Delhi

East Delhi

CC/92/2017

SHASHI DEVI - Complainant(s)

Versus

LIC of India - Opp.Party(s)

31 Jan 2019

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. 92/17

 

Smt. Shashi Devi

W/o Late Shri Tejveer Singh

R/o Village Sohi, P.O. sohi(Pahasuo)

District Bulandshahar

Uttar Pradesh                                                            ….Complainant

Vs.    

1. The Branch Manager

Life Insurance Corporation of India

Branch Unit 12-F, 13/14, Local Shopping Center

Pocket-II, Mayur Vihar Phase – I, Delhi – 110 092

 

2. The Zonal Manager

Life Insurance Corporation of India

Northern Zonal Office, Connaught Circus

New Delhi – 110 001                                                        …Opponents

 

Date of Institution: 01.03.2017

Judgement Reserved on: 31.01.2019

Judgement Passed on: 04.02.2019

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. Shashi Devi against the Branch Manager, LIC of India, Mayur Vihar (OP-1), and Zonal Manager, LIC of India, Zonal Office, Connaught Circus (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 Shri Tejveer Singh, deceased, husband of the complainant Smt. Shashi Devi, R/o Village Sohi, P.O. Sohi, Distt. Bulandshahar, UP, who was a farmer by profession, purchased the “Jeevan Anand” policy (Table no. 149, Term 66 and Premium Paying Term 25) of the Life Insurance Corporation (LIC) of India for a sum of Rs. 9,95,000/-.  He completed all the formalities as per the instructions of agent of LIC and upon complete investigation and satisfaction, the LIC issued policy no. 126917535 dated 28.08.2013 for the sum assured Rs. 9,95,000/- with commencement of risk date 30.09.2013. The complainant was his nominee.  The policy was issued by LIC of India from its Mayur Vihar branch office (OP-1). 

It has been stated that on 30.11,2013, the deceased husband of the complainant fell ill and showed the symptoms of jaundice.  He initially contacted the local Deshraj Vaid (Ayurved Acharya) of village Bhatt Papadi, Bharatpur Road, District Mathura, UP who advised him to get his LFT test.  His LFT test was carried out on 02.12.2013 confirming jaundice.  On the advice of some people, he visited Dharamshala, Himachal Pradesh for further treatment where he was provided herbal medicines.  However, there was no satisfactory improvement. 

On 18.12.2013, he visited Medanta Hospital, Gurgaon, where he was treated by Dr. Rajesh who advised MRCP test which was done on 19.12.2013 and Carcinoma was detected. He was admitted in the hospital on 21.12.2013 and discharged on 23.12.2013.  Late Shri Tejveer Singh, who was under treatment at Medanta Hospital, suddenly died on 20.02.2014 at home.  At the time of issuance of insurance policy, he was a healthy person and was not suffering from any ailment. 

The complainant being the nominee of deceased Late Shri Tejveer Singh, submitted the requisite form and documents and sought death claim under policy no. 126917535 for the sum assured Rs. 9,95,000/-.  She was asked through letter of dated 26.07.2014 to submit the documents which she submitted through letter of dated 29.07.2014.  She was again asked by LIC of India of Laxmi Nagar branch through its letter of dated 17.07.2014 which was received by her in the last week of October 2014 to submit the documents which were  already submitted.  She was further directed by LIC of India of Mayur Vihar branch (OP-1) through its letter of dated 30.07.2014 to participate in the Claims Camp in its branch office on 25.08.2014.  No fruitful result came out in the said Claim Camp. 

She again submitted an application dated 18.09.2014 to LIC of India (OP-1) and requested for supply of the proposal form which was filled up at the time of purchase of policy.  She again made a detailed representation through letter of dated 02.11.2014 to LIC of India of Laxmi Nagar Branch enclosing therewith the medical certificates.  She was again asked to attend the Claims Camp through letter of dated 12.01.2015 in the branch office of LIC of India on 22.01.2015 for spot settlement.  Inspite of settlement, one form no. 5152 was handed over to the complainant which was to be filled from Vaid Deshraj and Dr. C. Kalsang which was submitted to LIC office, Mayur Vihar-I on 03.03.2015.       

