condition of her husband and the same has been marked under Ex.A.4. The complainant contended that the opposite parties failed to settle the claim with false allegations and she filed medical certificate marked under Ex.A.5 issued by Dr A Rama Krishna and E N T Surgeon. She also filed different laboratory reports under Ex.A.6, A.7, A.8 and A.9. The discharge summery and other reports issued by Indo American Cancer Centre institute and research centre has been marked under Ex.A.10. The death summary report issued by the Yashodha Hospital has been marked under Ex.A.11.
    The opposite parties contended that the life assured had secured the policy by suppressing the material facts in the proposal form and the same has been marked under Ex.B.1. They also contended that the complainant failed to give all the required information in the claim form and the same has been marked under Ex.B.3 and the burial ground certificate has been marked under Ex.A.4. The opposite parties further contended that the life assured was on sick leave for more than 7 days on many occasions prior to the date of commencement of the policy, rather submission of proposal form. In the said proposal form the details were also not disclosed and to that extent the opposite parties filed Ex.B.6. They also contended that they received reliable information that the life assured was a known case of stage II Non-Hodgkin’s lymphoma with multiple relapses on salvage Chemotherapy and he was a diabetic since two years prior to his death and to that extent they relied on Exs.B.7,B.8 B.9 and B.10. The opposite parties also filed copy of medical certificate and fitness certificate marked under Ex.B.12 and B.13. A letter written by the life assured to their management is marked under Ex.B.14. The opposite parties also filed the medical record from 25.1.2002, and leave account under Ex.B.15 and B.16. The life assured’s out patient tickets have been marked under Ex.B.17 to B.21.
    After perusing the entire material on record filed by both the parties as we observed that the life assured had taken leave on several occasions under Ex.B.6 for domestic purpose and also under medical grounds. The life assured obtained the policy on 28.9.2003 and by this date the life assured was not diagnosed as cancer patient. The said policy was issued by the opposite parties under non medical category. As per Exs.A.7 report Dt.18.1.2004 the complainant’s husband was diagnosed that there is a possibility of Angio Lymphoid Hyperplasia. By this date the life assured already taken the policy from the opposite parties. The opposite parties filed the medical record of the life assured under various exhibits which were showing that the life is taking treatment for cancer. But, these records are not prior to the issuance of the policy. Even in other documents which were filed by the opposite parties prior to the issuance of policy, no way reveals that the life assured was suffering from cancer.
    Further, the complainant relied on decisions reported in; I 1999 CPJ Page.230, Haryana State Consumer Disputes Redressal Commission, Chandigarh between Life Insurance Corporation of India Vs Mrs Santosh, wherein it was held that; rejection of claim by the opposite party on ground of complainant being diabetic is arbitrary”.
    As per this the contention of the opposite parties that the life assured was a diabetic and taking medicines since 2002 and the same was not disclosed at the time of taking the policy. The diabetic was not an ailment, patient where of stood disqualify from being insured, as such the diabetic is not a disease, but it is only a disorder.
    As per the aforesaid observation the repudiation of claim by the opposite parties caused serious prejudice to the complainant. Hence, the complaint of the complainant is allowed and she is entitled for the claim.


    8. POINT NO.2: In the result, the complaint of the complainant is allowed directing the opposite parties to pay the sum assured i.e Rs.4,00,000/- (Rupees four lakhs only) with interest @9% P.A from 2.6.2007 till the date of realization. The opposite parties are further directed to pay Rs.1,000/- (Rupees one thousand only) towards costs.

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    CONSUMER COMPLAINT NO.04/2008.
    Friday, the 17th day of April, 2009.
    Between:
    1. K.V.Meenakshi, W/o. Late K.V.Satyanarayana,
    Hindu, 32 years, Housewife, R/o D.No.8-17-3,
    Sivalal Street, Vankayalavari Street, Rajahmundry.

    2. K.V.Bapi Raju, S/o. Ramakrishna Rao,
    Hindu, 45 years, Business, R/o. D.No.8-17-3,
    Sivalal Street, Vankayalavari Street, Rajahmundry. ...Complainants.

