Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 542.
Instituted on : 05.10.2016.
Decided on : 05.07.2017.
Jitender Singh s/o Sh. Rameshwar Singh R/O VPO and Post Bhalout, Rohtak.
………..Complainant.
Vs.
Life Insurance Corporation of India office at 3,4,5 SCO Sector-1, Rothak, through its Senior Divisional Manager.
……….Opposite party.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.JOGINDER KUMAR JAKHAR, PRESIDENT.
MS. KOMAL KHANNA, MEMBER.
SH. VED PAL, MEMBER
Present: Sh. Gulshan Chawla, Advocate for the complainant.
Sh.Satish Khera, Advocate for the opposite party.
ORDER
SH. JOGINDER KUMAR JAKHAR, PRESIDENT :
1. The present complaint has been filed by the complainant with the averments that late Smt. Darhsna Devi w/o Sh.Rameshwar Singh purchased a policy bearing No.173362197 with date of commencement as 28.03.2003 for the basic sum assured of Rs.50000/- for which deceased life assured made a half yearly instalment of Rs.1764/-. It is averred that at the time of availing/purchase and revival of the policy, the life assured was perfectly healthy and was not suffering from any type of disease. It is averred that due to financial constraint, the policy was lapsed which was later on revived by the opposite party by taking penal and other charges and policy in question was revived from the date of inception. It is averred that after the death of Smt. Darshna Devi, claim was lodged by the complainant with the opposite party and all the documents were submitted by the complainant. It is averred that opposite party vide its letter dated 03.06.2016 had repudiated the claim of the complainant ignoring the fact that deceased life assured was not suffering from any disease and furthermore the policy in question was taken by deceased life assured in 28.03.2003 and had made a regular premium for a span of approx. 12/13 years. It is averred that there had been no concealment of fact on the part of life assured at any span of time. It is averred that act and conduct of the opposite party is illegal and amounts to deficiency in service. As such it is prayed that complaint may kindly be allowed and opposite party be directed to make the payment of Rs.50000/- alonwith bonus and other benefits, interest, compensation and litigation expenses to the complainant.
2. On notice opposite party appeared and filed its written reply submitting therein that the opposite party had issued a policy no.173362197 on the life of Smt. Darshna Devi wife of Rameshwar Singh with DOC 28.03.2003, sum assured Rs.50000/-, half yearly installment: Rs.1764/-. It is incorrect and denied that the life assured was healthy before the revival because as per discharge card of PGIMS, Rohtak, CR No.919547, date of admission 24.01.2011, life assured was diagnosed as old case of DM Type II with acute coronary syndrome(heart disease). Policy was lapsed by non payment of premium due from September, 2013 to September, 2014 and was revived on 24.12.2014 after depositing 3 instalments of premiums for the full sum assured on the strength of a personal statement regarding health made by deceased. It is averred that the competent authority has repudiated the liability vide letter dated 3.6.2016 under the above policy on genuine grounds because the life assured made deliberate misstatements and withheld material information regarding her health at the time of getting the policy revived. Hence the revival of policy was declared null and void and all moneys paid towards revival of the policy and subsequent thereto belong to respondent. However, paid-up value is being paid. It is averred that there is no deficiency in service on the part of opposite party. All the other contents of the complaint were stated to be wrong and denied. Opposite party prayed for dismissal of complaint with costs.
3. Both the parties led evidence in support of their case.
4. Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C20 and closed his evidence. On the other hand ld. Counsel for the opposite party has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R6 and has closed his evidence.
5. We have heard ld. counsel for the parties and have gone through the material aspects of the case carefully.
6. In the present case it is not disputed that life assured had taken the policy in the year 2003 for sum assured Rs.50000/-. It is also not disputed that the policy was lapsed in the year 2013 and the same was revived on 24.12.2014. After the death of life assured complainant filed the claim with the opposite party but the opposite party vide its letter Ex.R1 had repudiated the claim on the ground that life assured had suffered from disease before revival of policy and she had disclosed these facts in the said proposal form. To prove its contention opposite party has placed on record copy of personal health statement Ex.R2, copy of discharge card Ex.R3, copy of treatment record Ex.R4 and leave certificate Ex.R5 and copy of status report Ex.R6 is also placed on record as per which an amount of Rs.20000/- has been paid by the opposite party.
