Haryana

StateCommission

A/275/2018

RANI - Complainant(s)

Versus

KODAK MAHINDRA OLD MUTUL LIFE INSURANCE - Opp.Party(s)

ASHOK KUMAR SHARMA

29 Mar 2019

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                                                             

 

First Appeal No :         275 of 2018

Date of Institution:       05.03.2018

Date of Decision :        29.03.2019

 

 

 

Rani wife of Shri Ram Bhagat, resident of Village Bahari, Tehsil Assandh and District Karnal.

                                      Appellant-Complainant

 

Versus

 

1.      Kotak Mahindra Old Mutual Life Insurance Limited, Registered Office, 4^th Floor, Vinay Bhavya Complex, 159-A, CST Road, Kalina, Santacruz (East), Mumbai-400 098 India through its Authorized Signatory.

 

2.      Kotak Mahindra Old Mutual Life Insurance Limited, through its Divisional Manager, Sector 12, Karnal.

 

Respondents-Opposite Parties

 

 

 

 

CORAM:             Hon’ble Mr. Justice T.P.S. Mann, President.

                             Shri Diwan Singh Chauhan, Member                      

 

 

 

Argued by:          Shri Ashok Kumar Sharma (Bhana), counsel for the appellant.

                             Shri Hitender Kansal, counsel for the respondents.

                            

 

                                                   O R D E R

 

T.P.S. MANN J.

 

          The instant appeal has been filed by the complainant for challenging the order dated13.12.2017 passed by the learned District Consumer Disputes Redressal Forum, Karnal whereby the complaint filed by him under Section 12 of the Consumer Protection Act, 1986 against the opposite parties stood dismissed.

2.      According to the complainant, her husband Ram Bhagat expired on 07.12.2014 due to pain in his chest.  As per the postmortem report, the cause of death was acute hemorrhagic stroke.  During his lifetime, her husband had obtained a policy from the opposite parties namely Kotak Assured Income Plan and the sum assured Rs.5,00,000/- whereas the policy term was 30 years.  At the time of obtaining the policy, her husband was hale and hearty.  The complainant was appointed by her husband as nominee in the said policy.  As per the condition/sections 2 and 14 of the policy, in the case of death of the insured, the sum assured would be 106% of basic sum assured and guaranteed maturity benefit to be paid to the nominee.  The matter was reported to the opposite parties and necessary documents regarding claim submitted.  The opposite parties assured her that the claim would be released shortly.  However, to her utter surprise, the opposite parties sent her a letter dated 31.03.2015 repudiating her claim without giving any satisfactory explanation.  As such, there was deficiency in service on the part of the opposite parties.  Hence, the complaint.

3.      Upon notice, the opposite parties filed written version raising preliminary objection regarding maintainability, jurisdiction and concealment/suppression of the material and relevant facts.  The husband of the complainant was suffering from non small cell carcinoma for which he was undergoing treatment prior to the date of signing the proposal form.  On merits, it was stated that the opposite parties received a duly filled and signed proposal form on 26.03.2014 from the husband of the complainant.  The detail and declaration mentioned in the proposal form was believed to be true and correct.  The policy was issued to the deceased.  Death claim intimation letter dated 24.03.2015 was received from the complainant informing the opposite parties that the assured expired on 07.12.2014 due to heart disease. On receipt of said intimation, the opposite parties conducted investigation and following facts were discovered:-

“a)     That the DLA was suffering from Non Small Cell Carcinoma which is evidence from the Pathology Report issued by Government Medical College Hospital, Chandigarh dated 4.3.2014.

b)      Further, the radiation Therapy was done on 4.3.2014 which is evident from the New Patients Registration Form.

Hence, from the pathology report it is clearly mentioned under the head of impression that “Right Lung Mass: Non Small Cell Carcinoma likely adenocarcinoma.”  From these medical records it is evident that the Life Assured was suffering from said disease. The said fact was not disclosed in the proposal form at the time of issuance of the policy. Hence there was no deficiency in service on the part of the OPs in repudiating the claim of the complainant.”

4.      After hearing learned counsel for the parties and going through the record, learned District Forum came to the conclusion that the complainant had given the answer in negative regarding any cancer, tumor, cyst and unusual growth.  As per report (Exhibit R-4) of the Pathology, the assured was having cancerous ailment.  As such, prior to the issuance of the policy in question, the assured was suffering from above mentioned diseases, which were material facts for the issuance of the policy but the assured had not disclosed in the proposal form about his previous ailment and suppressed the material facts.  Accordingly, it was held that the opposite parties committed no mistake in repudiating the claim of the complainant. 

5.      The State Commission has heard learned counsel for the parties and gone through the evidence.

6.      Assured Ram Bhagat, who was husband of the complainant had obtained policy having sum assured of Rs.5,00,000/- and the policy term 30 years.  According to the opposite parties, the assured had not disclosed the material fact of being suffering from serious ailment from non small cell carcinoma for which he was suffering from much before filling the proposal form.  Carcinoma is reflected in the Pathology report issued by Government Medical College and Hospital, Chandigarh on 04.03.2014 on which date, the radiation therapy was also done.  The factum of the assured suffering from non small cell carcinoma was material information, which the assured was required to share with the opposite parties but did not do so.  As such, the complainant, who is the nominee of assured Ram Bhagat is not entitled to the claim in terms of the policy.  At the same time, it would be noticed that the assured had paid an amount of Rs.51,994/- as premium for the policy, which the complainant was entitled for its refund.

7.      Resultantly, the appeal is partly allowed and the opposite parties directed to refund an amount of Rs.51,994/- to the complainant within 45 days from the date of receipt of the order.  In case the aforesaid amount is not refunded within the stipulated period, the complainant shall be entitled to claim interest on the same @ 9% per annum.  The complainant shall also be entitled to Rs.1,000/- as litigation expenses.              

 

 

Announced 29.03.2019

(Diwan Singh Chauhan) Member

(T.P.S. Mann) President

UK