BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.449 of 2017

      Date of Instt. 22.04.2017

      Date of Decision: 10.02.2020

1.       Charanjit son of Late Sh. Dass Ram aged 62 years;

2.       Resham Kaur aged about 60 years wife of Sh. Charanjit son of Late Sh. Dass Ram;

          Both residents of VPO Boparai Kalan, Tehsil Nakodar, District Jalandhar.

..........Complainants

Versus

1.       Life Insurance Corporation of India, Northern Zonal Office, Jeewan Bharti Building, 124, Konnaught Circus, New Delhi, through its Zonal Manager. Divisional Office, Jeewan Parkash, Model Town Road, Jalandhar, through its Divisional Manager.

2.       Life Insurance Corporation of India, Divisional Office, Jeewan Parkash, Model Town Road, Jalandhar, through its Divisional Manager.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before:        Sh. Karnail Singh           (President)

Smt. Jyotsna                   (Member)

Present:       Sh. O. P. Kangniwal, Adv. Counsel for the Complainants.

None for the OPs.

Order

Karnail Singh (President)

1.                The instant complaint has been filed by the complainants, wherein alleged that the son of the complainant namely Ravi Pal took the life insurance policy from the respondents on 03.02.2016 bearing Policy No.134908290. At the time of obtaining the above said policy, as per procedural requirements, the said Ravi Pal nominated the complainant No.1 Charanjit as his nominee, in case of any eventuality. Here it is one thing more worthwhile to submit that the complainant No.2 Resham Kaur have been impleaded as co-complainant in the present complaint, because she is real mother of the policy holder Ravi Pal.

2.                That unfortunately, the said insured Ravi Pal expired on 16.04.2017. After the death of above said Ravi Pal, the complainant No.1 submitted his claim before the respondent No.2 as per terms and conditions stipulated in the insurance policy itself, but the respondent No.2 turned down/repudiated the claim of the complainant No.1 on the ground that the conditions necessary for paying the benefits to the nominee are not fulfilled. For elaboration, the claim of the complainant No.1 was repudiated mainly on the ground that at the time of making the proposal on 03.02.2016 and its acceptance on 04.02.2016. The life insured, Ravi Pal was suffering from some physical problem and this fact was kept concealed from the office of the OP No.2. For more clarification, it has been alleged in the intimation letter dated 28.09.2017 of the repudiation of claim under policy, it has been written that above said Ravi Pal was having ill health. As per the CT scan, head report of life insured from SGL Hospital dated 25.01.2016 and 20.02.2016, there was bone defect of surgical intervention seen in left temporo-parietal region of life insured, as per scan report. Not only this, it has been alleged in the repudiation letter that as per the discharge slip of Miglani Hospital, Life Assured was also admitted in the hospital on 09.09.2016 and discharged on 06.10.2016. Further, as per form 3816 of SGL Hospital, Jalandhar, Life Assured was admitted on 26.03.2017 with complaint of seizures and headache, discharged on 06.04.2017 and was diagnosed for left frontal tuberculoma Brain Tumour. As per from 3816 from PGIMER Chandigarh, life assured was admitted on 09.04.2017 with complaint of fever and altered sensorial diagnosed for Tuberculoma and expired on 16.04.2017. The date of scan dated 25.01.2016 of SGL Hospital is prior to date of proposal which prove beyond no doubt that life assured was not keeping good health prior to date of proposal. Copy of repudiation letter placed on the file. It is worthwhile to mention here that the dates 25.01.2016 and 20.02.2016 for CT scan were typed due to typographical mistake, whereas CT Scans were not done on 25.01.2016 and 20.02.2016 respectively, rather the CT scans were done on 25.01.2017 and 20.02.2017. In this regard of typographical error, the SGL Charitable Hospital also issued a certificate in this regard. After the repudiation of the, complainants tried to make it clarify to the respondents and more specifically respondent No.2 that no CT Scan of above named Ravi Pal was conducted on 25.01.2016 and 20.02.2016, but the OPs did not agree and refused to admit the claim of the complainant without assigning any plausible reason and as such, there is deficiency in service on the part of the OPs, which gave cause of action to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay the whole amount stipulated in the insurance policy alongwith interest @ 24% per annum till realization and further, OPs are directed to pay compensation of Rs.3,00,000/- for causing mental tension and harassment and OPs be also directed to pay Rs.2,00,000/- for mental and physical harassments to the complainants and further, OPs be also directed to pay Rs.55,000/- as litigation expenses.

