Before the District Consumer Disputes Redressal Forum, Rohtak.

                                                                    Complaint No. : 63.

                                                                    Instituted on     : 08.02.2018.

                                                                    Decided on       : 20.06.2019.

Geeta Rani age 28 years, w/o Late Sh. Jitender Singh s/o Sh. Om Parkash R/o village-Dobh, Teh. & Distt. Rohtak.

                                                                    ..………..Complainant.

                                                Vs.

Life Insurance Corporation of India, Subhash Road, Opposite All India Radio Station, Rohtak through its Divisional Manager.

……….Opposite party.

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

BEFORE:  SH.NAGENDER SINGH KADIAN, PRESIDENT.

                   SH. VED PAL, MEMBER.

                   DR. RENU CHAUDHARY, MEMBER.

Present:       Sh.R.K.Nandal, Advocate for the complainant.

                   Sh. S.P.Gulati, Advocate for opposite parties.

                                      ORDER

NAGENDER SINGH KADIAN, PRESIDENT:

1.                          Brief facts of the case are that husband of complainant Jitender Singh was insured with the opposite party vide policy no.179915931 for a sum of Rs.500000/- and complainant is the nominee  in the said policy. That on 24.03.2017  the husband of complainant had expired . That complainant intimated the officials of the opposite parties  and field a claim with the opposite party. That after passing a sufficient long period, the officials of the opposite party did not pay the insurance amount and had repudiated the claim vide letter dated 02.01.2018. That  act of opposite parties is illegal and amounts to deficiency in service. As such, it is prayed that opposite parties may kindly be directed to pay Rs.500000/- as amount of insurance alongwith interest @ 18% per annum from the date of death of Jitender till actual realization and Rs.200000/- as compensation, Rs.11,000/- as litigation expenses to the complainant as explained in relief clause.

2.                          After registration of complaint, notice was issued to the opposite parties. Opposite parties in their reply has submitted that the opposite parties issued a policy bearing no.179915931 on the life of Sh. Sh. Jitender for sum assured of Rs.500000/- with date of commencement from 17.04.2015. That life assured was suffering from TB(CAT) at the time of taking insurance and he did not disclose this fact in his proposal form. That life assured was not in good health at the time of taking insurance. The competent authority has repudiated all liability under the above policy on genuine ground and informed the complainant by registered letter. That as per OPD card of PGIMS Rohtak, the deceased life assured had taken treatment of TB(CAT). As per treatment record of MEDANTA Hospital, the life assured was case of DM and Hypertension. As per leave record life assured had taken medical leave before taking insurance but not disclosed the same while taking insurance. The life assured had concealed material facts and information while taking insurance. Hence, it has been decided to repudiate all the liabilities and in terms of provisions of Section 45 of the Insurance Act, 1938. That there is no deficiency in service on the part of opposite parties .All the other contents of the complaint were stated to be wrong and denied and dismissal of complaint has been sought.

3.                          Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C10 and the evidence of complainant was closed by the order dated 23.10.2018 of this Forum. Ld. counsel for the opposite parties tendered affidavit Ex.R1 and documents Ex.R1 to Ex.R13 and closed his evidence on 03.01.2019.