    A N D

    1. Life Insurance Corporation of India,
    Rep. by its Branch Manager, Rajahmundry.

    2. Life Insurance Corporation of India,
    Rep. by its Branch Manager, Ravulapalem.

    3. Life Insurance Corporation of India,
    Rep. by its Divisional Manager, Rajahmundry. … Opposite parties.


    This case is coming 20.03.2009 for final hearing before this Forum and upon perusing the complaint, version of the opposite parties and other material papers on hand and upon hearing the arguments of Sri D.Appa Rao, advocate for the complainants 1 and 2being represented by Sri B.Srinivasa Rao, advocate for the Opposite parties 1 to 3 having stood over for consideration till this day, this Forum has pronounced the following.
    ORDER


    (PER SRI K CH MOHANTHY,PRESIDENT)

    This is a complaint filed by the complainants under Section 12 of the consumer Protections Act to direct the opposite parties to pay an amount of Rs.11,50,000/- towards the insurance amount under four policies with interest @12% P.A from 30.1.2006 till realization, to pay subsequent interest @12% P.A, to pay costs of the complaint and other reliefs.


    2. The case of the complainants as set out in the complaint is that the 1st complainant’s deceased husband used to run a shop under the name and style of VS Prink point (Screen printers) at Rajahmundry. The deceased died suddenly due to jaundice on 5.8.2004 prior to his admission into the hospital and taking medicine. The deceased life assured was hale and healthy and never suffered from any ailments, but unfortunately the DLA suffered from jaundice for the first time and he took country medicine at Vella, which is familiar in the Godavari districts for cure of jaundice, but to the misfortune of the complainant the DLA died on 5.8.2004 due to jaundice and the same was intimated to the opposite parties.

    It is further submitted that during the lifetime of the deceased the DLA life insurance polices from the opposite parties as mentioned below.
    SL. No.
    Name of the policy
    Sum assured
    Date of commencement
    Name of issuing branch
    Name of the nominee
    1
    802505943
    1,00,000
    28.2.2002
    Rajahmundry.
    1st complainant
    2
    801756137
    50,000/-
    28.3.2003
    Rajahmundry.
    1st complainant
    3
    802518912
    5,00,000/-
    1.11.2003
    Rajahmundry.
    1st complainant
    4
    802519278
    1,00,000/-
    6.12.2003
    Rajahmundry.
    1st complainant
    5
    802522571
    5,00,000/-
    7.3.2004
    Rajahmundry.
    2nd complainant

