Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 607.
Instituted on : 25.10.2017.
Decided on : 13.03.2019.
- Om Pati w/o Shri Nathi Ram and mother of Late Sh. Satish Garg, age 60 years, Mb. No.9416779675.
- Kavita wd/o Late Sh. Satish Garg.
- Tanisha D/o Late Sh. Satish garg and
- Vivek s/o Late Sh. Satish Garg, complainant no.3 & 4 being minor through their mother Kavita Garg, natural guardian as next friend, all residents of H.No.1740/31, Kamla Nagar, Rohtak, district Rohtak.
………..Complainants.
Vs.
- L.I.C. of India, through its Chairman, Central office, Yogakshema, Nariman Point, Mumbai-400021,
- Sr. Divisional Manager, L.I.C. of India, Divisional Office, Rohtak, 3,4,5 SCO Sector-1, Rohtak-124001.
- Branch Manager L.I.C. of India, 1st Floor, Richi Rich Plaza Opp. D. Park, Rohtak-124001.
- Parmod Kumar Gupta, Agent, LIC of India, Agent code 051811769999999, Main Branch, Rohtak-124001.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH.VED PAL, MEMBER.
DR. RENU CHAUDHARY, MEMBER.
Present: Smt.Bhim Kaur Chillar,Advocate for the complainant.
Sh. Krishan Lal, Advocate for opposite party no.1 to 3.
Sh.R.C.Mandhar Advocate for opposite party No.4.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that complainants are the legal heirs of deceased Satish Kumar Garg whose life was insured vide policy No.179913217 with the opposite party No.1. That after the death of Sh. Satish Garg his LRs stepped into his shoes and became consumers. That in the year 2015, the opposite party No.4 approached Sh. Satish Garg and informed him about the life insurance plan of LIC of India and Sh. Satish Kumar Garg got his life insured on 10.03.2015 vide policy No.179913217 by paying an annual premium of Rs.22192/- to opposite party no.3. That Sh. Satish Kumar Garg died on 14.07.2015 leaving behind his LRs. That complainant no.2 being the nominee filed the claim before the opposite parties claiming the sum assured of Rs.2.5 lacs. But she was surprised to know that the opposite party no.2 has illegally repudiated all the liabilities under the policy vide his letter date 05.07.2016 by making the false statement to the effect that the deceased withheld correct information regarding his health at the time of affecting the assurance with the opposite parties. In fact at the time of purchasing the life insurance policy, Sh. Satish Garg was not suffering from any disease. That opposite parties have wrongly rejected the claim of the complainants without affording them an opportunity of being heard which is even otherwise against the principle of natural justice. That the act of opposite parties is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite parties may kindly be directed to pay Rs.2.5 lacs i.e. sum assured in lieu of the death of Sh Satish Kumar, to pay Rs.50000/- as damages, Rs.100000/- as compensation and Rs.11000/- as litigation expenses to the complainant as explained in relief clause.
2. Notice of the complaint was issued to the opposite parties. Opposite party No.1 to 3 in their written reply has submitted that the respondent corporation had issued policy No.179913217 on the life of Satish Kumar Garg with date of commencement 10.03.2015, sum assured Rs.2.5 lacs. That the policy has run only for a period of four months. The deceased life assured was taking treatment from Shivam Liver & Gastro Hospital, SCF-12, HUDA Complex, Rohtak. He was suffering from chronic Diarrhoea from three to four years. He was taking treatment prior to taking policy. The deceased Life assured died on 14.07.2015 due to above mentioned chronic disease. As per form no.3816 from Shivam Liver & gastro Hospital Rohak the deceased life assured was suffering from chronic Diarrhea prior to taking policy. But the deceased life assured did not disclose these facts about his health at the time of taking policy and thus concealed the facts about his health. Thus the claim of the complainants have been righty repudiated as per terms and conditions of the policy vide letter dated 05.07.2016. Opposite parties prayed for dismissal of complaint with costs.
