Karnataka

Bangalore 4th Additional

CC/15/975

Smt. Sumangala - Complainant(s)

Versus

The Zonal Manager LIC Of India - Opp.Party(s)

17 Apr 2018

ORDER

Complaint filed on: 18.05.2015

                                                      Disposed on: 17.04.2018

 

BEFORE THE IV ADDL DISTRICT

CONSUMER DISPUTES REDRESSAL FORUM, BENGALURU

 1^ST FLOOR, BMTC, B-BLOCK, TTMC BUILDING, K.H.ROAD, SHANTHINAGAR, BENGALURU – 560 027       

 

 

CC.No.975/2015

DATED THIS THE 17^th APRIL OF 2018

 

PRESENT

 

 

SRI.S.L.PATIL, PRESIDENT

SMT.N.R.ROOPA, MEMBER

 

Complainant/s: -                           

Smt.Sumangala

W/o Sri.Shivakumarappa,

Aged about 72 years,

#176/B, 7^th cross,

1^st N block, Rajajinagar, Bengaluru-10.

 

By Adv.Sri.G.M.Paramasivaiah     

 

V/s

Opposite party/s

Respondent/s:-

 

1. The Zonal Manager,

LIC of India,

South Central Zone office,

“Zeevan Bhagya,” Saifabad, Hyderabad-500063

 

2. The Senior Divisional Manager, LIC of India,

Yeshwanthpur Branch Office, Divisional Office-1,

“Jeevan Prakash,”

J.C.Road,

Bengaluru-02.

 

3. The Senior Branch Manager,

LIC of India,

Yeshwanthpur Branch, Benglauru

 

By Adv.Sri.Rajesh Shetty

 

 

PRESIDENT: SRI.S.L.PATIL

 

 

            This complaint is filed by the Complainant against the Opposite party no.1, 2 & 3 (herein after referred as Op.no.1, 2 & 3 or Ops or LIC) seeking issuance of direction to pay all amounts due under the policy no.616599263 of K.S.Hemanth of Rs.5 lakhs with interest at 24% p.a. from 14.07.14 till realization as compensation and to grant such other reliefs deem fit for which the Complainant is entitled to.

 

          2. The brief facts of the case of the Complainant are that, she is the mother of the deceased K.S.Hemanth and he had taken a LIC policy of Assurance bearing no.616599263 dtd.17.11.11 when he was aged about 44 years. The life assured was hale and healthy at the time of taking policy. The policy was issued by Op after subjecting the life assured to all required medical tests and after satisfying itself as to the medical reports.  The policy was for Rs.5 lakhs. The Complainant further submits that, however the life assured suffered heart attack on the morning of 14.07.14 at his residence. The doctor on examination of K.S.Hemanth declared him dead at 9.42 am, he was buried in Complainant’s own land at Doddaballapura Dist., The Complainant made a claim before the Op.no.3 on 02.11.14 with the original LIC policy. The Complainant further submits that, Op.no.2 by its letter dtd.05.01.15 has repudiated the claim alleging that the deceased had withheld material information regarding his health at the time of effecting the assurance with LIC. It is stated in the proposal for assurance dtd.20.10.11 that the life assured had answered clauses 11(a), (b), (d) and (e) as NO and answered clause 11(i) as to the state of health as GOOD. These answers according to Op.no.2 were false alleging that LIC has evidence and reasons to believe that the deceased was not in good health and was suffering from hypertension & chronic gastritis and that he had consulted medical men for taking treatment much earlier to the date of proposal. It is further alleged that the deceased had made deliberate misstatements and withheld material information regarding his health and therefore LIC is not liable for payment. The Complainant further submits that, since the allegations made by Ops to repudiate the claim is totally wrong and untenable, an appeal was preferred before Op.no.1 on the following among other grounds:

a. The life assured was hale and healthy at the time of proposal and he had not made any mis-statement or withheld any material information regarding his health at the time of effecting the assurance.

b. That the life assured did not suffer from any acute myocardial infection or hypertension. That before issue of policy to the life assured, the authorized doctors of LIC have thoroughly examined the life assured and have given the report and on satisfying as to the report on the health of the life assured, the LIC had issued the policy to the life assured.

