Haryana

Rohtak

05/2013

Joginder Singh Hooda - Complainant(s)

Versus

Life Inssurance Corporation of india. - Opp.Party(s)

Sh. B.S. Saroha

19 May 2015

ORDER

District Consumer Disputes Redressal Forum Rohtak.
Rohtak, Haryana.
 
Complaint Case No. 05/2013
 
1. Joginder Singh Hooda
Joginder Singh Hooda S/o Sh. Nafe Singh Hooda, R/o House No. 863/28, Bharat Colony, Rohtak.
...........Complainant(s)
Versus
1. Life Inssurance Corporation of india.
Life Inssurance Corporation of india. Branch Subhash Road, Opposite All india Radio Rohtak.
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. Sh.Joginder Singh Jakhar PRESIDENT
 HON'BLE MS. Smt Komal Khana MEMBER
 
For the Complainant:Sh. B.S. Saroha, Advocate
For the Opp. Party: Sh. Krishan Lal, Advocate
ORDER

Before the District Consumer Disputes Redressal Forum, Rohtak.

 

                                                          Complaint No. : 5.

                                                          Instituted on     : 26.02.2013.

                                                          Decided on       : 21.05.2015.

 

Joginder Singh Hooda son of Shri Nafe Singh Hooda, resident of House No.863/28, Bharat colony, Rohtak.

 

                                                          ………..Complainant.

                             Vs.

 

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

                                                     ……….Opposite party.

 

 

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

 

BEFORE:  SH.JOGINDER KUMAR JAKHAR, PRESIDENT.

                   MS. KOMAL KHANNA, MEMBER.

                  

Present:       Sh.B.S.Saroha, Advocate for the complainant.

                   Sh.Krishan Lal, 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 wife of complainant named Saroj Hooda had availed LIC policy bearing no.178583345 dated 28.07.2009 sum assured therein Rs.1000000/- from the opposite party and paid all the required premium for the said policy. It is averred that at the time of availing the policy, wife of the complainant had disclosed all the facts regarding her health  and on fully satisfaction the official of the opposite party issued the policy in favour of wife of the complainant. It is averred that unfortunately the wife of complainant had died on 19.12.2010 and complainant duly intimated to the opposite party about the death of this wife and submitted his claim under the said policy but the opposite party has not paid the genuine claim of the complainant and vide letter dated 3.2.2012 has declined the claim amount on the false and arbitrary facts.  It is averred that the act of opposite party is illegal and amounts to deficiency in service. As such it is prayed that the opposite party may kindly be directed to pay the amount of Rs.1000000/- alongwith interest, other benefits under the said policy, compensation and litigation expenses to the complainant.

2.                          On notice opposite party appeared and filed its written reply submitting therein that it is denied that at the time of availing the said policy, wife of the complainant had disclosed all the facts regarding her health and status to the official concerned of the LIC. It is averred that in fact no medical examination of the wife of the complainant was conducted by the LIC Panel doctor as the case was issued under Non Medical Special Scheme as the wife of the complainant being a lecturer. It is evident that she was suffering from chronic disease since 10.06.2009 as is evident from the certificate dated 20.06.2009 issued by the Civil Surgeon, Rothak but she did not disclose this material fact in her proposal form at the time of availing of policy, hence the claim of the complainant has been repudiated as per terms and conditions of the policy. It is averred that as per the Civil Surgeon’s certificate, DLA was suffering from chronic disease since 10.06.2009 which is prior to the date of proposal of policy. As per form 3816 from Apollo Hospital DLA was admitted on 20.11.2010 with complaint of Dilated tortuous vein over right orbital fossil. She was a known case of CRF for 8 years. She had first visited in the Hospital on 27.02.2002. Thus the claim of the complainant was rightly repudiated and complainant was duly informed about the repudiation of his claim. It is averred that there is no deficiency in service on the part of opposite party and dismissal of complaint has been sought.

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.C7 and has closed his evidence. On the other hand ld. Counsel for the opposite party has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R21 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 insurance and death of deceased Saroj is not disputed. After the death of life assured complainant filed the claim with the opposite party but the same was repudiated by the opposite party on the ground of concealment of fact by the life assured at the time of proposal. The contention of ld. Counsel for the complainant is that at the time of availing the said LIC policy, wife of the complainant had disclosed all the facts regarding her claim and status to the official of the opposite party and on full satisfaction, the opposite party issued the said policy. Hence the repudiation of claim by the opposite party is illegal.