3.                Notice of the complaint was given to the OPs, who appeared through its counsel and filed a joint written reply and contested the complaint by taking preliminary objections that the present complaint is not maintainable in the eyes of law and same has not been properly verified as required under the provision of Consumer Protection Act and further submitted that the complaint is not maintainable, since the complainant has concealed the material facts from the Forum and even the complainant has not falls under the definition of Consumer Protection Act. The true facts of the case are that Sh. Ravi Pal was insured under policy for Rs.8,00,000/-. The duration of the policy i.e. 1 year 2 months, the life assured died on 06.04.2017. The death claim has been repudiated by the competent authority on 28.09.2017. On merits, the factum in regard to purchase of insurance policy by the deceased insured as well as repudiating the claim of the complainant are admitted facts, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.                                                                     

4.                In order to prove the case of the complainants, one of the complainant tendered into evidence his affidavit Ex.CW1/A along with some documents Ex.C-1 to Ex.C-6 and closed the evidence.

5.                Similarly, counsel for the OPs tendered into evidence affidavit of Parvathy Krishnan Manager (Claims) as Ex.OW1/A alongwith some documents Ex.O-1 to Ex.O-6 and closed the evidence.

6.                We have heard the arguments of learned counsel for the complainant and also gone through the case file very minutely.

7.                Coming to directly, issue in dispute, because the factum in regard to purchasing of insurance policy by deceased Ravi Pal and after his death the insurance claim was submitted and admittedly the same was repudiated, are not disputed facts. Coming to the repudiation letter Ex.C-1 dated 28.09.2017, whereby the claim of the complainant has been repudiated by the OPs by taking only one plea that the deceased insured concealed his pre-existing disease at the time of inception of the policy i.e. 03.02.2016 because as per documentary record, the insured deceased was having some problem on 25.01.2016 and 20.02.2016 as per scan reports Ex.O-2 and Ex.O-3 and accordingly, by making the base of these reports, the claim of the complainant has been repudiated.

8.                We think the OP should remember that human being is a ‘Putla’ of mistake and if any mistake is rectified that should be thoroughly verified and investigated, but in this case, the OP did not bother to listen the request of the complainant that the scan reports Ex.O-2 and Ex.O-3 dated 25.01.2016 and 20.02.2016 were inadvertently, due to typographical mistake have been issued on the said date, whereas the year of the said reports is 2017 instead of 2016, regarding that a certificate was also obtained by the complainant from the said institution i.e. SGL Charitable Hospital and the same is available on the file Ex.C-6, which is signed by the Dr. Ajay Mahajan as well as by Medical Superintendent and it is make clear in that certificate that inadvertently the year was put on the scan reports 2016 instead of 2017. So, when rectification of the date has been made by the same hospital, then why the OP did not bother to consider the said request. No doubt, the said clarification was got by the complainant after the repudiation of the claim, admittedly the claim was repudiated on 28.09.2017, whereas the clarification certificate was issued by SGL Hospital on 28.10.2017 and thus, we do not find any deficiency in service on the part of the OPs because the OP has considered the case on the basis of the scan reports pertaining to year 2016 and as such, we find the complainant is entitled for the insurance claim not for compensation or litigation expenses.

9.                Admittedly, as per version of the OPs, the insurance claim of the deceased insured was Rs.8,00,000/-, if so, then the complainants are entitled for that insured amount.

10.              In view of the above detailed discussion, the complaint of the complainants is admitted and the same is partly accepted and both the complainants are entitled to get the insurance claim of their son i.e. Rs.8,00,000/- from OPs. Further, OPs are directed to pay the said insurance claim of Rs.8,00,000/- to the complainant in equal share, within one month from the date of receipt of the copy of the order, failing which the OPs will further liable to pay interest on the aforesaid amount @ 12% per annum from the date of filing complaint i.e. 22.04.2017, till realization. This complaint could not be decided within stipulated time frame due to rush of work.

11.              Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated                                                 Jyotsna                            Karnail Singh

10.02.2020                                        Member                          President