c. The life assured died due to massive heart attack. He had not concealed any material information at the time of proposal. Even presuming but not admitting, the life assured was suffering from hypertension, in common parlance this hypertension is not a decease as such. Therefore repudiation on the basis of hypertension cannot be sustained in law.

d. That the proposal is supported by medical examiners confidential report given by the authorized medical examiners of LIC of India and therefore the issue of policy was not only based on the statement of the life assured but also based on the medical examination reports of the medical personnel of Op. Therefore repudiation of the claim by Op because the policy is less than 3 years old and alleging material suppression, which is not true, is not sustainable in law.

e. That there is no evidence or proof whatsoever to come to the conclusion that the life assured had concealed or withheld any material information at the time of proposal. The stand taken by Op is baseless and misconceived.

f. that viewing the matter from any angle, the alleged reasons given by the Senior Divisional Manager of LIC to repudiate the claim under the policy is illegal and baseless cannot be sustained in law.

 

Accordingly it was prayed to set-aside the order of repudiation dtd.05.01.15 of Op and allow the claim of K.S.Hemanth, but Op.no.1 has failed to take any action in the matter. The Complainant further submits that, the LIC has issued the policy after satisfying itself as to the requirement and compliance on the part of the policy holder for issue of the policy. The policy was in force as on the date of death of the policy holder as all the premiums have been paid up to date and therefore there is no reason for OP to repudiate the claim but the same is done on false and untenable grounds. The Op has adopted unethical trade practices in repudiating the claim of the Complainant. Hence this complaint.