7.                          On the other hand contention of ld. Counsel for the opposite party is that the claim of the complainant has been repudiated by the opposite party vide letter Ex.C7/Ex.R1 on the ground that the deceased had withheld correct information regarding her health at the time of effecting the assurance with the opposite party. As per Civil Surgeon’s certificate DLA  was suffering from chronic disease since 10.06.2009 which is prior to the date of FPR i.e. 28.07.2009. As per form 3816 from Apollo Hospital DLA was admitted on 20.11.2010 with complaint of Dilated tortuous vein over right orbital fossil. She was a known case of CRF for 8 years.  She did not, however, disclose this fact in her proposal form/personal statement.  In order to prove the fact of concealment of disease by the life assured, opposite party has placed on record Proposal form Ex.R2, Certificate of Hospital Treatment Ex.R3, letter Ex.R7 of Director General Higher Education, Haryana, copy of certificate issued by Civil Surgeon, Rothak Ex.R9 and copies of sanction orders Ex.R10 to Ex.R14 for reimbursement of amount of treatment, copies of sanction letters and orders Ex.R15 to Ex.R18 issued by the College and Claim Enquiry Report Ex.R21. The contention of ld. Counsel for the opposite party is that no medical examination of the deceased was conducted by the LIC penal doctor at the time of proposal of the policy as the case was accepted under Non Medical Special Scheme.  But the life assured had concealed the pre-existing disease intentionally and did not disclose the same in proposal form.  Ld. Counsel has also placed reliance upon the law cited in IV(2014)CPJ 658(NC) titled as Life Insurance Corporation of India Vs. Neelam Sharma, 2014(1)CPC 603 titled as Life Insurance Corporation of India Vs. Archna Dayanand Vakade   and 2014(1)CPC670 titled as Life Insurance Corporation of India Vs. S.S.Jamuna.

8.                          After going through the file and hearing the parties it is observed that as per the policy Ex.C2 the date of proposal is 28.11.2009 and the policy was dated back and risk was commenced from 28.7.2009. It is also observed that as per the Certificate Ex.R9 issued by the office of Civil Surgeon, Rohtak the “Life assured Smt. Saroj Hooda was suffering from ESRD CHHD w.e.f. 10.06.2009 which was a Chronic Disease” and the date of disease goes prior to proposal for the policy. But the life assured in proposal form Ex.C3 has given the wrong answers about her personal history that she did not consult a medical practitioner for any ailment requiring treatment for more than a week, that she was never been admitted in any hospital or nursing home for general checkup, observation, treatment or operation and remained absent from place of work on the ground of health. But as per the documents placed on record by the opposite party i.e. Ex.R10 to Ex.R14 he had taken medical reimbursement for so many times w.e.f. 16.11.2009 to 30.04.2010 and afterwards in connection with her treatment as chronic patient on the advice of authorized medical attendant in Inder-Prastha Apollo Hospital, New Delhi.  As per the Certificate of Hospital Treatment Ex.R3 of Apollo Hospital, DLA was admitted on 20.11.2010 with complaint of Dilated tortuous vein over right orbital fossil. She was a known case of CRF for 8 years and had first visited in the Hospital on 27.02.2002.  Hence she has deliberately suppressed the material facts regarding her health in the proposal form. In this regard Hon’ble National Commission in Neelam Sharma’ Case(Supra) has rightly held that: “Answers given by insured in proposal form were untrue to his knowledge-There was clear suppression of ‘material facts’ in regard to health of insured- it was not for insured to determine whether information sought was material for purpose of two policies-Repudiation justified”.   

 9.                         In view of the documents placed on record as well as the aforesaid law placed on record by ld. Counsel for the opposite party which are fully applicable on the facts and circumstances of the case, it is observed that the life assured was suffering from chronic disease before the proposal for the policy and she had not disclosed this fact at the time of taking the policy. As such the complainant is not entitled for any claim. Accordingly the present complaint stands dismissed with no order as to costs. 

10.                        Copy of this order be supplied to both the parties free of costs.

11.                        File be consigned to the record room after due compliance.

Announced in open court:

21.05.2015.

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

                                                          Joginder Kumar Jakhar, President

                                                         

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

                                                          Komal Khanna, Member.

 

 

 
 
[HON'BLE MR. Sh.Joginder Singh Jakhar]
PRESIDENT
 
[HON'BLE MS. Smt Komal Khana]
MEMBER

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