Punjab

Sangrur

CC/316/2015

Smt.Kiran Prasad - Complainant(s)

Versus

LIC Of India - Opp.Party(s)

Shri Harpreet Singh

08 Jan 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

 

                                                               

                                                Complaint No.    316

                                                Instituted on:      18.05.2015

                                                Decided on:       08.01.2016

 

Smt. Kiran Prasad wife of Hari Prasad,  resident of H.No.135, Ajit Nagar, Sunam, Distt. Sangrur.

                                                        …Complainant

                                Versus

1.     L.I.C. of India, Divisional Office, “Jeevan Prakash”, Post Box No.42, Sector 17-B, Chandigarh through its D.M.

2.     L.I.C. Branch Office, Railway Road, Sangrur through its Manager.

3.     E-meditac, S.C.F. No.77, Sector 40-C, Chandigarh through its Manager.

                                                        ..Opposite parties

 

 

For the complainant    :       Shri Rajat Bansal, Adv.

For OPs No.1&2        :       Shri Amit Bedi, Adv.

For OP No.3              :       Shri Amit Goyal, Adv.

 

Quorum:    Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President.

 

1.             Smt. Kiran Prasad, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the complainant obtained the services of Ops by getting the insurance policy, namely, Jeevan Arogya having policy number 165641399 with the date of commencement of the policy as 16.11.2013 with a premium of Rs.2989/-, but the OPs did not supply any terms and conditions of the policy along with the policy.  It is further averred that the next premium of the policy was due in May, 2014 and the complainant was in impression that his premium was to be deposited yearly, so the complainant did not deposit the premium, but when the complainant came to know about the policy premium was to be paid half yearly, then he went to the office of the OPs on 5.8.2014 and paid the premium along with interest and got revived the policy in question. 

 

2.             Further case of the complainant is that he undergone a major surgery on 16.09.2014 in Max Super Speciality Hospital, Mohali, in which she gave her one kidney to her own son, whose kidney was damaged and that was necessity to save the life of her child and this was due to love and affection and without any consideration and on such, the complainant spent a huge amount of Rs.2,14,000/-.  It is further averred that the complainant submitted the claim to the Ops to make the payment of Rs.2,10,000/-, but the Ops repudiated the claim of the complainant without any reason vide letter dated 15.02.2015, wherein the OPs mentioned repudiation code W04 and cause of repudiation mentioned that if the claimant was hospitalized within 45 days from the date of revival of the policy, then he is not entitled to claim.   It is further averred that the complainant thereafter also got served a legal notice upon the OPs to pay the claim, but all in vain.  Thus, alleging deficiency in service on the part of the Ops, the complainant has prayed that the Ops be directed to pay to the complainant an amount of Rs.2,10,000/- along with interest @ 12% per annum and further claimed compensation for mental torture, agony and harassment and  litigation expenses.

 

3.             In the written reply filed by the Ops number 1 and 2, preliminary objections are taken up on the grounds that the complainant has not come to the court with clean hands, as such is not entitled to get any relief.  It is stated further that the complainant is neither a consumer of the OP nor the dispute detailed in the complaint is a consumer dispute. It is further stated that this scheme is available to the employees and their family members only and under this scheme any employee/family member of any employee can purchase the LIC policy on concessional rates.  In the present case, the father of the complainant, Hari Prasad, who is working as Development Officer purchased the policy and he was well aware about the terms and conditions of the policy.  Moreover, the LIC is sending the booklet of terms and conditions along with the policy bond to each of policy holder.  It is stated that the claim has been declined as the claim had arisen within 45 days of the reinstatement of the policy.  On merits, the purchase of the insurance policy by the complainant has been admitted, however it is denied that the terms and conditions were not supplied to the complainant.  However, it is stated that the complainant was well aware about the terms and conditions of the policy.  It is stated further that though the OPs have fully sympathy with the complainant that he had to undergo medical treatment, but to say that he would have delayed the said treatment in case he had knowledge about the said clause of 45 days is totally wrong and an after thought or in other words, it can be safely construed that the complainant tried to play fraud upon the LIC, as he intentionally got the policy renewed on 5.8.2014, as she was aware about his medical condition that she will need a surgery in a month or so time, as need to replace kidney cannot arise in fortnight.  He renewed his policy on 5.8.2014 and he was operated on 16.09.2014 as per his own statement. The claim of the complainant is said to has been rightly repudiated. The other allegations levelled in the complaint have been denied in toto. 

