Haryana

StateCommission

A/261/2019

LIFE INSURANCE CORPORATION OF INDIA LTD. AND ANOTHER - Complainant(s)

Versus

BALBIR SINGH AND OTHERS - Opp.Party(s)

S.C.THATAI

13 Jul 2023

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

 

 

First Appeal No.261 of 2019

Date of Institution: 15.03.2019                                                              Date of order: 13.07.2023

 

1. Life Insurance Corporation of India,  Opposite Radio Station, Subhash Road, District Rohtak, through its Branch Manager, Rohtak through S.Rajeev Malhotra, Manager (L&HPF), Divisional Office Jeevan Prakash Building, Sector 17 B Chandigarh.
2. Senior Division Manager, Life Insurance Corporation of India,Kunjpura road, Kaithal presently the appeal is filed through Sh.Rajeev Malhotra, Manager (L&HPF), Divisional Office, Jeevan Prakash Building, Sector 17 B Chandigarh.

…..Appellants

Versus

1.      Balbir Singh S/o BhagwanDass, near Jai Bharat School Pai District Kaithal.

…..Respondent

2.      Ashok Kumar Agent, S/o Dharmpal R/o VPO Songal Distt. Kaithal.

3.      Virender Kumar, S/o Sh.Chand, R/o Harijan Basti Village Pai, Distt. Kaithal, now posted at LIC office,Sector-2, Panchkula Bay No.71-72, Panchkula, Pin 134115 (Haryana).

…..Performa Respondents

CORAM:    S.P.Sood, Judicial  Member

 

Present:-    Mr.S.C.Thathai, Advocate for theappellants.

                   Mr.C.P.Tiwana, Advocate for the respondent No.1.

                   Mr.SikanderBakshi, Advocate for the respondent Nos.2 and 3.

 

                                                ORDER

S P SOOD, JUDICIAL MEMBER:

The present appeal No.261 of 2019 has been filed against the impugned order dated 21.01.2019 of the District Consumer Disputes Redressal Forum, Kaithal (In short  now “District Commission”) in complaint case No.235 of 2017, which was allowed.

2.      The brief facts of the case are that complainant’s daughter-Mamta Devi had purchased insurance policy No.479275064 dated 05.05.2016 (single premium policy) “Jiwan Shikhar” from opposite Party No.1 through OP Nos.3 and 4.  She paid premium to the tune of Rs.41,280/- for assured amount of Rs.4,18,200/-.    On 11.10.2016, Mamta Devi died due to heart attack.  Being nominee, the complainant  submitted death claim with the OPs, but,  the OPs illegally repudiated the claim vide letter dated 05.05.2017.  Faced with this situation, a legal notice was issued to the  OPs but to no avail. Thus there was deficiency in service on the part of the OPs, hence the complaint.

3.      Upon notice, OP Nos.1 and 2appeared and filed jointreply. They submitted that deceased (mamta) had submitted a proposal form dated 29.0.2016 for taking a policy for sum of Rs1,00,000/- and death sum assured of Rs.418200/- with single mode of premium Rs.41280/-. The life assured had concealed the fact that she was handicapped and was getting disability pension  from Social Welfare Office Karnal since November 2010, so the policy was obtained by the deceased on the basis of false information given in proposal form.  The matter was enquired and during investigation, it was found that she was unable to stand on her legs and she was drawing disability pension from Social Welfare Department, Kaithal under ID No. 1814-3027466. Due to concealment of material facts, the claim was rightly repudiated vide letter dated 05.05.2017. Thus there was no deficiency in service on the part of the OP Nos.1 and 2 and prayed for dismissal of the complaint. OP No.3 was proceeded against ex parte vide order dated 09.01.2018.

4.      After hearing both the parties, the learned District Commission, Kaithal has allowed the complaint vide order dated 21.01.2019, which is as under:-

“Thus, in view of above discussion, we allow the complaint and quashed the repudiation letter dated 05.05.2017 with a direction to OPs to pay Rs.4,18,200/- (being sum insured in case of death vide policy No.479275064 dated 05.05.2016) to the complainant. The OPs are also burdened with costs of Rs.5500/- as compensation for harassment, mental agony and costs of litigation charges to the complainant.  Let the order be complied with jointly and severally within a period of 30 days failing the amount would carry interest @ 9% per annum from the date of order till its realization.”

5.      Feeling aggrieved therefrom, OPs-appellants have preferred this appeal.

6.      These argument has been advanced by Sh.S.C.Thathai, learned counsel for the appellants as well as Sh.C.P.Tiwana, learned counsel for the respondent No.1 and Mr.SikanderBakshi, Advocate for the respondent Nos.2 and 3. With their kind assistance the entire records as well as the original record of the District Commission including whatever evidence has been led on behalf of  both the parties has also been properly perused and examined.

7.      It is not disputed that the complainant’s daughter Mamta had obtained two different life insurance policies from the opposite parties.  It is not also disputed during the continuation of said policies, its holder had expired. It is also admitted that being a nominee, complainant applied for the claim amount under the same. The deceased had taken another policy No.178260331 commencing from 19.03.2013 with date of maturity 19.03.2023. The OP No.1 had honoured the death claim by paying an amount of Rs.333180/- in the account of the complainant through NEFT.  Another policy bearing NO.479275064 dated 05.05.2016 was not honoured by the appellant on the ground  of suppression of material facts such as permanent disability and educational status in the proposal form.   The file reveals that proposal form had filled by the agent of OP No.1, therefore it cannot be said that there was any suppression/concealment of material facts.  Since the appellants have also received the premium of another policy bearing No.178260331, which had already been honouredafter submitting the death claim of life assured Mamta Devi, therefore appellants should have followed the same yardstic in the subsequent claim vide insurance policy No.479275064 vide letter dated 05.05.2016instead of repudiating the same. The appellants should have conducted the same procedure the subsequent policy  as well.  Why should the appellants have adopted different criteria for processing these two claims whereby they had paid the  death claim of Mamta Devi to the complainant in one case and afterwards appellants have repudiated the claim on the ground of concealment of true facts because  at the time of filling up the form it was the agent who had filled the form, which was on behalf of appellants.At the time of obtaining the policy, the appellants should have got conducted medical tests of the insured, but in this case, the appellant did not insist for the medical tests etc. of the life insured. The insurance company wrongly repudiated the claim of the complainant.  The District Commission has rightly allowed the claim of the complainant.  The learned District Commission had committed no illegality while passing the order dated 21.01.2019.  The appeal is also devoid of merits and stands dismissed.

8.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the respondent No.1-complainant-Balbir Singh against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

9.      Application(s) pending, if any, stand disposed of in terms of the aforesaid order.

10.    A copy of this order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 2019. This order be uploaded forthwith on the website of the Commission for the perusal of the parties.

11.    File be consigned to record room.

 

13thJuly, 2023                                                                                 S. P. Sood                                                                                                                            Judicial Member    

S.K

(Pvt. Secy.)