BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 114 of 2016
Date of Institution : 5.5.2016
Date of Decision : 15.11.2017.
Kavita wife of late Ram Kumar, resident of village Jagan, Tehsil Adampur, District Hisar.
……Complainant.
Versus.
1. DHFL Pramerica life insurance company limited, 4th Floor Building No.98 Cyber City, DLF City III Gurgaon- 122002 through its Managing Director or authorized person.
2. DHFL Pramerica life insurance company limited Sirsa Branch, 1st Floor Above ICICI Bank Dabwali Road, Sirsa through its Branch Manager.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SMT. RAJNI GOYAT ………………… MEMBER
SH. MOHINDER PAUL RATHEE …… MEMBER.
Present: Sh. Prem Singh Sokhal, Advocate for the complainant.
Sh. Abhishek Jain, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that husband of complainant namely Ram Kumar purchased policy bearing No.000126755 dated 28.1.2015 for sum assured of Rs.4,00,000/- from the opposite parties by making premium to the ops and got his life insured with the ops. That as per terms and conditions of the policy, during the life time the life assured himself and after the death of the life assured the nominee is entitled for claim benefit of the policy. That unfortunately the life assured Ram Kumar died during the subsistence period of the policy and thus the nominee is entitled for death claim benefit of the policy. It is further averred that the complainant is the nominee as per policy and the complainant is the wife and legal heir of the life assured. That the complainant applied for death claim with op no.1 and submitted death claim form, original policy and other documents required for the claim and also completed all the formalities and the officials of the ops assured the complainant that the claim will be disbursed within short time but no claim has been given to the complainant. It is further averred that now the complainant has received letter dated 28.1.2015 from the op no.1 vide which the op no.1 has repudiated the claim of the complainant on the ground of withholding material information regarding cancer at the time of taking the insurance policy. The whole version of the ops is concocted, false and fabricated only to repudiate the genuine claim of the complainant. The life assured was hale and hearty at the time of taking the policy and there was no any history of any kind of disease prior to and on the date of the issuance of the policy and till death. The life assured was checked up by the doctor on the panel of the insurance company before issuing the policy to the life assured and the doctor of the insurance company also found the life assured hale and hearty and thus the repudiation of claim of the complainant is false and fabricated. That the ops have committed deficiency in service by not paying the claim and repudiating the claim of the complainant. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statement taking certain preliminary objections. It is submitted that the insurance policy has been obtained after withholding material information regarding cancer at the time of affection/ inception of the policy. It has been revealed from the doctors records that the deceased was suffering from cancer disease prior to the issuance of policy. The deceased has suppressed the material facts about his past medical history at the time of taking the policy. The policy is a contract of uberrimaefide i.e. based upon utmost good faith and any policy issued on the basis of mis-description/ mis-representation of the facts and concealment of material facts is void and the premium paid shall be forfeited on account of non disclosure of material facts and as such the claim has been rightly repudiated by the ops as the policy is void on account of non disclosure of material facts and it was also conveyed to the complainant. It is further submitted that the deceased had concealed and suppressed the true and material facts from the insurance company at the time of getting insurance policy and hence the complainant is not entitled to get any relief whatsoever. It is further submitted that the deceased had died due to the pre-existing disease which has not been covered under the policy. It is further submitted that even if the DLA had undergone the medical examination with the doctors appointed by the ops, unless he discloses the details about the symptoms or the treatment that he had undergone, it is not possible for the doctors to give further treatment or diagnose the disease. It is further submitted that being an early claim as the person insured died within three months from the date of issuance of the policy and based on the assessment of the claim, it was revealed to the ops that the DLA had a history of cancer much prior to the date of application form and this information was not disclosed in the said application. The medical documents procured during investigation revealed that DLA was taking treatment for cancer. The medical records from Acharya Tulsi Cancer Hospital procured during investigation revealed that DLA was suffering from cancer and was taking treatment for the same since October, 2003. It is further submitted that Sub Registrar of Primary Health Centre (PHC) Kaljan (Hisar) had given written letter on dated 31.10.2014 stating that cause of death of DLA was cancer. Thus, it is clear that even after being aware of the fact that DLA was suffering from such dreadful disease, he had applied for the policy to get the undue advantage out of the same and thus played a fraud with the ops. Remaining contents of the complaint have also been denied and prayer for dismissal of complaint has been made.
