Delhi

East Delhi

CC/398/2015

BEENA DEVI - Complainant(s)

Versus

LIC of India - Opp.Party(s)

03 May 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

 

C.C. NO. 398/15

 

Smt. Beena Devi

5/99, Khichripur,

Delhi – 110 091                                                           ….Complainant

 

Vs.    

 

1. Senior Manager, LIC of India

Do-II “Scope Minar”

North Tower, 9^th Floor

Laxmi Nagar Distt. Centre

Delhi                                                 

 

2. Manager (Claims), LIC of India

Branch Unit – 12-F

Tirupati Balaji Building

13/14 DDA Local Shopping Centre

Pocket-II, Phase-I

Mayur Vihar, Delhi – 110 091                                          …Opponents

 

Date of Institution: 29.05.2015

Judgement Reserved on: 03.05.2018

Judgement Passed on: 11.05.2018

 

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By: Sh. Sukhdev Singh (President)

 

JUDGEMENT

            This complaint has been filed by Smt. Beena Devi against Senior Manager, Life Insurance Corporation of India (OP-1) and Manager-Claims, LIC of India (OP-2) under Section 12 of the Consumer Protection Act, 1986 with allegations of unfair trade practice and deficiency in service. 

2.         The facts in brief are that husband of the complainant Shri Ravinder Kumar purchased a policy from Life Insurance Corporation of India (OP-1) vide policy no. 125328711 for a sum assured of Rs. 2,50,000/- from 26.02.2011 through LIC agent Shri Mulakh Raj Sharma. 

            It was submitted that on 28.04.2011, husband of the complainant expired.  He had made regular payments of premium and made last payment in the month of April 2011.             

            The complainant submitted the death claim of her husband  alongwith relevant papers which was repudiated by the insurance company vide their letter No. Claims/Repudiation/08/12F dated July 25, 2012.

            It was further stated that the complainant made complaint to the office of the Ombudsman on 27.01.2014, but the complaint was dismissed.  Hence, the complainant has prayed for directions to OP to pay the claim amount of Rs. 2,50,000/- for policy no. 125328711.

 

3.         In the written statement, filed on behalf of Life Insurance Corporation of India (OP), they have taken various pleas. They have stated that the policy was granted on 26.02.2011 and life assured died on 28.04.2011 within 2 months and 2 days from the date of risk commencement.

            It was also stated that husband of the complainant (life assured) was suffering from Hypertension, CAD-Post PTCA to LAD (2006) for which he had taken treatment in the hospital from 12.05.2009 to 14.05.2009, but he did not disclose the same in the proposal form, therefore, claim was repudiated on the ground of concealment of material facts regarding previous illness.  Other facts have also been denied.     

 

4.         Rejoinder to the WS of OP was filed by the complainant where the contents of the WS have been denied and has reaffirmed the averments of her complaint.

 

5.         The complainant has filed evidence by way of affidavit where she has examined herself.  She has narrated the facts which have been stated in the complaint.   She has got exhibited documents such as copy of policy bond (Ex.CW-1/1), Identity card of the deceased (Ex.CW-1/2), death certificate (Ex.CW-1/3) and copy of repudiation letters (Ex.CW-1/4 onwards).

            In defence, Life Insurance Corporation of India (OP) have examined Smt. Vineeta De, Manager (Legal), who have deposed on affidavit.  She has also narrated the facts which have been stated in the written statement.  She has also got exhibited documents such as copy of leave record of deceased (Annex. A), copy of proposal form dated 24.02.2011 (Annex.B), copy of investigation report  (Annex.C), copies of treatment taken by deceased (Annex.D), copy of repudiation letter (Annex.E), decision of review committee (Annex.F) and copy of order of Ombudsman dated 04.02.2015 (Annex.G). 

6.         We have heard complainant and Ld. Counsel for OP and have perused the material placed on record.  It has been argued on behalf of OP that there was concealment of material facts regarding his previous illness which argument was refuted by complainant. 

            To appreciate the arguments of the complainant as well as Ld. Counsel for OP, a look has to be made to the testimony of complainant as well as testimony of Ms. Vineeta De, Manager-Legal and the documents placed on record.  The complainant in her testimony has only got exhibited the documents such as Identity card of the deceased (Ex.CW-1/2), death certificate (Ex.CW-1/3), due verification and scrutiny certificate (Ex.CW-1/1) and other documents in respect of appeal before Ombudsman, however, from the testimony of Vineeta De, Manager-Legal, she has exhibited documents such as proposal form where to column no. 11 under Personal History, he has answered ‘No’.  However, record of Kailash Hospital shows that husband of the complainant was admitted in the year 2009.  He was diagnosed as Hypertension, CAD-Post PTCA to LAD (2006).  The fact that he was suffering from Hypertension, CAD-Post PTCA to LAD in the year 2009, he did not disclose these facts which were material for issuance of health policy.  Thus, he has concealed the material facts from the LIC of India (OP), therefore, the repudiation on the ground of non-disclosure of material facts was justified and there was no deficiency on the part of LIC of India (OP).  When there was no deficiency on the part of LIC of India (OP), the complaint deserves its dismissal and the same is dismissed.  There is no order as to cost.

            Copy of the order be supplied to the parties as per rules.

            File be consigned to Record Room.

 

(DR. P.N. TIWARI)                                              (HARPREET KAUR CHARYA)

       Member                                                                             Member    

 

            (SUKHDEV SINGH)

                   President