    The complainants made claims on 8.11.2004 in respect of the above said polices, for which they are nominees. But, to the surprise of the complainants the claims were repudiated by the 3rd opposite party herein vide its letter Dt.30.1.2006 on the ground that the life assured had suffered from acute Myeloid Leukemia, for which he consulted a reputed hospital prior to the date of commencement of the policy. It is submitted that in fact the deceased life assured never suffered from any disease much less the alleged Leukemia at any point of time prior to taking the policies in dispute. The complainants preferred revision before the Zonal office, but in vein and confirmed the earlier repudiation on 14.3.2007. So, the opposite parties without considering the genuine claims of the complainants improperly repudiated the claims thereby causing mental agony to the complainants which amounts to deficiency in service on the part of the opposite parties. But surprisingly the 3rd opposite party after repudiating the claim made payment of Rs.1,00,000/- against the policy No.802505943 on 27.4.2007 even though the Zonal office confirmed the repudiation of policies on 14.3.2007. The present complaint is with regard to other policies for which the complainant are entitled as there is every deficiency of service on the part of the opposite parties. Hence, this complaint.
    3. The opposite parties filed their written version denying all the main and material allegations made in the complaint and the complaint is not maintainable either in law or on facts. It contended that it is not true and correct that the deceased life assured died due to a sudden effect of jaundice and there is no possibility to join the deceased in hospital. It is true that the deceased life assured obtained policies vide NOs.802305643, 802518912, 802519278 and 802522571 from the Rajahmundry main branch and the policy bearing No.801756137 from the Ravulapalem. In the said policies one policy bearing No.802522571 one K V Bapiraju brother of assured was placed as nominee and for the rest of the policies deceased’s wife was placed as nominee.
    It was contended that the life assured did not disclose the particulars of the earlier policies, while applying for the policies in the subsequent proposals submitted at Rajahmundry and Ravulapalem. AS per the death certificate received by this opposite parties, the DLA died on 5.8.2004 at Rajahmundry. It was further submitted that the 1st complainant informed in her letter of intimation on 18.11.2004 under four policies for which she was nominated stating that her husband was died with blood cancer with jaundice. The 2nd complainant informed vide his letter Dt.24.11.2004 under policy No.802522571 the cause of death has been stated as blood cancer with jaundice. Later the corporation received claim forms from both the complainants wherein the cause of death stated as jaundice.
    On enquiry by our investigating officials it is learnt that the life assured had obtained B+ve blood from Jagruthi blood bank, Rajahmundry 14 times from 23.4.2004 to 31.7.2004, which was confirmed by the said blood bank vide their letter Dt.9.11.2005 stating that the DLA obtained the blood as his platelet count is low due to acute Myeloid Leukemia. It is further submitted that the Sowbagya hospital doctor who is family physician of the deceased life assured orally informed that the deceased took treatment for cancer in one of the hospitals at Visakhapatnam. Our enquiries made at lines club cancer hospital, Visakhapatnam fetched nothing about the treatment of DLA. One Thota Krishna Kumar Brother in law of DLA in his letter Dt.23.7.2005 stated that the DLA used to visit Dr Paramahamsa, after expiry of DLA the said Dr Paramahamsa informed them that the life assured underwent blood transfusion through Sowbhagya hospitals. It is further submitted by this opposite party that the agent who canvassed the policies bearing No. 802505943, 802519278 and 802518912 respectively is a relative of the DLA and there is no possibility of the agent not knowing the health condition of the DLA. It is further submitted that the complainants informed in the claim forms that the DLA died of jaundice and there is no treatment, but they informed in their intimation that the DLA died of blood cancer and jaundice. It is further submitted that the blood transfusion was done very close to the date of commencement of policy and the blood transfusion is generally required at the last stage of cancer. It is further submitted that the DLA had taken high risk plans within short duration for huge some assured. The life assured submitted the proposal for assurance and he answered the following questions as follows:
    (a) During the last five years did you consult a medical practitioner for any ailment requiring treatment for more than a week? Ans: No.
    (b) Have you ever been admitted to any hospital or nursing home for general checkup, observation, treatment or operation? Ans: No.
    (c) Are you suffering from or have you ever suffered from ailments pertaining to Liver, stomach, Heart, lings, Kidneys, Brain or Nervous system? No.
    (d) Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Presure, Low Blood Presure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease? Ans:No.
    (e) What has been your usual state of health ? Ans: Good.


    The above answers were false and the life assured had suffered Acute Myeloid Leukemia and the details of the said ailment, till the treatment was not disclosed in the proposals which are material for assessing the risk and the deceased life assured made incorrect statement and withheld correct information from the corporation regarding his health at the time of effecting insurance. As the life insurance contracts are based on contract of utmost good faith there is a bounden duty on the contracting parties to disclose all facts which are material. So, it is submitted that the deceased life assured has deliberately suppressed his past illness and treatment with an intention to defraud the opposite parties and to make money. Hence, this opposite parties submits that the repudiation basing on the evidence collected and as per the declaration made by the proposal at the end of the proposal. So, the decision of repudiation of claim by the opposite parties is legal and there is no deficiency of service on the part of the opposite parties. Hence, the opposite parties prays the Honourable Forum may be pleased to dismiss the complaint with costs.



    4. Heard both the parties. Both the parties filed their written arguments.




    5. Points to be considered in this case are that;


    1. Whether there is any deficiency in service on the part of the opposite parties?
    2. Whether the complainants are entitled for the claim amounts and other
    reliefs asked for? If so, to what extent?


    6. Exs.A.1 to A.13 were marked on behalf of the complainants and Exs.B.1 to B.23 were marked on behalf of the opposite parties.




