Haryana

Jind

66/13

Shakuntla - Complainant(s)

Versus

LIC Of India - Opp.Party(s)

Sh. K.B. Nagar

19 Jan 2015

ORDER

                                    

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, JIND.

                                           Complaint No. 66 of 2013

   Date of Institution: 19.3.2013

   Date of final order: 21.1.2015

Shakuntla w/o late Sh. Satish Kumar r/o village Budha Khera Lather, Tehsil Julana, District Jind.     

                                                             ….Complainant.

                                       Versus

Life Insurance Corporation of India, District Shopping Centre, Jind through its Branch Manager.

                                                         …..Opposite party.

                          Complaint under section 12 of

 

Before: Sh. Hari Singh Khokhar, President.

            Smt. Bimla Sheokand, Member.

 

Present: Sh. K.B. Nagar, Adv. for complainant.

             Sh. Gulshan Arora, Adv. for opposite party.

            

ORDER:

            The brief facts in the complaint are that husband of 

complainant namely late Sh.Satish Kumar has purchased a policy for a sum of Rs.2,00,000/- vide policy No.177568454 dated 18.5.2011 commencing from 19.5.2011 to 19.11.2029. The complainant’s husband expired on 25.3.2012. The complainant is nominee of the above said policy in question. After the death of her husband, she  lodged a claim for payment  with the opposite party and submitted all the necessary documents. The opposite party has wrongly repudiated the lawful claim

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of the complainant vide letter dated 25.1.2013 arbitrarily.  The complainant served a legal notice dated 8.2.2013 through her counsel Sh. K.B. Nagar Adv.  upon the opposite party but all in vain.  Deficiency in service on the part of the opposite party is alleged. It is prayed that the complaint be accepted and opposite party be directed to pay the assured amount of Rs.2,00,000/-, a sum of Rs.50,000/- as compensation on account of mental pain and agony as well as to pay a sum of Rs.5,000/- as litigation expenses to the complainant.

2.     Upon notice, the opposite party has appeared and filed the written statement stating in the preliminary objections i.e. the complainant  has no cause of action and  locus-standi  to file the present complaint; the complaint is not maintainable in the present forum, the complainant has not come before this Forum with clean hands and has suppressed the true and material facts  and the complaint is false and frivolous. On merits, it is contended that  at the time of taking the policy, the husband of complainant had concealed the material fact about his health. The complainant’s husband was suffering from Neurofibromatosis and Hemi Paresis NF-1 and CVA, seizure disorder for the last eleven years as per claim form No.3816 received from PGI, Rohtak with report of Dr. Jagjit Singh, MD Medicines, PGI Rohtak.  The opposite party has rightly repudiated the claim of the complainant on the ground of concealment of facts about his health. All the other allegations have been denied by the opposite parties. Therefore, there is no deficiency in service on the part of the opposite party. Dismissal of complaint with costs of Rs.50,000/- is prayed for.

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3.     In evidence, the complainant has produced her own affidavit Ex. C-1, copy of policy Ex. C-2, copy of renewal premium receipt Ex. C-3, copy of proposal farm Ex. C-4, copy of death certificate Ex. C-5, copy of letter dated 25.1.2013 Ex. C-6, copy of application Ex. C-7, copy of postal receipt Ex. C-8, copy of legal notice dated 8.2.2013 Ex. C-9, copy of postal receipt Ex. C-10 and copy of document Ex. C-11 and closed the evidence.  On the other hand, the opposite party has produced the affidavit of Surinder Kumar  Ex. OP-1, copy of  proposal farm Ex. OP-2,  copy of application Ex. OP-3, copy of documents Ex. OP-4 and OP-5, copy of application Ex. OP-6, copy of letter dated 19.7.2012 Ex. OP-7, copy of letter dated 2.8.2012 Ex. OP-8, copy of certificate of hospital treatment Ex. OP-9, copy of document Ex. OP-10, copy of claim enquiry report Ex. OP-11,  copy of  report Ex. OP-12, copy of letter dated 25.1.2013 Ex. OP-13 and Ex. OP-14 and closed the evidence.

4.     We have heard the arguments of Ld. Counsel of both the parties and also perused the record placed on file. Ld. Counsel for the complainant has argued that the husband of the complainant had purchased an Insurance Policy vide policy No.177568454 dated 18.5.2011 w.e.f. 19.5.2011 to 19.11.2029 for a sum of Rs.2,00,000/- and the complainant is nominee of the above said policy in question Ex. C-2. The husband of the complainant has expired on 25.3.2012 Ex. C-5. After the death of life assured, the complainant lodged a claim for payment with the opposite party and submitted all the necessary documents along with an application Ex. C-7 but the opposite party repudiated the lawful claim of the complainant vide letter dated 25.1.2013. Thereafter, the complainant

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serve a legal notice dated 8.2.2013 upon the opposite party Ex. C-9 but all in vain. Deficiency in service on the part of the opposite party is alleged.

5.     On the other hand, Ld. Counsel for the opposite party has argued that at the time of taking the policy, the husband of the complainant had concealed the material fact about his health. The deceased life assured was suffering from ‘Neurofibromatosis and Hemi Paresis NF-1 and CVA, seizure disorder’ for the last 11 years as per claim form No.3816 received from PGI Rohtak with report of Dr. Jagjit Singh, MD Medicines, PGI Rohtak. The opposite party has rightly repudiated the claim of the complainant on the ground of concealment of fact about his health. All the other allegations have been denied by the opposite party.

6.     We perused Ex. C-4, it  clearly shows that at the time of purchasing of said policy the deceased life assured Satish Kumar was duly medically examined by Dr. D.P. Jain M.B.B.S. M.D (Medicine) code No.334/171 in the presence of Life Insurance Company agent namely Sunil Kumar and found the said Satish Kumar hale and healthy.

7.     The deceased was serving in Delhi Police up to 17.3.2012 and he has not claimed any medical leave for the period of 2010 to 2012 which is fully proved by the RTI information letter dated 10.9.2014 by the ACP South West District Dwarka, New Delhi and this letter was produced by the counsel for the complainant during the arguments in this case and this letter is attached with this file. In this letter it is written that no medical leave has been taken by H.C. Satish Kumar PIS No.29750051 during the period of 2010 to 2012.

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8.     In this case, there is no evidence on record to prove that deceased life assured suppressed the material facts at the time of purchasing the policy. The onus lay on the opposite party to prove that the deceased life assured suppressed the material facts, the doctor of the opposite party, Dr. D.P. Jain M.B.B.S. M.D(Medicine)  examined the life assured at the time of taking the policy in the presence of life insurance corporation agent.

9.     After going through the facts and circumstances of the case, we are of the considered view that the opposite party has wrongly repudiated the claim of the complainant. Deficiency in service is established on the part of the opposite party. The complaint of the complainant is accepted and the opposite party is directed to make the payment of insured amount i.e. Rs.2,00,000/- to the complainant. This order be complied within one month after receiving the certified copy of this order. In case of failure, the opposite party will pay a simple interest @ 9% p.a. to the complainant w.e.f.  filing of the complaint i.e. 19.3.2013 till its full realization of amount. Parties will bear their own costs.  Copies of order be supplied to the parties under the rule. File be consigned to the record room after due compliance.

  Announced on: 21.1.2015

                                                                President,

 Member                                  District Consumer Disputes                                                                  Redressal Forum, Jind