Before the District Consumer Disputes Redressal Forum, Rohtak.

                                                          Complaint No. : 411.

                                                          Instituted on     : 14.07.2017.

                                                          Decided on       : 14.01.2019.

Smt. Saroj wd/o Sh.Partap Singh s/o Sh. Ram Kishan, r/o H.No.1850/34, New Vijay Nagar, Rohtak.

                                                                    ………..Complainant.

                             Vs.

Life Insurance  Corporation of India Ltd.  through its Manager, Divisional office, 3,4,5, Sector-1, Rohtak.

……….Opposite party.

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

BEFORE:  SH.NAGENDER SINGH KADIAN, PRESIDENT.

                   SH. VED PAL, MEMBER.

                   SMT. SAROJ BALA BOHRA, MEMBER.

Present:       Sh.M.S.Verma, Advocate for the complainant.

                   Sh.Sameer Gambhir, Advocate for the opposite party.

                                      ORDER

NAGENDER SINGH KADIAN, PRESIDENT:

1.                          Brief facts of the case are that husband of the complainant had obtained a life insurance policy No.179733291 on dated 28.10.2013 for a sum of Rs.200000/- from the opposite party. That husband of the complainant regularly deposited 5 installment in time and unluckily the husband of the complainant fall ill due to heart attack on 15.02.2016 and expired on 26.02.2016. That the insurance premium was to be paid on 15.10.2015 and thereafter after his death, the complainant could not pay the insurance premium. That after his death, complainant filed the claim with the opposite party but the opposite party had repudiated the claim of the complainant on 26.12.2016 vide letter No.Claim/Rep/2016-17 without any basis. That the husband of the complainant had not concealed any information from the officials of the opposite party and he was examined properly by the authorized doctor of the opposite party.  That the act of opposite party is illegal and amounts to deficiency in service. It is therefore, prayed that the opposite party may kindly be directed to pay Rs.200000/- alongwith interest, compensation and litigation expenses as explained in relief clause.

2.                          Notice of the present complaint was issued to the opposite party who appeared and filed its written reply submitting therein that life assured Partap Singh(deceased) has misrepresented and suppressed the material facts from the answering opposite party company. That life assured had concealed the fact at the time of availing of insurance policy that he was suffering from the diabetes mellitus since 4 to 5 years. That discharge card of PGIMS Rohtak disclose that life assured was suffering from diabetes even prior to the date of availing the Insurance Policy.  Hence the claim was rightly rejected under section 45 of the Insurance Act and repudiation letter dated 26.12.2016 was sent to the complainant.  Opposite parties prayed for dismissal of complaint with costs.  

3.                          Both the parties led evidence in support of their case.

4.                          Ld. Counsel for the complainant in his evidence has tendered affidavit Ex.C1/A, documents Ex.C1 to Ex.C11 and closed his evidence. On the other hand ld. Counsel for the opposite party has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R40 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.                          As per the documents placed on record by the complainant, the last premium was paid on dated 15.04.2015 for the policy in dispute and the next premium was due for 15.10.2015. The perusal of the documents itself shows that complainant or the deceased life assured had not deposited the due installment with the respondent. But in the written statement filed by the respondent, they have not taken any objection regarding the payment but they have submitted that the deposit of premium as alleged in the para are matter of record. In this way, OP has not specifically denied or submitted that policy was in lapsed condition. This objection is neither taken by the opposite party in its written statement or in affidavit. Perusal of the written statement shows that date of commencement of the policy was 07.11.2013 and the claim of the complainant has been repudiated by the opposite party on the ground that deceased life assured was suffering from Diabetes Mellitus Type-II at the time of proposal of policy and he concealed the alleged fact from the answering opposite party. To prove its contention, ld. counsel for the OP has placed reliance upon the law of Hon’ble Supreme Court 2009CPJ 8 titled as Satwant Kaur Vs. New India, 2014(CPJ) 281 Shnyni Vs. State Bank of India and 2017(2)CPJ titled as Bajaj Allianz Vs. Ram Kumar. On the other hand, ld. counsel for the complainant has also placed reliance upon the law IV(2011)CPJ 373 (NC) titled  as Life Insurance Corporation of  India Vs. Charanjit Kaur and III(2014)CPJ 552(NC) titled as SBI Life Insurance Co. Ltd. Vs. Harvinder Kaur & Anr.

7.                          After going through the file and hearing the parties it is observed that the facts of the authorities cited above by ld. counsel for the opposite party are different from the facts of the present case. In the present case, the deceased life assured had filled the proposal form in the year 2013 whereas all the record placed on record by the respondent pertains to the year 2016. No opinion of any doctor or written submission has been placed on record by the opposite party that deceased LA was suffering from diabetes mellitus type-II in the year 2013, 2014 or 2015. As such the respondent has wrongly repudiated the claim and the complainant is entitled for the claim under the policy. Since the 3 years of the policy were not completed, hence we hereby allow the 75% of claim amount i.e. on non-stadard basis.

8.                          As such, complaint is partly allowed and it is directed that opposite party shall pay 75% claim amount i.e.Rs.150000/-(Rupees one lac fifty thousand only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 14.07.2017 till its actual realization and shall also pay an amount of Rs.5000/-(Rupees five thousand only) as litigation expenses to the complainant within one month from the date of decision. However, the amount of premium due on 15.10.2015 shall also be deducted by the OP from the awarded amount.

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

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

Announced in open court:

14.01.2019.

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

                                                          Nagender Singh Kadian, President

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

                                                          Ved Pal Hooda, Member.

                                                                        …………………………………

                                                                        Saroj Bala Bohra, Member.