BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KAITHAL.
Complaint Case No.431 of 2019.
Date of institution: 16.12.2019.
Date of decision:16.05.2022.
Ravi Kumar S/o late Avtar Singh, R/o Village Dheru Majra, Umri (Part) (370), Kurukshetra-136131.
…Complainant.
Versus
- Aditya Birla Sun Life Insurance Company Ltd. One Indiabulls, Tower 1, 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013.
- Aditya Birla Sun Life Insurance Company Ltd., Ist Floor, Amartara Plaza, Khurania Shopping Kurukshetra Road, Above IDBI Bank, Kaithal through Branch Manager.
….Respondents.
Complaint under Section 12 of the Consumer Protection Act
CORAM: DR. NEELIMA SHANGLA, PRESIDENT.
SMT. SUMAN RANA, MEMBER.
SH. RAJBIR SINGH, MEMBER.
Present: Sh. Amit Beniwal, Advocate, for the complainant.
Sh. Manoj Ichhpilani, Advocate for the respondents.
ORDER
DR. NEELIMA SHANGLA, PRESIDENT
Ravi Kumar-Complainant has filed this complaint under Section 12 of Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the respondents.
In nutshell, the facts of present case are that the father of complainant namely Avtar Singh (since deceased) took a policy “BSLI Vision Life Secure Plan” bearing No.007361523 dt. 19.08.2017 from the respondents and paid a sum of Rs.21,923/- towards premium. It is alleged that all the requisite formalities were completed by the respondents prior to issuance of policy including the father of complainant was got medically examined by medically officer on 12.08.2017 in front of respondents’ agent but diagnosed no disease at that time. It is further alleged that the father of complainant died on 27.05.2018 due to chest pain at home. The complainant lodged the death claim with the respondents and submitted all the necessary documents but the respondents repudiated the claim of complainant vide letter dt. 14.09.2018. The said repudiation of claim is stated to be wrong and illegal. So, it is a clear cut case of deficiency in service on the part of respondents and prayed for acceptance of complaint.
2. Upon notice, the respondents appeared before this Commission and contested the complaint by filing their written version raising preliminary objections with regard to locus-standi; maintainability; cause of action; that the father of complainant i.e. late Avtar Singh had submitted an online proposal/application dt. 10.08.2017 for the purchase of “BSLI Vision Life Secure Plan”. In the said plan, policy term was 15 years, premium paying term was 15 years, basic premium was Rs.21,922.56 paise semi-annually & sum assured was Rs.4,00,000/-. The life assured selected the payment of semi-annual premium i.e. Rs.21,922.56 paise. The proposal was accepted on the standard rates based on the information provided by the DLA and consequently a policy was issued bearing No.007361523 dt. 10.08.2017 and the said policy commenced on 19.08.2017; that the answering respondents received the death claim of the DLA from the complainant, wherein it was reported that the DLA died on 27.05.2018 i.e. within a period of less than 10 months from the date of purchasing the policy. The death claim was suffering from “CARCINOMA” prior to purchasing the said insurance policy from the respondents and was under treatment in Govt. Medical College & Hospital, Chandigarh vide CR No.170505421 since 24.05.2017 and this fact was not disclosed by the DLA in the Declaration of medical history. Had the correct information regarding his health disclosed in the declaration of good health, the answering respondents would not have issued the policy or DLA would have been subjected to detailed underwriting procedure. So, the claim of complainant was rightly repudiated by the respondents vide letter dt. 14.09.2018. There is no deficiency in service on the part of respondents. On merits, the objections raised in the preliminary objections are reiterated and so, prayed for dismissal of complaint.
3. To prove his case, learned counsel for the complainant tendered into evidence affidavit of complainant Ex.CW1/A alongwith documents Anneuxre-C1 to Annexure-C7 and thereafter, closed the evidence on behalf of complainant.
4. On the other hand, learned counsel for the respondents tendered into evidence affidavit of Ms. Aakriti Manocha, Senior Manager, Legal Ex.RW1/A alongwith documents Annexure-R1 to Annexure-R6 and thereafter, closed the evidence on behalf of respondents.
5. We have heard the learned Counsel for both the parties and perused the record carefully.
6. Sh. Manoj Ichhpilani, Adv. for the respondents has stated that Avtar Singh son of Juna Ram had been suffering from tonsil cancer for which he had taken the treatment in Govt. Medical College & Hospital, Sector-32, Chandigarh w.e.f. 24.05.2017 till 09.08.2017. Thereafter, concealing the facts regarding his disease of tonsil cancer, he obtained insurance policy from the respondents on 10.08.2017 and sum insured was Rs.4,00,000/-. He concealed the fact regarding his tonsil cancer prior to issuance of the policy. Lateron, he died on 27.05.2018 and he concealed the fact that he was suffering from tonsil cancer and he also concealed the fact he had taken treatment from Govt. Medical College & Hospital, Sector-32, Chandigarh. Hence, his insurance claim is repudiated by the respondents-insurance company.
7. Sh. Amit Beniwal, Adv. for the complainant has stated that vide Annexure-R4, in the investigation report, it is stated that Avtar Singh died due to “CARCINOMA” illness at his own home.
8. Since Avtar Singh died due to tonsil cancer which was concealed by him in his insurance policy papers while he was already admitted in Govt. Medical College & Hospital, Sector-32, Chandigarh for the period w.e.f. 24.05.2017 till 09.08.2017 and on the next following date i.e. 10.08.2017 he took medical insurance policy and concealed the fact that he was suffering from tonsil cancer and he was taking treatment from Govt. Medical College & Hospital, Sector-32, Chandigarh prior to the issuance of the policy.
9. Since Avtar Singh had already been suffering from tonsil cancer prior to the issuance of insurance policy and this fact was concealed by him. Due to this fact, the respondents had repudiated his insurance claim. For this reliance is placed on the authority laid down by Hon’ble National Commission in the case titled as Maya Devi Vs. LIC 2011(3) CPJ page 43 under Sections 2(1)(g), 14(1)(d) and 21(b) of Consumer Protection Act, 1986 in which it has been held that in a case of pre-existing disease, wherein there is suppression of material facts, then claim is rightly repudiated by the insurance company. In this case, the deceased was chronic patient of diabetes and illness concealed in form. It was held that insurance policy is an agreement in utmost good faith between insurer and insuree. Hence, breach by suppressing material facts on the part of insuree would result in repudiation of claim by insurer. Hence, Hon’ble National Consumer Disputes Commission, New Delhi upheld the order of Hon’ble State Commission.
Similar support is taken from another case authority laid down by Hon’ble National Commission in the case titled as Bajaj Allianz Life Insurance Co. Ltd. & another Vs. Raj Mittal, 2015(4) CLT page 379. In this case, the claim was repudiated by the insurer on the ground of concealment of material facts of pre-existing ailments. Hence, repudiation of claim was held proper.
10. Thus, in view of our aforesaid discussion since there was pre-existing disease of tonsil cancer with the deceased which was concealed before taking the insurance policy. Hence, repudiation of claim by the respondents is proper. Hence, there is no merit in the present complaint and the same is hereby dismissed accordingly. No order as to costs. A copy of said order be sent to the parties free of costs. File be consigned to record-room after due compliance.
Announced in open court:
Dt.:16.05.2022.
(Dr. Neelima Shangla)
President.
(Rajbir Singh), (Suman Rana),
Member. Member.
Typed by: Sanjay Kumar, S.G.