    7. Admitted facts in this case are that the deceased life assured i.e the 1st complainant’s husband and brother of the 2nd complainant obtained five life insurance policies from the opposite parties during his lifetime. Out of which the policy bearing number 801756137 for a sum assured Rs.50,000/- on 28.3.2003 at Ravulapalem branch vide Ex.A.2 of the 3rd opposite party herein, rest of the policies bearing numbers 802505943 for Rs.1,00,000/- Dt.28.3.2002 vide Ex.A.1, 802518912 for Rs.5,00,000/- Dt.1.11.2003 vide Ex.B.22, 802519278 for Rs.1,00,000/- Dt.6.12.2003 vide Ex.B.23 and 802522571 for Rs.5,00,000/- Dt.7.3.2004 vide Ex.B.13. The DLA’s wife was nominee to the above said policies except the policy bearing No.802522571 for Rs.5,00,000/- for which the brother of the DLA i.e the 2nd complainant herein was placed as nominee. The DLA died on 5.8.2004 at Rajahmundry vide Ex.B.7=Ex.A.7. The opposite parties paid only one policy amount of Rs.1,00,000/- vide policy No.802505943 vide Ex.A.1 on 27.4.2007 vide Ex.A.13 to the 1st complainant and the remaining amounts on four policies including the 2nd complainant who was nominee for the policy bearing No.802522571 were repudiated by the opposite parties on 30.1.2006 vide their repudiation letters Exs.B.11 and B.20 and the same was confirmed by RM vide Ex.B.21.




    8. POINT NO.1: The case of the complainants is that the opposite parties paid only one policy amount of Rs.1,00,000/- pertaining to the DLA, though the DLA obtained five policies in all amounting to Rs.12,50,000/- during his life time. The opposite parties repudiated the claims of the complainants herein with a baseless allegation of blood cancer as against the ailment of jaundice with which the deceased died on 5.8.2004. So, the complainants contention is that they are entitled for the rest of the amounts totaling to Rs.11,50,000/- as per the polices obtained by the DLA during his life time.

    Whereas the opposite parties contended that the deceased life assured obtained 5 policies from the opposite parties, withholding the information with regard to his ailment and treatment of Acute Myeloid Leukemia and incorrect statements while submitting proposals for the above said policies. The DLA gave false answers to the questionnaire in the proposals under Column.11A supplied by the opposite parties, so that the opposite parties denied an opportunity of arriving a correct decision in accepting the risk. The 3rd opposite party herein made payment of Rs.1,00,000/- against policy No.802505943 on 27.4.2007 as the said policy crossed 2 years period.
    On perusal of the entire record placed before the Forum, We find that the contention of the opposite parties is that the DLA failed to mention and suppressed the fact about the earlier policy bearing No.802505943, while obtaining policy-bearing No.801756137 from Ravulapalem branch, further, this policy number.801756137 was not disclosed while obtaining policy No.802522571. With regard to this contention of the opposite parties, it is found that the policy bearing No.801756137 for Rs.50,000/- was obtained through an agent by name M S N Prabhakar Rao. On observation of the proposal for this policy it is found that the DLA subscribed only his signature on the proposal for this policy without his presence, but the rest was nothing but the handy work of the so-called agent of the opposite parties as the height of the DLA was noted as 174 Cms, whereas in all other proposals the height of the deceased was mentioned as 165 Cms. Further, the said proposal was obtained under medical category and signed by the panel doctor of the opposite parties by name Dr Chinta Papareddy of Ravulapalem and we do not understand how the panel doctor of Insurance company could certify the proposal without the proposor. If the panel doctor really examined the DLA in the present case, he could correct the height of proposor in the proposal form, even though the form was completed by the agent or others. This shows that the agents and officials of the opposite parties without verification of the statements and information furnished by the proposors, doing insurance business even in the absence of the proposors under the guise of procuring life insurance policies from the general public.
    Further, it is also observed that all the policies in the present case, were issued by the opposite parties after taking a reasonable time for acceptance of the proposals made by the DLA and the opposite parties had good time to enquire about the statements made and information furnished by the DLA. Generally, the insurance companies enquire into the information furnished by the proposers like age, health and earnings after receiving proposals and before issuing policy, particularly where the proposals are for higher amounts they are used to be very cautious. Here, in the present case the proposals were submitted for policies bearing No.802518912 for Rs.5,00,000/- on 1.11.2003 and the policy bearing No.802522571 for Rs.5,00,000/- on 7.3.2004 and the policies were issued by the opposite parties mentioning the issue date as 1.4.2004. So, the opposite parties have a reasonable time to inquire into the information furnished by the DLA, but it is evident that the opposite parties failed to do so, which responsibility rests on nothing but the opposite parties. The opposite parties for the non medical policy issued by them vide No.802519278 for Rs.1,00,000/- on 6.12.2003, the opposite parties relied on medical report filed in the proposal for policy No.802518912 for Rs.5,00,000/- on 1.11.2003.
    The opposite parties alleged that the complainants herein in their death intimation and claim forms stated that the cause of death was jaundice and blood cancer, but in the claim statements they mentioned that the DLA died of jaundice and the complainants did not give any particulars in medical attendance certificate and stated that the DLA was not hospitalized. On perusal of Death intimation vide Ex.B.4, B.5 =Ex.A.8 and Ex.B.6 and B.14 claim forms it appears that the matter was same in this documents and was written in English by some one else for which the complainants subscribed their signatures only and the complainants might not aware of what it contained. Further, as per Ex.B.18 letter Dt.23.7.2005 purported to be written by one Thota Krishna Kumar who is said to be the brother in law of the DLA is also not supported by any constructive evidence and what prompted him to write that letters.



