Haryana

StateCommission

A/797/2015

TATA AIA LIFE INSURANCE CO. - Complainant(s)

Versus

BODAN - Opp.Party(s)

S.C.THATAI

25 May 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA

 

                                      First Appeal No.           797 of 2015

                                                Date of Institution:       21.09.2015

                                                Date of Decision:         25.05.2016

 

1.      TATA AIA Life Insurance Company (Formerly known as TATA AIG Life Insurance Company Limited) Branch Office: 1^st Floor, Shiwalik Apartments, SCF 14, HUDA, Commercial Complex, Civil Road, Rohtak – 124001 through its Power of Attorney Holder/Authorized Representative Sh. Harsimran Singh.

 

2.      TATA AIA Life Insurance Company (Formerly known as TATA AIG Life Insurance Company Limited) (Registration No.110) Delphi-B Wing, 2^nd Floor, Orchard Avenue, Hiranandani Business Park, Powai, Mumbai -400076 through its Manager.

…..Appellants-Opposite Parties

 

Versus

 

1.      Bodan son of Daya Nand, resident of Village Barhana, Pana Milwan, Tehsil Beri, District Jhajjar 

 

2.      Poonam daughter of Daya Nand, resident of Village Barhana, Pana Milwan, Tehsil Beri, District Jhajjar 

 

…Respondents-Complainants

 

CORAM :            Hon’ble Mr. Justice Nawab Singh, President

                             Mr. B.M. Bedi, Judicial Member.

                             Mr. Diwan Singh Chauhan, Member.

                  

For the parties:  Mr. S.C. Thatai, Advocate for the appellants

                             Mr. Jagjeet Beniwal, Advocate for the respondents

 

O R D E R

 

NAWAB SINGH J, (ORAL)

 

          TATA AIA Life Insurance Company and another-opposite parties (hereinafter referred to as ‘Insurance Company’) have come up in appeal against the order dated July 08^th, 2015 passed by the District Consumer Disputes Redressal Forum, Rohtak (for short ‘District Forum’), whereby complaint filed by Bodan and Poonam-complainants was allowed.  The Insurance Company was directed to pay Rs.2,50,000/- after deducting Rs.18,529/- alongwith interest at the rate of 9% per annum from the date of filing the present complaint, that is, January 11^th, 2012 till its realization and Rs.2500/- litigation expenses to the complainants.

2.      Smt. Chand Kaur (since deceased) mother of complainants obtained life insurance policy from the Insurance Company on December 27^th, 2010.  The sum assured was Rs.2,50,000/-.  She died on March 25^th, 2011.  The claim lodged by the complainants with the Insurance Company, was repudiated on the ground that the life assured concealed material facts in her proposal form that she was suffering from Oropharyngeal Cancer prior to purchasing of the policy. 

3.      Challenging the repudiation of their claim, the complainants filed complaint under Section 12 of the Consumer Protection Act, 1986 before the District Forum.

4.      On appraisal of the pleadings of the parties and the evidence available on record, District Forum accepted the complaint. 

5.      Learned counsel for the Insurance Company has urged that the life assured was suffering from Oropharyngeal Cancer prior to her death and concealed this fact at the time of obtaining the insurance policy.  He has placed on record summary issued by the doctor from Pt. B.D. Sharma, PGIMS, Rohtak (Exhibit R-5) indicating that the life assured was already suffering from Carcinoma Oropharynx (Cancer) much prior to the filling up of proposal form.  The summary is reproduced as under:-

                   “Patient Chand Kaur, 60 years, Female, first reported in RT OPD, PGIMS, Rohtak on 04.08.2010 and was registered under RT No.1730/10 and was diagnosed as C/o Carcinoma Oropharynx HPR No.1139/10, 9.2.10 PGIMS, Rohtak- Mod. diff. Sq. Cell Ca.  Patient was treated with Neoadjuvant Chemotherapy Radical Radiotherapy last on 25.11.2010.  Patient has residual disease and was last seen in the OPD on 4.3.2011.”

6.      The summary given by PGIMS, Rohtak clearly indicates that the life assured had been diagnosed as a case of Carcinoma Oropharynx (Cancer) prior to the purchase of the insurance policy and she was regularly taking medicines.  The summary shows that the life assured had knowledge of being suffering from Carcinoma Oropharynx (Cancer) and still purchased the policy without disclosing this fact.  Had the life assured disclosed the fact suffering from Carcinoma Oropharynx (Cancer), question of issuing the policy to the assured could not have arisen.  It is well settled law that treatment record of hospital is sufficient evidence to prove that the patient was treated by the doctor/hospital and the same cannot be denied. 

7.      In view of above, District Forum has failed to appreciate the above stated evidence and erred in allowing the complaint because no relief can be granted to the complainants beyond the terms and conditions of the insurance policy.  Hence, the impugned order under challenge cannot be allowed to sustain. 

8.      For the reasons recorded above, this appeal is accepted, the impugned order is set aside and the complaint is dismissed. 

9.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification, in accordance with the rules, after the expiry of period of appeal/revision, if any.

 

 

Announced 25.05.2016

(Diwan Singh Chauhan Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President

 

U.K