Delhi

East Delhi

CC/253/2014

ANUJ - Complainant(s)

Versus

LIC - Opp.Party(s)

16 Apr 2018

ORDER

DISTRICT CONSUMER DISPUTE REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

C.C. NO. 253/14

SMT. ANJU GUPTA

W/O Late Shri SATISH GUPTA,

R/O 1/3487, ASHOK MARG,

RAM NAGAR EXTN., DELHI

                                                                                                                        ….Complainant

 

Vs

 

LIFE INSURANCE CORPORATION OF INDIA,

DELHI DIVISIONAL OFFICE-II,

9.  

THROUGH ITS BRANCH MANAGER

                                                                                                                                                                                                                                                                                         ….Opponent

 

Date of Institution: 12.03.2014

Judgment Reserved for: 16 .04.2018

Judgment Passed on: 04.05.2018

 

Order By: Ms. Harpreet Kaur Charya (Member)

 

JUDGEMENT

1. This complaint has been filed u/s 12 of the Consumer Protection Act by Smt. Anju Gupta against Life Insurance Corporation of India, praying for direction to OP to pay the insured amount of Rs.5,00,000/- along with interest @24% interest per annum, Rs.1,00,000/- towards compensation for mental agony and harassment.
2. The brief facts of the complaint are that the husband of the complainant had got himself insured vide policy no. 125362757 dated 13.09.2009 and policy no. 126009560 dated 23.08.2011 for Rs.5,00,000/- each. On 17.11.2012, the Deceased Life Assured (DLA) was admitted in Pushpanjali Medical Centre, Pushpanjali with the complaint of stomach pain, but got discharged around 12.00 O Clock on the same day, thereafter on the same day the DLA was admitted to St. Stephen’s Hospital, Tis Hazari, where he ultimately expired on 20.11.2012, where he was being treated for upper Gastro Intestinal Shock, Chronic Liver Disease etc. Claim was filed with OP for both the policies, where claim pertaining to policy no. 125362757 dated 13.09.2009 was paid but was repudiated for policy no. 126009560 vide letter dated 03.12.2013. On the ground that the DLA was suffering from “Gastro Intestinal Disease” at the time of proposal, material information and had withheld material information. Despite several visits to OP’s office, the claim was not settled. Hence, the present complaint seeking directions to OP to pay the insured amount of Rs.5,00,000/- alongwith interest @ 24%  p.a., Rs.1,00.000/- as compensation on account of mental agony  & harassment and cost of litigation.

The complainant has annexed premium receipt dated 06.10.2012 as Annexure A, premium receipt dated 22.08.2012 as Annexure B, the photocopies of medical papers of Pushpanjali Medical Centre as Annexure C, the photocopies of medical papers of St. Stephen’s Hospital,Tis Hazari, as Annexure D, photocopy of Death Certificate as Annexure E, the Photocopy of the surviving Member certificate as Annexure F and the photocopy of letter dated 03.12.2013 issued by respondent as Annexure G.

3. Written Statement was filed by OP, upon service of notice of the present complaint. OP in their defence have taken several pleas such as the complaint was not properly verified, the DLA had suppressed the true and material facts regarding to his health as the DLA was already suffering from CLD-Hepatic Encephlopathy Grade II Dyslectrlytemia, severe Anemia & Hpetorenal Syndrome, DLA had past history of Alcoholism & Ansarea 4 years back, which were not disclosed in the proposal form. It was submitted that the claim of the complainant had been repudiated after taking into consideration all the facts; the policy in dispute was a early death claim, thus after thorough investigation/scrutiny, it was repudiated, thus no deficiency in service could be attributed to them. Rests of the contents of the complaint have been denied.

Proposal form as Annexure A 13.10.2011, discharge summary form as Annexure B of Pushpanjali dated 17.11.2012, Annexure C as repudiation letter dated 03.12.2013 have been annexed with the reply.

4. Complainant filed her affidavit as evidence, where she has deposed on oath the contents of the complaint and has got exhibited the photocopies of the policy premiums receipts which are already on record as Annexure A and B and the same are Exhibited as CW1/A and CW1/B, photocopies of medical papers as Exhibit CW1/C, photocopies of medical papers as             Exhibit CW1/D, Photocopy of the Death Certificate as Exhibit CW1/E, Photocopy of the surviving Member Certificate as Exhibit CW1/F, photocopy of letter dated 03.12.2013 issued by respondent Exhibit CW1/G, and contents of the complaint filed by the complainant as Annexure H and the same as Exhibited CW1/H.
5. Sh. D.K. Joshi was examined on behalf of OP, who has also deposed on affidavit what they have stated in their reply. They have also got exhibited the photocopy of proposal form enclosed as Annexure-A and the same is Exhibited as RW1/A, photocopy of Discharge summary of Pushpanjali Hospital as Annexure B and the same is Exhibited as RW1/B, the photocopy of certificate of Hospital treatment as Annexure C and the same is Exhibited as RW1/C, the photocopy of Repudiation letter enclosed as Annexure D and the same is Exhibited as RW1/D and the contents of written statement as Annexure E and the same is Exhibited as RW1/E.
6. We have heard the arguments on behalf of the Ld. Counsel for complainant and the Ld. Counsel for OP. The Claim of the complainant was rejected on ground of DLA withholding material information regarding his health in the proposal form dated 13.10.2011, they have reproduced questionnaire in clause 11 of the proposal form, where the complainant has Answered “No” against all the questions especially (relevant portion is being reproduced).

 

PERSONAL HISTORY
…………………………………………
…………………………………………….
…………………………………………….
Are you suffering from or have you ever suffered from ailments pertaining to liver, stomach, heart, lungs, kidney, brain or nervous system?

 

Firstly, if we have a look at Ex. CW1/C, which is discharge summary issued by Pushpanjali Hospital which bears “Past History” as Alcoholic and Ansarea 4 years back” and simultaneous reading of death summary issued by St. Stephen’s Hospital as Ex CW1/D dated 20.11.2012 reflects diagnosis as upper gastrointestinal bleed, Chronic Liver Disease, Hepatic Encephalopalthy; it is clear that complainant was suffering from Liver disease but had concealed the same while filing the proposal form which is of dated 13.10.2011. It is settled principle of law that the contract of insurance is based on the principle “Uberrimae fidei” where the insured is expected to disclose all the information correctly, but in the present complaint the DLA had concealed the same. Hence, the OP has rightly rejected the claim of the complainant, therefore, no deficiency in service can be attributed to OP. Hence, the present complaint is dismissed being devoid of merit without order to cost.

Copy of this order be sent to both the parties as per law.

File be consigned to R/R.

 

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

   MEMBER                                                                                                      MEMBER        

 

 

           

(SUKHDEV SINGH)

PRESIDENT