    It is further observed that the opposite parties herein relied on Ex.B.19 document while repudiating the claim of the complainants. But, the doctor by name G Nageswara Rao of Jagruthi blood bank who issued the certificate under Ex.B.19, and the details appended to this certificate regarding issuance of blood to the DLA was prepared on ordinary papers and even one of them is nothing but a rough paper of the opposite parties with improper details and they were not the extracts of the records pertaining to the Jagruthi blood bank, which was a registered blood bank with the Government which is supposed to maintain blood indent register as per the rules and can be secured by the opposite parties to prove their case. Further, it is also observed that as per the blood indent details contained in Ex.B.19 it was mentioned on the first page that “the deceased has been treated as OP as entered in the OP register either one or two days earlier to issue of blood by the blood bank or on the same day. It is further observed on perusal of Ex.B.19 that the DLA obtained B+ve blood in all 14 times from Jagruthi Blood bank stating that his platelet count is low as he was suffering from Acute Myeloid Leukemia, but there was no referring letter or indent for blood from the said Sowbhagya hospital as stated in blood indent details. Further, it was mentioned that the doctor of Sowbagya hospital is family physician of the deceased family” and signed by one C B Chowdary whose details were not mentioned. How can a third person certify that the DLA’s family physician was doctor of Sowbhagya Hospital? The opposite parties contended that the blood transfusion was done very close to the date of commencement of the policies. But there is no proof from the opposite parties, that blood was transfused on the said dates to the DLA in the said hospital. Here it is observed that the two policies for higher amounts i.e Rs.5,00,000/- proposals were submitted on 1.11.2003 and accepted on 22.11.2003, 2nd one submitted on 22.2.2004 and accepted on 7.3.2004 by the opposite parties and issued policies on 1.4.2004. Whereas, as per Ex.A.19 details for the first time it was mentioned that DLA obtained blood on 23.4.2004, but there was no evidence that blood was transfused to the DLA on the said dates and there is no authenticated evidence that the said Jagruthi blood bank authorities supplied blood to the DLA on the said dates and that blood was transfused to the DLA at the said Sowbhagya hospital.


    Whereas, as per Ex.A.6 medical certificate issued by one Dr S V T R K Paramahamsa of Sowbhagya Hospital certified that “the DLA was examined by him at DLA’s house on 3.8.2004 and found to be having severe jaundice and as the deceased was taking some nature treatment at Vella, the doctor did not interfered in their treatment but, prescribed and executed intravenous fluids to correct dehydration for two days and the patient was expired on 5.8.2004 due to hemorrhage followed by shock. There is nothing mentioned about Acute Myeloid Leukemia. Further, the opposite parties in their version stated that the doctor of Soubhagya Hospital orally informed that the DLA had taken treatment for cancer at Visakhapatnam, but they themselves admitted that the enquiries made by their officials for possibility of treatment at Lions Club Cancer Hospital, Visakhapatnam revealed nothing. The opposite parties failed to prove contra for the contention of the complainants that the DLA was not hospitalized before his death.




