Haryana

Ambala

CC/366/2011

MANIDER SINGH - Complainant(s)

Versus

ICICI PRUDENTIAL LIFE INSURANCE COMPANY LTD - Opp.Party(s)

C.S SULLER

08 Feb 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

            Complaint Case No.    : 366 of 2011

Date of Institution       : 22.11.2011

             Date of Decision         : 08.02.2017

Maninder Singh S/o Balkar Singh R/o village Kangwal P.O. Kathgarh District Ambala.                                                                                               

……Complainant.

Versus

ICICI Prudential Life Insurance Co. Ltd., Plot No.15-16, above Reliance Fresh, Prem Nagar, Ambala City.

                                                                                                ……Opposite Party.

Complaint Under Section 12 of the Consumer Protection Act

BEFORE:       SH. D.N. ARORA,  PRESIDENT.

                        SH. PUSHPENDER KUMAR, MEMBER.                       

Present:          Sh. C.S. Sullar, Adv. for complainant.

                        Sh. D.S. Maan, Adv. for OP.

ORDER.

                        In nutshell, brief facts of the complaint are that complainant’s father namely Balkar Singh got himself insured with OP vide policy number 14446915 on 30.08.2010 and paid a sum of Rs.13,000/- as half yearly premium. It has been submitted that father of complainant expired on 21.11.2010 and so, complainant  applied  for the payment of sum assured /death benefit amount  of Rs.1,30,000/- under the policy but the OP repudiated the claim of complainant on false and frivolous grounds  though  before  taking the said policy, the father of complainant was immediately examined after finding the same as fit and he was insured. As such, the complainant has prayed that the OP is deficient and negligent in providing proper services to the complainant and thus prayed for seeking relief as per prayer clause.

2.                     Upon notice, Op appeared through counsel and filed reply raising preliminary objections qua non-maintainability of complaint and suppression of material facts. On merits, It has been admitted that the insurance policy has been issued to the complainant by their company.  It has been submitted that Life Assured   was well aware of his medical status and the illness being suffered by him on the day of filling of proposal form and deliberately misled the OP by concealing material information and furnishing false replies to the questions in the proposal form.  Furhter it has been submitted that  it is clearly mentioned in the proposal form that in the event, a reply to  a question in  the proposal form turns out to be false or mis-leading the contract of insurance is liable to be declared null and void and also that a claim under the policy is liable to be repudiated. It has been specifically submitted that the Life Assured, despite being specifically asked about the material information had not disclosed his adverse health conditions/health complaints in the proposal form. So, claim of complainant was rightly repudiated vide letter dated 31.03.2011.

3.                     To prove his version, counsel for complainant tendered affidavits Annexure CX,Cy & CZ alongwith documents as Annexure C-1 to C-6 and closed the evidence. On the other hand, counsel for Op tendered affidavit Anenxure RX alongwith documents as Annexures R-1 to R-4 and closed the evidence.

4.                     We have heard learned counsel for complainant and gone through the case file very carefully. The arguments of counsel for complainant is that father of complainant namely Balkar Singh (deceased) was insured under the policy (Annexure C-1) with the OP and he died on 21.11.2010 (death certificate Annexure C-3) but the Op vide their letter dated 31.03.2011 (Annexure C-5) repudiated the genuine claim of the complainant despite the fact that there is no relation between the death and illness of the life assured. Thus the counsel for complainant has argued that the Ops have played unfair trade practice with the complaint and sought for acceptance of the complaint.

                        On the other hand, counsel for OP has argued that the deceased Life Assured had given wrong answer to the question in the proposal form and as per medical record of the life assured, consulted in Diabetes and Heart Care Centre on July 20,2007as a known case of Diabetes Mellitus since 6 months and accelerated Hypertension and was on treatment for the same.  So, the complainant has suppressed the material facts from the OP insurance company.  Moreover, there is nexus between the death and the pre-existing/suppressed aliment of the life assured and thus claim of complainant was rightly rejected by them.

5.                     After going through the arguments of counsel for the parties, it is admitted on record that the policy in question has been issued by OP Insurance Company in the name of deceased Life Assured Balkar Singh. The Op Insurance company has repudiated the claim of complainant on the ground that the life assured (deceased) was having pre-existing disease as per treatment record (Annexure R-3) whereas in the proposal form dated 30.08.2010; questions no.22(a), 23(c), (f) & (h)(i) i.e.(i & ii) Have you ever suffered  or suffering from any of the following(i) Diabetes /High Blood Sugar (ii) High /Low Blood Pressure  and also relating to fitness and medical history have been denied by the life assured. Perusal of medical treatment record (Annexure R-3) reveals that the life assured had been diagnosed on 20.07.2007 as a case of  Diabetes and also hypertension for the previous six months.  Meaning thereby that the life assured had suppressed his illness knowingly and intentionally at the time of taking the policy in question.  As per affidavit of complainant, he taken the stand that his father (life assured) died  after suffering heart attack. Although there is no medical record on file that the life assured died due to heart attack, however, the illness of Diabetes Mellitus and Hypertension can be a reason for heart attack. Therefore, we are of the view that life assured has suppressed the material facts from the OP while taking the policy in question and thus violated the terms & conditions of the policy. Hence, the complainant is not entitled for any claim and the Op insurance company has rightly repudiated the claim of complainant. Accordingly, the complainant is not entitled to get any from qua the policy and the complaint is dismissed with no order as to costs.  Copies of the order be sent to the parties concerned, free of costs, as per rules. File after due compliance be consigned to record room.   

Announced on:08.02.2017                                                   Sd/-  

                                                                                      (D.N. ARORA)                                                                                                                                                                                                    PRESIDENT

 

                                                                                       Sd/-

                                                                                 (PUSHPENDER KUMAR)                                                                                                                                                                                          MEMBER