3. The complainant produced her affidavit Ex.C1 and copy of repudiation letter Ex.C2. On the other hand, ops produced affidavit of Sh. Sahil Mahajan, designated as Dy. Manager Legal Ex.R1, copy of proposal form Ex.R2, copy of laboratory test report Ex.R3, copy of radiological investigation Ex.R4, copy of report of Sub Registrar Birth and Death, PHC Kajlan Ex.R5 and copy of letter dated 28.1.2015 Ex.R6.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. Learned counsel for the complainant has strongly contended that it is only a clerical and typographical mistake that in para no.1, the date of policy is mentioned as 28.1.2015 and date of repudiation letter is also mentioned as 28.1.2015 in para no.6. It is only clerical mistake. It has been further contended that it is proved case of complainant that husband of complainant namely Ram Kumar had purchased policy bearing No.000126755 for the insured value of Rs.4,00,000/- from the opposite parties and after the death of Ram Kumar, his wife present complainant is entitled for the insured amount, but however, the ops have arbitrarily and illegally repudiated the claim of the complainant on the ground that insured had concealed the factum of his pre-existing disease of cancer while filling the blank columns of the proposal form and the declaration.
6. On the other hand, learned counsel for ops has strongly contended that it is proved on record that deceased life assured was suffering from cancer since 2003 and had been getting treatment from Acharya Tulsi Cancer Hospital and ultimately died after short time of the purchase of the policy and the Sub Registrar of the Primary Health Centre, Kajlan has also issued death certificate in which the cause of death has been mentioned due to cancer and the ops have rightly repudiated the claim of the complainant.
7. The perusal of the record reveals that the complainant in order to prove her complaint has furnished her affidavit Ex.C1 and copy of repudiation letter Ex.C2. On the other hand, ops have furnished affidavit of Sh. Sahil Mahajan, designated as Deputy Manager Legal as Ex.R1 and have also placed on record copy of proposal form Ex.R2, copy of laboratory test report Ex.R3, copy of radiological investigation Ex.R4, copy of report of Sub Registrar Birth and Death, PHC Kajlan Ex.R5 and copy of letter dated 28.1.2015 Ex.R6.
8. Though during the course of arguments, learned counsel for complainant has conceded the fact of wrong mentioning of the date of policy as 28.1.2015 and the same appears to be only a typographical mistake since there is no dispute regarding issuance of the policy between the complainant and the opposite parties.
9. The bone of contention between the parties is qua the concealment of facts at the time of purchase of the policy while making declaration by deceased life assured. As per the version of the complainant, deceased LA had not concealed any fact as he was not suffering from any disease prior to the purchase of the policy but on the other hand, as per version of the ops the deceased LA was suffering from cancer since 2003 and was getting treatment from different hospitals and ultimately he died due to cancer. As per perusal of the proposal form Ex.R2 reveals that while making declaration, the deceased LA had declared that he was not suffering from any disease whereas perusal of report Ex.R3 reveals that radiotherapy of deceased life assured was done and as per investigation report Ex.R4 surgery for laprotomy growth 2nd Duedenum G.B. Mass was done. All these records show that deceased life assured was suffering from cancer prior to the purchase of the policy in question and this fact also finds corroboration from the certificate Ex.R5 issued by Sub Registrar Birth & Death, PHC Kajlan (Hisar), in which it has been categorically mentioned that Ram Kumar son of Harji Ram, resident of village Jagan died due to cancer. So, it appears from the evidence of the opposite parties that ops have rightly repudiated the claim due to the reason well mentioned in the repudiation letter and there does not appear to be any deficiency in service on the part of opposite parties.
10. In view of our above discussion, we find no merit in the present complaint and same is hereby dismissed but with no order as to costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:15.11.2017. Member Member District Consumer Disputes
Redressal Forum, Sirsa.
