Haryana

StateCommission

A/672/2017

RAJU - Complainant(s)

Versus

AVIVA LIFE INSURANCE CO. - Opp.Party(s)

NARENDER KAAJLA

28 Aug 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :      672 of 2017

Date of Institution:      01.06.2017

Date of Decision :      28.08.2018

 

Raju s/o Sh. Sher Singh, Resident of Village and Post Office Rawat Khera, Tehsil and District Hisar.

                                      Appellant-Complainant

Versus

1.      Aviva Life Insurance Company Limited, 3^rd Floor, near SBI and Minerva Hotel, Red Square Market, Hisar through its Branch Manager.

2.      Aviva Life Insurance Company Limited, Registered Office, 2^nd Floor, Prakashdeep Building, 7, Tolstoy Marg, New Delhi-110001, through its authorised person.

                                      Respondents-Opposite Parties

 

CORAM:             Mr. Balbir Singh, Judicial Member.

                                                                                                         

Argued by:          Shri Narender Kaajla, Advoate for appellant.

                             Shri Inderjit Singh, Advocate for respondents.

 

                                                   O R D E R

 

        This appeal has been preferred against the order dated May 04^th, 2017 passed by District Consumer Disputes Redressal Forum, Hisar (for short ‘the District Forum’).

2.                Sher Singh s/o Sh. Mukh Ram (since deceased) father of complainant Raju, Resident of Village Rawat Khera, Tehsil and District Hisar during his life time was provided a life insurance policy bearing No.ALA3123194 by Aviva Life Insurance Company Limited – Opposite Parties/appellants (hereinafter referred to as ‘the Aviva Life Insurance’) mentioning the total sum assured as Rs.6,00,000/- and date of commencement as January 05^th, 2013. Proposal Form was submitted on December 28^th, 2012. Date of birth of Sher Singh (hereinafter referred to as the ‘Life Assured’) in the proposal form was mentioned as August 01^st, 1964.  During subsistence of the insurance policy, the life assured died due to heart failure on January 22^nd, 2013. The complainant being nominee of the life assured, informed the Aviva Life Insurance immediately regarding death of Sher Singh and submitted insurance claim alongwith needed documents. The insurance claim submitted by the complainant was repudiated vide letter dated April 25^th, 2013 mentioning that the life assured concealed material facts from the Aviva Life Insurance while obtaining the insurance policy. The life assured was suffering from cancer but he gave information in his proposal form that he was not suffering from cancer or tumor. The repudiation of the insurance claim submitted by the complainant is illegal and unjustified. The complainant alleged that it is a clear case of unfair trade practice and deficiency in service. The complainant had to face unnecessary harassment and mental agony due to faults of the opposite parties.

3.                The complainant filed complaint under Section 12 of the Consumer Protection Act, 1986 before the District Forum with a prayer to direct the opposite parties to pay a sum of Rs.6,00,000/- being total sum assured to the complainant with interest at the rate of 18% per annum; to pay an amount of Rs.1,00,000/- as compensation on account of un-necessary harassment, mental agony and an amount of Rs.11,000/- as litigation expenses.

4.                The opposite parties in their written version have taken plea that the complaint is not maintainable in the present form; that the complaint is bad for non-joinder of necessary parties; that the District Forum has no jurisdiction to decide this complaint as factual and legal controversies are involved in this case; that it is not a case of deficiency in service and that the complainant has no cause of action to file the present complaint. It is pleaded that the life assured expired just within three months of the acceptance of the risk under the policy, thus even otherwise the Aviva Life Insurance is well within its right to repudiate the claim under the policy in view of the provisions of Section 45 of the Insurance Act, 1938. The Aviva Life Insurance has right to declare the contract as null and void within two years from the date of effecting the risk on the ground of misstatement and misrepresentation. The life assured did not disclose the true facts regarding his ill health and it is a case of pre-existing disease. The life assured was undergoing treatment since September 14^th, 2012 regarding ulcerative well defined Keratinizing Squamous Cell Carcinoma of anus. This fact was not disclosed by the life assured in the proposal form dated September 28^th, 2012. Had these facts been disclosed by the life assured, the Aviva Life Insurance would not have covered the risk under the insurance policy. The life assured was provided insurance policy considering the facts disclosed in his proposal form dated December 28^th, 2012 to be true and correct in good faith. It is admitted fact that the life insurance policy was provided to the life assured mentioning total sum assured as Rs.6,00,000/- mentioning date of commencement as January 05^th, 2013. It stands established during investigation on the basis of medical reports and hospital treatment record that the life assured was suffering from Adenocarcinoma and was undergoing the treatment for the same and he did not disclose regarding his pre-existing medical ailment in his proposal form. The insurance claim of the complainant has been rightly repudiated vide letter dated April 26^th, 2013. The complainant on the basis of a fake and concocted version wants to grab huge money from the Aviva Life Insurance. The complainant is not entitled to receive any amount as claimed in the complaint. It is prayed that the complaint be dismissed with cost.

