Haryana

Ambala

CC/77/2014

RAGHBIR KAUR - Complainant(s)

Versus

LIFE INSURANCE CORPORATION OF INDIA - Opp.Party(s)

RAJESH KUMAR

21 Aug 2017

ORDER

FBEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

AMBALA.

                                                  Complaint Case No.: 77 of 2014.

                                                   Date of Institution:     13.03.3014.

                                                     Date of order:                    21.08.2017.

 

Raghbir Kaur widow of Sh.Kirpal Singh son  of Sh.Jhanda Singh r/o village Mohri P.O.Bhanukheri, Tehsil & District Ambala.

                                                                          ….. Complainant.

                                          Versus     

 

1.Life Insurance Corporation of India, Jeevan Jyoti Building, Jawahar Lal Nehru Marg, Ambala Cantt. through its Branch Manager.

2.Life Insurance Corporation of India, through its Director, Central Office Yogakshema, 5^th Floor Link,J.B.Road, Post Box No.19953 Mumbai 400021.

 

….Opposite parties.

 

Complaint U/s 12 of the Consumer Protection Act

                                                                                

BEFORE:       SH. D.N. ARORA, PRESIDENT

                   SH. PUSHPENDER KUMAR, MEMBER         

                   MS. ANAMIKA GUPTA, MEMBER                 

 

Present:          Shri Rakesh Kumar, Advocate for the complainant.

                  Shri R.K.Jindal, Advocate for the opposite parties.

 

ORDER:

 

                   The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against the opposite parties (hereinafter to be referred as OPs).

2.                Briefly stated the facts of the present complaint are that husband of the complainant namely Kripal Singh had got himself insured with the OPs vide insurance policy No.177357342 under Bima Bachat Plan 175 S.A 14,45,000/- under T.T.175-09(1). On 23.05.2011 life assured-Kirpal Singh died and after his death, the complainant submitted all the relevant documents to the OPs and also completed all the formalities but the OPs repudiated the claim of the complainant vide letter No.Claims/Rep/M/Con.2Y/11-12/40 dated 08.02.2012 received by the complainant on 28.02.2012 on the ground that life assured did not furnish the correct information regarding his health, therefore, the OPs have given ex-gratia amount of Rs.9,00,219/- and have not paid the requisite amount of Rs.14,45,000/-. Thereafter the complainant wrote a letter dated 29.02.2012 to the OPs for paying the requisite amount but the same rejected vide letter dated 16.04.2012. Again the complainant requested the Ops to pay requisite amount vide letter dated 07.05.2012 but again the claim was repudiated on 12.08.2013. The act and conduct of the Ops clearly amounts to deficiency in service. In evidence, the complainant has tendered affidavit Annexure CX and documents Annexure C1 to Annexure C7.

3.                Upon notice, OPs appeared through counsel and resisted the complaint by filing joint reply wherein they have taken many preliminary objections regarding cause of action, jurisdiction, maintainability and suppression of true and material facts. The life insured at the time of filling of proposal form was suffering from kidney problem  and he had also consulted a doctor and also taken treatment but he disclosed this information intentionally and also replied the answers wrongly.  The OPs  have rightly repudiated the claim of the complainant vide letter dated 08.02.2012 as the life assured himself has concealed his state of health at the time of obtaining the policy in question and he had died on 23.05.2011 at GMCH, Chandigarh.  The letters of the complainant were duly replied and after reconsideration of the claim the repudiation was upheld by the Zonal Office Claim Review Committee vide letter dated 29.03.2012 and Central Office Claim Disputes Redressal Committee Mumbai vide letter dated 02.08.2013.  Other contents made in the complaint have been controverted and prayer for dismissal of the claim has been made. In evidence, the OPs have tendered affidavit Annexure RX and documents Annexure R1 to Annexure R7.

4.                We have heard learned counsel for the parties and have perused the case file carefully.

5.                It is admitted fact that it was a single premium money back policy for a period of ten years started from 28.10.2010 to 28.10.2019 and the policy was enforced on 29.10.2010. The maturity amount was to be received by the insured to the sum of Rs.14,45000/- but  the insured had died during the subsistence of the policy on 23.05.2011. As per terms and conditions of the policy, if the insured died within one year of the issuance of the policy then the ex-gratia amount to the tune of Rs.900129/- was to be payable by the insurance company. It is also not disputed that the amount to the tune of Rs.900129/- has already   been received by the complainants.

6.                Now only dispute in this present complaint is that whether the complainants are entitled for full insured amount i.e. Rs.14,45,000/-.

7.                The OP has only paid Rs.900129/- as an ex-gratia amount as per terms and conditions and rest of the amount has been withhold that the deceased had concealed the material facts at the time of obtaining the insurance and proposal form was filled up by insured wherein the insured had denied about suffering from any disease as per Annexure R4.

8.                The relevant column (d) & (e) qua suffering from any ailment regarding Liver, stomach, heart, lungs, kidney, brain or nervous system, high blood pressure, low blood pressure, cancer, epilepsy, hernia hydrosol, leprosy or any other disease  have been replied as NO by the insured.

9.                The opposite parties have denied the rest of the amount on the ground that the policy holder was suffering from kidney problem at the time of taking the policy and had taken the treatment from a hospital but did not disclose above facts in the proposal form and falsely replied the column (d) & (e).  The opposite parties have placed on record copy of the   proposal form as well as the claim wherein the claimant has mentioned that the insured was suffering from kidney problem for the last one year duly thumb marked by complainant and same was attested by Development Officer.  In the claim form 3816 produced by the complainant to the OPs the history of the deceased/insured has been mentioned as known case of chronic kidney disease past one year was on Maintenance Hemo-dialsys.  The above mentioned claim form has been certified by a doctor of Government Medical Hospital Sector 32, Chandigarh. The case laws titled as Gurmeet Kaur @ Meeto & Anr. Vs. LIC of India Part No.XXXIV October 2015, Volume IV (NC), Satwant Kaur Sandhu Vs. New India Assurance Company Limited 2009 (4) RCR (Civil)  and Jagdeep Arora Vs. Life Insurance Corporation of India & Ors. 2015 (3) CPR 513 (NC) relied upon learned counsel for the OPs are fully applicable to the present case.

10.              In view of the admission made in the claim form by the claimant as well as in the form Annexure R3 one thing is clear that the deceased had died due to kidney problem and above said facts have not been rebutted by the complainants. The Opposite parties have rightly paid the ex-gratia amount as per the terms and conditions and we found no deficiency in service on the part of OPs. Accordingly, complainant is not entitled for any relief as prayed for.

11.              In view of the above discussion we are of the considered view that the present complaint deserves dismissal. Accordingly, we dismiss the present complaint leaving the parties to bear their own costs.  A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.

Announced on:21.08.2017     

                                                                                                                  

 

(Pushpender Kumar)    (Anamika Gupta)                      (D.N.Arora)

Member                         Member                             President

                                                                    District Consumer Disputes                                                                       Redressal Forum, Ambala.