Haryana

Sonipat

CC/474/2015

Smt. Laxmi Devi W/o Jai Singh - Complainant(s)

Versus

Branch Manager Life Insurance Corporation of India - Opp.Party(s)

Naveen Ranga

04 Jul 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

SONEPAT.

               

 

                                Complaint No.474 of 2015

                                Instituted on:23.12.2015

                                Date of order:04.07.2016

 

Smt. Laxmi Devi wife of Jai Singh, r/o H.No.73, Rajiv Nagar, near Gurudwara, Kheri Kalan, Faridabad also at c/o Hari Krishan son of Jagdish, Narender Nagar, Gali no.6, ITI Chowk, Rathdhana road, Sonepat.

 

…Complainant.  

Versus

 

1.Branch Manager, Life Insurance Corporation of India,  Jeewan Jyoti Building, Sector 15 Sonepat.

2.Divisoinal Manager, LIC of India, Sector 1, Divisional Office Rohtak-124001.

                                                      …Respondents.

 

 

COMPLAINT UNDER SECTION 12 OF       

THE CONSUMER PROTECTION ACT,1986

 

Argued by: Sh. Naveen Ranga Adv. for complainant.

           Sh. OP Wadhwa, Adv. for respondents.

 

BEFORE     NAGENDER SINGH, PRESIDENT.

          PRABHA WATI, MEMBER.

           J.L. GUPTA, MEMBER.

         

 

O R D E R

 

          The complainant has filed the present complaint against the respondents alleging therein that her son namely Ravinder was having LIC Money Back Plan-20 policy bearing no.179804766 for Rs.one lac.  On 17.4.2015, the said Ravinder was admitted in National Institute of TB&RD New Delhi with complaint of cough and fever and unluckily, he expired on 24.4.2015.  After his death, the complainant submitted all the required relevant documents with the respondent no.1 and requested to make the payment of the claim amount, but of no use.  Rather the complainant was shocked to receive the letter dated 19.11.2014 from the respondents whereby the claim of the complainant was declined.  The complainant has alleged the repudiation of the claim to be wrong and illegal. So, she has come to this Forum and has filed the present complaint.

2.        In reply, the respondents have submitted that the claim of the complainant has been repudiated on account of the deceased having suppressed the true and correct information regarding his health and habits at the time of purchase of the policy in question.  The policy no.179804766 was issued by the respondent no.1 in favour of the deceased LA Ravinder.  The said policy had run for a period of 11 months only  and due to this, the claim was put to investigation under early death claim settlement procedure and it was revealed from the certificate of hospital treatment on form no.3816 issued by National Instt. of TB & RD that the deceased LA although admitted in the said hospital on 17.4.2015 and declared himself suffering from cough and expectoration & fever & shortness of breath for the last 156 days, but it was also revealed by the patient himself as per recital of clause 5(b) of the said form that the deceased LA was diagnosed as suffering from miliory tuberculosis with respiratory futive disease and had the past history of ATT since 9 years back with gout problem since 8 months.  As per death summary, the deceased LA was in the habit of taking alcohol and Biri Smoking since 2/3 years.  Thus, the answers given by the deceased LA were found false during the investigation and thus, the claim was repudiated in a lawful manner as the complainant is not entitled to any claim against the policy in question.  There was no deficiency in service on the part of the respondents and thus, prayed for the dismissal of the present complaint.

3.        We have heard the arguments advanced by the ld. Counsel for both the parties at length and we have also gone through the entire relevant material available on the case file carefully & minutely.

          Ld. Counsel for the complainant has submitted that the respondents have repudiated the legal and genuine claim of the complainant only to harass and humiliate her, whereas she was legally entitled to get the claim amount in respect of the policy in question which was obtained by her son Ravinder during his life time from the respondent no.1.

          On the other hand, ld. Counsel for the respondents has submitted that claim of the complainant has been repudiated on account of the deceased having suppressed the true and correct information regarding his health and habits at the time of purchase of the policy in question.  The policy no.179804766 was issued by the respondent no.1 in favour of the deceased LA Ravinder.  The said policy had run for a period of 11 months only  and due to this, the claim was put to investigation under early death claim settlement procedure and it was revealed from the certificate of hospital treatment on form no.3816 issued by National Instt. of TB & RD that the deceased LA although admitted in the said hospital on 17.4.2015 and declared himself suffering from cough and expectoration & fever & shortness of breath for the last 15 days, but it was also revealed by the patient himself as per recital of clause 5(b) of the said form that the deceased LA was diagnosed as suffering from miliory tuberculosis with respiratory futive disease and had the past history of ATT since 9 years back with gout problem since 8 months.  As per death summary, the deceased LA was in the habit of taking alcohol and Biri Smoking since 2/3 years.  Thus, the answers given by the deceased LA were found false during the investigation and thus, the claim was repudiated in a lawful manner as the complainant is not entitled to any claim against the policy in question.  There was no deficiency in service on the part of the respondents.

          But we find no force in the contentions raised by the ld.counsel for the respondents.  The respondents have repudiated the claim on the basis of the report made on claim form no.3816.  But there is no affidavit of the person/doctor who issued the said report.  The said person/doctor has not been examined by the respondents in support of the version.

          The other plea of the respondents is that the deceased LA declared himself regarding suffering of cough with expectoration, fever and shortness of breath for the last 15 days but it was also revealed by the deceased LA himself as per recital of clause 5(b) of the form that he was diagnosed as suffering from miliory tuberculosis with respiratory futive disease  and has a past history of ATT since 9 years back with gout problem since 8 months.

          We have perused the question and answer which is reproduced below:-

During the last five years, did you                  No.

Consult a medical practitioner

For any ailment requiring

Treatment for more than a week?

 

          The answer of this question was given by the deceased LA as “No” and in our view rightly so, because the respondent had asked from the deceased LA about the last five years history.  As per the deceased LA, he was not suffering from any disease at the time of obtaining the insurance policy from the respondent no.1.  Further a person could not survive particularly when he is suffering from TB & Respiratory diseases or ATT for the last nine years.  Thus, it is held that the action taken in the matter of the complainant while repudiating her legal and genuine claim is altogether wrong and totally unjustified.   Accordingly, we hereby direct the  respondents to make the payment of Rs.1,00,000/- (Rs.one lac) to the complainant in respect of the policy bearing no.179804766 within a period of 45 days from the date of passing of this order, failing which, the said amount shall fetch interest at the rate of 09% per annum from the date of passing of this order till its realization.

           With these observations, findings and directions, the present complaint stands allowed.

Certified copy of this order be provided to both the

parties free of cost.
          File be consigned to the record-room.

 

 

(Prabha Wati) (J.L. Gupta)                 (Nagender Singh-President)

Member DCDRF  Member DCDRF                    DCDRF, Sonepat.

 

Announced:04.07.2016