- (1.) THIS appeal under Section 15 of the Consumer Protection Act, 1986 is directed against the order dated 29.3.2004, passed in Complaint No. 388/2003 by the District Consumer Disputes Redressal Forum, Raipur (hereinafter referred to as the District Forum for short) whereby the complaint for deficiency in service against the LIC was dismissed by the District Forum.
(2.) THE facts not presently in dispute are that the father of the complainant late Dr. Lokeshwar Das had obtained Jeewan Surabhi Policy bearing No. 381391635 on 28.3.1996 for the assured sum of Rs. 1,00,000/ - from the respondent/opposite party. Six monthly premia for the said policy was Rs. 5,870/ -. It is also undisputed that the insured Dr. Lokeshwar Das died on 12.2.2001 and the basic cause of death was Cirrhosis with Portal Hypertension. It is also not in dispute that the insurer had intimated vide letter dated 29.10.2002 that they had rejected the revival of the policy as while filing personal statement of health in connection with revival of policy, the deceased had suppressed material information regarding his state of health. The complainant had also approached Claim Review Committee.
(3.) BESIDES admitted facts, the facts as averred in the complaint are that the Claim Review Committee had repudiated the claim vide letter dated 28.3.2003 but the policy number mentioned in the said letter was 381391653 instread of 381391635 as such it is apparent that some other claim and not the one of the complainant was repudiated. It is further averred that her father was working as Asstt. Surgeon and was hale and hearty but died a sudden death. He neither suffered from any disease nor was he admitted to any hospital. It is further averred that the opposite party/insurer repudiated the claim on wrong premises, hence prayed for the grant of assured sum together with interest, costs and damages. The opposite party insurer had averred in the written version that the claim review committee had rightly repudiated the claim of the complainant though due to clerical mistake the policy number was wrongly mentioned. By way of additional pleading the insurer has averred that Lokeshwar Das had applied for revival of the lapsed policy on 6.4.2000 and had in this regard filed the necessary form No. 680 dated 11.5.2000 relating to his state of health whereby he had declared himself to be healthy and had admitted that in case the declaration is found to be false the insurer shall have the right to declare the revival as void. It is further averred that it was on the strength of this declaration that the Corporation received due instalments of half yearly premia lying due for September, 1998, March, 1999, September, 1999 and March, 2000 together with interest and revived the policy in the month of May, 2000 and the insured died on 12.2.2001. It is further averred that as the life assured died within two years of revival of policy the complainant was required to fill various forms, etc. and on the basis of these forms the Corporation came to know that the deceased was Head of the Medicine Department and Dr. Yadav of Medical College Hospital had treated the insured and further that the life assured was himself a doctor and was sick from the period of two years prior to his death and obtained leave for the purpose. The opposite party insurer had further averred that the policy was revived solely on the basis of declaration given by the life assured and he had suppressed material facts regarding his state of health and as such not entitled to any relief. Hence the claim was repudiated bona fide and by doing so the company has not committed any deficiency in service.;