Haryana

Karnal

219/2013

Munni Devi W/o Raghu Nandan Mehato - Complainant(s)

Versus

Life Insurance Corporation Of India - Opp.Party(s)

Sh. Davinder Sharma

03 Jun 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                               Complaint No.219 of 2013

                                                             Date of instt.:06.05.2013

                                                               Date of decision:03.06.2016

 

Smt. Munni Devi wife of late Shri Raghu Nandan Mehato resident of Galia no.,8, near Rajwaha Shiv Colony, Karnal.

 

                                                                   ……..Complainant.

                                      Vs.

Life Insurance Corporation of India, Jiwan Parkash Building, Model town, Karnal through its Divisional Manager.

 

                                                                   ………… Opposite Party.

.

                      Complaint u/s 12  of the Consumer Protection Act.

 

Before                   Sh.K.C.Sharma……….President.

                   Sh.Anil Sharma…….Member.

 

Present:-      Sh.Devender Sharma Advocate for the complainant.

                    Sh. Satpal Singh Advocate for opposite party.

 

 ORDER:

 

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer protection Act 1986, on the averments that her husband Raghunandan Mehto (deceased life assured) obtained life insurance policy no.176570395 in the year 2011 from opposite party, for sum assured of Rs.2,50,000/-. He regularly paid the premiums of the policy. Unfortunately, he died on 21.4.2012. Thereafter, she lodged claim with the opposite party for payment of the insurance claim being the nominee of the deceased life assured, but her claim was rejected, vide order dated 18.3.2013, on the ground that the deceased life assured withheld the correct information from the opposite party regarding his health at the time of obtaining the policy. Infact, the deceased life assured was not suffering from any disease and in that regard he was medically examined by the doctor of the opposite party. He did not conceal anything regarding his health while obtaining the policy. In this way, rejection of the claim by the opposite party without any basis, amounted to deficiency in service, which caused her mental pain, agony and harassment apart from financial loss.

2.                Notice of the complaint was given to the opposite party, who appeared and filed written statement controverting the claim of the complainant. Objections have been raised that the complainant has no locus standi to file the present complaint; that the complainant has not approached this Forum with clean hands; that the complaint is not maintainable and that the complicated questions of law and facts are involved, which cannot be adjudicated by this Forum in summary manner.

                   On merits, it has been submitted that the deceased life assured had undergone for cholecystectomy for gall stone for which he got treatment from Medanta Medicity Hospital, Gurgaon and Raj Trust Hospital, Patna. He also availed leave on medical ground before obtaining the policy. However, he did not disclose the material information regarding the ailment with which he was suffering and thus concealed the material facts from the opposite party for obtaining the policy. Therefore, the contract of insurance became void on account of mis-statement/suppression of true facts and as such the claim of the complainant was rightly repudiated.

3.                In evidence of the complainant, her affidavit EX.CW1/A and documents Ex.C1 to C3 have been tendered.

4.                On the other hand, in evidence of the opposite parties, affidavit of Balihar Singh Manager Ex.OP1 and documents Ex.OP2 to Ex.OP8 have been tendered.  

5.                We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

6.                From the pleadings and evidence of the parties, it is not in dispute that the deceased life assured had obtained life insurance policy from the opposite party in the year 2011 and he died on 21.4.2012. The claim of the complainant was repudiated by the opposite party, vide letter dated 18.3.2013 Ex.C1.

7.                Learned counsel for the opposite party laid emphasis on the contention that the deceased life assured had underwent for cholecystectomy for gall stone and got treatment for the same from Medanta Medicity Hospital, Gurgaon and Raj Trust Hospital, Patna, as is evident from Ex.OP2, Ex.OP3, Ex.OP6 and Ex.OP7. The deceased life assured even availed medical leave for the period of 7.4.2008 to 23.4.2008, 3.12.2008 to 16.12.2008 and then 10.3.2012 to 21.3.2012. However, while obtaining the policy he did not disclose about his ailment, the treatment taken by him from the aforesaid hospitals and the medical leave availed by him during the treatment period. In this way, he concealed material facts from the opposite party, which rendered the policy void, because the contract of insurance falls in the category of contract uberrima fide  i.e. utmost good faith. Concealment of previous ailment was suppression of material facts, therefore, the claim lodged by the complainant was rightly repudiated.

8.                The copies of the certificates issued by Dr. J. L. De Mokama (Patna) E.OP6 and Ex.OP7  indicate that the deceased life assured remained under the treatment of the said doctor for entric fever from 7.9.2008 to 23.9.2008 and for Acute Bacillary Dysentery from 3.12.2008 to 16.12.2008. Ex.OP2 shows that he remained admitted in Medanta hospital from 10.3.2012 to 21.03.2012 and during investigation it was found that he had Asictes positive for malignant cells. In the said document it was also mentioned that he had past history of Cholecystectomy 3 years back for gall stone.

9.                Admittedly, the policy commenced from 20.01.2011, therefore, the fact that he remained admitted in Medanta Hospital from 10.3.2012 to 21.3.2012 does not render any help to the opposite party. However, the documents Ex.OP2, Ex.OP6 and Ex.OP7 show that he underwent Cholecystectomy for gall stone in the year 2008 or 2009 and got treatment for entric fever and Acute Bacillary Dysentery in the year 2008. There is no medical record to establish that he underwent Cholecystectomy for gall stone in the year 2008 or 2009. Entric fever and dysentery do not fall in the category of the disease, because such problems may be due to viral infection or water generated infection and most of the people suffer with such problems sometime during their life. Even otherwise, the employees to avail medical leave, when casual leave or earned leave are not due generally obtain such medical certificates regarding problems of fever and dysentery. Under such circumstances, the evidence of the opposite party is not sufficient to conclusively establish that the deceased life assured had underwent  Cholecystectomy for gall stone and was suffering from some serious ailment prior to obtaining insurance policy.

10.              Even if, it is accepted that the deceased life assured had under went Cholecystectomy for gall stone, suffered from entric fever and Acute Bacillary Dysentery prior to obtaining the policy, the question arises as to whether he concealed about the same while obtaining insurance policy from the opposite party. It is not in dispute that a proposal form is filled up by a person intending to take life insurance policy and after considering the contents of the proposal form, the policy is issued or proposal is rejected. Thus, the proposal form could be a most material document to show whether the deceased life assured had disclosed all the material facts regarding his health or concealed about his operation and suffering from entric fever and Acute Bacillary Dysentery. However, the opposite party has not been able to produce the copy of proposal form. Thus, the opposite party altogether failed to establish that the deceased life assured concealed material facts regarding his health for obtaining policy. Therefore, under such circumstances, repudiation of the claim by the opposite party on the ground of concealment/suppression of material facts by the deceased life assured amounted to deficiency in service.

11.              As a sequel to the foregoing discussion, we accept the present complaint and direct the opposite party to pay Rs. 2,50,000/- as  insured amount  alongwith interest thereon @ 9% per annum from the date of filing of complaint till its realization.  We further direct the opposite party to pay Rs.5500/- to the complainant on account of mental agony and harassment suffered by him and for the litigation expenses. This order shall be complied within 30 days of receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 03.06.2016

                                                                                      (K.C.Sharma)

                                                                                         President,

                                                                             District Consumer Disputes

                                                                             Redressal Forum, Karnal.

                             (Anil Sharma)

                               Member