Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 53.
Instituted on : 23.01.2017.
Decided on : 19.11.2018.
- Smt. Nanhi Devi w/o Late Shri Sant Lal
- Chandveer
- Ashok Kumar Both sons of Late Shri Sant Lal,
All R/o H.No.649/34, HAri Singh Colony, Rohtak.
………..Complainants.
Vs.
Branch Manager, Life Insurance Corporation of India, Opposite Radio Station, Subhash Road, Ambedkar Chowk, 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.Vijay Malik, Advocate for the complainant.
Sh.Puneet Chahal, Advocate for the opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that husband of the complainant i.e. Sant Lal obtained a policy bearing No.179600861 and he paid the premium regularly. That husband of the complainant was not suffering with any disease nor was undergoing any medical treatment or medicines and he died on 21.12.2014 at his residence. That the complainant informed the opposite party and submitted all the documents with the opposite party for getting the insurance claim. That the opposite party has ignored to pay the claim of the complainant on the ground that the husband of complainant died due to cancer and the same was not disclosed by her husband at the time of taking the policy. That the husband of the complainant was healthy at the time of obtaining the insurance policy so alleging the concealment does not arise. That the act of opposite party is completely against the law and principal of natural justice. It is therefore, prayed that the respondent may kindly be directed to pay the sum assured of Rs.5 lacs with bonus earned alongwith interest, compensation and litigation expenses as explained in relief clause.
2. Notice of the complaint was issued to the opposite party. Opposite party in its written reply has submitted that the respondent has repudiated the liability under the above policy on genuine ground and complainant was informed by vide letter dated 07.11.2015, in the proposal for assurance dated 30.03.2013, the life assured had answered some question in negative and all the answers were false as there is indisputable proof to show that DLA was a cancer patient as per 3816 from PGIMS, Rohtak. LA was first reported on 26.07.2013 with symptom of one year duration increased frequency of Micturition pain right up joint & right lower limb and back pain for one year. Life assured had concealed material facts and information while taking insurance. He made incorrect statements and withheld correct information from the OP regarding his health at the time of effecting assurance and hence in terms of the policy contract and the declaration contained in the forms of proposal for assurance and personal statement, claim was rightly repudiated. That there is no deficiency in service on the part of opposite party. Opposite party 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.CW1/A, documents Ex.C1 to Ex.C7 and closed his evidence. On the other hand ld. Counsel for the opposite party has tendered affidavit Ex.R1/A, documents Ex.R1 to Ex.R5 and has closed his evidence.
5. We have heard ld. counsel for the parties and have gone through the written arguments placed on record by the complainant as well as material aspects of the case carefully.
6. The claim of the complainant was repudiated by the opposite party on the ground that the deceased LA concealed the material facts from the opposite party that he was suffering from cancer prior to taking the policy. In support of its contention, opposite party has placed on record document Ex.R3, the certificate of hospital treatment issued by PGIMS, Rohtak. The perusal of the documents itself shows that the LA Sant Lal firstly reported in the hospital for the ailment on dated 26.07.2013. He was admitted as indoor patient in hospital on dated 20.11.2013 to 16.12.2013 and discharged on 17.12.2013 in stable condition. All the documents and the treatment history was perused. After perusal of the same we come to the conclusion that the date of commencement of policy is 30.03.2013. After 3 months LA first time contacted in the hospital regarding the ailment. Initially the patient submitted that he is suffering from increased frequency of Micturition for one year, pain in right lower limb and in the back for last one year.
7. The perusal of the history itself seems that the LA was not suffering from any chronic disease. Moreover the LA signed the proposal form on 30.03.2013 and answered some questions of the respondent in negative. These questions are mentioned in para no.2 of the written statement. The deceased LA rightly answered that he had not consulted from any medical practitioner for any ailment for last 5 years and that he has not got any general check up etc. and has not suffered from any disease or ailment. A bare perusal of the history itself shows that the deceased LA was not suffering from any ailment pertaining to liver, stomach, Heart, Lungs, Kidney, brain or nervous system. Moreover, when the proposal form was signed on dated 30.03.2013, he has no knowledge regarding the ailment on that day. The deceased LA came to know regarding the ailment after 26.07.2013. On the other hand, opposite party has also not placed on record any treatment history of deceased LA prior to taking the policy. So the act of respondent for declining the genuine claim of the complainant on the ground that wrong information has been submitted by the deceased LA regarding his health at the time of effecting the insurance is wrong and amounts to deficiency in service. As such opposite party is liable to pay the insurance claim. At the time of arguments, ld. counsel for the complainant moved an application for impleading other legal heirs of deceased Sant Lal, which was allowed and accordingly amended title was filed.
8. In view of facts and circumstances of the case, complaint is allowed and it is directed that opposite party shall pay the amount of Rs.500000/-(Rupees five lacs only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 23.01.2017 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 compensation on account of mental agony and harassment and litigation expenses to the L.Rs. of the complainant i.e. Smt. Nanhi Devi w/o Late Sh. Sant Lal, Chandveer s/o Late Sh. Sant Lal and Ashok s/o Late Sh. Sant Lal in equal share.
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:
19.11.2018. ................................................
Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
…………………………..
Saroj Bala Bohra, Member.
