DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II
Udyog Sadan, C-22 & 23, Qutub Institutional Area
(Behind Qutub Hotel), New Delhi-110016.
Case No. 433/2010
Smt. Promila Biswas
W/o late Sonatan Biswas
R/o D-22, D-Block, Masoodpur
Vasant Kunj, New Delhi …Complainant
Versus
Future Generali India Life Insurance Company Ltd.
M-10, South Extension Part-II, New Delhi …Opposite Party
Date of Institution: 05.07.2010 Date of Order: 10.05.2016
Coram:
N.K. Goel, President
Naina Bakshi, Member
O R D E R
As per averments made in the complaint, Sh. Sonatan Biswas, Husband of the Complainant was the holder of policy known as Term Assurance Plan vide policy No. 00137484, Customer ID No. 10891863 with risk commencement date 8.6.2009 with the OP but he died due to heart attack on 15.7.2009 during his visit at his native place. The complainant being her wife and nominee approached the OP for process of her claim but despite several visits and issuances of notice dated 31.5.2010 the OP did not respond. Therefore, the complainant has filed the present complaint for issuing directions to the OP to pay to her Rs. 14,80,000/- along with interest @ 24% p.a. from the date of filing of the complaint till realization, Rs. 50,000/- towards mental pain and agony and Rs. 25,000/- as litigation charges.
In the reply, the OP has inter-alia stated that while taking the policy in question, the deceased husband of the complainant had suppressed the material facts from the OP inasmuch as he was suffering from ailments including cancer but he did not disclose the said facts in the proposal form. It is stated that the repudiation of the claim by the OP was after due application of mind and, hence, there is no negligence, carelessness and deficiency in service on the part of the OP. Copy of certificate/declaration issued by one Dr. P.K. Golder is enclosed with the reply. According to OP, in any case the loan claimed by the complainant is very excessive, imaginary and not supported by any logic or reasons. It is prayed that the complaint be dismissed.
The complainant has filed a rejoinder to the reply and has inter-alia stated that all the material information was duly supplied to the agent of the OP and thereafter the deceased was assured. It is denied that the deceased was suffering from cancer. It is, however, admitted that the claim of the complainant was declined by the OP.
Complainant has filed her own affidavit in evidence.
From the perusal of the order-sheets recorded by our predecessors, it transpires that the OP was proceeded exparte. Hence, no affidavit in evidence has been filed on behalf of OP.
Written arguments have been filed on behalf of complainant.
We have gone through the file very carefully.
The onus to prove that at the time of taking the policy in question the husband of the complainant had suppressed the material facts from the OP was on the OP. Copy of the Traditional Life Insurance Proposal Form stated to have been filled up by the husband of the complainant while taking the policy in question has been filed on the record which we now mark as mark ‘AA’ for the purposes of identification. Clause 8.2 deals with “Health details of life to be assured” in which the deceased husband of the complainant had ticked “NO” in the information “medical information details including whether he was or had suffered from cancer”.
It may be correct that the husband of the complainant had suppressed the material fact from the OP that at the time of taking the policy in question he was suffering from cancer. However, in the present case, the undisputed and unchallenged version and case of the complainant is that her husband had died due to Heart attack during his visit at his native place. This fact has not been controverted by the OP in the written statement. Therefore, it stands proved on the record that the husband of the complainant had, in fact, died due to Heart attack and not due to cancer. Therefore, the suppression of the disease (cancer) while taking the policy in question was/is no ground to repudiate the claim of the complainant because her husband died because of the Heart attack and not due to cancer.
Therefore, we hold that by repudiating the claim of the complainant, the OP committed serious deficiency in service. Therefore, we allow the complaint and direct the OP to refund Rs. 14,80,000/- (sum assured as shown in proposal form) along with interest @ 6% p.a. from the date of filing of the complaint till the date of realization and Rs. 25,000/- towards mental agony and litigation charges to the complainant within 30 days of receipt of copy of this order failing which OP shall become liable to pay Rs. 14,80,000/- along with interest @ 8% per annum from the date of filing of the complaint till realization. The complainant shall, however, be entitled to this amount on production of a certificate/valid document to the effect that she has not remarried.
Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations. Thereafter file be consigned to record room.
(NAINA BAKSHI) (N.K. GOEL) MEMBER PRESIDENT
Announced on 10.05.16.
Case No. 433/10
10.5.2016
Present – None
Vide our separate order of even date pronounced, the complaint is allowed. OP is directed to pay to refund Rs. 14,80,000/- (sum assured as shown in proposal form) along with interest @ 6% p.a. from the date of filing of the complaint till the date of realization and Rs. 25,000/- towards mental agony and litigation charges to the complainant within 30 days of receipt of copy of this order failing which OP shall become liable to pay Rs. 14,80,000/- along with interest @ 8% per annum from the date of filing of the complaint till realization. The complainant shall, however, be entitled to this amount on production of a certificate/valid document to the effect that she has not remarried. Let the file be consigned to record room.
(NAINA BAKSHI) (N.K. GOEL) MEMBER PRESIDENT
