Chandigarh

StateCommission

A/175/2019

Max Life Insurance Company Ltd. - Complainant(s)

Versus

Janinder Singh - Opp.Party(s)

M.L. Singhi, Nitesh Singhi & Priya Singhi Adv.

28 Feb 2022

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

UNION TERRITORY, CHANDIGARH

 

Appeal No.	175 of 2019
Date of Institution	06.08.2019
Date of Decision	28.02.2022

Max Life Insurance Company Limited, Madhya Marg, Chandigarh through its Branch Manager.

    …..Appellant/Opposite Party

Versus

Janinder Singh S/o Sh. Ranbir Singh R/o H.No.2928, Sector 37-C, Chandigarh.

                                                                      …..Respondent/Complainant              

BEFORE:  JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

                 MRS. PADMA PANDEY, MEMBER

                 MR. RAJESH K. ARYA, MEMBER

               

Argued by:  Sh. Nitesh Singhi, Advocate for the Appellant.

 Sh. Munish Kumar, Advocate for the Respondent.

                       

PER PADMA PANDEY, MEMBER

              This appeal is directed against an order dated 25.06.2019, rendered by District Consumer Disputes Redressal Forum-I (now District Commission-I), U.T., Chandigarh (in the short ‘the District Commission’ only), vide which, it partly allowed the Consumer Complaint, with the following directions: -

“a)  To pay the sum of Rs.2,00,000/- to the complainant alongwith interest @9% per annum w.e.f. 31.1.2017 i.e. the date of repudiation till realization.

b)  To pay an amount of Rs.20,000/- to the complainant as compensation for causing mental agony and harassment to him;

c)   to pay Rs.10,000/- to the complainant as costs of litigation.”

      This order shall be complied with by the OP within thirty days from the date of its certified copy, failing which, it shall make the payment of the amounts mentioned at Sr. No.(i) & (ii) above, with interest @12% per annum from the date of this order, till realization, apart from compliance of direction at Sr. No.(iii) above.”

 

2. The facts, in brief, are that the complainant is the real sister of deceased Ms. Satbir Kaur and was living with her. It was stated that she had purchased life insurance policy called Max Life Fast Track Super Regular Pay floated by the OP having annual premium of Rs.25,000/- and the sum assured was Rs.2,50,000/-.  It was further stated that the first premium was paid on 20.07.2016 and the second premium was paid for the year 2016-17 and she was all well till December 2016.  It was further stated that the she was a govt. employee and served in Railway Claims Tribunal, Chandigarh as Superintendent. Maintained, in the last week of December 2016, during the validity of the policy in question, she complained of pain in her heart and was rushed to the Fortis Hospital, but, could not be saved and had expired on 31.12.2016. It was further stated that in the policy, the deceased had nominated complainant as her nominee. It was further stated that the claim was submitted, but it was repudiated on 31.01.2017 on the grounds that she had concealed the pre-existing disease.  It was further stated that the Opposite Party had transferred an amount of Rs.50,000/- i.e. the originally deposited amount of two installments of Rs.25,000/- each in the account of the complainant. It was further stated that the aforesaid act of the Opposite Party, amounted to deficiency, in rendering service, as also indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint, was filed.
3. The Opposite Party filed reply and stated that the material facts were concealed as on the date of issuance of the policy, complainant had pre-existing disease i.e. kyphoscoliosis, congenital restrictive lung disease, Type 1 respiratory failure and on Bilevel Positive Airway since 10 years i.e. prior to the signing of the proposal form.  It was further stated that as per terms and conditions, the claim was repudiated which is justifiable in facts and law. It was further stated that there is no deficiency in service on its part, and the Opposite Party had prayed for dismissal of the complaint.
4. In the rejoinder, filed by the complainant, she reiterated all the averments, contained in the complaint.
5. The parties led evidence, in support of their case.
6. After hearing the Counsel for the Parties, and, on going through the evidence, and record of the case, the District Commission, partly allowed the complaint against Opposite Party, as stated above.
7. Feeling aggrieved, the instant appeal, has been filed by the Opposite Party.
8. We have heard the Counsel for the Parties, and have gone through the evidence, and record of the case, carefully.
9. After giving our thoughtful consideration, to the contentions, advanced by the Parties, and the evidence, on record, we are of the considered opinion, that the appeal is liable to be dismissed, for the reasons to be recorded hereinafter.
10. On a perusal of the records of the learned District Commission, we find that there is no authentic evidence on record that cardiac arrest or say myocardial infarction acute had a nexus with the alleged disease of kyphoscoliosis with pulmonary hypertension with restrictive lung disease. In the absence of the link of cardiac arrest with the said disease, it cannot be said that the alleged disease let to cardiac arrest. The ground taken by the appellant was that the respondent had concealed the pre-existing disease. The appellant contested the consumer complaint by stating that the material facts were concealed as on the date of issuance of the policy that the respondent has pre-existing disease i.e. kyphoscoliosis, congenital restrictive lung disease, Type 1 respiratory failure and on Bilevel Positive Airway since 10 years i.e. prior to the signing of the proposal form. Hence, the appellant held that as per terms and conditions, the claim was repudiated which is justifiable in facts and law. The learned District Commission has placed a reliance upon judgment dated 11.12.2009 titled as LIC of India & Anr. Vs. Smt. Jaimanti Sharma & Anr. passed by the HP State Commission, which had been further relied upon the case titled as Smt. Kalpana Rajendra Chavan Vs. Life Insurance Corporation of India by the State Commission, Maharashtra on 11.12.2013. Accordingly, this Commission is inclined to fall in line with the decision of the District Commission and accordingly, the appeal stands dismissed.
11. However, while adjudicating this appeal, this Commission directed both the parties to file an affidavit on the subject that whether the deceased (Satbir Kaur) was medically examined at the time of issuance of policy. The parties have placed the affidavits on records. The respondent has given an affidavit that the deceased was examined medically before issuance of policy, whereas the appellant has denied so. When, it is considered that the respondent has been examined medically then why did the insurance company issue the policy and where was the opinion of medical experts confirming pre-existing disease?
12. For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, with no order as to costs. The order of the District Commission is upheld.
13. Certified copies of this order, be sent to the parties, free of charge.
14. The file be consigned to Record Room, after completion.

 

Pronounced.

28.02.2022

      

 

                                                                     Sd/-

[JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

                                                                             Sd/-                

[PADMA PANDEY]

 MEMBER

 

                                                                                 Sd/-                                       

[RAJESH K. ARYA]

 MEMBER

GP