Haryana

Ambala

CC/06/2013

SMT SHOBHA KUMARI - Complainant(s)

Versus

LIC - Opp.Party(s)

K.C JAIN

20 Jun 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

 

Complaint Case No.      : 6 of 2013

Date of Institution         : 03.01.2013

Date of Decision            : 20.06.2017

 

Smt. Shoba Kumari, wife of Late Sh. Vishwanath Chaturvedi, S/o Sh. Tej Ram, R/o Block NO. 12 H, Railway Colony, Ambala Cantt.

                                                                            

……Complainant.

 

                                                                                      Versus

          Life Insurance Corporation of India through its :-

 

1. Chief Manager, LIC of India, Branch Office Jagadhri Road, Ambala Cantt.
2. Sr. Div. Manager, LIC of India, Div. Office, Model Town Karnal

 

                                                                             ……Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act

 

 

BEFORE:   SH. D.N. ARORA,  PRESIDENT.

                   SH. PUSHPENDER KUMAR, MEMBER.

                   MS. ANAMIKA GUPTA, MEMBER.

                  

Present:       Sh. K.C. Jain, counsel for complainant.

                   Sh. R.K. Jindal, counsel for the OPs.

                  

ORDER.

 

                    In nutshell, brief facts of the complaint are that the husband of the complainant was a Railway employee, who had insured himself with OP No. 1 for a sum of Rs. 1,20,000/- vide policy No. 176544599, which had commenced w.e.f 28-02-2009 and Rs. 10,150/- was the yearly premium for this policy and the complainant was made the nominee under the said policy. During the subsistence of the policy, the assured died of a sudden and severe heart attack on 09-04-2010 at Northern Railway Hospital, Ambala Cantt., where the assured was got admitted at 1:30 Am on dt. 09-04-2010 with the complainant of a sudden chest pain and he died there at 10:00 AM on the same day due to sudden and severe heart attack. Thereafter, the complainant being the nominee under the policy, filed her claim with the OP No. 1 for the payment of the death claim under the policy of insurance. All the formalities were duly completed but OP No. 2 vide its letter No. Claims/Rep/M/Con<2y/11-12/08 dated 07-11-2011 repudiated the claim on frivolous and untenable grounds. It was stated vide the above said letter that before the assured proposed for the policy in question, he had suffered from “Bronchitis and acute Gastroentitis”, for which he had consulted a medical man and had taken treatment from him in a hospital and also he availed medical leave from his place of work. It is further submitted that before accepting the proposal of insurance dated 23-02-2009, the OP had got the deceased medically examined from its own medical examiner namely Dr. Vinay Kumar Gupta, who after thorough medical check-up and examination, found the proposer Sh. Vishwanath Chaturvedi medically fit for the said proposed insurance. Besides the above said medical examination, the assured was also put to special medical tests viz. ECG, Blood Sugar etc., which were found to be within normal limits. Thus, after the due consideration and assessment of the contents of the proposal form and the above said medical reports, the proposal for the said insurance was accepted and policy bearing No. 176544599 was issued to the assured and this fact also established on record that at the time of effecting the said insurance, the deceased life assured was not suffering from any disease and was hale and hearty. It is further submitted that the deceased life assured had availed the medical leave from his place work from 24-07-2006 to 07-08-2006, 26-07-2007 to 04-08-2007 and 01-01-2009 to 09-01-2009 as he was suffering from acute gastroentitis and bronchitis and the life assured had joined his duty after availing medical leave on the production of a fitness certificate every time, which was duly issued by Railway doctor and he was treated as an outdoor patient every time at Ambala Cantt. Railway Hospital. An ailment required to be disclosed by the assured is with reference to the serious disorder in his health, whereas, the OP has failed to show that the assured suppressed facts which were material to be disclosed, as to have any bearing on the risks to be undertaken.  As such, the complainant has prayed that the OPs are deficient and negligent in providing proper services to the complainant and thus prayed that the OPs may kindly be directed to pay death claim of Rs. 1,20,000/-  with the accrued bonuses along with penal interest @ 15% p.a., Rs. 20,000/- as compensation for causing undue physical harassment and Rs. 11,000/- as costs of litigation, to the complainant.

2.                Upon notice, OPs appeared through counsel and filed reply raising preliminary objections qua non-maintainability of complaint and suppression of material facts. It has submitted that the deceased has taken a policy No. 176544599 for sum assured Rs. 1,20,000/- commencing from 25-04-2009 and the annual premium for the same is Rs. 10,030/-. The deceased has appointed the complainant as nominee under the policy in question. For taking a policy of Life Insurance, the deceased had filled a proposal from on 23-02-2009 and on the basis of declaration and the answer to the questions mentioned in proposal form given by the life assured/deceased, the OP has issued the said policy. The deceased life assured was duty bound as per the terms and conditions of the policy and proposal form to disclose all the diseases suffered by him and treatment taken by him and also medical leave taken by him prior/at the time of filling the proposal form, as the contract of insurance is a contract of atmost good faith. The deceased Shri Vishwa Nath Chaturvedi was suffering from “Bronchits & Acute Gastroentitis” for which he had consulted a medical man and had taken treatment from him time to time and also he availed medical leave from his place of work, but he did not disclose these facts in the proposal form and made false and mis-statement in the proposal form intentionally and played a fraud with the OPs, had he disclosed the above said facts in the proposal form, the OPs would not have issued the said policy to the deceased. The deceased-life assured had died due to the above said disease, as such the OPs have rightly repudiated the claim on 07-11-2011. It is submitted that the medical check up of the deceased-life assured on the basis of the answer to the questions given by him before the Medical Officer, but the deceased Life assured intentionally to play a fraud with the answering OP did not disclose the disease Bronchits and acute gastroentitis suffered by him to the medical officer and also did not disclose the same in the proposal form and at the time of taking the policy in question and filling the proposal form. Hence, the OPs prayed that the  present complain may kindly be dismissed with costs.

