Haryana

Bhiwani

CC/160/2018

Laxmi - Complainant(s)

Versus

LIC - Opp.Party(s)

Naresh Gautam

25 Jul 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BHIWANI.

 

                                                         Consumer Complaint No. : 160 of 2018

                                                    Date of Institution            : 29.11.2018

                                                              Date of order                     : 25.07.2024

 

Laxmi Devi widow of Sh. Zile Singh son of Durga Parsad R/o Nawa ki Dhani (Gujran), Tehsil and District Bhiwani.

  

           ……Complainant.

 

Versus

 

1.       Life Insurance Corporation of India, Branch office Bhiwani through its Branch Manager.

 

2.       Life Insurance Corporation of India, Divisional Office, Rohtak through its Divisional Manager.

 

…… Opposite Parties.

 

COMPLAINT U/S 12 OF CONSUMER PROECTION ACT, 1986.

 

BEFORE:       Mrs. Saroj Bala Bohra, Presiding Member.

  Ms. Shashi Kiran Panwar, Member.

 

Present:-       Sh. Naresh Gautam, Advocate for complainant.

 Sh. M. L. Sardana, Advocate for OPs.

 

ORDER:

 

Shashi Kiran Panwar, Member.

 

1.                 Brief facts of this complaint are that husband of complainant Zile Singh was insured with OPs for a sum of Rs.5.00 lac under policy no.179885427 from 10.03.2015. The policy was for a term of 21 years having half yearly premium of Rs.15,217/-. Complainant is nominee in the said policy. It is submitted that Zile Singh expired suddenly on 24.10.2015. So, claim was lodged with OPs submitting all necessary documents but the Ops denied the claim vide letter dated 27.03.2017. Hence, the present complaint has been preferred alleging deficiency in service on the part of OPs resulting into monetary loss as well as mental and physical harassment. In the end, prayer  has been made to direct the Ops to pay Rs.5.00 lac alongwith interest and due benefits. Further to pay Rs.60,000/- on account  of compensation for harassment besides Rs.11,000/- towards litigation expenses. Any other relief to which this Commission deems fit has also been sought.

2.                 OPs appeared through counsel and filed written statement raising preliminary objections qua maintainability, cause of action, suppression of material facts and complaint bad for non-joinder of necessary parties. On merits, insurance policy to the life assured Zile Singh subject to certain terms and conditions. It is submitted that in the proposal form, the life assured declared that he is not suffering from any ailment on the day of taking the policy or prior to it, however, the insured person  denied such questions in the proposal form.  Whereas, true facts were that life assured was taking treatment of lungs cancer from Acharya Tulsi Regional Cancer Treatment and Research Centre, Bikaner from 17.02.2015 and thus denied claim to the complainant. In the end, denied for any deficiency in service on their part and prayed dismissal of the complaint with costs.

3.                 In evidence of complainant, her affidavit Ex.CW1/A alongwith documents Annexure C-1 to Annexure C-5 were tendered and closed the evidence on 21.03.2023.

4.                 On the other hand, in evidence of OPs, affidavit Ex. RW1 of Ms. Sunita Matta, Manager (Legal) alongwith documents Annexure R-1 to Annexure R-5 were filed and closed the evidence on 13.06.2024.

5.                 We have heard learned counsels for the parties and perused the record minutely. Written arguments submitted on behalf of Ops.

6.                 Learned counsel for complainant has argued that the OP insurance company has arbitrarily and illegally repudiated the genuine claim of complainant on the ground of suppression of previous ailment by life assured while taking the insurance policy. The counsel has vehemently argued that in fact, the life assured was not suffering from any disease and he was died his natural death.

7.                 On the other hand, learned counsel for OPs has argued that there was suppression of previous ailment which is violation of terms and conditions of insurance policy, therefore, the claim of complainant was righty repudiated within the meaning of the Insurance Act, 1938 wherein at point 45(2) it is written that ‘A policy of the life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider of the policy, whichever is later, on the ground of fraud.’  To strengthen his case, the counsel has placed reliance on case laws delivered by Hon’ble National Consumer Disputes Redressal Commission, New Delhi in case titled Paramjit Kaur Vs. LIC & Anr. R.P. No.1308 of 2013 decided on 28.07.2014.  Darshan Singh Vs. HDFC Standard Life Insurance  Co. Ltd. & Anr. II (2019) CPJ 243 and Ramesh Kumar Vs. Tata AIA Life Insurance Co. Ltd. & Anr. III (2019) CPJ 208.

8.                 After hearing learned counsel for the parties and going through the record put-forth by both the sides, it is not in dispute that at the time of death of life assured, he was under the risk cover of the policy in question.  It is admitted case of OPs that insured amount under the policy is Rs.5.00 lacs. As per pleadings of OPs and repudiation letter (Annexure R-4), the claim to complainant has been denied on account of suppression of material facts.

9.                 We have minutely perused the proposal form (Annexure R-1) and found that the  on giving answers to the questions relating to health of the life assured,  he was medically examined by concerned doctor as depicts from seal on the proposal form.  It means that at the time of taking the policy in question, the life assured was hale and hearty. Further, no medical report produced on file from OP side which could assist this Commission that cause of death in this case was/is the disease mentioned in patient summary Annexure R-3 by the hospital at Bikaner.

10.               In view of the above, we have observed that repudiation of the claim of complainant is not tenable on the basis of documents on file especially the medical examination of life assured before issuance of the policy. Thus , it is concluded the claim of complainant has been repudiated by the OPs in a casual manner without mentioning any cogent and convincing reason thereof which shows that the OP insurance company has adopted a trend not to release claim of the poor persons rather compel them to knock the doors of the Consumer Commission. It is worthwhile to mention here that the OP(s) are not settling even genuine claims of consumers/complainants which is illegal and amounts to indulgence into unfair trade practice/malpractice resulting into monetary loss as well as mental and physical harassment to complainant.  Hence, the complaint is allowed OPs, jointly and severally, are directed to comply with the directions within 40 days from the date of order:-

(i)       To pay a sum of Rs.5,00,000/- (Rs. Five lacs) to the complainant alongwith simple interest @ 9% per annum from the date of filing of complaint till actual realization. The amount if any, already received by complainant be deducted from the awarded amount.

(ii)      Further, to pay Rs.20,000/- (Rs. Twenty thousand) as compensation  for  harassment. 

3. To pay Rs.11,000/- (Rs.Eleven thousand) as litigation expenses.

                    In case of default, the Ops shall liable to pay simple interest @ 12% per annum on the aforesaid all the amounts for the period of default. If this order is not complied with, then the complainant shall be entitled to the execution petition under section 71 of Consumer Protection Act, 2019 and in that eventuality, the opposite parties may also be liable for prosecution under Section 72 of the said Act which envisages punishment of imprisonment, which may extend to three years or fine upto rupees one lac or with both.  Certified copies of the order be sent to parties, free of costs, as per rules. File be consigned to the record room, after due compliance.

Announced.

Dated:25.07.2024.