3. On receipt of the notice, Op.no.1 to 3 did appear and filed common version denying the allegations made in the complaint except admitting that deceased K.S.Hemanth was the holder of the Life Insurance Policies. Ops submit that, they examined the matter properly and correctly and after confirming that the life assured had suppressed the material facts, the Ops have repudiated the claim. The repudiation is perfectly in accordance with law and with valid reasons supported by valid documents and evidence. Therefore there is absolutely no deficiency of service. Ops further submit that, the relief sought for by the Complainant are discretionary reliefs and as such she is required to set out true facts and further required not to suppress material facts. But then the Complainant is guilty of suppression very and suggestion falsi. Ops further submit that, K.S.Hemanth submitted a proposal for insurance on own life to the Op on 2010.11. In the proposal form, titled the personal history regarding his health, the life assured answered the questions at column 11(a) to (f)(h)(i) as ‘NO’ and 11(i) as ‘GOOD’. Ops further submit that, K.S.Hemanth has also given a declaration in the proposal form that the statements and answers given by him are true and complete in every respect and that he has not withheld any information and also declared that if any untrue averments were contained in the proposal form the contract shall be absolutely null and void. No medical report was submitted/obtained along with the proposal form and based on the underwriting rules and answers given in the proposal mainly at clause 11 the proposal was completed under non-medical. Ops further submit that, on the basis of the information furnished by the life assured in the proposal form, the Op issued LIC’s Jeevan Tarang Policy (with profits) bearing no.616599263 for sum assured amount of Rs.5 lakhs with date of commencement of policy on 17.11.11 and date of maturity 17.11.2032. As per policy conditions K.S.Hemanth was required to pay installment premium of Rs.25,541/- very year. Further he had nominated his mother Smt.Sumangala in respect of the policy u/s 39 of the Insurance Act, 1938 to receive the policy money in the event of his death before receiving the payment on maturity. Ops further submit that, Complainant informed about the death of K.H.Hemanth and submitted a claim to the Op.no.3 to settle the death claim. While considering the claim may by the Complainant, the Op made investigation and it was observed that the life assured was a patient since 2009 and was hypertensive and was under treatment. The life assured also had chronic gastritis and was taking treatment for the above ailments from Dr.Susheela Suresh. Ops further submit that, on further investigation in to the cause of death of K.S.Hemanth it was observed that the antecedent cause of death of the life assured is hypertension and immediate cause of death of the life assured is Acute Myocardial infection. Ops further submit that, the insured had withheld correct/material information regarding his health at the time of taking insurance policy no.616599263 & 698387423 and hence violated the basic principles of Utmost Good Faith applicable to insurance policies. Ops further submit that, the answer to the questions in clause 11 of the proposal form were false as the life assured had suffered from hypertension and chronic gastritis and had taken treatment from Medical practitioner for the above ailment since 2009. It is therefore evident that the life assured had made incorrect mis-statement and withheld correct information from the Op regarding his health at the time of effecting the insurance. It is obligatory on the part of the insured to give correct answers at the time of obtaining insurance policy. As the life assured suppressed material facts regarding the disease, the claim was rightly repudiated. Ops further submit that, the Complainant nominee is the mother being a close associate of the assured who states that the assured was residing with his parents ridiculously in the complaint has stated that her son was hale and healthy at the time of taking policy and that he did not suffer from any acute myocardial infection or hypertension. By this it is evident that the Complainant is also trying to suppress the real facts knowingly well aware of all the health status of her son and the treatment obtained by him earlier to commencement of policy till the date of his death. Both the insured and the Complainant have intentionally suppressed the real facts and succeeded in obtaining the policy. Under the circumstances the decision arrived and taken by the Op in repudiating the policy is quite correct and appropriate decision. Ops further submit that, at the time of submitting the proposal the assured has not disclosed the details of the policies previously taken by him from the Op at clause 12C of the proposal form. This is very relevant and important to decide whether insurance cover can be given to the assured or not. Based on his physique, financial position and based on his total sum at risk the LIC would have called for some special reports or requirements and on the merits of the said reports the LIC would have considered whether to issue the policy or defer or withdraw or impose extra premium. Since the life assured had suppressed the true and material facts regarding previous policies taken by him in the proposal form, on this ground also the claim made by the Complainant is not sustainable in law. Ops further submit that, only at the time of submitting the claim form the Complainant has disclosed the details of policies previously taken by the insured from various branches of the Op. From the above it is clear that the life assured knowingly did not disclose the facts regarding obtaining several policies in the proposal form dtd.20.10.11 with malafide intention to avoid special reports from being called for by the Op. Ops further submit that, the policy bearing no.698387423 taken by the insured from R.T.Nagar branch of Op having date of commencement 16.04.12 was settled in favour of the Complainant by mistake. The Op is contemplating to take recovery action against the Complainant for recovery of the amount paid the Complainant in respect of the said policy before the appropriate forum. Ops further submit that, the life assured had intentionally suppressed and concealed the material facts regarding treatment taken by him for various ailments and about the details of the policies taken by him previously from the Op in the proposal form. Non-disclosure and suppression of the material facts by the life assured is intentional. In fact, such material facts lead to assess risk involved in the case. If at all the life assured had revealed the said facts, the Ops would not have issued the policies or would have issued the policies with proper terms & conditions relating to the said health report. Ops further submit that, there is no negligence or deficiency of service on the part of Ops. The Complainant has not come with clean hands and has concealed the true and material facts. The preliminary investigation conducted by Ops have proved that the life assured was not having good health at the time of taking the policy in question. Hence there is no bonafides in the complaint and the same is liable to be dismissed. Hence on these grounds and other grounds prays for dismissal of the complaint.

         

          4. The Complainant to substantiate her case filed affidavit evidence and produced 9 documents. The Manager (legal & HPF) of Op corporation filed affidavit evidence and produced 4 documents. None of the parties got marked the documents, anyhow the said documents referred as document numbers. Both filed written arguments. Heard both side.

  

5. The points that arise for our consideration are:

1. Whether the Complainant proves deficiency of service on the part of Ops, if so, whether she entitled for the relief sought for ?    
2. Whether, Ops justified the repudiation of the claim of the Complainant  ?    
3. What order ?

                   

           

 

6.  Our answers to the above points are as under:

 

Point no.1: In the Affirmative  

Point no.2: In the Negative 

Point no.3: As per the final order for the following

 

REASONS

 

          7. Point no.1 & 2: Since these points are interconnected, hence we have taken these points together for our discussion just to avoid the repetition of the facts.

