BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, FATEHABAD.
Complaint no.306/2017.
Date of instt.07.11.2017.
Date of Decision:22.03.2018.
Smt.Sunita Rani wife of late Sh.Madan Lal, resident of Shiv Chowk, Near Raghunath mandir, Fatehabad, Tehsil and District Fatehabad.
..Complainant.
Versus
1.Life Insurance Corporation of India, Branch Office Fatehabad, Tehsil and Distt. Fatehabad, through its Branch Manager.
2.Life Insurance Corporation of India, Divisional Office SCO No.3, 4 and 5, Sector-1, HUDA, Rohtak, District Rohtak through its Divisional Manager.
..Respondents/OPs.
Complaint under Section 12 of Consumer Protection Act, 1986.
Before Sh.Raghbir Singh, President.
Sh.M.K.Khurana, Member.
Present : Sh.Dayanand Siwach, Advocate for complainant.
Sh.S.K.Dharnia, Advocate for the OPs.
ORDER
The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties (hereinafter to be referred as OPs) with the averments that her husband Madan Lal during his life time had purchased an insurance policy from the OPs on 12.04.2013 for a sum assured of Rs.1 lac. Prior to the issuance of insurance policy, the medical checkup of her husband was conducted and on receiving the medical checkup report the above said policy was issued to him by the OPs. The complainant is nominee of Sh. Madan Lal being wife in the above said insurance policy. Therefore after death of Sh. Madan Lal she is consumer of the OPs.
2. It is further submitted that unfortunately the husband of the complainant suddenly died on 29.03.2014 and prior to that date her husband was not suffering from any disease. After death of life assured she gave intimation to the OPs and submitted all the requisite documents as per instruction of the OPs for settlement of death claim of her husband. She was assured by the OPs that the insurance claim will be settled at the earliest by the OPs. However, thereafter she visited the office of OPs for settlement of the claim, but no satisfactory reply was given to her and finally she was told that the insurance claim of her husband has been repudiated vide letter dated 31.03.2016 on the ground that the life assured withheld the correct information at the time of getting the insurance policy. It is further submitted that the repudiation of the genuine insurance claim of the complainant by the OPs is illegal, wrong, arbitrary and the same amounts to deficiency and unfair trade practice on their part. The complainant has further prayed that OPs be directed for making payment of assured amount of Rs.1 Lac with interest and compensation on account of mental agony, physical harassment suffered by her. Hence, the present complaint.
3. On being served, the OPs appeared and resisted the complaint by filing a joint written version wherein various preliminary objections with regard to maintainability, cause of action, locus-standi, concealment of material facts etc.; have been raised.
4. On merits, it is submitted that the diseased had withheld correct information regarding his health at the time of affecting the insurance with the OPs. It is further submitted that in the proposal form dated 12.04.2016 submitted by him for obtaining insurance the life assured answered the questions as under:-
a). During the last five years did you consult a medical practitioner for any ailment requiring treatment for more than a week – No.
b). Have you ever been admitted to any hospital or nursing home for general checkup, treatment or operation? – No.
c). Have you remained absent from place of work on grounds of health during the last five years. - No.
d). Are you suffering from or you have ever suffered from ailment for pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or nervous system? – No.
e). Are you suffering from or have ever suffered from Diabetes, Tuberculosis, high blood pressure low blood pressure, cancer, epilepsy, Hernia, Hydroeele, Leprosy or any other disease. – No
f). What has been you usual state of Health?. – Good.
However all the above answers given by the life assured were found false in the investigation got conducted by the OPs. In the investigation it was revealed that the life assured was suffering from CAD (Coronary Artery Disease) & DVD (Double Vessel Disease) since last two years prior to the date of proposed policy as per record of G.B.PANT Hospital New Delhi and as per record of Balaji Action Hospital New Delhi. It is further submitted that the life assured died on 29.03.2014 i.e. within a period of one year after purchasing the policy and the policy was obtained in order to fetch the money from the OPs. Therefore the claim of the complainant was correctly repudiated as per terms and conditions of the policy vide repudiation letter dated 31.03.2016 and the complainant was intimated about the same vide a registered post. The repudiation of the insurance claim of the complainant by the OPs is perfectly in accordance with the terms and conditions of the policy and the same is sustainable in the eyes of law. Therefore the present complaint is without any merit and the same deserves dismissal.