5.                Parties led evidence in support of their respective claims before the District Forum.

6.                After hearing arguments, vide impugned order dated May 04^th, 2017 the complaint filed by the complainant was dismissed.

7.                Aggrieved with the impugned order dated May 04^th, 2017, the complainant/appellant has filed the present First Appeal No.672 of 2017 with a prayer to set aside the impugned order and to grant relief to the complainant as prayed in the complaint.

8.                I have heard learned counsel for the parties and perused the case file.

9.                During the course of arguments, there was no controversy of any type that for providing Aviva Life Insurance policy to life assured Sher Singh during his life time, proposal form was submitted on December 28^th, 2012. The insurance policy was provided mentioning total sum assured as Rs.6,00,000/- and date of commencement as January 05^th, 2013.  It will be pertinent to mention here that in fact the complainant as well as the opposite parties did not adduce in evidence the insurance policy, if any, issued by the opposite parties. Exhibit R-2 is the proposal form submitted by the life assured. It is evident from a letter dated January 02^nd, 2013 issued by the opposite parties, Exhibit R-6, that the insurance company had informed the complainant that in case the insurance company is unable to contact the complainant up to January 15^th, 2013 to complete the pre-issuance verification, this proposal will be cancelled and the premium amount shall be refunded. These are the only two documents concerned with the insurance policy. Apart from it, ‘Product Features’ Exhibit R-5 prepared on December 28^th, 2012 has also been adduced in evidence wherein the total sum assured is mentioned as Rs.6,00,000/-.

10.              It is admitted fact that the life assured Sher Singh died on January 22^nd, 2013. IN the death certificate Exhibit C-6 issued from the Health Department, date of death is mentioned as January 22^nd, 2013 but cause of death is not mentioned. In the claim investigation report cause of death is mentioned as heart failure. The complainant  placed on the file photo copies of the statement of Village Lambardar and his own statement mentioning that Sher Singh died in his Village. The complainant Raju also in his statement mentioned that Sher Singh was not suffering from any ailment and he did not get treatment from any hospital and opposite party has no record in this regard. In this way, version of the complainant is that Sher Singh died a natural death free from any disease on January 22^nd, 2013.

11.              During investigation by ‘Sharp Eagle Investigation Private Limited’ observations were made that Sher Singh was got admitted in Dr. Bal Krishan Gupta Hospital, Hisar on January 14^th, 2013. Investigator was told by Mr. Kuldeep that the patient was referred to Jindal Hospital but no medical record could be collected regarding ailment of the life assured from ‘Jindal Hospital, Hisar’. Hospital treatment record has also been placed on the file wherein it was opined that patient Sher Singh Resident of Village and Post Office Rawat Khera was suffering from Adenocarcinoma.  In the hospital treatment record it is mentioned that Sher Singh remained admitted in Dr. Bal Krishan Gupta Hospital from January 14^th, 2013 up to January 18^th, 2013.  So, from the record on the file it appears that the life assured Sher Singh got treatment from Mr. Bal Krishan Guptal Hospital from January 14^th, 2013 up to January 18^th, 2013 as he was suffering from cancer disease.