 

          8. In the forgoing paragraphs, we have briefly stated the contents of the complaint as well as the version filed by Ops. The undisputed facts which reveals from the pleadings of the parties goes to show that, the deceased K.S.Hemanth who was the son of Complainant herein had taken the LIC policy of Assurance bearing no.616599263 dtd.17.11.11 when he was aged about 44 years. According to the case of the Complainant, the life assured was hale and healthy at the time of taking policy. The said policy was issued by Ops after subjecting the life assured to all required medical tests and after satisfying itself as to the medical reports.  The said policy was for an amount of Rs.5 lakhs. Soon after the death of the said insured, it was informed to Ops for the claim amount covered under the said policy. The same was denied by Ops stating that, Complainant has suppressed the pre-existing disease i.e. hypertension and chronic gastritis. According to the brief synopsis submitted by the Complainant, goes to show that, on 14.07.14, deceased suffered heart attack in the morning, doctor was summoned from Fortis hospital and doctor arrived with ambulance, examined the patient and declared dead at 9.42 a.m. That on 02.11.14, mother of the deceased Smt.Sumangala who is the Complainant herein, being the nominee under the LIC policy made a claim before Op.no.3 Senior Branch Manager, LIC along with medical report of Fortis hospital, burial report, declaratory affidavit and death certificate. On 05.01.15, Op.no.2 Senior Divisional Manager repudiate the claim on the ground that the deceased had withheld material information in his proposal form dtd.20.10.11, namely: clauses 11a, 11b, 11d & 11e filled as ‘No’, clause 11(i) as ‘Good’, but LIC stated that they are false as LIC has evidence and reasons to believe that the deceased was not in good health, stating that the deceased was suffering from hyper tension and chronic gastritis. LIC also stated that the deceased had consulted medical men for taking treatment much earlier to the date of proposal. As per the case of the Complainant, admitted facts are:

a. Issue of policy bearing no.616599263 for Rs.5 lakhs and its validity as on the date of death of the insured.

b. The claimant being the nominee under the policy is admitted in para-7 of the version of Op.

c. Claim petition made to Op.no.3 of LIC

 

     9. The LIC contends that the life assured suppressed the fact of existence of previous policies and so not eligible for compensation under the policy in question. But as admitted by LIC in para 4 of its version as well as in para 5 of its affidavit evidence, the life assured had taken as many as 7 LIC policies between 19.03.2000 and 16.04.2012 for the sums assured ranging from Rs.3 lakhs to Rs.10 lakhs, including the policy in question bearing no.616599263 for Rs.5 lakhs. All the policies were issued by LIC of India and no other insurance company. The details of all the policies issued by LIC to the life assured was within the knowledge of the LIC itself. Moreover, because of the mistake on the part of LIC agent, claimant cannot be made to suffer. Nothing prevented LIC from taking any step or precaution before issuing policies to the life assured and in fact LIC had taken all such precautions required under law before issuing the LIC policies. Therefore LIC cannot contend that they were not aware of other policies and that they were not aware of particulars or information about the life assured. More so in the present day situation where the technology has developed to such an extent that at the click of a button/key the entire history about the life assured is known. It is also submitted by the Complainant that, LIC has settled the claims under all the policies including the policy bearing no.698387423 dtd.16.04.2002 which was taken subsequent to taking of the policy in question bearing no.616599263 for Rs.5 lakhs. In this context, the Complainant has placed reliance on the following citations:

1. AIR 2001 SC 549 – it is held that matter of repudiation of policy should not be dealt with in a mechanical and routine manner but should be one of extreme care and caution.

Further held that mere inaccuracy of falsity in respect of some recitals or items in the proposal is not sufficient. The burden of proof is on the insurer to establish these circumstances and unless the insurer is able to do so, there is no question of the policy being avoided on ground of mis-statement of facts.

