Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 386.
Instituted on : 25.09.2013.
Decided on : 16.03.2016.
Randhir Singh s/o Sh. Kasrainti, Teh.Sampla, Distt. Rohtak.
………..Complainant.
Vs.
- Life Insurance Corporation of India, Opposite Radio station, Subhash Road, Rothak through its Branch Manager, Rothak.
- Life insurance Corporation of India, Divisional Office, 3,4,5, SCO Sector-1, Rohtak.
……….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.Ravinder Gaur, Advocate for the complainant.
Sh.Punit Chahal, 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 wife of complainant named Sunita Devi had obtained the policy No.176822020 from the opposite party no.1 for a sum of Rs.100000/-. It is averred that complainant was nominated as nominee by his wife in the insurance policy. It is averred that at the time of taking the policy, insured Sunita Devi was examined by the paneled doctor and she was quite healthy. It is averred that unfortunately the wife of the complainant had died on 24.08.2011 and the complainant duly informed the opposite parties regarding the death of his wife and duly applied for disbursement of claim amount to the opposite parties but till date claim amount has not been released to the complainant. It is averred that the opposite party has not settled the claim of the complainant on the ground that Smt. Sunita Devi was suffering from cancer at the time of availing policy and she had died due to 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 other benefits and a sum of Rs.100000/- 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 Smt. Sunita Devi was insured for the sum of Rs.100000/- and first unpaid premium is 12.11.2011 and Sh. Randhir Singh is nominee as per record. It is averred that the policy was lapsed due to non payment of premium due from 05.2010 to 05/2011. The deceased life assured revived the policy on 03.08.2011 by submitting declaration of good health form no.680 dated 03.08.2011. It is denied that the medical of DLA was done by penal doctor of LIC at the time of proposal of this policy. It is submitted that the policy has been issued under non-medical general scheme. It is averred that the policy in question was lapsed due to non payment of premium due from 05/2010 to 05/2011. The deceased life assured got revived the policy on 03.08.2011 by concealing the pre-existing disease of cancer in the DGH From no.680 dated 03.08.2011. Hence the claim of the complainant has been repudiated by the competent authority vide letter dated 19.11.2012 as per policy conditions. It is further submitted that the policy has run only 21 days from the date of revival. As per investigation officer report, DA was suffering from cancer since 4/2011. She had taken treatment from PGIMS Rohtak, Action cancer Hospital and Mittal Nursing Home, Rohtak. It is averred that the history of illness goes prior to the date of revival. It is averred that opposite party has rightly repudiated the claim of the complainant. 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.CW1/A to Ex.CW1/D 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.R18 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 Sunita 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 parties vide their letter Ex.R1 on the ground that the life assured had withheld the correct information regarding her health at the time of effecting the revival of policy. 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 health to the officials of the opposite parties and on full satisfaction, the opposite parties issued the said policy. Hence the repudiation of claim by the opposite parties is illegal.
7. On the other hand contention of ld. Counsel for the opposite parties is that the claim of the complainant has been repudiated by the opposite parties on the ground that the deceased had withheld correct information regarding her health at the time of revival of policy. It is further contended that as per DGH form no.680 dated 03.08.2011 DLA has withheld the correct information about her health. It is averred that as per treatment papers of PGIMS Rohtak, Action Balaji Delhi & Mittal Nursing Home Rohtak, DLA was cancer patient prior to date of revival. In order to prove the fact of concealment of disease by the life assured, opposite parties have placed on record Form No.680, treatment record of Sunita Devi from PGIMS, Rohtak Ex.R6 to Ex.R13, Ex.R14 is Upper Endoscopy report of Mittal Nursing Home, receipts Ex.R15 to Ex.R17 of Action Cancer Hospital and Ex.R18 of Narula X-ray Clinic. The contention of ld. Counsel for the opposite parties 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 General Scheme. But the life assured had concealed the pre-existing disease intentionally and did not disclose the same at the time of revival of policy.
8. 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 that at the time of revival of policy, life assured was suffering from cancer. But to prove its contention opposite parties have placed on record only copies of documents Ex.R6 to Ex.R18 but the same are not supported with the affidavit of the doctor concerned. Moreover at the time of revival of policy no disease was detected by the penal doctor of the opposite party. In this regard reliance has been placed upon the law cited in 2001(3)CLT633 Joginder Kaur & Others Vs. Life Insurance Corporation of India & another whereby 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 1(2013) CPJ 20B(NC)(CN) titled as Life Insurance Corporation of India Vs. Ranjana Anilrao Dhandole & Ors. Hon’ble National Commission, New Delhi has held that: “Insured was fully examined by Panel Doctor of LIC-Cancer cropped up subsequent to obtaining the policy-LIC failed to prove that repudiation of claim was correct”, as per 2014(3)CLT50 titled as Manager, Bajaj Allianz Life Insurance Co. Ltd. & Ors. Vs. Mrs. Raj Kumar Hon’ble National Commission has held that: “Usually, the authorized doctor of the Insurance Company examines the insured, assesses the fitness and after complete satisfaction, then only the policy will be issued-Therefore, we feel the OP was wrong in repudiating the claim of the complainant”, as per 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”. In view of the aforesaid laws 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 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(2)CPC 483 titled as Maya Devi Vs.Life Insurance Corp. of India, 2009(1)CPC 242 titled as Diwan Surender Lal Vs. Oriental Insurance Co. Ltd. and 2012(1)CPC 261 titled as LIC of India Vs. Premlata Aggarwal are not fully applicable on the facts and circumstances of the case.
9. 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. no.176822020 i.e. Rs.100000/-(Rupees one lac only) alongwith interest @ 9% p.a from the date of filing the present complaint i.e. 25.09.2013 till its actual realization, other benefits under the policy, if any and shall also pay an amount of Rs.3000/-(Rupees three thousand 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.
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:
16.03.2016.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
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Ved Pal, Member.
