STATE CONSUMER DISPUTES REDRESSAL COMMISSION KERALA FIRST APPEAL NO. SC/32/A/586/2017 BRANCH MANAGER LIC OF INDIA, KOTTAYAM PRESENT ADDRESS - BRANCH MANAGER LIC OF INDIA, PB NO-48, MARTHOMABUILDING, TK ROAD, THIRUVALLA ,KERALA.

.......Appellant(s)

Versus WILSON K VARGHESE PRESENT ADDRESS - KUNNUMPURATHU HOUSE, NARAKATHENI.P.O, VENNIKULAM, PATHANAMTHITTA- 689544 ,KERALA.

.......Respondent(s)

BEFORE:

HON'BLE MR. JUSTICE SRI.B.SUDHEENDRA KUMAR , PRESIDENT HON'BLE MR. SRI.AJITH KUMAR.D , JUDICIAL MEMBER SRI.RADHAKRISHNAN.K.R , MEMBER FOR THE APPELLANT:

BRANCH MANAGER LIC OF INDIA, KOTTAYAM, ANITHA AJI (Advocate)

FOR THE RESPONDENT:

WILSON K VARGHESE DATED: 19/02/2025

ORDER

KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM APPEAL No.586/2017 JUDGEMENT DATED: 19.02.2025 (Against the order in C.C.No.18/2016 of the CDRC, Pathanamthitta)

PRESENT:

HON’BLE JUSTICE SRI. B. SUDHEENDRA : PRESIDENT KUMAR SRI. AJITH KUMAR D. : JUDICIAL MEMBER SRI. K.R. RADHAKRISHNAN : MEMBER APPELLANTS:

1. Life Insurance Corporation of India represented by Branch Manager, P.B.No.48, Marthoma Building, T.K. Road, Thiruvalla

2. The Manager, CRM Department, LIC of India, Divisional Office, “Jeevan Prakash”, P.B.No.609, Nagampadom, Kottayam – 695 001 represented by the Authorised Officer, Manager L&HPF, LIC of India, Divisional Office, Thiruvananthapuram (by Adv. Anitha Aji)

Vs.

RESPONDENTS:

1. Wilson K. Varghese, Kunnumpurathu House, Narakatheni P.O., Vennikulam, Pathanamthitta – 689 544 (expired, represented by legal heirs respondents 2 to 4

2. Alice Wilson, W/o Wilson K. Varghese, Kunnumpurathu House, Narakatheni P.O., Vennikulam, Pathanamthitta – 689 544

3. Melwin Saira Wilson, D/o Wilson K. Varghese, Kunnumpurathu House, Narakatheni P.O., Vennikulam, Pathanamthitta – 689 544

4. Melinta Marium Wilson, D/o Wilson K. Varghese, Kunnumpurathu House, Narakatheni P.O., Vennikulam, Pathanamthitta – 689 544 (by Adv. Rubeena Hilal)

th

5. Branch Manager, E-Meditek (TPA) Services Ltd., KPV Estate, 4 Floor, Civil Line Road, Opposite ING Vysya Bank, Palarivattom P.O., Ernakulam

JUDGEMENT

SRI. K.R. RADHAKRISHNAN : MEMBER This is an appeal filed under section 15 of the Consumer Protection Act, 1986, by the st nd

1 and 2 opposite parties in C.C.No.18/2016 on the files of the District Consumer Disputes Redressal Commission, Pathanamthitta (the ‘District Commission’ for short). 2. As per the order dated 30.06.2017, the District Commission had allowed the complaint as under:

1. The opposite parties 1, 2 and 3 are directed to reimburse an amount of Rs.3,00,000/-

(Rupees Three Lakhs only) (60% of the sum assured) to the complainants with 10%

interest from the date of filing of this case onwards i.e.03.02.2016;

2. The opposite parties 1,2 and 3 are also directed to pay a compensation of Rs.25,000/-

(Rupees Twenty Five Thousand only) and costs of Rs.3,000/-(Rupees Three Thousand only) to the complainants with 10% interest from the date of order onwards.

The appeal is filed against the said order.

3. The brief details of the complaint are as follows:

st nd The complainant had taken a Health Protection Plus Plan (T902) of the 1 and 2 opposite party insurer vide policy No.395303368 dated 26.05.2011 for the period from 26.05.2011 to 26.05.2027 for a sum assured of Rs 5 lakhs. The policy covered the complainant, wife and two children. The annual instalment premium was Rs.30,000/- (Rupees Thirty Thousand only). The complainant paid the premium regularly till March 2015 totalling Rs.1,20,000/-(Rupees One Lakh Twenty Thousand only) as premium for four years. It was diagnosed on 16.07.2015 that the complainant was suffering from ‘Large Hepato Cellular Carcinoma’. He was admitted at Kovai Medical Centre & Hospital Ltd., Coimbatore on 20.07.2015 and on 21.07.2015 he was subjected to Trans Arterial Radio Embolisation using Rhenium and Lipidol. He was admitted again on 01.09.2015 and discharged on 05.09.2015. Thereafter, he was admitted on 09.10.2015 and discharged on 10.10.2015. The compla