2. III (2014) CPJ 162 (UP) – It is held concealment of previous policies either accidentally or inadvertently or even deliberately is not a fact for repudiation of claim unless it is proved that disclosure of such facts had an adverse impact on rights of insurer.
3. III (2014) CPJ 582 (NC) – Agent’s mistake – non-disclosure of facts relating to earlier policy – not material facts –claim repudiated.

Held, legal representatives should not suffer for omission and commission of agent.

 

     10. It is also submitted that, second contention of Ops that the life assured was a patient since 2009 is patently false. The life assured was not hypertensive nor was suffering from chronic gastritis and he was hale and healthy till his death. In this context, Op has miserably failed to prove that the life assured was suffering from any ailment as complained by LIC. Except producing as document no.3 a letter dtd.11.10.14 from Dr.Susheela Suresh titled as ‘To whomsoever it may concern” and document no.4 her ‘medical certificate’ dtd.18.07.14 both of which are subsequent to the death of the life assured, no other documents either supportive to the said two certificates or any proof of treatment given are produced. Moreover, the said two certificates have been issued by none other than the LIC doctor whose LIC code number is 807611 which is borne out in the said two certificates. Further it is the contention of the Complainant that, even the contents of these two certificates throw a shadow of doubt. The certificate dtd.11.10.14 states as though Dr.Suseela Suresh attended the life assured on 13.07.14 and 14.07.14 which is not true. It also states that Dr.Suseela Suresh was treating the life assured right from 2009 till his death on 14.07.14 which is again not true and correct. No documentary proof is produced to prove. The Ops have not produced any supporting documents in this regard nor any affidavit is filed of the doctor who alleges to have treated the life assured. That is because the life assured was not suffering from the ailments complained of nor he was a patient under the LIC doctor Dr.Suseela Suresh. Further the cause of death certificate dtd.18.07.14 issued by the same doctor Dr.Suseela Suresh discloses that death occurred due to acute myocardial infection and hypertensive and the interval between on set and death was 15 minutes. Therefore, when the death was sudden as per the report in the certificate dtd.18.07.14, there was no need for the doctor to attend on the life assured on 13.07.14 when the heart attack took place on 14.07.14 all of a sudden and everything was over in 15 minutes duration. One another discrepancy which can be noticed in these certificates is that it is reported that the life assured died at 9 a.m. on 14.07.14 whereas the Fortis hospital doctor who attended on the life assured on 14.07.14 morning at the residence of the life assured reported that the life assured died at 9.42 a.m. Therefore the Complainant submits that, at the most the said two medical certificates issued by LIC doctor Dr.Suseela Suresh may be termed as self-serving documents which are at document no.3 & 4 produced by Ops. Hence, no importance can be attached to these documents in the absence of proof. Further, Complainant submits that, the information furnished by the life assured in the proposal and the answers given to questions in clause 11 thereof were true and correct and there was no suppression of any fact. It is also submitted that, the life assured died out of sudden heart attack and therefore the beneficiary under the policy was entitled for the compensation under the policy. In this context, Complainant has placed reliance on the following four citations:

1. III (2011) CPJ 327: Held that heart ailment is such a disease which can cause death of any person at any point of time and that too without having any previous symptom therefore in such cases repudiation is unjustified.
2. III (2011) CPJ 418 (NC): Contention that insure suppressed material facts pertaining to his health – not accepted – medical certificate produced by petitioner (insurer) not proved on record – production of a document is different from proof of same – ordered to settle claim with interest.
3. III (2011) CPJ 301: Held that in the absence of any evidence regarding the alleged suppression of material facts having bearing on the insurance policy in question, complaint was allowed and Op was directed to indemnify the Complainant by making payment.
4. III (2014) CPJ 340 (NC): Op did not produce any evidence to prove that which medication and how long the Complainant was taking for diabetes/hypertension- held – concealment not established – repudiation not justified.

 

       11. Therefore it is for the Ops to produce documents to prove the stand taken by them. The Ops have failed to prove that K.S.Hemanth, the life assured was undergoing treatment for any ailment by producing acceptable medical records instead of producing self-serving medical certificates issued by their own doctor Dr.Suseela Suresh. Therefore, when LIC has settled all other claims under different policies of the life assured, there is no reason or cause to deny the claimant benefit, she is entitled to under the said policy for an amount of Rs.5 lakhs.

