Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 558.
Instituted on : 13.10.2016.
Decided on : 09.07.2019.
Mr. Gulshan age 32 years, s/o Sh., Dhanshyam Dass s/o Sh. ramji Dass H.No.633/1, W No.2, Garghi Mohalla, Rohtak..
………..Complainant.
Vs.
- Birla Sunlife Insurance Company Ltd. Through its Chairman and Managing Director Registered office at
One Idiabulls Centre, tower 1, 16tth Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg Elphinstone Road, Mumbai -400013. r.
- Birla Sunlife Insurance Company Ltd., Through its Branch Manager, Ground floor, Plot No.1 Scheme No.19 Subhash Park, Opp. Radiom Station, Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
DR. RENU CHAUDHARY, MEMBER.
Present: Sh.M.L.Dhingra Advocate for the complainant.
Sh. Gulshan Chawla, Advocate for opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the complaint are that uncle of the complainant namely Harish Kumar had taken the insurance policy from the respondent No.2 on the request of respondents in the month of February 2014 and paid Rs.19160/- as annual premium for a term of 30 years. That the policy was issued in the name of Harish Kumar(now deceased) and the complainant Gulshan Kumar was appointed as nominee. That sum assured of the policy was Rs.950000/-. That deceased Harish Kumar paid two installments of Rs.19158.25/- on dated 27.02.2014 and Rs.19160/- on dated 20.09.2014 and died on 04.11.2014 at PGIMS, Rohtak,. That complainant informed the opposite parties about the death of life assured Harish Kumar and filed the insurance claim by completing all necessary formalities. That complainant requested the opposite parties to pay the genuine claim of complainant but to no effect. That complainant also sent a legal notice dated 06.07.2016 but the opposite parties refused to pay the claim amount. That the act of opposite parties of repudiating the lawful claim of complainant is illegal and against the natural justice. Hence this complaint and it is prayed that the opposite parties may kindly be directed to make the payment of Rs.950000/- alongwith interest, compensation and litigation expenses, as explained in relief clause to the complainant.
2. After registration of complaint notice was issued to the opposite parties. In reply to the complaint, opposite parties have submitted that believing the information given in the proposal form to be correct, answering respondents issued the policy 006399823 on 27.02.2014 for the policy term 30 years for the basic sum assured of Rs.950000/- with half yearly payment of Rs.19158.25P. That an
intimation regarding the death of Harish Kumar was received in the office of answering respondents after a span of 1 year and 4 months from the alleged date of death i.e. 04.11.2014. That as per the documents submitted by the complainant, the deceased life assured had expired on 04.11.2014 whereas intimation was given to the answering respondents on 16.08.2016. That since the death of life assured had occurred within a short span of 8 months and 8 days from the issuance of policy, hence the claim was investigated and on investigation, it was found that fraud being played by the life assured/complainant in collusion with each other and the present policy has been taken by life assured after concealment of material facts regarding the state of his health. As per the documents collected, life assured was suffering from Alcoholic liver with Ascites and Upper Gastrointestinal bleed and was under treatment for the same prior to the proposal for the insurance. That such treatment/disease was not disclosed at the time of the proposal. That the complainant failed to submit the documents and later on lodged the present complaint, without waiting for the decision from insurance company as regard to the death claim of the deceased life assured. That the claim of the complainant has been rightly repudiated vide letter dated 20.02.2017 duly served upon the complainant. Hence there is no deficiency in service on the part of
opposite parties and it is prayed that complaint may kindly be dismissed with costs.
3. Ld. counsel for the complainant has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C14 and closed his evidence on 23.04.2019. On the other hand, ld. counsel for the opposite parties has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R5 and has the evidence of the opposite parties was closed by the order dated 16.04.2018 of this Forum.
4. We have heard ld. counsel for the parties and gone through the material aspect of the case very carefully.
5. After going through the file and hearing the parties it is observed that the claim of the complainant has been repudiated by the opposite party on the ground that life assured was suffering from Alcoholic liver with Ascites and Upper Gastrointestinal bleed and was under treatment for the same prior to the proposal for the insurance. That such treatment/disease was not disclosed at the time of the proposal. To prove this fact, opposite party has only placed on record copy of Hospital record annexed with Ex.R4, as per which the admission date of deceased is 31.10.2014 and date of death is 04.11.2014 but in the alleged document it is not mentioned anywhere that the deceased was suffering from the alleged disease prior to proposal for insurance policy. The policy in
question was issued on 27.02.2014 and no previous treatment record has been placed on file by the opposite parties. Moreover, no affidavit of doctor has been placed on record to prove the alleged fact. As such repudiation of claim by the opposite party is illegal and against the natural justice. Ld. counsel for the complainant has also placed reliance upon the law 2005(2)CPC675 titled as Surinder Kaur and Ors. Vs. LIC of India of Hon’ble NCDRC and order dated 16.04.2012 of Hon’ble State Commission, Chandigarh titled as Lalita Devi vs. LIC of India, which are fully applicable on the facts and circumstances of the case.
6. In view of the facts and circumstances of the case, complaint is allowed and it is directed that opposite parties shall pay the claim amount of Rs.950000/-(Rupees nine lac fifty thousand only) alongwith interest @ 9% from the date of filing the present complaint till its realisation and shall also pay a sum of Rs.5000/-(Rupees five thousand only) as compensation on account of deficiency in service and litigation expenses to the complainant within one month from the date of decision.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
09.07.2019.
................................................
Nagender Singh Kadian, President
…………………………………
Ved Pal, Member.
………………………………..
Renu Chaudhary, Member.