She has further stated that she has been harassed by the concerned branch of LIC of India at one pretext or the other even after completing all the formalities and submitting the relevant documents and after withholding the claim of the complainant for more than one year, her claim has been rejected  by order of dated 07.05.2015.  Thus, she has filed the present complaint alleging deficiency in service on the part of LIC of India and have prayed for award a sum/compensation of Rs. 10,95,000/- alongwith 18% interest from the due date of claim and Rs. 50,000/- towards cost of litigation.

3.         In the written statement, LIC of India have taken various objections such as husband of the complainant who took policy no. 126917535 was already suffering from Carcinoma of the Gall Bladder with Liver Metastasis; the policy was for sum assured of Rs. 9,95,000/- for a person of meager income of 10,000/- to 15,000/- per month.  The investigations revealed that the life assured/deceased Late Shri Tejveer Singh was a resident of Uttar Pradesh, but took the policy from Delhi; discharge summary of Medanta Hospital where he was admitted and treated from 21.12.2013 to 23.12.2013 confirmed that he was a known case of Carcinoma of Gall Bladder with Liver Metastasis. 

            It has further been stated that inspite of reminders of dated 26.07.2014, 17.07.2014, 30.07.2014, 20.08.2014, 28.10.2014 and 04.09.2014, the complainant failed to submit his two pathology report of cancer of gall bladder.  Due to incorrect and false answers, furnished by the life assured in the proposal form regarding heath suppression of carcinoma of gall bladder with liver metastasis at the time of filling up of the proposal form, non-compliance of condition no. 12 of the terms and conditions of the policy, they have rightly repudiated the claim.  They have denied other pleas of the complainant.

4.        The complainant has filed rejoinder to the WS of OPs, wherein he has controverted the pleas taken in the WS and reasserted her pleas. 
5. n support of its case, the complainant have examined herself.  She has deposed on oath.  She has narrated the facts which have been stated in the complaint.  She has got exhibited documents such as copy of  complaint (Ex. CW), copy of Aadhar card (Ex.CW1/A), copy of policy no. 126917535 (Ex.CW1/B), copy of death certificate of Shri Tejveer Singh (Ex.CW1/C), copy of claim application alongwith documents (Ex.CW1/D), copy of letter dated 26.07.2014, 29.07.2014, 17.07.2014 and 30.07.2014 (Ex.CW1/E to 1/H), copy of application dated 18.09.2014 (Ex.CW1/I), copy of letter dated 02.11.2014, 12.01.2015 and 07.05.2015 (Ex.CW1/J to 1/L), copy of representation dated 05.06.2015 (Ex.CW1/M), copy of letter dated 04.07.2015 (Ex.CW1/N), copy of reminder dated 04.02.2016 (Ex.CW1/O), copy of letter of manager claim dated 28.09.2016 and reply dated 28.10.2016 (Ex.CW1/P colly), copy of letter dated 09.11.2016 (Ex.CW1/Q), copy of order dated 19.01.2016 (Ex.CW1/R) and copy of mediation/conciliation report (Ex.CW1/S).

In defence, OPs have examined Ms. Dipa Sinha, Manager (L&HPF), LIC of India.She has deposed on affidavit and narrated the facts which have been stated in the written statement. She has also got exhibited documents such as copy of policy no. 126917535 with blankproposal form (Ex.OPW1/A), copy of claim enquiry report (Ex.OPW1/B colly), copy of note sheet with DMR opinion (Ex.OPW1/C) and copy of letters dated 20.08.2014, 28.10.2014 and 04.09.2014 (Ex.OPW1/D).

