Complaint Case No. 35/2014

Prem Shankar Sharma S/o  Sri Radhey Shyam Sharma  R/o Gram and Post Gadrana  Distt. Aligarh

V/s

1. Canara HSBC Oriental Bank of commerce Life Insurance Co. Ltd. Uniteck Trade Centre Second Floor, Sushant Lok, Phase No.1 Sector 43 Gurugram Hariyana.
2. Sheyash Gramin Bank, Branch Office Gadrana by Head office Lal Diggi, Near Abdulla Girls College, Aligarh
3. Canara HSBC Oriental Bank of commerce Life Insurance Co. Ltd. Second floor Rajendra Point No.1 Raghunath Nagar, Agra

CORAM

 Present:

1. Shri Hasnain Qureshi, President
2. Shri Alok Upadhayay, Member
3. Smt. Purnima Singh Rajpoot, Member

PRONOUNCED by Shri Hasnain Qureshi, President

JUDGMENT

1. The present complaint has been filed by the complainant before this commission for directing the Ops to pay compensation Rs.116000 with interest.    
2. Complainant has stated that his wife  Shakuntla Devi was insured with the Op on 25.2.2010 through Akhilesh Jaiswal and the premium amount Rs. 15000 was fixed under the health and personal declaration. Complainant’s wife had completed the condition of the provisions of section 41 and 45 of the Insurance Act, 1938. As per section 3 of the policy the insurance Company was liable to cover  all the risks after the death but the insurance company has not paid the assured sum. Complainant’s wife was admitted on 6.2.2011 at J.N. medical College, Aligarh and died on 15.2.2011. Complainant’s wife aged about 44 years had been maintaining good health. OP no1 was given the death certificate of Shakuntla Devi and a cheque of the Rs.11000 was given as compensation. OP no.1 has not paid any compensation under Saral Bima Plus Plan of the Canara HSBC Oriental  Bank of commerce. Complainant’wife was 44 year old at the time of death and she was a house wife and her income at Rs.200 per day is presumed  and total  income comes to Rs.72000 per annum and by applying the multiplier of 15 the total amount for compensation comes to Rs.1080000. the amount of Rs.26000 is litigation expenses. The family members of the Complainant and her dependents be paid compensation with the interest @12% per annum.                   
3. OP No.1 and 3 stated in WS that Late Shakuntla Devi had applied for Insurance Policy under the Canara HSBC Oriental Bank of Commerce Life Saral Bima plus Plan and   premium Rs.15000 was proposed to pay annually for the sum assured Rs.75000. The complainant was proposed to be a nominee. The deceased life assured has declared in the proposal form that she was never diagnosed or treated for a heart condition etc. or any other medical condition requiring hospitalization for more than two weeks but it was found that the deceased   life assured had been suffering from TB and was on anti-tubercular treatment prior to signing the proposal from. As is evident from J.N. Medical College record 6.2.2011. If the material fact is suppressed the insurer will be within his right to treat the contract of Insurance as void.    
4. Op no.2 stated in WS that Shakuntla Devi was insured through HSBC Oriental Bank of Commerce Company and insurance Company was under obligation for complete examination of health of the insured and the dispute is between insurance and complainant and Op no.2 has no concern with it. Complainant has taken loan Rs.30000 under KCC scheme and is liable to pay Rs. 23244 by the date 31.3.2014.
5. Complainant has filed his affidavit and papers in support of his pleadings. OP no3 has filed their affidavit and papers in support of their pleadings
6. We have perused the material available on record and heard the complainant.
7. The first question of consideration before us is whether the complainant is entitled any relief?
8. Admittedly Op insurance company had accepted the proposal submitted by the complainant’s wife for issuance of Life Insurance Policy with the assured sum Rs.75000 on death. Op insurance Company has raised the plea of Preexisting disease tuberculosis. Apart from the statement made by the deceased  life   assured, Insurance Company was also liable to have satisfied with the health condition of the deceased life assured. Insurance Company was under obligation to have medically examined the deceased life assured to be satisfied with her health condition. Once the Insurance Company accepted the proposal submitted by the insured for contract of insurance, the insurance company is estopped from the liability under contract of insurance. As the contract of insurance was for payment of Rs.75000on death of the insured, insurance company is liable to pay the said amount to the nominee of deceased life assured, who is complainant in the case. As the complainant has received the amount Rs.11000 and therefore OP insurance company liable to pay the remaining amount Rs.64000 with interest.   
9. The question formulated above is decided as above in favor of the complainant.
10. We hereby direct the Op insurance company to  pay to the complainant the amount Rs.64000 with pendente lite and future interest @10% per annum.
11. Ops shall comply with the direction failing which Ops shall be prosecuted for non-compliance in accordance with section 72 of the Act for awarding punishment against him.
12. A copy of this judgment be provided to all the parties as per rule as mandated by Consumer Protection Act, 2019. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties.
13. File be consigned to record room along with a copy of this judgment.