 

4.             The learned counsel for OP number 3 also made a statement on 17.08.2015 that the written reply filed by Ops number 1 and 2 be also read as reply of OP number 3.

 

5.             The learned counsel for the complainant has produced Ex.C-1 copy of legal notice, Ex.C-2 and Ex.C-3 copies of postal receipts, Ex.C-4 copy of reply of legal notice, Ex.C-5 copy of policy, Ex.C-6 copy of repudiation letter, Ex.C-7 copy of RTI from Chandigarh, Ex.C-8 copy of RTI from New Delhi, Ex.C-9 copy of reply of RTI from Bombay, Ex.C-10 copy of claim detail, Ex.C-11 copy of proposal form, Ex.C-12 brochure of the policy, Ex.C-13 copy of pamphlet, Ex.C-14 copy of bill of Max Hospital, Mohali, Ex.C-15 affidavit and closed evidence. On the other hand, the learned counsel for OPs has produced Ex.OP-1 affidavit, Ex.OP-2 copy of delegation of power, Ex.OP-3 copy of terms and conditions and closed evidence.

 

6.             We have very carefully perused the complaint, version of the opposite parties, evidence produced on the file and written submissions and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits dismissal, for these reasons.

 

7.             In the present case, the complainant obtained the insurance policy, namely, Jeevan Arogya by paying a sum of Rs.2989/- as premium on 16.11.2013 from Ops number 1 and 2.  The premium was to be paid half yearly but the complainant mistook it to be a yearly premium and could not pay the premium due in May, 2014, but got the policy revived by paying the premium on 5.8.2014 along with interest on the delayed premium and till then no terms and conditions were supplied to the complainant by the OPs number 1 and 2.  On 16.09.2014 the complainant had undergone a major surgery as she donated  one kidney to her own son, whose kidney was damaged and that was the necessity to save the life of her child and that was due to love and affection and without any consideration.  It has been further contended by the learned counsel for the complainant that an amount of Rs.2,10,000/- was spent by her due to this operation,    but the same was declined by the Ops on the ground that the claim was within 45 days of reinstatement of the policy,  as per the terms and conditions of the policy no claim is payable.  But, then it is the specific case of the complainant that no terms and conditions were ever supplied by the Ops to the complainant. 

 

8.             After hearing the arguments of the learned counsel for the parties and on perusal of the documents placed on record, we find that the policy in question was launched by the Ops number 1 and 2 on 16.11.2013 as the same is evident from the document Ex.C-5 on record.   The complainant had obtained the policy on the same day i.e. 16.11.2013 as per document Ex.C-5 on record.  The learned counsel for the complainant has argued that the instructions material was printed on 12.6.2014 i.e. approximate 8 months after commencement of the policy and when the instructions have been printed only on 12.6.2014, then how the OPs number 1 and 2 could have supplied the copy of the terms and conditions along with the policy in question.  More over, OPs number 1 and 2 have not placed on record any cogent and reliable evidence on record in support of their version that the copy of the terms and conditions were ever supplied to the complainant along with the policy.

 

9.             After perusal of the case file and hearing the arguments, we find that in the present case, the question for determination before us is  whether the complainant is entitled to get any claim from the OPs being the donor of the kidney to her own son.  We have very carefully perused the copy of LIC’s Jeevan Arogya Conditions and Privileges and have also perused the Major Surgical Benefit Annexure, wherein at serial number 114, it has been clearly mentioned that “total nephrectomy due to medical advice (not as a transplant donor),   meaning thereby the donor in the policy is not entitled to get any claim amount from the OPs under the policy.   Further,  the complainant has not produced on record any cogent, reliable and trustworthy evidence on record to show that a donor of organ is entitled to get any claim from the Ops under the policy.  As such, we find that the complainant has failed to establish his case by producing the respective evidence on the point in dispute.  

 

10.            In view of our above discussion, we find no merit in the complaint and the same is dismissed. However, the parties are left to bear their own cost. A copy of the order be issued to the parties free of cost. File be consigned to records.  

                Pronounced.

                January 8, 2016.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                              (K.C.Sharma)

                                                                Member

 

 

                 

                                                                (Sarita Garg)

                                                                    Member