    The opposite parties in their repudiation letter showed the reasons as the DLA gave false answers under Column.No.11 (a) (b) (d) (e) and (i) contained in the proposal form submitted at the time of obtaining policies from them and the DLA had suffered from Acute Myeloid leukemia for which he had consulted a reputed hospital prior to the date of commencement of the policies and had taken treatment. The proposals were submitted on 28.3.2003,1.11.2003, 4.12.2003 and 22.2.2004 while he was suffering from the above ailments and the details of the said ailment and treatment was not disclosed in the proposal, which is material for assessing the risk. But the opposite parties failed to prove the above said reasons stated for the repudiation of claims preferred by the complainants with any constructive proof of evidence, that the DLA took treatment for the said ailment in any hospitals before obtaining policies or after obtaining the said policies.



    The complainant relied on the following decisions reported in
    1)2009 CPJ 324, Himachal Pradesh State Consumer Commission, between Life Insurance Corporation of India Vs Kanthadevi, wherein it was held;” Even if it be assumed for the sake of argument that the deceased was suffering from cancer, does not show any nexus between the cause of death and the alleged disease of cancer from which he was suffering according to the appellant”.


    2)II 2008 CPJ 374, APSCDRC between United India Insurance Company Vs Anumolu Ramakrishna wherein it was held that; “Consumer Protection Act, 1986 – Section 2(1)(g) – Insurance – Repudiation of claim – Suppression of material facts alleged – Life assured suffering from alleged disease and was in knowledge of disease, deliberately suppressed it prior to issuance of policy, not proved – Deficiency in service on part of insurance company proved – Complaint allowed by Forum – Order upheld in appeal”


    3)2008 NCJ 353 (NV)NCDRC, between M/s Mono Industries Vs New India Assurance Company Ltd, wherein it was held that;”if the amount is with held by the insurance company for years together lump sum award as compensation covering both interest and costs not suffice. Hence, just compensation is required to be awarded. Just compensation would mean award of reasonable rate of interest in case of loss suffered in terms of rupees. In other words proper measure or yardstick for granting compensation would be award of appropriate of rate of interest on the amount which complainant would have received had the claim been settled at the right time”.


    4)2005 NCJ 272 (NC) NCDRC, New Delhi between Life insurance corporation of India Vs Badri Nageswaramma (Deceased ) and others wherein the apex commission relied on earlier decision of Apex court in LIC of India Vs Chennabasamma AIR 1991 SC 392 and in LIC and others Vs Asha Goel (2001) 2 SCC 160, it was held that the burden of proving that the insured had made false representations and suppressed material facts is undoubtedly on the corporation, basing on this it was held that; “ as there is no conclusive evidence on record to suggest that there was any suppression on the part of the deceased, the insurance company has failed to prove the suppression on the part of the deceased relying”.


    5) 2005 NCJ 340 (NC), NCDRC, New Delhi between National Insurance Company Ltd Vs Bipul Kundu wherein it was held that; Consumer Protection Act, 1986 – Section 21(b)- Insurance Claim – Repudiation by insurer – Rheumatic heart disease – No evidence on record – Held – Repudiatin unjustified and baseless – Company liable to pay amount of policy”


    6) 2002 (4) ALD 520 Branch Manager, LIC of India, Kodad and another Vs Ambati Laxmamma, wherein it was held that;”Insurance Act, 1938 – Sec.45 – Repudiation of policy by Life Insurance Corporation on the ground of mis-statement by policy holder at the time of revival of policy – Corporation failed to establish that the misconduct was made by the policy holder and with a fraudulent intention – In case of any doubt, benefit should go to the policy holder or claimants – Hence, the Corporation has to pay the amount covered by the policy to the claimants”.
    Whereas, the opposite parties relied on the following decisions reported in:
    1)Uttar Pradesh State Consumer Disputes Redressal Commission, Lucknow
    between Shahida Khatoon Vs LIC of India & others.
    2)II 2003 CPJ 135 (NC) NCDRC, New Delhi between LIC of India Vs Mansa Devi.
    3)III 2003 CPJ 15 (NC) NCDRC, New Delhi, between Panni Devi Vs LIC and
    others.
    The opposite parties also filed some medical literature with regard to Acute Myeloid Leukemia.
    The decisions filed by the complainants are very much applicable to the facts and circumstances of the present case. Whereas the decisions filed by the opposite parties including the medical literature about Acute Myeloid Leukemia however not applicable to the facts and in the context of the case.