 

          12. As we have already stated above, the reasons assigned by Op.no.1 to 3 to repudiate the claim was with regard to suppressing of pre-existing disease at the time of availment of the said policy. In this context, we do not find any substance in the contention taken by Ops, as the death of the deceased was due to heart attack nothing more than that. In this context, the decisions cited by the learned counsel for the Complainant supports the contention taken by the Complainant. In addition to the decisions cited by the learned counsel for the Complainant, we also come across with some of the following decisions:

1. Hon’ble National Commission,1 (2008) CPJ 501 NC, in the case of National Insurance company ltd., v. Raj Narain, dtd.15.01.2008, wherein at para 7 it is held that: In Revision Petition no.1696/2005, Praveen Datnani v. Oriental Insurance co. ltd., IV (2006) CPJ 189 (NC) this commission has held that:

The District forum also relied on clause 4.1 of the policy which states that it is not material whether the insured had knowledge of disease or not, and even existence of symptoms of the disease prior to effective date of insurance enables the insurance company to disown the liability.

If this interpretation is upheld, the insurance company is not liable to pay any claim, whatsoever, because every person suffers from symptoms of any disease without the knowledge of the same. This policy is not a policy at all, as it is just a contract entered only for the purpose of accepting the premium without the bonafide intention of giving any benefit to the insured under the garb of pre-existing disease. Most of the people are totally unaware of the symptoms of the disease that they suffer and hence they cannot be made liable to suffer because the insurance company relies on their clause 4.1 of the policy in a malafide manner to repudiate all the claims. No claim is payable under the mediclaim policy as every human being is born to die and diseases are perhaps pre-existing in the system totally unknown to him which he is genuinely unaware of them. Hindsight everyone relies much later that he should have known from some symptom. If this is so every person should do medical studies and further not take any insurance policy. Even on the facts on record, there is no material to show that the petitioner had any symptoms like chest pain, etc., prior to 11.08.2000. Since, there were no symptoms, the question of linking up the symptoms with a disease does not arise. In any case, it is the contention of the Complainant that he was thoroughly checked up by the doctors who were nominated by the insurance company and at that time he was found hale and hearty. In such set of circumstances, it would be difficult to arrive at the conclusion that the insured had suppressed the pre-existing disease.

In view of the above discussions and from the records available before us, in our opinion, the Complainant has proved that he was unaware of the disease at the time of taking the policy and hence the complaint is allowed.

2. Hon’ble National Commission Decision reported in II (2005) CPJ 78 NC, in the case of LIC of India Vs. Joginder Kaur & Ors, where in it is held that: Consumer Protection Act 1986 – Section 21(b) – Life insurance – Repudiation of claim – concealment of material facts alleged – contention, deceased suffering from diabetes mellitus, was chronic alcoholic and had an attack of jaundice, not acceptable in absence of any evidence in support – complaint rightly allowed by State Commission – no interference required in revision.
3. Punjab SCDRC, Chandigarh decision reported in I (2001) CPJ 53 in the case of LIC of India Vs. Charanjit Kaur, wherein it is held that: Consumer Protection Act, 1986 – Section 15 – Appeal – Life insurance – repudiation of claim – suppression of material facts – onus of proving that deceased made false statement lies on insurance company – death due to hypertension and abdomen pain not proved – Complainant entitled to get policy amount along with interest.
4. Hon’ble National Commission (Circuit Bench at Hyderabad) Decision reported in II (2005) CPJ 9 (NC), in the case of Life Insurance Corporation of India Vs. Badri Nageswaramma (deceased) & Ors, where in it is held that: Consumer Protection Act 1986 – Section 21 – Life insurance – Repudiation of claim – Deceased an old T.B patient, having diabetes, not known on date of proposal – burden to prove false representations and suppression of facts on insurer – Doctor’s certificate without affidavit in support no basis for repudiating the claim – No conclusive evidence produced to suggest suppression on part of deceased – company liable under policy.

