Haryana

StateCommission

A/277/2016

MOHAN LAL - Complainant(s)

Versus

BIRLA SUN LIFE INSURANCE CO. - Opp.Party(s)

C.R.OLLA

27 Sep 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                               

                                        First Appeal No.277 of 2016

                                      Date of Institution:04.04.2016

                                      Date of Decision :27.09.2016

 

Mohan Lal son Ganga Ram, resident of village Bhimsana (Sadalpur), Tehsil Rajgarh, District Churu, Rajasthan.

                                                …Appellant

 

 

                                      Versus

 

1.      Birla Sun Life Insurance Co. Ltd., on the upper side  Canara Bank, G.T. Road, Fatehabad, through its Branch Manager.

2.      Birla Sun Life Insurance Co. Ltd., Registered office One Indiabulls Centre, Tower-1, 15^th and 16^th Floor, Jupiter Mill Compound, Senapati Bapat Marg, Elphonistone Road, Mumbai-400013 through its authorized signatory, IInd Add:- Birla Sun Life Insurance Company Ltd., G Crop Tech Park, 5^th and 6^th Floor, Kasar Vadawali, Near Hypercity Mall, Ghodbunder Road, Thane (W) 400061.

                                          …Respondents

 

 

CORAM:   Mr. R.K. Bishnoi, Judicial Member

                   Mrs. Urvashi Agnihotri, Member

 

 

Present:     Mr. C.R. Olla, Advocate for the appellant.

Mr. S.C. Thathai, Advocate for the respondents.

 

                                       O R D E R

 

R.K. BISHNOI, JUDICIAL MEMBER

 

          It was alleged by the complainant that one Karanpal obtained insurance policy for Rs.15,50,000/- from opposite parties (in short ‘OPs’) commencing from 16.07.2011. After paying premium policy was  reinstated w.e.f. 20.03.2014. At that time he (deceased life assured-DLA) was not having any problem and was also examined by the doctor of insurance company. During subsistence of that policy DLA expired. As being nominee he submitted death claim benefits under the policy and was consumer. Vide letter dated 13.01.2015 he was informed that his claim was repudiated. Hence, the complaint and OPs be directed to pay the sum assured, besides other benefits.

2.      OPs filed reply controverting his averments and alleged that after obtaining policy on 15.07.2011 son of complainant approached them on 11.03.2014 and submitted health declaration form to the effect that he was free from all types of diesease on the date of entering into major revival form. He paid due amount under the policy and considering information supplied by DLA as true, the policy was reinstated w.e.f. 20.03.2013. After receiving intimation about death of life assured it came to their notice that he expired on 08.04.2014. As there was close proximity in-between death and renewal of insurance policy, the matter was got investigated and it came to their notice that DLA was suffering from cancer of penis when major revival form was submitted. He was receiving treatment from Acharya Tulsi Regional Caner Treatment and Research Centre, Bikaner vide registration No.4279/11. In this way DLA concealed the fact of previous illness and got the policy revived by fraud. Contract of life insurance is Uberrama Fides. As the previous ailment was concealed, so the claim was rightly repudiated. Objections about maintainability of complaint, locus-standi, concealment of material facts, non-joinder of necessary parties were also raised and requested to dismiss complaint.  After hearing both the parties, learned District Consumer Disputes Redressal Forum, Fatehabad (in short ‘District Forum’) dismissed complaint vide order dated 10.12.2015.

3.      Feeling aggrieved therefrom complainant preferred this appeal.

4.      Arguments heard. File perused.

5.      Learned counsel for the complainant vehemently argued that when insurance policy was renewed DLA was properly examined by doctor of OP and no problem was detected. Had he been suffering from any problem insurance company must not have revived previous insurance policy. Learned District Forum failed to take into consideration these aspects and dismissed the complaint of complainant. In support of his arguments he placed reliance upon the opinion of Hon’ble Madras High Court expressed in W.P (MD) No.8115 of 2009 titled as “G.Muthupackiam Vs. The Zonal Manager, Chennai & Anr.” decided on 31.01.2012.

6.      This argument is of no avail. When policy was revived DLA filled form Ex.R-3. At that time it was specifically asked from him whether he was suffering from cancer or not and he replied in negative which is clear from clause 15 (F) of Ex.R-3. This answer is falsified from the treatment record of DLA issued by Sardar Patel Medical College and Hospital, Bikaner Ex.R-7 dated 20.09.2011. As per this record it is clear that he was suffering from cancer and receiving regular treatment. It shows that DLA was aware about illness and that is why he got insurance policy revived on 11.03.2014 just before his death on 08.04.2014. As per O.Ps declaration form was submitted by son of DLA. There is difference of only one month in-between death and revival of insurance policy. it shows that DLA was aware about his condition and that is why he got policy revived. Appellant-complainant cannot derive any benefits of reliance placed above because it is based on different facts.  In that case it was not possible for DLA to know about ailment whereas in the present case he was already receiving treatment. More so, it may be mentioned here that complainant has not impleaded legal representatives (L.Rs.) of deceased as party.  Nominee cannot sit over the right of L.Rs.

6.      As a sequel of aforesaid discussion, we are of the opinion that order of Learned District Forum is well reasoned and based on law and cannot be disturbed. So, appeal fails and same is hereby dismissed.

September 27^th,               Urvashi Agnihotri        R.K. Bishnoi

2016                                Member                     Judicial Member

                                       Addl. Bench                Addl. Bench