7. After going through the file and hearing the parties it is observed that the claim of the complainant has been repudiated by the opposite party on the ground of concealment of pre-existing disease at the time of revival of policy. To prove its contention, opposite party has placed on record copy of personal statement Ex.R2 but the same is merely a photocopy and it not proved that the same was filled and signed by the life assured. Documents Ex.R3 & R4 are also a photocopy and are not supported with any affidavit of the doctor that the L.A. was suffering from the disease prior to taking the policy. It is also observed that the opposite party has not placed any record of treatment of complainant prior to commencement of policy.. In this regard reliance has been placed upon the law cited in II(2013)CPJ 60 titled Life Insurance Corporation of India & Anr. Vs. Raj Kumar Sharma whereby it is held that: “Neither inquiry officer was examined nor his affidavit had been tendered into evidence by appellant to prove that LA was suffering from peptic ulcer at the time of filling the proposal form-Evidence of inquiry officer was withheld for unknown reasons-In repudiation letter no name and identity of person is disclosed from whom ‘LA’ had taken treatment and no proof to this effect was produced-Appellant had failed to prove that LA suffering with peptic ulcer and she had deliberately made wrong report/answer to agent at the time of filling proposal form-Repudiation not justified”. Moreover it is not proved on file that life assured had died due to heart disease. Hence there is no nexus between the cause of death of life assured and the alleged disease. In this regard reliance has been placed upon the law cited in 2006(2)CPC495 titled as Life Insurance Corp. of India Vs. Smt. Kulwant Kumari whereby Hon’ble State Commission, Chandigarh has held that: “Policy had elapsed due to non-payment of premium-it was revived after payment of permission-Assured died of heart attack within two years of revival of policy-Repudiation of claim on the ground that accused was suffering from diabetes at the time of policy is not justified-there is no nexus of concealment of disease(diabetes) and cause of death-heart failure-Repudiation of claim rightly set aside by District Forum. Award of full claim within interest and cost upheld”. Regarding taking the leave from the workplace on medical ground, we have placed reliance upon the law cited in 1(2009)CPJ479 titled as Life Insurance Corporation of India & Anr. Vs. Shanti Rajbhar, Hon’ble West Bengal State Commission, Kolkata has held that: “Leave taken by employee on medical ground, not proof of actual illness of employee-Repudiation of claim unjustified-Insurer liable under policy”. It is also observed that the policy was taken by the life assured in 2003 and the disease alleged to have been caused to the life assured in the year 2011. In this regard reliance has been placed upon AIR1962 Supreme Court 814(V 49 C117) as per which Hon’ble Supreme Court of India has held that: “Whether the revival of policy constitute a new contract or not for other purpose. It is clear from the wording of the operative part of S.45 that the period of two years for the purpose of the section has to be calculated from the date on which the policy was originally effected”. In view of the aforesaid law which are fully applicable on the facts and circumstances of the case it is observed that complainant is entitled for the claim as per policy. As per document Ex.R6 an amount of Rs.10000/- on 28.02.2008 and Rs.10000/- on 28.03.2008 were paid as due amount under the policy and as such the same is not deductible from the sum assured. As per policy the sum assured is Rs.50000/-. Hence the complainant is entitled for the alleged amount.
8. In view of facts and circumstances of the case it is observed that opposite party shall pay the amount of Rs.50000/-(Rupees fifty thousand only) to the complainant alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 05.10.2016 till its actual realization, other benefits under the policy, if any and shall also pay an amount of Rs.3500/-(Rupees three thousand five hundred only) as litigation expenses to the complainant maximum within one month from the date of decision failing which the opposite party shall be liable to pay interest @ 12% p.a. on the awarded amount from the date of decision. Complaint is allowed accordingly.
9. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
05.07.2017.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
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Ved Pal, Member