5.         We have heard Ld. Counsel for the parties and have perused the material placed on record.  It has been argued on behalf of LIC of India that the deceased was having pre existing disease as in the discharge summary of Medanta Hospital where he was admitted and treated from 21.12.2013 to 23.12.2013 confirmed that he was a known case of Carcinoma of Gall Bladder with Liver Metastasis.  He has further argued that in the proposal form, the policy holder gave incorrect and false answers.  It has further been argued that income of the deceased was not commensurate with the policy sum assured. 

            On the other hand, Ld. Counsel for the complainant have argued that the deceased Tejveer Singh and his family members came to know about the cancer of the deceased Tejveer Singh for the first time when he was admitted and treated in Medanta Hospital.  The complainant was not provided the proposal form to ascertain with regard to the suppression of material facts.  With regard to his income, not commensurate to the policy sum assured, it has been stated that he was doing farming as well as having agency at his village.

            To appreciate the arguments of Ld. Counsel for the parties, a look has to be made to the testimony of complainant as well as evidence of Ms. Dipa Sinha, Manager, LIC.  She has got exhibited the policy form       (Ex.OPW1/A) claim enquiry report (Ex.OPW1/B colly), note sheet with DMR opinion (Ex.OPW1/C) and letters written to the complainant (Ex.OPW1/D) asking for submission of papers.

            Complainant Smt. Shashi Devi have got exhibited documents such as copy of policy (Ex.CW-1/B), copy of death certificate (Ex.CW-1/C) and correspondence exchanged with LIC

 

 

            The main plea which has been taken on behalf of LIC of India has been that deceased Tejveer Singh did not disclose the disease of Carcinoma of Gall Bladder with Liver Metastasis from which he was suffering from.  He has suppressed the material facts.  If the documents got exhibited in the testimony of Dipa Sinha, Manager – LIC are perused, it is noticed that she has not placed on record the proposal form to show that Shri Tejveer Singh, deceased, have not disclosed the disease from which he was suffering from.  When no proposal form has been placed on record to substantiate this allegation, this plea of LIC of India cannot be accepted at all.   On the contrary, LIC of India have filed the blank proposal form which have no relevance at all (OPW-1/A). 

            Further, neither the complainant nor OP have got exhibited the discharge summary of deceased Tejveer Singh.  If the discharge summary of deceased Tejveer Singh is looked into, it is noticed that the discharge summary states under the column “Medical history and presenting complaints”, “Mr. Tejveer Singh, 36 years old, male is a known case of Carcinoma of Gall Bladder with Liver Metastasis”. Here, the hospital have used the word ”A known case of Carcinoma of Gall Bladder with Liver Metastasis” however, no period has been mentioned to ascertain his case as a known case of Carcinoma of Gall Bladder and Liver Metastasis.  When no period has been mentioned to ascertain from when Mr. Tejveer Singh was suffering from Carcinoma of Gall Bladder and Liver Metastasis, it cannot be said that he was a known case of Carcinoma of Gall Bladder and Liver Metastasis.

            With regard to the capacity of the deceased Tejveer Singh that his income did not commensurate to the policy sum assured have no relevance at all as the deceased paid the premium to the LIC of India.  This plea cannot be gone into.   The same also stands rejected. 

            In view of the above, we are of the opinion that by rejection of the claim of the complainant Smt. Shashi Devi for her husband deceased Tejveer Singh without any ground by LIC of India amounts to deficiency in their services which has caused mental pain and suffering to the complainant also.  Thus, we order that Smt. Shashi Devi, complainant, who is the nominee of deceased Tejveer Singh be paid an amount of              Rs. 9,95,000/-, the sum assured with 9% interest from the date of filing the complaint.  She be further paid an amount of Rs. 30,000/- on account of mental pain and suffering which includes the cost of litigation.

            The awarded amount be paid within a period of 60 days, if not paid, the amount of compensation of Rs. 30,000/- shall also carry 9% interest from the date of order.  

             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