AFR / NAFR CHHATTISGARH STATE CONSUMER DISPUTES REDRESSAL COMMISSION PANDRI, RAIPUR Date of Institution: 11/07/2024 Date of Final Hearing: 27/02/2025 Date of Pronouncement: 19/03/2025 APPEAL No.- FA/24/475 IN THE MATTER OF :

Branch Manager, Life Insurance Corporation of India, Dharampura, Jagdalpur, Dist. Bastar (CG) … O.P. No.1/ Appellant Through: Smt. Varsha Vyas Choubey, Advocate Vs.

1. Smt. Nazma Khan W/o. Late Mo. Anwar Khan, … Complainant No.1/ Respondent No.1

2. Miss Mahinoor, D/o. Late Mo. Anwar Khan, Minor through Mother: Smt. Nazma Khan W/o. Late Mo. Anwar Khan … Complainant No.2/ Respondent No.2 Both R/o. Veer Sawarkar Ward No.05, Mata Mandir Road, Pathraguda, Jagdalpur, Dist. Bastar (CG)

(Name of complainant No.3/ respondent No.3 was deleted since dead vide order dated 27.02.2025)

Both through: Smt. Madhuri Uike, Advocate

3. Umesh Panigrahi, S/o. Shri G.N. Panigrahi, LIC Agent, R/o. Vill. & P.O. Aasna Khas Para, Dist. Bastar (CG) … O.P. No.4/ Respondent No.3 Through: In person.

CORAM: -

HON’BLE SHRI JUSTICE GAUTAM CHOURDIYA, PRESIDENT HON’BLE SHRI PRAMOD KUMAR VARMA, MEMBER PRESENT: -

Smt. Varsha Vyas Choubey, Advocate for the appellant.

Smt. Madhuri Uike, Advocate for the respondent Nos.1 & 2.

None for the respondent No.3.

O RDE R

PER: - JUSTICE GAUTAM CHOURDIYA, PRESIDENT This appeal is filed against order dated 29.05.2024 passed by District Consumer Disputes Redressal Commission, Bastar at Jagdalpur (C.G.) (hereinafter called “District Commission” for short) in complaint case No.CC/2022/48, whereby the complaint was partly allowed directing the opposite party No.1/ appellant herein to pay the complainants/ respondent Nos.1 & 2 herein Rs.13,25,791 (thirteen lakhs twenty five thousand seven hundred ninety one) towards medical expenses of treatment of deceased original complainant Late Mo. Anwar Khan with simple interest thereon @ 7% p.a. from the date of filing complaint 03.07.2021 till realization within one month failing which the interest was directed to be paid @ 9% p.a. The opposite party No.1/ appellant was also directed to pay compensation for mental agony and sufferings Rs.10,000/- (ten thousand) within one month and cost of litigation Rs.5,000/- (five thousand) to the complainants/ respondent Nos.1 & 2.

2. In nutshell the facts of the case are that on 28.03.2016 the husband of the complainant No.1/ respondent No.1 and father of complainant No.2/ respondent No.2 obtained a Jeevan Arogya insurance policy from the opposite party No.1/ appellant through their agent opposite party No.2/ respondent No.3. Premium of Rs.3,041/- was to be paid half yearly. As per terms and conditions of the policy entire medical expenses incurred in treatment of policy-holder during the period of coverage was to be borne by the insurer. The premium was being continuously paid half yearly through the opposite party No.2/ respondent No.3. On 24.06.2019 policy-holder Late Mo. Anwar Khan fell ill, immediate intimation of which given on mobile to the opposite party No.2/ respondent No.3 and to the opposite party No.1/ appellant on 21.08.2019 by the policy holder himself while undergoing treatment. After discharge from the Hospital claim was also submitted before the opposite party No.1/ appellant which was repudiated stating that the premium was not timely paid, whereas all the premiums were being timely paid to the opposite party No.2/ respondent No.3 but even if the premium was not deposited promptly, then the opposite party No.2/ respondent No.3 agent of the opposite party No.1/ appellant insurer was responsible for such delay and for such act of the agent the principal opposite party No.1/ appellant insurer was also responsible and thereby was liable to pay the claim amount. With these averments seeking direction of payment of medical expenses incurred in treatment of the policy holder complaint was filed before the District Commission.

3. The opposite party No.1/ appellant except the admitted facts denied all the adverse allegations leveled ag