Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 609.
Instituted on : 27.10.2017.
Decided on : 13.06.2019.
- Smt. Sunita age 43 years, wd/o Late Jai Bhagwan.
- Poonam age 17 years d/o Late Jai Bhagwan.
- Vijeta age 22 years, d/o Late Jai Bhagwan.
- Sagar (minor) 16 years s/o Late Jai Bhagwan.
- Sachin(minor) 14 years s/o Late Sh. Jai Bhagwan.
Both minors through their mother Smt. Sunita being natural guardian and next friend.
All residents of village-Nonand, Distt. Rohtak.
..………..Complainants.
Vs.
- Manager, Life Insurance Corporation of India, Branch Shyamji Complex, Delhi Road, Bahadurgarh.
- Divisional Manager, Divisional office Life Insurance Corporation of India, SCO No.3, 4, 5, Sector-1, Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
DR. RENU CHAUDHARY, MEMBER.
Present: Sh.Kuldeep Singh, Advocate for the complainants.
Sh. S.P.Gulati, Advocate for opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that the life of Late Sh. Jai Bhagwan was insured with the opposite party No.1 vide policy no.179724690 dated 28.10.2013 for a sum of Rs.500000/- and complainant no.1 Sunita is the nominee of deceased Jai Bhagwan in the said policy. That unfortunately, Late Jai Bhagwan had died on 11.05.2016 leaving behind him all the complainants as his only Class-1 legal heirs so they are legally entitled to receive the amount of the above said policy. That since the date of death of Late Jai Bhagwan to upto date, the complainants have run from pillar to post to get the amount of their policy. But the respondent have always been avoiding the same under one pretext or the other which amounts to deficiency in service. As such, it is prayed that opposite parties may kindly be directed to pay Rs.500000/- as amount of insurance alongwith interest @ 18% per annum from the date of filing of complaint till realization and Rs.100000/- as compensation, Rs.11,000/- as litigation expenses to the complainant as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite parties. Opposite parties in their reply has submitted that the opposite parties issued a policy bearing no.179724690 on the life of Sh. Jai Bhagwan s/o Captan Singh for sum assured of Rs.500000/- with date of commencement from 28.10.2013. That life assured was not in good health at the time of taking insurance. The competent authority has repudiated all liability under the above policy on genuine ground and informed the complainant by registered letter dated 31.01.2017. That as per form no.3816 from PGIMS Rohtak , the deceased was an operated case of GLIOMA(Brain Tumor) three years back from 10.05.2016. That deceased life assured had not disclosed this adverse history in the proposal form. The life assured had concealed material facts and information while taking insurance. Hence, it has been decided to repudiate all the liabilities and in terms of provisions of section 45 of the Insurance Act, 1938. The respondent is refunding the premium paid under the policy towards full and final settlement of complainant claim. All the other contents of the complaint were stated to be wrong and denied and dismissal of complaint has been sought.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C11 and the evidence of complainant was closed by the order dated 14.03.2019 of this Forum. Ld. counsel for the opposite parties tendered affidavit Ex.RW1/A and documents Ex.R1 to Ex.R7 and closed his evidence on 24.04.2019.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. After going through the file and hearing the parties it is observed that claim of the complainant was repudiated by the respondent’s officials on the ground that deceased LA was operated case of GLIOMA(Brain Tumor) 3 years back i.e. from 10.05.2016. Meaning thereby, the deceased LA submitted false and fabricated information at the time of obtaining of insurance policy. The following questions were given in negative by the complainant as shown in Ex.C4:
During the last five years, did you consult a medical practitioner for any ailment requiring treatment for more than a week? | No |
Have you ever been admitted to any Hospital or nursing home for general check up, observation, treatment or operation? | No |
Have you remained absent from place of work on grounds of health during last five years? | No |
Are suffering from or have ever suffered from Diabetes, , Tuberculosis, High BP, Cancer, epilepsy, hernia or any other diseases? | No |
Are you suffering from or have ever suffered from the ailment for pertaining to liver, stomach, Heart, Lungs, Kidney, Brain or nervous system? | No |
6. After considering these answers, the respondent officials believed that the deceased was known case of GLIOMA(Brain tumor) and he has not disclosed the correct information with the respondent insurance company in the proposal form. So the claim was repudiated on these grounds. We have perused document Ex.R6. As per this document, the deceased was admitted in PGIMS on dated 10.05.2016 and at that time his movement of body was abnormal, poor case of consciousness about two days back. In this document, it has also been mentioned that the deceased LA was suffering from GLIOMA for last 3 years and was treated by Neurology Department. In the column of date of first admission and date of discharge and condition on discharge, the department has submitted that there is no record regarding these facts. Meaning thereby, it has not been mentioned in this document that at which date the deceased LA was treated by the Doctor of PGIMS regarding the ailment of GLIOMA and on which date, he was admitted and discharged regarding ailment in PGIMS, Rohtak. Simply a history has been mentioned but it has not been mentioned in this document that who disclosed these facts before the treating doctor. Moreover, the deceased LA was died on 11.05.2016 at about 2.30AM. In the present case the respondent officials have a lot of time that they can gather the information regarding the ailment of GLIOMA from the concerned considering department i.e. PGIMS, Rohtak but they failed to provide the same and they also failed to prove that deceased LA was earlier treated by GLIOMA by PGIMS Rohtak. Moreover, no affidavit of doctor is attached in the evidence of the respondent official that they treated the patient for GLIOMA in the PGIMS, Rohtak till the date of his death. Regarding these facts, Hon’ble National Commission, New Delhi in order dated 31.05.2019 titled as Reliance Life Insurance Co. Ltd. Vs. Tarun Kumar Sudhir Halder has held that: “The onus to prove the pre-existing disease lies on the Insurance Company and no supporting documents have been filed by the Insurance Company in support of their assertion”. The law cited above is fully applicable on the facts and circumstances of the case. As such, the repudiation of claim by the opposite parties is not justified and the complainant is entitle for the claim amount as per policy.
7. In view of the facts and circumstances of the case, complaint is allowed and it is directed that the opposite parties shall pay the claim amount of Rs.500000/-(Rupees five lac only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 27.10.2017 till its actual realization and shall also pay a sum of Rs.5000/-(Rupees five thousand only) as compensation and litigation expenses to the complainants in equal share within one month from the date of decision. It is also made clear that the amount after disbursement on account of complainant no.4 of minor son Sagar and complainant no.5 minor son Sachin, should be deposited in any nationalized bank till their majority and will be paid to them on attaining the age of majority.
8. 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:
13.06.2019.
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Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
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Renu Chaudhary, Member.
