SANDHYARANI DAS Vs. LIC OF INDIA

JUDGEMENT

(1.) THIS appeal filed by the complainant of C. D. Case No. 263 of 2003 challenging the ex parte orders dated 16. 8. 2004 of dismissal of the C. D. case on merit by the District Forum, Cuttack.

(2.) THE facts of the case in brief out of which this appeal arises are that Surender Prasad Das by profession an Auto Rickshaw driver, had L. I. C. policy bearing No. 583225522 for a sum assured Rs. 1,00,000 (Rs. one lakh) with half-yearly premium on 31. 7. 1999. Proposal for policy was submitted by Surendra on 25. 7. 1999. Half-yearly premium Rs. 3,813 was deposited by Surendra on 31. 7. 1999. Sandhyarani Das, wife of Surendra is shown as nominee. Life assured Surendra as an out-patient, with complaint of abdomen swelling, loss of appetite since 1 months was treated at Acharya Harihar Regional Cancer Centre at Cuttack, in short, A. H. R. C. C. on 29. 7. 1999 and was admitted in said hospital on 30. 7. 1999 where diagnosis was done as Hepato Cellular Cancer and was discharged on condition viz. "relieved" on 7. 9. 1999 in view of the "certificate of Hospital treatment" as per proforma of the L. I. C. , Cuttack Division granted by the Assistant Professor and H. O. D. of said hospital (the original and xerox copy of which is filed by the opposite parties ). On 8. 9. 1999 in the native village Gud, District Balasore, Surendra died (xerox copy of death certificate Annexure-2 filed ). Then Sandhyarani Das -the complainant lodged death claim of Rs. 1,80,000 on account of sudden death due to heart attack at 8 a. m. on 8. 9. 1999, complaining heart burning before one day of his death as per death claim form (Annexure-4) dated 19. 1. 2000 (xerox copy ). But, the opposite parties repudiated the claim of the complainant on the ground of suppression of material fact of suffering from Hepato Cellular Cancer and was being treated at the Acharya Harihar Regional Cancer Centre, Cuttack before the life assured submitted proposal for the policy in question and died for the same disease. Repudiation of claim was communicated vide letter dated 11. 12. 2002 (Annexure-5 ).

(3.) COMPLAINANT has stated through her complaint petition that the date of proposal is 25. 7. 1999 which was commenced on the same date and is also dated back to 28. 4. 1999. Life assured died on 8. 9. 1999 at his native village of Gud, District Balasore due to heart attack. In respect to his treatment as an indoor patient in the A. H. R. C. C. , complainant has clarified in paragraph 8 of the complaint petition that life assured "neither was an indoor patient nor attacked by Hepato Cellular Cancer and opposite parties are estopped to raise such question since disease of any kind is inherent in nature and one cannot predict and dictate the unforeseen disease. " According to the complaint, vide letter of repudiation, opposite party No. 1 intimated her to make representation for reconsideration of her claim after claim is repudiated, to their Zonal Office at Calcutta, in case she is not satisfied with their repudiation of claim. Therefore, vide letter (xerox copy Annexure-6) copy to opposite party No. l, she made representation to said Zonal Office which is acknowledged by the said office. The General Manager of said office vide letter dated 30. 1. 2003 (xerox copy Annexure-7) asked her to wait for further information as the matter for consideration being discussed by his office with Divisional Office, Cuttack. But no intimation in this respect was received. She has incurred loan with high rate of interest for the maintenance of herself and minor children who were supposed to remain under starvation had she not incurred loan, with a hope to repay after receipt of L. I. C. insurance claim amount. In spite of contacts so many times, she was not allowed the death claim. Therefore, she filed the C. D. case claiming policy amount of Rs. 1,00,000 with interest @ 18% per annum and for loss and compensation in total Rs. 2,14,000 as per paragraph 10 of the complaint. The opposite parties have filed joint written version justifying repudiation of claim filed by the complainant on the ground of suppression of material facts of suffering from Hepato Cellular Cancer by the life assured while entering into aforesaid policy and filing the proposal form as narrated above. They have also challenged the territorial jurisdiction of the District Forum, Cuttack in admitting the C. D. case.