Haryana

Karnal

CC/308/2018

Raj Bala - Complainant(s)

Versus

Bharti AXA Life Insurance Company Limited - Opp.Party(s)

B.R. Dahiya

04 Nov 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                       Complaint No.308 of 2018

                                                         Date of instt. 13.11.2018

                                                         Date of decision:04.11.2019

 

Raj Bala wd/o late Shri Ram Mehar resident of village Kharak Ramji, near Harijan Chaupal, Jind.                                                                                                                                                                                                                                          …….Complainant

                                        Versus

 

1. Bharti AXA Life Insurance Company Ltd. having its Head office: office of Insurance Ombudsman, SCO 101, 102, 103, Batra Building, 2^nd floor, Sector-17-D, Chandigarh (Haryana) through its Managing Director.

2. Bharti AXA Life Insurance Company Ltd. having its Branch office: Chaudhary Complex, 2^nd floor, 82-83, Mugal Canal, Karnal (Haryana) through its Branch Manager.

 

                                                                      …..Opposite Parties.

 

           Complaint u/s 12 of the Consumer Protection Act. 

         

Before   Sh. Jaswant Singh……President.  

                Sh. Vineet Kaushik………Member

                Dr. Rekha Chaudhary……Member

 

 Present:  Shri B.R.Dahiya Advocate for complainant.

                  Shri Vikas Chaudhan Advocate for OPs.

                                     

                   (Jaswant Singh President)

ORDER:                    

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986 on the averments that Ram Mehar husband of the complainant purchased an insurance policy no.501-3446561 from the office of the OPs, valid from 31.07.2015 upto maturity, thereby who (Ram Mehar) himself insured with the OPs and assured amount of Rs.5,89,690/- towards death benefits. The complainant is nominee in the aforesaid policy. OP no.1 is the branch office and OP no.2 is registered office of Max Life Insurance Company Ltd., hence both OPs are responsible for act and conduct of each other. On 17.11.2015, the husband of complainant died naturally. The complainant being nominee and beneficiary of the deceased Ram Mehar is entitled for the insurance claim of Rs.5,89,690/-. The complainant has submitted the claim application alongwith required documents with the OPs but despite repeated requests OPs have not released the insurance claim to the complainant. The OPs also received the original policy and other documents from complainant and same are in possession of the OPs. The OPs lastly repudiated the claim of the complainant, vide letter dated 29.02.2016 on the false and frivolous grounds. In this way there was deficiency in service on the part of the OPs. Hence complainant filed the present complaint.

2.             Notice of the complaint was given to the OPs, who appeared and filed written version raising preliminary objections with regard to cause of action; jurisdiction and concealment of true and material facts. On merits, it is pleaded that the policy was issued on 31.07.2015 and the life assured had died on 17.11.2015 i.e. within 4 months of the issuance of the policy. Death Claim was received by the company on 12.01.2016 and the matter was investigated. It is further pleaded that the claim falls in the category of early claim, the company has drawn certain process of documentation and verification for early claims (within 2 years of issuance of the policy), during the claim investigation it is established that the Life Assured was a known case of Liver Cancer since April, 2015 and was hospitalized prior to policy for chemotherapy thereby treatment for the same. Further, the life assured had habitual of alcohol and tobacco consumption in a large quantity since 20 years. This medical history was prior to the life assured filing the proposal form for the policy and answers furnished by him were thus false and he had given false and misleading information to the OPs. Had the life assured replied correctly and truthfully, while signing the proposal and had informed the OP of his health status/hospitalization and report, the OPs under no circumstances would have enrolled him under the subject policy. The OP was thus misled into issuing the policy by non-disclosure/suppression of material facts. It is further pleaded that the life assured was diagnosed of Cancer and was under treatment in Acharya Tulsi Regional Cancer Treatment and Research Centre, Bikaner Rajasthan. The said diagnose and treatment was not intimated to the company though it was prior to issuance of the policy and was required to be informed in terms of the proposal form and policy. Thus, the OPs have rightly repudiated the claim of the complainant on the ground that non-disclosure/suppression of material information regarding the health of life assured. Hence there is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Complainant tendered into evidence her affidavit Ex.CW1/A and documents Ex.C1 to Ex.C8 and closed the evidence on 24.07.2019.