5. In evidence the counsel for the complainant placed on record affidavit of the complainant as Ex.CW1/A and documents as Annexures C1 to C3 and closed the evidence. On the other hand, the learned counsel for the OPs placed on record an affidavit of Rajender Singh, Manager, Divisional Office as Annexure RW1/A and the documents as Annexures R1 to R10 and closed the evidence.
6. The learned counsel for the complainant in his arguments reiterated the submissions made in the complaint and further contended that a genuine claim of the complainant has been repudiated by the OPs on false and filmsy ground. It is further contended that no material information was concealed by the complainant in the proposal form for obtaining the insurance policy. The OPs have failed to produce any evidence to prove that the complainant was suffering from any disease prior to the filing of proposal form.
7. On the other hand, the learned counsel for the Ops rebutted the arguments advanced by learned counsel for the complainant and further contended that the repudiation of the insurance claim of the complainant by the OPs is perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law. The learned counsel further contended that the life assured was suffering from CAD & DVD since last more than two years prior to the obtaining of the policy as per the record of G.B.PANT Hospital New Delhi and as per record of Balaji Action Hospital New Delhi. Since the life assured had concealed deliberately material information with regard to his health while filing the proposal form as such the repudiation of the insurance claim of the complainant is perfectly in order and sustainable in the eyes of law. In support of his contention the learned counsel for OPs relied upon the judgment rendered by Hon’ble National Commission in case titled as LIC of India Vs. Prem Lata Aggarwal decided on 12.10.2011 and cited as 2012 (2) CLT. The learned counsel also relied upon the judgment cited as II (2002) CPJ Paged 92 (NC) and the judgment rendered by State Commission Delhi on 19.01.2016 in case titled as Chief Post-Master General Vs. Kabul Devi.
8. We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record. It is not disputed that the life assured had obtained an insurance policy for an amount of Rs.1 lac from the OPs on 12.04.2013. It is also not disputed that the life assured died within the subsistence of the policy. The insurance claim of the complainant has been repudiated by the OPs vide letter dated 31.03.2016 on the ground that the life assured withheld correct information with regard to his health at the time of effecting the assurance with the OPs. We are of the considered opinion that onus was upon the OPs to prove that the life assured withheld correct information with regard to his health at the time of filing of proposal form. However the OPs have failed to produce on record any evidence or document to prove that the life assured was suffering from any disease or he remained admitted in any hospital prior to the filing of proposal form for obtaining the policy in dispute. No medical treatment record has been produced by the OPs to prove that the Life Assured was suffering from any disease prior to the submitting of the proposal form. From the medical treatment record of G.B.PANT Hospital New Delhi and record of Balaji Action Hospital New Delhi, it is not proved that prior to filing of the proposal form the life assured was having heart problem. In view of aforesaid discussion, we are of the considered opinion that the complainant has been able to prove deficiency on the part of OPs in rendering service to him and the insurance claim of the complainant has been repudiated on a baseless ground. The present complaint is accordingly allowed. The OPs are directed for making payment of insurance claim of Rs.1 lac to the complainant along-with compensation and litigation charges of Rs.7000/-. The OPs are further directed to comply with the order within a period of one month otherwise the amount of Rs.1 lac will carry an interest @ 7% p.a. from the date of receipt of the present order till the date of relazation. Copy of this order be communicated to the parties free of costs. File be consigned to the record after due compliance.
Announced in open Forum.
Dated: 22.03.2018.
(Raghbir Singh)
President
(M.K.Khurana) District Consumer Disputes
Member Redressal Forum,Fatehabad