    With the above said discussion and on perusal of the decisions reported by both the parties, we are in the considered opinion that the complainants herein are entitled for the claims preferred by them with the opposite parties under the above disputed policies obtained by the DLA during his life time as the opposite parties miserably failed to prove their case with any cogent evidence and we opine that the repudiation was made in a routine and negligent manner, for which kind of act the complainants suffered mental agony to some extent. Hence, the opposite parties herein are liable to pay an amount of Rs.11,50,000/- in all as claimed by the complainants in the present complaint under the above said four policies in dispute with accrued benefits if any, on the policies along with a reasonable interest ,since the claims are pending for a long time with the opposite parties. The 1st and 2nd complainants are entitled for the respective claim amounts for which they were nominated by the deceased DLA. However, the opposite parties are entitled to deduct the premium amounts due on the said four policies if any for that current year in which the DLA died.


    9.POINT NO.2: In the result, the complaint of the complainants is allowed directing the opposite parties to pay an amount of Rs.11,50,000/- (Rupees eleven lakhs fifty thousand only) on the four policies in dispute with accrued benefits if any on that policies along with interest @9% P.A from the date of repudiation i.e 30.1.2006 till payment after deducting the due premium amounts if any on the said policies. We further direct the opposite parties to pay an amount of Rs.2,000/- (Rupees two thousand only) towards the costs of this complaint.

  15. #30
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    Order delivered by Sri. Nazeer Ahmed U. Shaikh, Member
    1)This is a complaint praying to direct the OPs to pay the remaining 50% of the insured amount with interest and costs.

    2)Brief facts of the complaint are that the mother of the complainant while working under OP-3 as a sweeper took two LIC policies under No.631589-305 and 631589306 each for Rs.1,00,000-00 under Salary Saving Scheme (SSS) with the OPs1&2. She expired on 20-10-2006. The complainant being the nominee submitted claim with the OPs 1&2. They paid 50% of the insured amount, but refused to pay the 50% remaining amount through letter dated 16-6-2007. This is the deficiency of service by the OPs and they are liable.

    3)The OPs 1 & 2 appeared and filed WS. The OP-3 failed to appear before this Forum even after service of notice. Hence the OP-3 is set ex-parte.

    4)The OPs 1 & 2 filed WS admitting the issuance of the policies, the complainant being the nominee and payment of 50% of the insured amount to the complainant after the death of the insured, and further stating that the Life Assured failed to pay the premium for 5 months and the policy was in lapsed condition. A letter was issued to the life assured regarding the non-payment of 5 premiums. But there was no any reply from her. On humanitarian grounds the OPs have considered the claim and paid the half of the sum insured. There is no deficiency of service by OPs and they are not liable to pay the balance amount.

    5)Both the parties have filed their affidavits. The complainant has got marked Ex.C-1 to C-9 and the OPs1&2 Ex.R-1 to R-5.

    6)The point that arises for our consideration is: “Whether there is deficiency of service on the part of the OPs?

    7)We have heard both the counsels in length. It is admitted fact that the mother of the complainant while she was working under OP-3 insured her life under 2 policies, under SSS with the OPs 1 & 2. After the death of the life assured the OPs 1 & 2 have paid 50% of the insured amount to the complainant and denied to pay the balance amount for the reason that the life assured even after issue of notice has not paid 5 premiums. Ex.R-5 is a copy of letter said to be sent by the OPs to the life assured. But there is no record to show that the letter has reached the life assured. The OP-3 being an agent of the OPs 1 & 2 has to make payment of the premiums regularly to the OPs 1 & 2. The failure to pay the premium amount by the employer makes liable the insurance Company to pay the full insurance amount with all benefits. The non-payment of the insured amount is deficiency of service on the part of the OPs and they are liable with cost of the complaint.
    So, we pass the following order.
    ORDER

    The complaint is allowed. The OPs are directed to pay to the complainant the balance 50% of the assured amount with all benefits and with cost of Rs.1000-00

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