4.                          We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.

5.                          After going through the file and hearing the parties it is observed that claim of the complainant has been repudiated by the respondent’s officials on the ground that as per OPD card of PGIMS, Rohtak, the deceased life assured had taken treatment of TB(CAT). We have perused the OPD card. This card was prepared on dated 22.03.2017 which   is Ex.R7. In    this  card, it  has  not   been    mentioned   anywhere that the deceased Jitender s/o Sh. Om Parkash was suffering from TB(Tuberculosis). The respondent officials failed to provide any document or medical record to prove that he was suffering from Tuberculosis and he had taken any follow up treatment from PGIMS, Rohtak or from any other hospital. The second objection taken by the opposite party is that as per treatment record of MEDANTA Hospital, the life assured was case of DM and Hypertension. We have also perused documents placed on record by the respondent Ex.R8, Ex.R9 and Ex.R10, prepared in Medanta Hospital and through these documents, the respondent wants to prove that LA was suffering from Haemopetysis DM and HT. As per document Ex.R10, the deceased Jitender consulted  in Medanta Hospital on 24.03.2017 with complaint of Haemopetysis for last two days, fever for last 15 days and some other ailments. The ailment Haemopetysis was also informed in OPD Card issued by PGIMS, Rohtak placed on record as Ex.R7.  But in both the treatment records, it has not been mentioned anywhere that the ailment was from how many days. The respondent insurance company in order to prove that the deceased was suffering from these diseases has placed on record copy of DDR and copy of Post Mortem Report as Ex.R11 and Ex.R12. We have also perused Post Mortem Report, as per which Medical officer mentioned on page no.3 that cause of death: “In my opinion will be given after report of HPE”. Meaning thereby, the exact cause of death has not been disclosed even in the post mortem report because the HPE report has not been placed on record or before the doctor who conducted the post mortem report. So the exact cause of death of deceased Jitendeer Kumar could not be established till date. So it cannot be presumed simply on the basis of DDR or some Photostat copy of the document that the deceased was suffering from TB, DM and Hypertension at the time of issuance of policy. One more document has also been placed on record by the respondent officials i.e. certificate of employer through which the insurance company wants to prove that the deceased had taken so many leaves on medical ground during his service, because he was suffering from some chronic disease. The deceased LA was died on 24.03.2017 during the service period.

6.                          We have perused all the relevant documents. As per the document, deceased was working in Haryana Roadways and he took so many medical leaves during his service. In our opinion, if an employee took medical leave from concerned department and at the time of his re-joining his service, he had to produce the fitness certificate before the employer. Here the respondent insurance company failed to produce any fitness certificate before the Forum to establish that the deceased LA was suffering from chronic disease at the time of taking leave or at the time of commencement of policy. Respondent officials failed to produce the fitness certificate issued by any doctor at the time of re-joining his duties. Moreover, the respondent insurance company also failed to produce any document to prove that deceased LA was remained admitted as indoor patient in any hospital till his death. Regarding these facts, Hon’ble National Commission, New Delhi in order dated 31.05.2019 titled as  Reliance Life Insurance Co. Ltd. Vs. Tarun Kumar Sudhir Halder has held that: “The onus to prove the pre-existing disease lies on the Insurance Company and no supporting documents have been filed by the Insurance Company in support of their assertion”. The law cited above is fully applicable on the facts and circumstances of the case. On the other hand, law cited by ld. counsel for the opposite party of Hon’ble National Commission, New Delhi in Revision Petition No.1316 of 2008 decided on 27.01.2009  titled as Kapil Raj Singhani Vs. LIC and Revision Petition no.1863 of 2014 decided on 17.09.2015 titled as Dilraj Singh Vs. LIC of India are not fully applicable on the facts and circumstances of the case, as in the present case, it is not proved that deceased has suppressed any previous ailment at the time of obtaining the policy. As such, the repudiation of claim by the opposite parties is not justified and the complainant is entitle for the claim amount as per policy.  

7.                          In view of the facts and circumstances of the case, complaint is allowed and it is directed that the opposite parties shall pay the claim amount of Rs.500000/-(Rupees five lac only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 08.02.2018 till its actual realization and shall also pay a sum of Rs.5000/-(Rupees five thousand only) as compensation and Rs.5000/-(Rupees five thousand only) as litigation expenses to the LRs of deceased Jitender as shown in copy of Ration card Ex.C5 in equal share within one month from the date of decision. It is also made clear that the amount after disbursement on account of minors should be deposited in any nationalized bank till their majority and will be paid to them on attaining the age of majority.

8.                         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:

20.06.2019.

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                                                          Nagender Singh Kadian, President

                                                          ..........................................

                                                          Ved Pal Hooda, Member.

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                                                         Renu Chaudhary, Member.