3.                To prove his version, counsel for complainant tendered affidavit Annexure CX alongwith documents as Annexure C-1 to C-8 and closed the evidence. On the other hand, counsel for OPs tendered affidavit of Balbir Kumar as annexure RX alongwith documents as annexure R-1 and R-10 and closed the evidence on behalf of the OPs.

4.                We have heard learned counsel for complainant and gone through the case file very carefully. It is not disputed that deceased-life assured obtained the policy in question commencing from 25-04-2009 and the life assured Sh. Vishwanath Chaturvedi had died on 09-04-2010. Counsel for the complainant has argued the assured died due to sudden and severe heart attack on 09-04-2010. But the death claim was repudiated on the ground that before the assured proposed for the policy in question, he had suffered from “Bronchitis and acute Gastroentitis”, for which he had consulted a medical man and had taken treatment from him in a hospital and also he availed medical leave from his place of work. Counsel for the complainant has relied upon the judgment cited in 1997 (2) CLT titled as Life Insurance Corporation of India v. Smt. Paramjit Kaur Gill and case law cited in IV (2011) CPJ 326 (NC) titled as LIC of India v. Tara Chand. We have gone through the above said judgments but these are not identical to the facts of the present as the deceased/life assured was suffering from the above said diseased for more than one week, hence, it is necessary to disclose in the proposal form.

                   On the other hand, counsel for the OPs has argued that the deceased for taking a policy of Life Insurance, filled a proposal from on 23-02-2009 and but in the proposal form he did not disclose the diseases suffered by him and treatment taken by him and also availed medical leave prior/at the time of filling the proposal form, as such he played a fraud with the OPs. Counsel for the OPs has relied upon the case law cited in 2017 (1) CPR 535 (NC) titled as Savitri Singh v. Bajaj Allianz Life Insurance Co. Ltd, 2015 (3) CPR 513 (NC) titled as Jagdeep Arora v. Life Insurance corporation of India & ors, Revision petition No. 3201/2007 Legal Digest April 2012 titled as LIC of India v. N.P. Nagarathna, Legal Digest July 2011 Revision Petition No. 1958 of 2010 titled as  Smt. Bhanwari Devi v. Life Insurance Corporation of India & Ors. Civil Appeal No. 2776 of 2002, D/d 10-07-2009 titled as Satwant Kaur Sandhu v. New India Assurance Company Ltd. and AIR 1986 Kerla 201 titled as P. Sarojam vs. LIC of India, which are squarely covering the facts of the present case.

5                 We have gone through the document annexure R2 i.e. proposal form, wherein it is filled by the life assured/deceased and signed by him in the point No. 11(a) During the last five years he did not consult a Medical Practitioner for any ailment requiring treatment for more than a week and in point No. 11(c) During the last five years, he did not remain absent from the place of work on the ground of health. But it is proved on the file that the life assured/deceased had availed the medical leave from 24-07-2006 to 07-08-2006, 26-07-2007 to 04-08-2007 and 01-01-2009 to 09-01-2009 as per annexure R7 to annexure R9  as he was suffering from acute gastroentitis and bronchitis and accordingly the life assured was remained ill/under treatment for more than one week. The said fact is also admitted by the complainant in para No. 5 of complaint as well as per annexure C5 to C7.

6.                After going through the arguments of counsel for the parties as well as in view of the laws placed on the file by the counsel for the opposite parties, we are of the view that the life assured/deceased concealed the material facts at the time of filling of proposal form and at the time of obtaining policy in question. Hence, as per the terms and conditions of the insurance policy in question, nothing is payable to the complainant or any other legal heirs of the deceased Vishwanath Chaturvedi. Accordingly, the complainant is not entitled to get any relief qua the present policy and the complaint is dismissed with no order as to costs.  Copies of the order be sent to the parties concerned, free of costs, as per rules. File after due compliance be consigned to record room. 

 

Announced on: 20.06.2017                                                                                         Sd/-

                                                                                                                   (D.N. ARORA)                                                                                                      

                                                                                                                            PRESIDENT

 

                                                                            Sd/-

                                                                   (PUSHPENDER KUMAR)                                                                                     

                                                                           MEMBER

 

                                                                                Sd/-

                                                                   (ANAMIKA GUPTA)

                                                                             MEMBER