Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 291.
Instituted on : 03.07.2015.
Decided on : 17.05.2016.
Rajesh son of Murti Devi wife of Rameshwar resident of near Sharma Nagar, House No.414, Bhiwani Road, Jind.
………..Complainant.
Vs.
- Life Insurance Corporation of India, through its Sr. Divisional Manager, Office at SCO 3-4-5 Sector-1, Rohtak.
- Life Insurance Corporation of India, through its Zonal Officer, office at Jeewan Bharti, Cannaught Circus, New Delhi.
……….Opposite parties.
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.J.S.Hooda, Advocate for the complainant.
Sh.Krishan Lal, Advocate for the opposite parties.
ORDER
SH. JOGINDER KUMAR JAKHAR, PRESIDENT :
1. The present complaint has been filed by the complainant with the averments that the mother of the complainant namely Murti Devi had obtained a policy bearing no.178762511 from the opposite parties for a sum of Rs.100000/-. It is averred that unfortunately the mother of the complainant has expired on 24.08.2014 and after the death of the policy holder complainant duly informed the opposite parties regarding the death of Murti Devi and has applied for insurance claim and submitted all the relevant documents but the opposite party vide its letter dated 18.04.2015 had repudiated the genuine claim of the complainant on the illegal and arbitrary facts while mother of the complainant did not suffer from any disease. It is averred that complainant requested the opposite parties many times to disburse the lawful claim of the complainant but to no effect. It is averred that the complainant served registered legal notice dated 16.06.2015 to the opposite parties through his counsel but the opposite parties did not bother to reply the same. It is averred that the 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 the amount of Rs.100000/- as insurance claim with all other accrued benefits, a sum of Rs.25000/- as compensation on account of harassment, mental agony alongwith interest and litigation expenses to the complainant.
2. On notice opposite parties appeared and filed their written reply submitting therein that it is admitted that the policy bearing No.178762511 for sum assured of Rs.100000/- was issued in the favour of Murti Devi with date of commencement 28.04.2010. It is averred that the death claim under above policy is repudiated on account of deceased life assured having withheld correct information regarding her health at the time of availing the policy. It is submitted that the deceased life assured was suffering from Cancer and was taking Chemotherapy from PGIMS, Rohtak since 2008, but he did not disclose this material fact in her personal statement in proposal form at the time of availing of the policy. Moreover she has not disclosed the material fact about her health in F-680(decaration of good health) at the time of revival of policy that is on 14.08.2014 to defraud the respondent corporation, hence the claim of the complainant has been repudiated as per terms and conditions of the policy on 18.04.2015. Infact the policy was lying under the lapsed condition, at the time of revival the deceased life assured was not keeping good health. It is submitted that the revival of a policy is a new contract. The policy after its revival run only for a short period. It is averred that the complainant has availed the policy by not disclosing about her illness and treatment from PGIMS, Rohtak where she remained admitted vide CR No.RT-1905/08. It is averred that there is no deficiency in service on the part of opposite parties and dismissal of complaint has been sought.
3. Both the parties led evidence in support of their case.
4. Complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C8 and has closed his evidence. On the other hand ld. Counsel for the opposite parties has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R7 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 Murti Devi is not disputed. After the death of life assured complainant filed the claim with the opposite parties but the same was repudiated by the opposite party vide their letter Ex.R1 on the ground that the life assured had made deliberate incorrect statement regarding her health at the time of effecting the insurance and she was suffering from Cancer and was taking Chemotherapy from PGIMS, Rohtak since 2008 and did not disclose these facts in her proposal form. In order to prove this fact opposite parties have placed on record document Ex.R3 to Ex.R5 i.e. X-ray investigation forms and OPD Cards Ex.R6.
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 parties on the ground that at the time of proposal of policy, life assured had not disclosed the fact regarding the disease of Cancer for which she was taking Chemotherapy from PGIMS, Rohtak since 2008. To prove their contention opposite parties have placed on record only X-ray Investigation forms Ex.R3 to Ex.R5 and OPD Slip Ex.R6 but from these documents it is not proved that she was suffering from Cancer. Moreover these documents are merely photocopy and are not supported with the affidavits of the doctor concerned. No other treatment record relating to the year 2008 of life assured as alleged by the opposite parties has been placed on record by the opposite parties. In this regard reliance has been placed upon the law cited in CLXIV(2011-4) 5 titled as LIC of India Vs. Smt. Shanta Gupta whereby Hon’ble Delhi High Court has held that: “Disclosure of ailment-Every human being at some point of time and at every stage in life does have some or the other ailment, however, these non-serious ailments are not what are required to be disclosed to the appellant-corporation what an insured is required to disclose are only serious or life threatening diseases or deep rooted malignant ailments which would have a bearing on the grant of a policy”, it is further held that “Revival of life insurance policy-Corporation has very easily taken money at the time of renewal of the policies and is happy to renew lapsed policies, however, when the unforeseen event of death happened to the insured person every objection, whether they be genuine or not, is being sought to be raised to defeat valid claims of the legal heirs of the insured/deceased-This is indeed not a happy state of affairs”, as per 2001(3)CLT633 Joginder Kaur & Others Vs. Life Insurance Corporation of India & another Hon’ble Punjab State Commission, Chandigarh has held that: “OP failed to lead direct evidence to prove that the life assured was suffering from any prior ailment or disease-Merely producing copy of hospital record/medical certificate as evidence does not mean that the contents thereof are necessarily true-it would not be acted upon or relied upon unless the writer thereof is subjected to examination and cross examination before the District Forum-The mere fact that the death occurred only after 11 months of taking the Insurance Policy is not a suspicious circumstances to deny the relief to the complainants-Order of District Forum dismissing the complaint set aside”, as per II(2013)CPJ 60 titled Life Insurance Corporation of India & Anr. Vs. Raj Kumar Sharma 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”. In view of the aforesaid law which are fully applicable on the facts and circumstances of the case, it is observed that the opposite parties have failed to establish the concealment of disease by the life assured at the time of proposal/revival of policy. Hence the repudiation of claim by the opposite parties is illegal and unjustified and the complainant is entitled for the claim amount as per policy. On the other hand, law cited by ld. Counsel for the opposite parties cited in 2011(3)CPC 609 titled as Bhanwari Devi Vs. Bhartiya Jeewan Bima Nigam & Anrs. is not fully applicable on the facts and circumstances of the case as in the present case it is not proved that life assured was suffering from cancer.
8. In view of the facts and circumstances of the case it is observed that opposite parties shall pay the sum assured under the policy no. 178762511 i.e. Rs.100000/-(Rupees one lac only) alongwith interest @ 9% p.a from the date of filing the present complaint i.e. 03.07.2015 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 awarded amount shall carry further interest @ 12% p.a. 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:
17.05.2016.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
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Ved Pal, Member.