4.             On the other hand, OPs tendered into evidence affidavit of Snehal Sawant Ex.RW1/A and documents Ex.R1 to Ex.R6 and closed the evidence on 26.09.2019.

5.             We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

6.             The case of the complainant, in brief, is that husband of complainant purchased an insurance policy bearing no.501-3446561 from the OPs, valid from 31.07.2015 upto maturity. On 17.11.2015 the husband of complainant was expired. The complainant being nominee lodged the death claim of her husband with the OPs and submitted all the required documents but OPs did not pay the claim and repudiated the same on the false grounds.

7.             On the other hand, the case of the OPs is that the claim of the complainant was rightly repudiated as the husband of the complainant has suppressed the true facts regarding his health at the time of issuance of the policy.  The husband of complainant i.e. life assured was diagnosed of Cancer and was under treatment in Acharya Tulsi Regional Cancer Treatment and Research Centre, Bikaner Rajasthan. The said diagnose and treatment was not intimated to the company though it was prior to issuance of the policy.

8.             Admittedly, the deceased life assured was insured with the OPs for the sum assured of Rs.5,89,690/-. The policy in question had issued on 31.07.2015. It is also admitted that the husband of complainant expired during the subsistence of the policy i.e. on 17.11.2015. It is also admitted that complainant is the nominee of the deceased life assured.

9.             In the column no.7 of the proposal form Ex.R1, information was sought in respect of past medical history, the life assured answered in the negative to all the questions and based on the response, the OP was persuaded to issue the policy. The claim of  the complainant has been repudiated by the OPs, vide repudiated letter Ex.R6 dated 29.02.2016 on the ground that life assured has given false and misleading information to the company and non-disclosure of material information at the time of making the proposal.

10.            Learned counsel of the OPs submitted that life assured was under the treatment from Acharya Tulsi Regional Cancer Treatment and Research Centre, S.P. Medical College & A.G. of Hospital, Bikaner, Rajasthan since April, 2015 which proved from the patient summary Ex.R5, and at the time of making the proposal of the policy this facts has been concealed by the life assured. Thus, the OPs have rightly repudiated the claim of the complainant.

11.            As per the patient summary Ex.R5 the life assured was under treatment of Cancer since 13 April, 2015. On the basis of proposal form Ex.R5 dated 31.07.2015 the policy in question was issued on the same day. As per patient summary Ex.R5 life assured had under treatment since 13 April, 2015 i.e. prior to issuing the policy dated 31.07.2015. The learned counsel of the OPs relied upon the judgments of Supreme Court in case Satwant Kaur Sandhu Versus New India Assurance Company Ltd. (2009) 8 SCC 316; Life Insurance Corporation of India Vs. Smt. Asha Goel (2001) 2 SCC 160; Life Insurance Corporation of India Versus Smt. G.M. Channabasamma 1991 (1) SCC 357 and P.C. Chacko Versus Chairman, Life Insurance (2008) 1 SCC 321. Further in case Life Insurance Corporation of India Versus Shahid Khatoon and Anr., IV (2013) CPJ 370 (NC) and LIC of India Vs. MU Jakia, IV (2013) CPJ129 (NC). All the authorities are based upon the suppression of material facts regarding the health of life assured prior to issuance of insurance policy and the same are fully applicable to the case in hand.

12.               In view of above cited authorities, facts and circumstances of the case, we do not find any merits in the complaint and the same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 04.11.2019

                                                                        President,

                                                           District Consumer Disputes

                                                           Redressal Forum, Karnal.

 

 

                     (Vineet Kaushik)     (Dr. Rekha Chaudhary) 

                        Member                       Member