 

   13. In the light of the decisions cited supra by us and also in the light of the decisions cited by the learned counsel for the Complainant, we come to the conclusion that, the Ops have failed to establish that, death of the deceased was due to pre-existing disease. Further the said Dr.Suseela Suresh is not examined by Ops who issued two certificates produced by Ops as document 3 & 4, which are futile to the case of the Ops.  

 

    14.  The Ops to substantiate their stand, placed reliance on two decisions reported in IV (2009) CPJ 8 (SC) in the case of Satwant Kaur Sandhu vs. New India Assurance co., ltd., and III (2012) CPJ 288 (NC) in the case of LIC of India vs. Vidya Devi & Anr. We placed reliance on the said decisions. The facts of the said two decisions are quite different to the present case on hand.

 

15. In the instant case, deceased never withheld pre-existing disease at the time of taking the said policy. More over cause of death was due to sudden heart attack which deceased never expects. Hypertension & chronic gastritis are not related to the cause of death of the deceased. In the decisions cited supra by us, wherein it is held that, even if non-disclosure of the hypertension, chronic gastritis and also the diabetic, may not be the reasons to repudiate the claim. With regard to the non-disclosure of the earlier policies are concerned, which will not come in the way to pay assured sum under the said policy as per the decision reported in III (2014) CPJ 582. In this view of the matter, we come to the conclusion that, the claim repudiated by the Ops is illegal, arbitrary, against the settled principle of law as laid down in the decisions cited supra. Accordingly, we come to the conclusion that, there is deficiency of service on the part of Ops and Ops failed to substantiate their stand in repudiating the claim of the Complainant. When such being the fact, Complainant is entitled for an amount of Rs.5 lakhs under the policy number:616599263 with interest at 6% p.a. from the date of submitting the claim application till the date of realization. With regard to the cost of litigation is concerned, we fix it to Rs.1,000/-. Accordingly we answered the point no.1 in the affirmative and point no.2 in the negative.

 

       16. Point no.3: In the result, we passed the following:

 

ORDER

 

          The complaint filed by the Complainant is hereby allowed.

 

2. Op.no.1 to 3 are jointly and severally liable to pay an amount of Rs.5 lakhs under the policy number:616599263 with interest at 6% p.a. from the date of submitting the claim application till the date of realization to the Complainant within six weeks from the date of receipt of this order, failing which the Complainant is at liberty to have the redress as per law.

 

 

3. Ops are also directed to pay Rs.1,000/- being the cost of litigation to the Complainant.

 

          Supply free copy of this order to both the parties.

 

          (Dictated to the Stenographer, got it transcribed, typed by her/him and corrected by me, then pronounced in the Open Forum on 17^th April 2018).

 

 

 

(ROOPA.N.R)     MEMBER

(S.L.PATIL)  PRESIDENT

                                                                        

1. Witness examined on behalf of the complainant/s by way of affidavit:

 

Smt.Sumangala, who being the complainant was examined. 

Copies of Documents produced on behalf of Complainant/s:

 

Doc.no.1	Claim petition to LIC
Doc.no.2	Acknowledgement of LIC
Doc.no.3	Medical report issued by Fortis hospital
Doc.no.4	Burial report
Doc.no.5	Declaratory affidavit
Doc.no.6	Death certificate of Hemanth dtd.02.08.14
Doc.no.7	Op letter dtd.05.01.15 along with covering letter dtd.23.03.15
Doc.no.8	Representation of Op.no.1 dtd.31.03.15
Doc.no.9	Postal acknowledgement dtd.04.04.15

 

2. Witness examined on behalf of the Opposite party/s Respondent/s by way of affidavit:

 

Sri.K.Bheemasena Rao, who being the Manager (legal & HPF) of Op corporation was examined.

 

Copies of Documents produced on behalf of Opposite party/s

 

Doc.no.1	Proposal from
Doc.no.2	Jeevan Tarang policy
Doc.no.3	Letter dtd.11.10.14
Doc.no.4	Medical certificate of cause of death, Form no.4A

 

 

 

 

(ROOPA.N.R)     MEMBER

(S.L.PATIL)  PRESIDENT