12.              During the course of arguments, learned counsel for the complainant argued that relief should not be declined to the complainant merely on the basis of the hospital record placed on the file. Firstly, because in the hospital treatment record mentioned above, father’s name of patient Sher Singh is not mentioned and age of the patient is also mentioned as 60 years whereas the life assured had mentioned his age approximately 48 years in his proposal form and in his other record also date of birth is mentioned as August 01^st, 1964.  At the time of hearing arguments before this Commission, the complainant also placed on the file one certificate issued by Smt. Suman Devi, Sarpanch of Village Rawat Khera wherein it is mentioned that Sher Singh s/o Sh. Mukh Ram died on January 22^nd, 2013 all of a sudden due to heart failure. Sher Singh was healthy and there are few other persons residing in the same village having their names as Sher Singh. Om Parkash Lambardar of the Village in his statement simply mentioned that Sher Singh s/o Sh. Mukh Ram died on January 22^nd, 2013 in the Village. Certificate of Village Sarpanch has been placed on the file to prove that the hospital treatment record placed on the file is not concerned with the life assured as his father name is nowhere mentioned in the hospital record and there are some other persons living in the same village having their names as Sher Singh. I feel the above mentioned certificate placed on the file issued by Village Sarpanch is of no help to the complainant in any way. In the above mentioned certificate Village Sarpanch has mentioned that there are few other persons in the same Village having their names as Sher Singh and at the time of his death Sher Singh son of Mukh Ram was quite healthy. In my view the above mentioned certificate is not of any help to solve this controversy. The Village Sarpanch should have specifically mentioned the complete names, father’s names and address of the other persons having the same name living in the village. Rather from the above mentioned certificates it appears that no other person having his name Sher Singh used to reside in the village in those days. That is the reason village Sarpanch could not mention their names and complete address. 

13.              It is true that in the proposal form date of birth of the life assured is mentioned as August 01^st, 1964. In this way, Sher Singh was only 48 years old when the proposal form was submitted. In other documents placed on the file also, other than the hospital treatment record, date of birth of Sher Singh is mentioned as August 01^st, 1964.  In the medical treatment record of Sher Singh placed on the file, age of Sher Singh is mentioned as 60 years. I feel merely due to this reason, findings cannot be given that Sher Singh s/o Mukh Ram was not admitted in the hospital from January 14^th, 2013 upto January 18^th, 2013. It is a matter of common knowledge that at the time of getting admission in the hospital and issuance of prescription slips, nobody is found to be so much serious regarding mentioning correct age of the patient. Sometimes age of the patient is told by some attendant of the patient and sometimes approximate age is mentioned.

14.              As per discussion above, I feel only due to the above mentioned two reasons, finding cannot be given that Sher Singh who remained admitted in Dr. Bal Krishan Gupta Hospital, Hisar from January 14^th, 2013 up to January 18^th, 2013 was other than the life assured Sher Singh s/o Mukh Ram. In this way, it clearly appears that the life assured Sher Singh son of Mukh Ram was suffering from cancer and he remained admitted in the above mentioned hospital from January 14^th, 2013 upto January 18^th, 2013.

15.              Version of the complainant in this case is that his father Sher Singh son of Mukh Ram was enjoying good health and he was not suffering from cancer or any other ailment. This fact also cannot be completely overlooked that Sher Singh son of Mukh Ram died just after four days when he was got discharged from the hospital. It appears that the condition of the life assured was serious and he was suffering from cancer disease. Merely because the life assured died in his house in the village, finding cannot be given that he was quite healthy. In the absence of any medical record, finding also cannot be given that Sher Singh died due to heart failure.

16.              Version of the opposite parties is that the life assured concealed this fact at the time of submitting the proposal form that he was suffering from cancer and as the life assured did not disclose his pre-existing disease, the Aviva Life Insurance is not liable to pay any amount to the complainant on the basis of the insurance policy.  Learned counsel for the complainant argued that the opposite parties could not produce any medical record prior to the date of issuance of the insurance policy regarding ailment of the life assured, so finding cannot be given that the life assured concealed his pre-existing disease. Learned counsel for the complainant argued that the life assured was not supposed to have any knowledge regarding his ailment prior to the issuance of the insurance policy. In my view in the present circumstances certainly finding can be given that the life assured was suffering from cancer prior to the date of submitting the proposal form and he obtained the insurance policy by playing fraud and misrepresentation. It appears that the life assured obtained the life insurance policy so that his legal heirs or nominee may be able to grab huge money from the Insurance Company. Obtaining insurance policy like in the case in hand is not uncommon. Moreover, this version of the complainant is found fake that the life assured was healthy and he did not remain admitted in hospital from January 14^th, 2013 up to January 18^th, 2013. Certainly version of the complainant cannot be believed that the life assured had no knowledge regarding his pre-existing disease prior to the date of submitting the proposal form. The complainant appears to be a man of such a character that he can tell a lie for his personal benefits.

17.              As a result as per discussions above in detail, I feel complainant is not entitled to receive any amount as insurance claim from the opposite parties as the life assured did not disclose his pre-existing disease at the time of submitting the proposal form. In these circumstances, I find no illegality in the impugned order passed by the learned District Forum. Findings of the learned District Forum stand affirmed. Hence, appeal is dismissed being devoid of any merits. 

 

Announced: 28.08.2018

(Balbir Singh) Judicial Member

 

CL