3. Opposite party No.4 in its reply has submitted that it is correct that the opposite party No.4 is the agent of opposite party No.1. That Sh. Sasith Kumar Garg intended to get his life insured and accordingly the answering opposite party filled up all the forms as per wish of Sh. Satish Kumar Garg. That the claim has been repudiated by opposite party no.2 and the answering opposite party has nothing to do with the same because the role of the respondent no.4 is only as agent and there is no liability on his part. It is prayed that complaint may kindly be dismissed against the answering opposite party.
4. Both the parties led evidence in support of their case.
5. Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C3 and closed his evidence. On the other hand ld. Counsel for the opposite party No.1 to 3 has tendered affidavit Ex.RW1/A, documents Ex.RW1 to Ex.RW9 and has closed his evidence. Ld. Counsel for the opposite party No.4 has tendered affidavit Ex.RW4/A and has closed his evidence.
6. We have heard ld. counsel for the parties and have gone through the material aspects of the case carefully.
7. The main contention of the respondent is that the deceased LA has suppressed the true and material facts from the respondent officials. In fact the deceased was suffering from chronic diarrhea from the last 3 to 4 years and this fact has not been disclosed by the life assured. The respondent officials placed on record Ex.C4 after believing that the deceased LA was suffering from chronic diarrhea for last 3/4 years. To prove its contention opposite parties have placed on record a photocopy of investigation report Ex.RW4 which is issued on dated 26.03.2016. Ld. counsel has also placed reliance upon the law of Hon’ble National Commission, New Delhi in 2014(1)CPC 438 titled as LIC of India & Ors. Vs. Nita Bhardawaj, 2014(1)CPC(NC) 670 titled as LIC Vs. S.S.Jamuna and 2014(1)CPC(NC)88 titled as LIC of India v.s Shahida Khatoon(Smt.) & Anr.
8. A thorough perusal of investigation report Ex.R4 shows that and the same was signed by Dr. Manoj Goel, MD, DNB Gastro, Senior Consultant. The respondent officials have not placed on record any affidavit of the doctor to prove that this certificate has been issued by the above said doctor. We have also perused the document i.e. Ex.RW1, the no Claim letter, in which some details of proposal form has been mentioned and as per the respondent, the deceased life assured had answered some questions on dated 10.03.2015 and he denied and marked ‘No’ to all the questions asked from him about his ailment/treatment. Perusal of this document Ex.RW1 also reveals that ‘Chronic Diarrhea’ has not been mentioned anywhere. So the plea taken by the respondent/insurance company that life assured has disclosed the relevant facts about his disease itself falsify because in the proposal form no such ailment has been denied by the Life Assured. Moreover, the respondent has placed on record certificate of employer Ex.RW8, through which the respondent wants to prove that deceased took so many leaves during the period 23.04.2012 to 14.07.2015. The bare perusal of this document shows that the deceased LA took only 27 days leave from 23.04.2012 to 27.04.2015 on different dates. After believing this document, it cannot be said that the deceased was suffering from any chronic disease as he has not availed any medical leave during this period and no long leave has been taken by the deceased L.A. Hence this objection of opposite parties is also turned down. We have also relied upon the law of Hon’ble National commission cited by ld. counsel for the complainant in (2016) 2 CPC 649:(2016)1 CPR 892 in case titled Kamla Devi Vs. LIC of India & Ors. which is fully applicable on the facts and circumstances of the case. On the other hand, law cited above by ld. counsel for the opposite parties are not fully applicable on the facts and circumstances of the case.
9. In view of facts and circumstances of the case, complaint is allowed and it is directed that opposite party No.1 to 3 shall pay the amount of Rs.250000/-(Rupees two lac fifty thousand only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 25.10.2017 till its actual realization and also to pay Rs.5000/-(Rupees five thousand only) as compensation and litigation expenses to the complainants in equal share within one month from the date of decision. It is also made clear that the amount after disbursement on account of complainant no.3 of minor daughter Tanisha and complainant no.4 Vivek should be deposited in any nationalized bank till their majority and will be paid to them on attaining the age of majority.
10. 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:
13.03.2019.
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Nagender Singh Kadian, President
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Ved Pal, Member
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Renu Chaudhary, Member.
