DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH Consumer Complaint No | : | 152 of 2011 | Date of Institution | : | 15.03.2011 | Date of Decision | : | 04.08.2011 |
Sunita widow of late Sh. Rajbir, resident of House No.321, Dadu Majra Colony, U.T., Chandigarh. …..Complainant V E R S U S 1. Canara HSBC Oriental Bank of Commerce, Life Insurance Company Ltd., SCO No.. 2917-2918, First Floor, above Karnatka Bank, Sector 22-C, Chandigarh through its authorized person. 2. Canara HSBC Oriental bank of Commerce, Life Insurance Company Ltd. United Trade Centre, Second Floor, Sushant Lok, Phase-I, Sector 43, Gurgaon-122002, through its authorized person. ……Opposite Parties CORAM: SH.P.D.GOEL PRESIDENT SH.RAJINDER SINGH GILL MEMBER DR.(MRS) MADANJIT KAUR SAHOTA MEMBER Argued by: None for complainant. Sh.Pankaj Jain, Counsel for OPs. PER P.D. GOEL, PRESIDENT The complainant-Smt.Sunita has filed the present complaint under section 12 of the Consumer Protection Act (as amended upto date) “hereinafter referred to as the Act”. Briefly stated, the case of the complainant is that her husband took Saral Beema Plan Policy No.009389917 for a period of 15 years for a coverage proposed amount of Rs. 30,000/- from the OPs and paid the first premium. The complainant averred that at the time of taking the policy her husband was hale and hearty. According to the complainant, in 2010 her husband unfortunately fell sick and ultimately died on 1.8.2010. Being the nominee, she lodged the claim with the OPs and fulfilled all the requisite formalities but the OPs repudiated the claim vide letter dated 18.2.2011 on the ground of pre-existing disease. Hence this complaint. 2. OPs filed their reply. It has been admitted that husband of the complainant obtained Insurance Policy. The OPs pleaded that the life assured was suffering from diabetes and Tuberculosis and for this he was taking treatment but the life assured had concealed these material facts regarding his health and made a false declaration while taking the policy and therefore, the claim of the complainant was rightly repudiated vide letter dated 18.02.2011. All the other allegations of the complainant has been denied and prayer for dismissal of the complainant is made. 3. Parties led evidence in support of her contentions. 4. None is present on behalf of the complainant, therefore, we decide to dispose of this complaint even in the absence of the complainant. We have heard the counsel for the OPs and have also perused the record. 5. Admittedly, the husband of the complainant took Saral Beema Plan Policy for a period of 15 years for Rs.30000/- from the OPs (Annexure R-1). It is the case of the complainant that at the time of taking the policy her husband was hale and hearty. However, unfortunately her husband fell sick and died on 1.8.2010. Being the nominee, she lodged the claim with the OPs after completing all the formalities but the OPs repudiated the claim vide letter dated 18.2.2011 on the ground of pre-existing disease. 6. OPs have raised the plea that the L.A. was suffering from diabetes and Tuberculosis and was also taking treatment for the same but the L.A. had concealed these material facts prior to taking the insurance policy and therefore, the claim of the complainant was rightly repudiated vide letter dated 18.02.2011 on the ground of pre-existing disease. All the other allegations of the complainant has been denied and prayer for dismissal of the complainant is made. 7. Now the only point which call determination from this Forum is whether the L.A. was guilty of concealing the material facts regarding his health. The answer to this is in negative. 8. The repudiation letter dated 18.02.2011 is Annexure C-3 qua which the claim had been denied by the OPs on the ground that the L.A. had concealed material facts regarding his health and taking treatment for diabetes and Tuberculosis prior to taking the insurance policy. To prove that the L.A had concealed the facts with regard to treatement for diabetes and Tuberculosis, the OPs have placed reliance upon the Annexure R-2 which is a letter written by the complainant to the OPs wherein it has been stated that her husband was treated for diabetes and Tuberculosis in Govt. Dispensaryu, Sector 22 in July, 2009 and after the treatment, the doctor certified that the L.A. was not suffering from diabetes and Tuberculosis. Admittedly, the OPs have not produced on record any medical record or certificate issued by any doctor to prove that the L.A. was suffering from any pre-existing disease. 9. It is settled proposition of law that the policy holder is not supposed to disclose normal wear and tear of human life at the time of obtaining the policy. It is always on the insurer to prove concealment of pre-existing disease at the time of obtaining the policy. The ‘Disease’ means a serious derangement of health or chronic deep-seated disease frequently one that is ultimately fatal for which an insured must have been hospitalized or operated upon. Further the Malaise of hypertension, diabetes, occasional pain, cold, headache, arthritis and the like in the body are normal wear and tear of modern day life which is full of tension at the place of work, in and out of the house and are controllable on day-to-day basis by standard medication and cannot be used as concealment of ‘pre-existing disease’ for repudiation of the insurance claim. Reliance placed on Oriental Insurance Co. Ltd. Vs. Mohinder Singh (Dr.) reported in IV(2008) CPJ 511 and Lakhwinder Singh and Anr. Vs. United India Insurance Co. Ltd. and Others reported in II(2010) CPJ 265 decided by our own Hon’ble State Commission. 10. Besides this, the repudiation of the claim cannot be stated to be legal as the proposal for issuance of the insurance policy was accepted by the OP after due examination by its doctors. Had the L.A. was suffering from any pre-existing disease, the doctors on the panel of the Ops would have certainly declared the L.a. unfit for obtaining the insurance policy. Annexure R-2 referred to above is not sufficient to prove on record that the L.A. was suffering from any pre-existing disease. In this case, the OP had not been able to establish the concealment by leading proper and cogent evidence. Reliance placed on LIC of India and others Vs. Harbans Kaur, 2010(1) CLT (NC). 11. As a result of the above discussion, this complaint is accepted with a direction to OPs to pay the sum assured along with all benefits to the complainant under the policy in question along with interest @ 12% p.a. from the date of repudiation i.e. 18.02.2011 till its realization besides Rs.10,000/- as litigation expenses within one month. 12. The certified copies of this order be sent to the parties free of charge. The file be consigned. | Sd/- | Sd/- | Sd/- | 04.08.2011 | [Madanjit Kaur Sahota] | [Rajinder Singh Gill] | [P.D.Goel] | | Member | Member | President |
| | MR. RAJINDER SINGH GILL, MEMBER | HONABLE MR. P. D. Goel, PRESIDENT | DR. MRS MADANJIT KAUR SAHOTA, MEMBER | | 
