BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
CONSUMER COMPLAINT NO.125 of 2014
DATE OF INSTITUTION: - 12.05.2014
DATE OF ORDER: -23.11.2015
Smt. Bala Devi, aged 50 years, wife of Om Parkash, resident of village Tigrana, Tehsil and District Bhiwani.
……………Complainant.
VERSUS
- Life Insurance Company Ltd., B-1/B-2 HUDA City Centre, Near Mini Sect. Bhiwani branch through its Branch Manager.
- Life Insurance Company Ltd., Divisional Office Rohtak, 3, 4, 5, SCO, Sector-1, Rohtak, through its Divisional Manager.
………….. Opposite Parties.
COMPLAINT U/S 12 & 13 OF CONSUMER PROECTION ACT
BEFORE :- Shri Rajesh Jindal, President
Smt. Ansuya Bishnoi, Member
Present: - Shri Sanjiv Tanwar, Advocate for complainant.
Shri Mahipal Tanwar, Advocate, for the OPs.
ORDER:-
Rajesh Jindal, President:
The case of the complainant in brief, is that her son Deepak (now deceased) had obtained insurance policy in his name covering the risk for a sum of Rs. 50,000/- vide policy no. 174594516 dated 28.10.2005, T.T. No. 75-20 from the Ops. The complainant was nominated as nominee in the above said policy. On 04.07.2013 the son of the complainant expired and the intimation was given to OP no. 1 and got completed the necessary formalities. The complainant approached to OP no. 2 for disbursement the amount of policy but the OP no. 2 repudiated the claim of the applicant alleging therein that as per report of PGIMS, Rohtak deceased was patient of heart disease for the last two years. The complainant alleged that she visited to the office of the Ops time and again for obtaining the claim but to no avail. The complainant further alleged that due to the act and conduct of the respondents, she had to suffer mental agony, disappointment and humiliation Hence, it amounts to deficiency in service on the part of OPs and as such she had to file the present complaint for seeking compensation.
2. On appearance, OPs filed written statement and took preliminary objections and denied the allegations of the complainant. It is submitted that the last premium paid by the deceased on 26.04.2013. It is submitted that the said policy was revival on 01.01.2013 and at the time of revival of policy, deceased Deepak has withheld correct information regarding his health. It is submitted that as per investigation officer, life assured has taken the treatment of Heart Disease since 2 years from PGIMS Rohtak so the claim of the complainant has repudiated by the competent authority as per terms and conditions of the policy. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of OPs and complaint of the complainant is liable to be dismissed with costs.
3. In order to make out his case, the counsel for complainant has placed on record Annexure P1 to Annexure P-11 alongwith supporting affidavit.
4. In reply thereto, the counsel for OPs has placed on record Annexure R1 to Annexure R-27 alongwith supporting affidavit.
5. We have gone through the record of the case carefully and have heard the learned counsels for the parties.
6. Learned counsel for the complainant reiterated the contents of the complaint. He submitted that Deepak life assured, the son of the complainant died on 04.07.2013. The Ops are liable to pay the insured amount to the complainant.
7. Learned counsel for the opposite parties reiterated the contents of reply. He submitted that the Ops have repudiated the claim of the complainant vide letter dated 09.01.2014 Annexure R-1, because the life assured was suffering from heart disease for the last 2 years but this information was not disclosed by the life assured at the time of the revival of the policy. In support of his contention he referred Form 3816 Annexure R-3. He relied upon the following judgment of Hon’ble National Commission:-
I Life Insurance Corporation of India Vs. Kempamma and another in Revision Petition No. 3848 of 2007 decided on 24.01.2013.
8. In the light of the pleadings and arguments of the parties, we have examined the relevant material on record. The Ops in support of their contention have relied upon the Form 3816 Annexure R-3. According to which the life assured was admitted in the hospital on 18.06.2013 and expired on 04.07.2013. The Ops have alleged that the life assured was suffering from heart disease for the last 2 years, but the Ops have not produced any hospital treatment record that the LA had taken the treatment for his heart ailment within the period of 2 years as alleged by the Ops. The policy in question was issued on 28.10.2005 for the sum insured of Rs. 50,000/- and which was remained in lapsed condition from April 2009 to October 2012 and was revived on 01.01.2013. No cogent evidence has been adduced by the Ops that the life assured had taken any treatment within the last 2 years from the date of his death regarding his heart ailment. The Ops have failed to adduce any reliable evidence in support of their ground for repudiation of the claim of the complainant. We hold that the Ops have no justification to repudiate the claim of the complainant. Resultantly, we allow the complaint of the complainant and Ops are directed to pay the sum insured of Rs. 50,000/- to the complainant within 45 days from the date of passing of this order, otherwise the Ops shall be liable to pay the interest at the rate of 6 % per annum from the date of passing of this order till the date of payment. Certified copies of the order be sent to the parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: 23-11-2015.
(Rajesh Jindal)
President,
District Consumer Disputes
Redressal Forum, Bhiwani.
(Ansuya Bishoni),
Member.
