BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KAITHAL.
Complaint no.184/16.
Date of instt.: 01.07.2016.
Date of Decision: 11.04.2017.
Ramphal S/o Sh. Suraj Bhan, S/o Sh. Birkhu, r/o VPO Serdha, Tehsil and Distt. Kaithal.
……….Complainant.
Versus
- Branch Manager, HDFC Life Insurance, Office at Dhand Road, Kaithal.
- Smt. Rama Bhasin, Secretary General Office of Governing Body of Insurance Council, 3rd floor, Jeewan Sewa Annexe, S.V.Road Santacurz (W), Mumbai-400054.
..……..Opposite Parties.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Sh. Jagmal Singh, President.
Sh. Rajbir Singh, Member.
Smt. Harisha Mehta, Member.
Present : Sh. Munish Sikri, Advocate for complainant.
Sh. Vikram Tiwari, Advocate for the Op No.1.
Op No.2 exparte.
ORDER
(JAGMAL SINGH, PRESIDENT).
The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that the father of complainant was insured with the Op No.1 vide policy No.162171098 dt.05.08.2013 for a sum of Rs.2,27,777/-. It is alleged that during the subsistence of the policy, the father of complainant died and before death, he deposited a sum of Rs.33,000/- with the Op No.1 vide receipt No.A7846655 dt. 05.08.2015, a sum of Rs.32,496/- vide receipt No.X1049703 dt. 21.08.2014 and a sum of Rs.32,561/- vide receipt No.X2535113 dt. 10.08.2015. It is further alleged that the complainant lodged the claim with the Op No.1 and submitted all the necessary documents but the Op No.1 did not settle the claim of complainant. This way, the Ops are deficient in service. Hence, this complaint is filed.
2. Upon notice, the opposite party No.1 appeared before this forum, whereas Op No.2 did not appear and opted to proceed against exparte. Op No.1 filed reply raising preliminary objections with regard to maintainability; cause of action; locus-standi; that upon the information supplied by the life assured by submitting online proposal form, the answering Op issued a policy bearing No.161171098 for sum assured of Rs.2,27,777/- on 15.08.2013; that after receipt of claim, the answering Op got investigated the matter and on enquiry, they found that the life assured was suffering from Paralysis of half body, asthma, hypertension and diabetes since the year 2011 but the life assured concealed the material fact about his pre-existing disease; that the life assured had also concealed about his age as the life assured had represented himself to be of 51 years and had declared his date of birth as 06.09.1963 and submitted one copy of forge pan card in support of his age but during the course of investigation, it has been proved that the actual date of the life assured was 74 years at the time of purchase of policy. There is no deficiency in service on the part of answering Op. On merits, the contents of complaint are denied and so, prayed for dismissal of complaint.
3. In support of his case, the complainant tendered in evidence affidavit Ex.CW1/A and documents Ex.C1 to Ex.C8 and Mark-C1 & Mark-C2 and closed evidence on 08.12.2016. On the other hand, the Op No.1 tendered in evidence affidavit Ex.RW1/A and documents Annexure-R1 to Annexure-R7 and closed evidence on 28.02.2017.
4. We have heard ld. counsel for both the parties and perused the case file carefully and minutely and have also gone through the evidence led by the parties.
5. Ld. Counsel for the complainant reiterated all the points mentioned in the complaint. He argued that the father of complainant was insured with the Op No.1 vide policy No.162171098 dt.05.08.2013 for a sum of Rs.2,27,777/-. He further argued that during the subsistence of the policy, the father of complainant died and before death, he deposited a sum of Rs.33,000/- with the Op No.1 vide receipt No.A7846655 dt. 05.08.2015, a sum of Rs.32,496/- vide receipt No.X1049703 dt. 21.08.2014 and a sum of Rs.32,561/- vide receipt No.X2535113 dt. 10.08.2015. He further argued that the complainant lodged the claim with the Op No.1 and submitted all the necessary documents but the claim of complainant was wrongly denied by Op No.1 vide repudiation letter, Ex.C8. He further argued that the Ops have not proved on the file that the life assured was suffering from paralysis of half body, asthma, hypertension and diabetes since the year 2011. He further argued that the Op No.1 has procured a false certificate from a doctor, who was only RMP doctor. Moreover, the said doctor has given an affidavit which was placed on the file by the complainant as Ex.C6, wherein the said doctor has specifically mentioned that Suraj Bhan insured was treated by him on 01.12.2015 for simple fever and cuff and due to mistake, the date was written as 01.01.2015 instead of 01.12.2015. Ld. Counsel for the complainant submitted authorities cited in 2010(2) CLT page 121 (Uttrakhand State Commission) titled as LIC Vs. Bina Joshi; 2009(3) CLT page 204 titled as LIC Vs. Leelawati and 2006(2) CLT page 558 (both of the Consumer Disputes Redressal Commission, UT Chandigarh). On the other hand, ld. Counsel for the Op No.1 argued that after receipt of claim, the Op No.1 got investigated the matter and on enquiry, they found that the life assured was suffering from Paralysis of half body, asthma, hypertension and diabetes since the year 2011 but the life assured concealed the material fact about his pre-existing disease. He further argued that the life assured had also concealed about his age as the life assured had represented himself to be of 51 years and had declared his date of birth as 06.09.1963 and submitted one copy of forged pan card in support of his age but during the course of investigation, it has been proved that the actual age of the life assured was 74 years at the time of purchase of policy. Ld. Counsel for the Op No.1 submitted written arguments and a computerized copy of order titled as Birla Sunlife Vs. Manjeet Singh (NC) decided on 23.02.2015.
6. From the pleadings and evidence of the parties, it is clear that the father of complainant was insured with the Op No.1 vide policy No.162171098 dt.05.08.2013 for a sum of Rs.2,27,777/-. The insured Suraj Bhan died on 02.12.2015. The claim of the complainant was denied by Op No.1 on the ground that the life assured was suffering from Paralysis of half body, asthma, hypertension and diabetes since the year 2011 and the life assured concealed these material facts about his pre-existing disease. To prove these facts, the Op No.1 has placed a document, Ex.R5 from doctor Sube Singh Dhull (RMP). From Ex.R5, it is clear that the said doctor Sube Singh was an RMP doctor only. No test report has been placed on the file by the Op No.1 on the basis of which the said doctor had given the certificate, Ex.R5. There is no report from any well qualified doctor, who had treated the life assured. Moreover, if a person is suffering from paralysis of half body, then it will not be possible for the life assured to conceal the said disease. The Op No.1 has failed to prove on the file by cogent evidence that the life assured had concealed the material facts regarding his disease. The investigator has also not placed any such document which could prove that the life assured had concealed the material facts of his pre-existing disease at the time of purchase of the policy. So, in the facts and circumstances of the case, we are of the considered view that the Op No.1 has failed to prove that the life assured had concealed his pre-existing disease at the time of purchase of the policy, hence, the Op No.1 has wrongly denied the claim of complainant and is deficient in providing services to the complainant.
7. Thus, as a sequel of above discussion, we allow the complaint and direct the Op No. 1 to pay Rs.2,27,777/- the sum assured under the policy in question and further to pay Rs.3,000/- as lump sum compensation on account of harassment, mental agony and costs of litigation charges. Let the order be complied with within 30 days, failing which, the complainant shall be entitled interest @ 8% p.a. from the date of commencement of this order till its realization. A copy of this order be sent to both the parties free of costs. File be consigned to the record room after due compliance.
Announced.
Dt.11.04.2017.
(Jagmal Singh),
President.
(Harisha Mehta), (Rajbir Singh),
Member. Member.
