Haryana

StateCommission

A/237/2015

LIFE INSURANCE CORP.OF INDIA - Complainant(s)

Versus

KRISHNA DEVI - Opp.Party(s)

RAJNEESH MALHOTRA

05 Jan 2016

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

                  

                                                First appeal No.237 of 2015

Date of the Institution: 11.03.2015

Date of Decision: 05.01.2016

 

1. Life Insurance Corporation of India, Panipat-11, SCOP 12-13, Sector 25, G.T. Road, Panipat through its Branch Manager.
2. Life Insurance Corporation of India, Divisional Office P.O. Box No.106, Jeevan Parkash, 489, Model town, Karnal through its Sr.Divisional Manager.

…..Appellants

Versus

 

Krishna Devi Wd/o Late Shri Dharam Singh R/o village Bagempur, P.O. Gudia,  Tehsil Gharaunda, District Karnal, Haryana.

                                                                             .….Respondent

 

CORAM:    Mr.R.K.Bishnoi, Judicial Member

                    Mrs.Urvashi Agnihotri, Member

 

Present:-    Mr.Rajneesh Malhotra, Advocate counsel for the appellants.

                   Mr.A.K.Singhal, Advocate counsel for the respondent.

 

O R D E R

R.K.Bishnoi, JUDICIAL MEMBER:

 

As per complainant her husband  Dharam Singh was insured for Rs.3,00,000/- by opposite parties (O.Ps.) vide policy No.177377206 on 28.01.2011.  He expired on 08.01.2013 and thereafter she submitted claim but the same was repudiated vide letter dated 06.11.2013 on the ground of concealment of the ailment at the time of obtaining insurance policy though at the time of insurance, he was medically examined by the doctors of O.Ps.  Registered notice was also sent for giving claim, but, to no result.

2.      O.Ps. filed reply admitting the obtaining of insurance policy but alleged that she was not entitled for any compensation because the insurance was obtained by concealing the previous ailment.  It was stated at the time of obtaining insurance policy that he was not suffering  from any ailment.  After submitting claim when the matter was got investigated it came to the knowledge that he was the known case of hyper tension since 10-12 years and was also chronic alcoholic.  As per condition No.5 of insurance policy if any statement was found to be false then claim  could be repudiated.  Objections about accruing cause of action, locus standi, concealment of true facts etc. were also raised and requested to dismiss the complaint.

3.      After hearing both the parties, learned District Consumer Disputes Redressal Forum, Panipat (In short “District Forum”) allowed the complaint  vide order dated 19.01.2015 and directed as under:-

“In view of above discussion, present complaint succeeds. We hereby allow the present complaint with a direction to opposite party to pay Rs.3,00,000/- to the complainant with interest @ 9% per annum from the date of filing the complaint till its realization.  Cost of litigation quantified at Rs.2200/- is also allowed to be paid by the opposite parties to the complainant.”

4.      Feeling aggrieved therefrom, appellants-O.Ps. have preferred this appeal on the ground that learned district Forum did not appreciate the law and facts properly.

5.      Arguments heard.  File perused.

6.      Learned counsel for the appellants vehemently argued that life assured (L.A.)  was known case of hyper tension and alcoholic.  He was also having head injury, but, did not disclose the same at the time of obtaining insurance policy as mentioned in OPD card of PGI (Ex.R-4).  This fact was also proved during investigation as mentioned in Ex.R-5.  When L.A. concealed the material facts at the time of obtaining insurance policy complainant is not entitled for any compensation.  Learned District Forum wrongly placed reliance upon the case law captioned as 2000 (1) CLT page 619 Life Insurance Corporation of India, Chandigarh Versus Miss Veenu Babbar and another.  When there is specific certificate of doctor he need not be examined.  In support of his arguments he placed reliance upon the opinion of Hon’ble National Commission expressed in Life Insurance Corporation of India Vs. Krishan Chander Sharma II (2007) CPJ 51 (NC).

7.      However there is no dispute as far as opinion expressed by Hon’ble National Commission in Life Insurance Corporation of India Vs. Krishan Chander Sharma’s case (supra) because that case is based on altogether different footings.  In that case enquiry report and certificate issued by N.C. Jindal Hospital were produced by insurance company in support of it’s averments, whereas in the present case no such record is produced. O.Ps. produced in evidence copy of OPD card Ex.R-4 wherein it was mentioned that patient was known case of hyper tension since 10-12 years.  This fact is mentioned only in the notes prepared at the time of preparing this OPD card and not on the basis of any findings.  Who gave this information is no where explained.  There is no treatment record to come to this conclusion.   Same is the situation about case of Alcoholic. When there is no finding and report is also not based on any document the same is not sufficient to presume that L.A. was  having these problems and complainant is not entitled for compensation.  In Ex.R-5 also it is mentioned that L.A.  was head injury case since 5-6 years, but, no such record was produced before District Forum.  Alongwith the appeal record of patient  taken to Mata Kalawati Hospital was produced, but, it was dated 23.10.2012, whereas the insurance was obtained on 24.01.2011. There is no record on the file showing that L.A. was having any problem at the time of obtaining insurance policy, so learned District Forum rightly disbelieved the version of the appellants on the basis of opinion of Hon’ble National Commission expressed in Life Insurance  Vs. Veenu’s case (supra).    Ex.R-5 is a report prepared by the officials of LIC and not by any doctor. When there is no record on the file showing that complainant was having problem of hypertension or was chronic alcoholic at the time of obtaining insurance policy the appellants were not justified in repudiating the claim. So these arguments is of no avail.

8.      Findings of learned District Forum are well reasoned based on law and facts and impugned order dated 19.01.2015 cannot be disturbed.  Resultantly appeal fails and the same is hereby dismissed.

9.      The statutory amount of Rs.25000/- deposited at the time of filing of the appeal be refunded to the appellants against proper receipt and identification.

 

January 05th, 2016     Urvashi Agnihotri                   R.K.Bishnoi,                                                         Member                        Judicial Member                                                 Addl. Bench                  Addl.Bench                 

S.K.