DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

C.C. No.406/2016

Date of Institution:04.08.2016

Judgment Reserved on:03.07.2024

Judgment Passed on:12.07.2024

QUORUM:

Sh. S.S. Malhotra (President)

Sh. Ravi Kumar (Member)

Judgment By: Shri Ravi Kumar (Member)

JUDGMENT

The Complainant has alleged deficiency in service on the part of OP  in not re-starting/reviving his LIC policy bearing No.126683156 for the reason that OP had advised the Complainant to undergo some expensive medical tests which the Complainant was not inclined to do.

1. The Complainant in his complaint has contended that he had taken Jeewan Ankur Policy of Rs.5,00,000/- bearing No. 126683156 dated 28.07.2013 for 16 years from OP with the premium of Rs.2,140/- per month. The policy was issued from Laxmi Nagar, Delhi Branch Office of OP.
2. The Complainant paid premium regularly till May, 2015 however due to some financial difficulties he could not pay the premium for some time and soon as his financial condition improved, he decided to re-continue his policy. He approached OP and on the advice of OP, Complainant got himself examined from the Doctor authorised by the OP and the reports were normal however there was a remark that there was some wound mark on his forehead which was caused in 2011.
3. Thereafter OP advised Complainant to undergo certain tests which were quite expensive whereas the wound mark was much prior to the obtaining of the policy in question on 28.07.2013.
4. Since the Complainant was not interested to undergo such expensive medical tests on the advice of the OP, the OP did not revive his Policy No. 126683156. He issued Legal Notice dated 04.06.2016 however no reply was given by OP. Complainant has also stated that he had another two policies bearing No.123445070 and 123933374 which also got lapsed during the same period due to non-payment of premium however OP revived these two policies without any Medical Examination.
5. The Complainant in his complaint has sought following relief:
   • OP be directed to re-start/continue the Policy No.1236683156 without medical tests and if the OP is not able to re-start/resume then OP be directed to refund the amount paid with interest and also to pay Rs.90,000/- to the Complainant for mental agony and harassment.
6. Notice was issued and OP filed its reply and has stated that under certain plans, a policy can be revived without any requirement within a period of 10 years provided the policy has been continuation for 5 years and some policies can be revived with medical tests. The two policies bearing No.123445070 and 123933374 were revived without any formalities however with regard to the lapsed policy in question i.e. No.1236683156 the Complainant did not complete the required formalities and hence his policy could not be revived.
7. The policy holder i.e. Complainant submitted DGH dated 07.05.2016 alongwith FMR dated 13.05.2016 (abbreviation not explained) conducted by OP’s third party administrator Dr. Robin Goel (Regd. No. DMC/R/5711) and thereafter all the reports were sent to DO-2 of OP, Delhi for approval. However vide letter dated 23.05.2016, DO-2 called for the Hospital Discharge Report of the Complainant and advised to submit following medical test reports:

1. Deaf Q
2. CNS Q.
3. Epilepsy
4. Treatment details, CT scan, finding and other relates documents.

8. However Complainant chose not to provide these medical test reports and as a result his No.1236683156 could not be revived and therefore there is no merit in the complaint.
9. Complainant has filed Rejoinder denying the reply of the OP and has re-iterated the contents of his complaint.

Complainant has filed his evidence by way of affidavit wherein he has marked the following documents as exhibits:

• Copy of policy No.126683156 as exhibit C-1.
• Copy of two other renewed policies i.e. policy No.123445070 and 123933374 as exhibit C-2.
• Complainant has also filed Discharge Summary of Guru Teg Bahadur Hospital where he was admitted for treatment of Head injury.

10. OP has filed evidence by way of affidavit of Mr. Ajay Tyagi, Manager Legal, Jewan Prakash, 25 KG Marg, Delhi wherein following documents have been marked as exhibits:
    • Documents pertaining to medical reports with regard to Policy No. 126683156 as exhibit RW1/A (Colly).
    • Copy of Written Statement as exhibit RW1/B.
11. This Commission has heard the arguments of both sides and perused the records.

The case of the Complainant is that he had Jewan Ankur Policy number  1266183156 for Rs.5,00,000/- issued by OP for 16 years on 28.07.2013 and the premium was Rs.2,140/- per month for the Policy.

It is admitted that Complainant could not pay the premium of this policy after May, 2015 due to his financial problems and he approached the OP for revival of the policy. OP advised the Complainant to undergo medical examination through their Doctor which was done on 13.05.2016 and report from Dr. Robin Goel was submitted which did not find any major problem with the health of the Complainant. However there was an observation by the Doctor in his report that Complainant met with accident in 2011 and suffered some head injury and he was hospitalised however there was no operation done and the Complainant had injury marked on his forehead.

These reports of  Dr. Robin were submitted to the OP who further referred the same to its higher office DO-2 Delhi who advised that the Complainant should submit the following tests report and also submit report of hospital discharge papers. The details of the tests recommended were as per exhibit RW1/A:

1. Deaf Q
2. CNS Q.
3. Epilepsy

Treatment details, CT scan report.

However complainant did not agree to undergo these expensive tests at his own cost. When the Complainant expressed inability to undergo these tests the OP did not revive his policy in question.

12. On perusal of exhibit RW1/A (Colly) it is observed that at the time of the request made by the complainant for renewal of his policy he had filled Personal Statement Regarding Health dated 16.08.2016 wherein he has replied to the query under point 2(b) that he never had any operation, accident or injury whereas in the Medical Examiner’s Confidential Report it is mentioned that he suffered head injury in 2011 but there was no operation done. When the  matter was reffered by the branch to their higher office then the details of above referred medical reports were sought from the complainant.
13. Complainant has filed copy of discharge summary of Guru Teg Bahadur Hospital, Delhi wherein details of the injury suffered by him were mentioned and the actual date of admission was recorded as 03.12.2012 and discharge date was 04.12.2012 and it is also mentioned that CT Head has been done.
14. On referring the matter by OP to its higher office alongwith the doctor’s report wherein details of his head injury in 2011 (actually 2012) are mentioned the higher office of the OP sought Hospital Discharge Report which the complainant was having alongwith reports of the tests as mentioned in the above Para No.11. The complainant should have furnished these available reports which he has now submitted to the Commission and rather doing this he apparently mistook the same that the OP was demanding these test to be done whereas as per the affidavit of the OP they had sought the details of Hospital Discharge papers and other reports as mentioned above and the complainant should have provided the all available documents pertaining to his head injury happened in 2012 but he chose to not to submit by interpreting/understanding that these reports are required afresh and instead seeking clarification from the OP he did not provide the hospital discharge report and other reports including CT Scan done in the said hospital and he chose to file complaint before this Commission for deficiency in service on the part of OP in not re-starting his policy number 126683156 issued on 28.07.2013. It is also obvious that when the issue of head injury to the applicant pertains to the year 2011 (correct year 2012) and that the complainant was admitted also in hospital was brought to the notice of the OP then only related documents i.e. Hospital Discharge Paper and other documents including CT Scan were sought by OP.
15. Thus from the above it can be reasonably concluded that on account of mis-interpretation of the requirement of the OP for providing hospital discharge paper, the complainant chose to not to provide the available documents and he also did not seek clarification from the OP hence there is no deficiency established on the part of OP and the complaint filed by the complainant is dismissed.

Copy of the order be supplied/send to parties free of cost as per rules.

File be consigned to Record Room.

Announced on 12.07.2024