Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 235.
Instituted on : 21.05.2015.
Decided on : 10.05.2016.
Smt. Kusum Devi w/o Sh. Sanjeet Kumar R/o V.P.O. Sunarian Kalan, Teh. & Distt. Rohtak.
………..Complainant.
Vs.
Life Insurance Corporation of India, through its Branch Manager of Rothak office, Opp. All India Radio, Rothak.
……….Opposite party.
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.Sandeep Hooda, Advocate for the complainant.
Sh.S.P.Gulati, 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 husband of the complainant namely Sanjeet Kumar had taken a policy no.179739797 from the opposite party for a sum of Rs.200000/-. It is averred that unfortunately the husband of the complainant has expired on 02.11.2014 and after the death of the policy holder complainant duly informed the opposite party regarding the death of Sanjeet Kumar and has applied for insurance claim and submitted all the relevant documents but the opposite party vide its letter dated 07.04.2015 has repudiated the claim of the complainant on the ground that the husband of complainant was suffering from renal calculus and he did not disclose these facts in his proposal form. It is pertinent to mention here that renal calculus(kidney stone) is not life threatening diseases. It is averred that complainant requested the opposite party many times to disburse the lawful claim of the complainant but to no effect. It is averred that the act of opposite party is illegal and amounts to deficiency in service. As such it is prayed that opposite party may kindly be directed to pay the amount of Rs.200000/- as insurance claim with other benefits, a sum of Rs.50000/- as compensation on account of harassment, mental agony alongwith interest and litigation expenses to the complainant.
2. On notice opposite party appeared and filed its written reply submitting therein that it is admitted that the policy bearing No.179739797 for sum assured of Rs.200000/- was issued in the favour of Sanjeet Kumar with date of commencement 28.01.2014 and Kusum Rani is nominee but the said policy was subject to terms and conditions printed on the policy bond i.e. furnishing the correct information regarding health. It is averred that the death claim under above policy is repudiated on account of deceased life assured having withheld correct information regarding his health at the time of effecting assurance. It is submitted that in the proposal for assurance dated 26.01.2014 the life assured had falsely answered regarding his health as the opposite party LIC hold indisputable proof to show that deceased life assured was suffering from Renal Calculus in 3/2010 as per Misri Devi Jain Dharmarth Poly Clinic and USG report from City Diagnostic Centre dated 27.03.2010. He did not however disclose these facts in his proposal form. There was concealment of material fact about his health by deceased life assured. Hence in terms of policy contract and the declaration contained in the form of proposal for assurance, the claim is repudiated in accordance with policy condition no.5 of the policy contract and intimated to the claimant. It is averred that the claim was repudiated on valid grounds and nothing is payable. 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.C4 and has closed his evidence. On the other hand ld. Counsel for the opposite party has tendered affidavit Ex.R1, documents Ex.R2 to Ex.R8 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 Sanjeet Kumar 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 vide its letter Ex.C2/Ex.R8 on the ground that the life assured had made deliberate incorrect statement regarding his health at the time of effecting the insurance. The contention of ld. Counsel for the complainant is that at the time of availing the said LIC policy, husband of the complainant had disclosed all the facts regarding his health to the officials 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 on the ground that the deceased had withheld correct information regarding his health at the time of proposal for insurance. It is further contended that deceased life assured was suffering from Renal Calculus in 03/2010 as per Mishri Devi Jain Dharmarth Poly Clinic hence the claim has rightly been repudiated by the opposite party. In order to prove this fact opposite party has placed on record document Ex.R5 and Ex.R6 i.e. prescription slip and USG Report Ex.R6.
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 proposal of policy, life assured had not disclosed the fact regarding the disease of Renal Calculus which he was suffering in the year 2010. To prove its contention opposite party has placed on record only prescription slip and ultrasound report. In this regard it is observed that on the prescription slip Ex.R5, no disease is mentioned and the patient was diagnosed only for ‘Pain epigastric region’. The USG Report Ex.R6 of City Diagnostic Centre is not signed by the doctor. Moreover both the documents are not supported with the affidavits of the doctor concerned. No other treatment record of life assured prior to taking the policy has been placed on record by 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 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”. Moreover as per Claim Enquiry report Ex.R4 the cause of death is Sudden at home. Hence there is no nexus between the cause of death and disease of renal calculus. In view of the aforesaid law which are fully applicable on the facts and circumstances of the case, it is observed that the opposite party has failed to establish the concealment of disease by the life assured at the time of proposal of policy. Hence the repudiation of claim by the opposite party 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 party in revision petition No.982 of 2004 decided on 19th September 2014, titled as Life Insurance Corporation of India Vs. Roshan Lal Gupta is 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 party shall pay the sum assured under the policy no.179739797 i.e. Rs.200000/-(Rupees two lac only) alongwith interest @ 9% p.a from the date of filing the present complaint i.e. 21.05.2015 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.
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:
10.05.2016.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
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Ved Pal, Member.
