Chandigarh

DF-I

CC/275/2015

Santosh Kumari - Complainant(s)

Versus

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

Nitin Kant Setia

07 Apr 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH

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Consumer Complaint  No	:	275 of 2015
Date  of  Institution	:	6.5.2015
Date   of   Decision	:	7.4.2016

 

 

 

 

 

Ms. Santosh Kumari mother of late Sh. Ravi Kumar wife of Batan Singh r/o Village TOP, PO Baiduhak, Tehsil Nadaun, District Hamirpur, Himachal Pradesh.

 

….Complainant

Vs.

Life Insurance Corporation of India  through Divisional Manager, Divisional Office, Jeevan Prakash Building, Sector 17-B, Chandigarh

 

…… Opposite Party 

 

BEFORE:                                                                     PRESIDENT

MRS.SURJEET KAUR                             PRESIDING MEMBER

SH. SURESH KUMAR SARDANA           MEMBER

 

 

For Complainant	:	Sh. Imtiaz Ali, Adv proxy for Sh. Nitin Kant Setia, Adv.
For OP	:	Sh. Nitish Singhi, Adv. Alongwith priya Singhi, Adv.

 

 

PER SURESH KUMAR SARDANA, MEMBER

 

 

 

                The facts, in brief, are that the complainant is the next of Kin/nominee of the deceased insured Ravi Kumar under 5 policies number 165226146 to 165226150. All the policies commenced from 28.7.2012. Unfortunately during the subsistence of the policy the life insured died on 25.5.2013 after critical illness and contracting multiple health problems. It is averred that however, when the policies were taken on 3.8.2012 the decease was healthy and he had no disease of any kind. It is alleged that the Opposite Party vide letter dated 31.3.2014 repudiated the claim of the complainant on the ground of deceased having withheld correct information regarding his health at the time of entering into the contract of insurance.  It is further averred that the deceased had no pre existing disease at the time of issuance of the  policy however, the Opposite Party wrongly presumed that the complainant concealed this fact.  The deceased was not suffering from tuberculosis at the time of signing proposal form for the said insurance polices. In fact he caught his sickness all of a sudden and got himself admitted in the hospital on 17.5.2013 and unfortunately could not recover of his illness and succumbed to his illness on 25.5.2013.  It has further been averred that the  deceased paid all the premiums for the life insurance policies and the death of the deceased is insurable claim as per insurance policy terms signed between the deceased and Opposite Party. Alleging  deficiency on the  part of the Opposite Party the instant complaint has been filed.

         

2.           Notice of the complaint was sent to Opposite  Party, seeking its version of the case.

3.          Opposite Party in its reply while admitting the factual matrix of the case stated that the life assured was not healthy at the time of taking the policies in question and it was in his knowledge. But he intentionally concealed the true and material facts relating to his health affairs from the Opposite Party and gave wrong answers in the proposal form at the time of taking policy just to obtain the policies. The life assured  was suffering from TB at the time of taking policy and he was under treatment for the same under National TB Control Programme from Urban Health Training Centre, Palsora, but he did not disclose this very fact before the date of first premium receipt not only that the life assured on the day of proposal got himself checked at OPD GMSH Sector 16 Chandigarh where he is diagnosed with history of one month of jaundice, fever and chest X-Ray done showed Tuberculosis. It is  averred that the life assured  was bound by the terms and conditions of the policy and declaration so made by him in the proposal form.  It is further averred that the contract of insurance is a special contract which is based upon the good faith between the parties and the concealment on their part of either party makes the contract null and void. Denying all other allegations and stating that there is no deficiency in service or unfair trade practice on their part, Opposite Party has prayed for dismissal of the complaint.

4.          Parties were permitted to place their respective evidence on record, in support of their contentions.

 

5.          We have heard the learned counsel for the parties and have perused the record carefully.

 

6.          The case of the complainant is that the claims of the deceased were repudiated by the OP on account of the deceased having withheld correct information regarding his health at the time of taking the policies from the OP. In the written statements of the Opposite Party in  parawise reply at para NO.2 , it is mentioned that the deceased LA never purchased any policy earlier but all of sudden he purchased five different policies for the sum assured of Rs.1 lacs each at the same time, which creates suspicion.  We are of considered opinion that if it had caused suspicion, then the OP should have got conducted medical check up  of the deceased when he has signed for five policies all of a sudden, which it failed to do so. The Opposite Parties at their open will had given five insurance policies to the insurer and had taken the premium due from the  deceased without raising any suspicion/doubt regarding
his health and now OP is denying to honour its commitment. There appears to be no omission on the part of the deceased about giving any false statement as Opposite Parties have failed to produce any concrete evidence about the fact that the deceased was aware about his illness at the time of taking the policies in question.

7.          Hence we hold that repudiating the claim of the complainant as nominee regarding the policies in question by the Opposite Party amounts to deficiency in rendering service and indulgence into unfair trade practice.  

8.          In the light of above observations, we are of the concerted view that the Opposite Party is found deficient in giving proper service to the complainant and having indulged in unfair trade practice. Hence, the present complaint of the Complainant deserves to succeed against the Opposite Party, and the same is allowed, qua it. The Opposite Party is  directed  to:-

 

[a]     To pay the claim of the complainant to the tune of Rs.5.00 lacs with interest @9% p.a. from the date of claim till it is paid. 

 

[b]     To make payment of Rs.10,000/- to the complainant towards compensation for causing mental and physical harassment.

 

[c]      To make payment of Rs.7,000/- to the complainant as litigation expenses.

 

 

9.          The above said order be complied with by the Opposite Party, within 30 days from the date of receipt of its certified copy, failing which the amounts at Sr. No.[a]  shall carry interest @12% p.a. from the date of claim till realization & at [b] shall carry interest @12% per annum from the date of filing of the present Complaint, till actual payment, besides payment of litigation costs.

 

10.          The certified copy of this order be sent to the parties free of charge, after which the file be consigned.

 

Announced

7.4.2016         

 (P.L. AHUJA)

PRESIDENT

Sd/-

 (SURJEET KAUR)

PRESIDING MEMBER

 

Sd/-

 (SURESH KUMAR SARDANA)

MEMBER

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