BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KAITHAL.
Complaint no.212/12.
Date of instt.: 06.09.2012.
Date of Decision: 22.12.2014.
Rajpal S/o Sh. Jaimal r/o Village Songal, Tehsil and Distt. Kaithal (Haryana).
……….Complainant.
Versus
1. Birla Sunlife Insurance Co. Ltd., 6th Floor Waman Centre, Makhwana Road, Off Andheri Kurla Road, near Marol Naka, Anbdheri (E) Mumbai-400059, through its Managing Director.
2. Branch Manager, Birla Sunflife Insurance Co. Ltd., Amartara Building Khurania Complex, Kurukshetra Road, Kaithal.
3. Sachin Punia S/o Sh. Jagjeet Singh, Birla Sunflife Insurance Co., Amar Plaza, Ist Floor, Kurukshetra Road, Kaithal (M) 98964-03342.
..……..Opposite Parties.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Sh. Rajbir Singh, Presiding Member.
Smt. Harisha Mehta, Member.
Present : Sh. S.S.Malik, Advocate for complainant.
Sh. Rajesh Vadhera, Advocate for the opposite parties.No.1 & 2.
Sh. J.P.Jaglan, Adv. for Op No.3.
ORDER
(HARISHA MEHTA, MEMBER).
The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that the wife of complainant namely Smt. Ompati got herself insured with the Ops for her life in the sum of Rs.5,00,000/- vide policy No.004293829 dt. 28.07.2010. It is alleged that the wife of complainant died on 27.09.2011 at Village Songal, District Kaithal. It is further alleged that the death of Smt. Ompati, the complainant being nominee lodged the claim with the Ops and submitted all the necessary documents but the Ops repudiated the claim of complainant. This way, the Ops are deficient in service. Hence, this complaint is filed.
2. Upon notice, the opposite parties appeared before this forum. Ops No.1 & 2 filed written statement raising preliminary objections with regard to maintainability; cause of action; locus-standi; that the deceased life assured i.e. Smt. Ompati had submitted the Ops, a proposal form/application dt. 30.07.2010 for the purchase of BSLI Dream Endowment FAV Plan-Term 30 Pay 15, the proposal was accepted based on the information provided by the DLA and consequently, a policy was issued bearing policy No.004293829 dt. 28.07.2010 which commenced on 28.07.2010; that before acceptance of the proposal by the Ops, the contents of the proposal form/application, illustrations and the abdendum forms were read and explained to the DLA. On the basis of the information furnished in the application/proposal form, the proposal was processed by the Ops and thereafter, the said policy was issued to the DLA; that the policy in dispute was issued on the basis of an application for insurance dt. 30.07.2010 submitted by Smt. Ompati i.e. DLA on her own life. In the said application for insurance, the DLA had applied in negative to the questions numbered XII-D.1 2.(a), (b), (c) 3. (f). There is no deficiency in service on the part of answering Ops. On merits, the contents of complaint are denied and so, prayed for dismissal of complaint.
3. Ld. Counsel for the Op No.3 made statement on 21.11.2014 that the reply filed on behalf of Ops No.1 & 2 be also read on the part of Op No.3.
4. In support of their case, both the parties submitted their affidavits and documents.
5. We have heard ld. counsel for both the parties and perused the case file carefully and minutely.
6. We have gone through the evidence produced by both the parties. The complainant contended that Smt. Ompati, wife of complainant got herself insured with the Ops for her life in the sum of Rs.5,00,000/- vide policy No.004293829 dt. 28.07.2010 and used to deposit the premium instalment as per terms and conditions of above-said policy. The complainant was nominated as nominee in the policy. The wife of complainant died on 27.09.2011. After her death, the complainant has applied for the claim against the life insurance policy of said Ompati but the Ops have rejected the above-said claim. The Ops contended that the investigations carried out by the Ops revealed and established from the medical records dt. 27.05.2010 of Jindal Institute of Medical Sciences (N.C. Jimcare & O.P. Jicare) that the DLA was diagnosed of stomach cancer and had undergone treatment for the mentioned illness much prior to the application for insurance (Ex.R3). They also contended that if the material information regarding the pre-existing disease/correct medical information been disclosed to the Ops in the application form dt. 30.07.2010 by the DLA at the time of applying for the said insurance policy, the Ops would not have issued the said policy at all. It is crystal clear from the Admission Discharge Record of Jindal Institute of Medical Sciences, Model Town, Hisar (Ex.R3), which showed that Smt. Ompati was admitted in the hospital on 27.05.2010 and was discharged on 01.06.2010. The wife of complainant was suffering from stomach cancer and was diagnosed of IV stage Adeno carcinoma and was undergoing chemotherapy. In this regard, we can rely upon the authority reported as LIC & others Vs. Jasmeri Devi, 2012(1) CPJ page 316, wherein it has been held that Repudiation-Suppression of material facts-The proposal form and certificate reflected that at the time of obtaining the policy, the life assured (deceased) had full knowledge about the cancer suffered by him-Despite this he made false statement in the proposal form by giving wrong answers to the question No.11-It is clear that the life assured had obtained the insurance policy by playing fraud with insurance company by giving wrong answers while making his personal statement-Appellant-Ops were justified while repudiating the complainant’s claim-District Forum failed to appreciate the true facts of the case and as such, the impugned order cannot be allowed to sustain and liable to be set-aside. Moreover, Birla Sun Life Insurance Company decided to refund cash surrender value i.e. Rs.3094/- under the policy as an ex-gratia. But the complainant and Ops did not disclose about receiving of this cheque. So, we are of the considered view that the complainant has failed to prove any deficiency on the part of Ops.
7. Thus, in view of above discussion, we find no merit in the present complaint and dismiss the same. A copy of this order be sent to both the parties free of cost. File be consigned to the record room after due compliance.
Announced.
Dt.22.12.2014.
(Harisha Mehta), (Rajbir Singh),
Member. Presiding Member.
