DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KANDHAMAL, PHULBANI
C.C NO. 39 OF 2015
Present: Sri Rabindranath Mishra - President.
Miss Sudhiralaxmi Pattanaik - Member.
Sri Purna Chandra Tripathy - Member.
Smt. Ambika Sahu, aged about -42 years
W/O: Late Bipra Charan Sahu Vill: Bhubaneswari Sahi, Peon pada
Po/PS: Phulbani Dist: Kandhamal ……………………….. Complainant.
Versus .
1. The Branch Manager,
L.I.C of India, Phulbani Branch
At/PO/PS: Phulbani Dist: Kandhamal
2. The Sr. Divisional Manager,
L.I.C of India, Berhampur Division
AT: Khodasingi, Main Road, Berhampur Dist: Ganjam.
3. The Zonal Manager, L.I.C of India
East central Zonal Office, Jeevan Deep Building
6th Floor, Exhibition Road, PATANA – 800001. ………………………. OPP. Parties.
For the Complainant: Sri Sidheswar Das,Advocate, Phulbani
For the OPP. Parties: Sri Bijay Kumar Mohanty, Advocate, Phulbani
Date of Order: 28-07-2016
O R D E R
The case of the Complainant in brief is that her husband Bipra Charan Sahoo started a policy bearing No. 572906289 on 13-03-2010 under the plan term 179-20-20 and the quarterly premium was Rs.1254/-. The sum assured of the said policy is Rs.1,00,000/- and the Complainant was his nominee being his wife . On 02-09-2011 he died suddenly in his residence at
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Phulbani. He has deposited all the premiums before his death and the said policy was in- force at the time of his death. The Complainant being nominee applied to the O.P No.1 in the prescribed format along with the death certificates and other relevant documents to get the death benefit but the O.Ps threw a deaf year in spite of several approaches. In the month of December 2014 she approached the O.Ps for the last time to get the death benefit of the policy of her deceased husband. Due to nonpayment of death benefit the Complainant was harassed and suffered mentally and filed this complaint against the O.Ps for a direction for payment of the assured sum of Rs. 1,00,000/- with interest and bonus as admissible along with 30,000/- as compensation and Rs. 5,000/- towards cost of litigation . She has filed the copies of relevant documents along with her complaint petition.
The case of the O.Ps as per their joint version is that the policy holder was a patient and was under treatment continuously. It is ascertained by them that the policy holder was under treatment at M.K.C.G Medical College Hospital Berhampur vide OPD case No. 19731 and Registration No. 5411 dated 23-03-2011. Due to his illness he had not deposited the premiums from June 2010 to March 2011. The policy holder had suppressed the fact of his illness and submitted declaration form as good health at the time of reviving of the said policy. On good faith the O.P revived the policy which was lapsed due to nonpayment of premiums in due time. It is also ascertained that the policy holder was admitted as indoor patient at District Head Quarter Hospital, Phulbani since 28-06-2011 before his death on 02-09-2011. The policy holder was under treatment of Dr. Charan Panda, Assistant Professor of Surgery, M.K.C.G Medical College, Berhampur as well as under Dr.Sambit Kumar Mohanty and Dr. Sudarsan Sethy at District Head Quarter Hospital, Phulbani continuously. He was suffering from CARCINOMA STOMACH at M.K.C.G Medical College Berhampur and he was admitted at District Headquarter Hospital, Phulbani for chemotherapy continuously till his death. He deposited the premium of four quarters at a time by suppressing the fact of illness with intention to defraud the corporation. So, the claim was repudiated by the O.Ps. The Complainant has also suppressed the truth by not producing the relevant documents regarding the treatment of the policy holder for which the O.ps required time for finalization of the claim. As the policy holder as well as the Complainant suppressed the material fact and ill health at the time of reviving of policy and earlier she is not entitled to get any benefit as claimed, for which the complaint may be dismissed.
During course of hearing the Complainant has filed an affidavit in token of evidence and she was examined and cross examined in this case. Non examined on behalf of the O.Ps. Exit-1 to Exit -8 were marked on behalf of the Complainant and no documents were filed on behalf of the O.Ps.
We have heard the Complainant and her counsel and also the counsel of the O.Ps. We have gone through the complaint petition, the version filed by the O.Ps, the affidavit and deposition of the Complainant and the copies of documents marked Exhibits 1 to 8 on behalf of the Complainant. The sole point of consideration in this case is that whether the deceased husband of the Complainant has suppressed his illness at the time of revival of the policy and earlier.
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It is seen from Exit -1 that this policy was started on 13-03-2010 and the name of the Complainant was mentioned therein as nominee being the wife of the policy holder. Exit-4 is the discharge record given by M.K.C.G Medical College , Berhampur wherein it is mentioned that the husband of the Complainant was admitted on 05-05-2011 and discharged on 26-05-2011 for treatment of CARCINIMA STOMACH .Exit -5 & Exit -5/1 are two discharge certificates issued by D.H.H. Phulbani . It transpires from this discharge certificates that the husband of the Complainant was admitted under the said hospital on 28-06-2011 and discharged on 03-07-2011 and subsequently admitted on 27-07-2011 and discharged on 02-08-2011 for his stomach problem. Exit -8 is the death certificate of the husband of the Complainant and the date of death of the policy holder was on 02-09-2011. So, on 30-03-2011 on the date of revival of the policy the policy holder was not under treatment neither at M.K.C.G Medical College hospital Berhampur nor at District Head Quarter Hospital, Phulbani as reveals from Exit-4, Exit-5 and Exit-5/1. In the said circumstances the plea taken by the O.Ps that the policy holder was under treatment on 23-03-2011 prior to 30-03-2011 the revival date is not sustainable. The onus lies on the O.Ps to prove that the policy holder was under treatment on or before 30-03-2011 the date of revival of the policy. No evidence was adduced by the O.Ps, in this regard. The concerned doctor was also not examined by the O.Ps to support their stand. There is no other evidence also to support the plea of the O.P. Hence, it cannot be said that the policy holder and nominee suppressed the material fact of illness of the deceased at the time of the original policy and it’s renewal. Accordingly the defence failed and repudiation of the claim of the nomine of the policy holder made by the Senior Divisional Manager, Berhampur, the O.P No.2 is not justified.
In the above circumstances, the complaint filed by the Complainant is allowed. The O.Ps are jointly and severally liable to pay the death claim of the policy holder to the nominee, the Complainant of this case. Accordingly the O.P No.1 on behalf of all the O.Ps is directed to pay Rs. 1, 00000/- the sum assured under the relevant policy along with other admissible benefit if any as per provision to the Complainant the nominee of the deceased with 10 % annual interest from the date of death of the policy holder it is on 02-09-2011 till the date of payment. The O.Ps are further directed to comply the said order within 30 days from the date of receipt of this order otherwise the Complainant shall be entitled to get 12 % annum interest from 02-09-2011 till the date of Payment .
MEMBER MEMBER PRESIDENT
