DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II
Udyog Sadan, C-22 & 23, Qutub Institutional Area
(Behind Qutub Hotel), New Delhi-110016.
Case No.370/2006
Smt. Subhash Narang
W/o Late Sh. Inder Parkash Narang
R/o 14-C, Pocket A-10, Kohinoor Apartments,
Kalkaji Extn., New Delhi-110019 ….Complainant
Versus
Life Insurance Corporation of India,
through its Divisional Manager
Branch Division I, Defence Colony,
New Delhi-110024 ……Opposite Party
Date of Institution : 10.07.06 Date of Order : 30.09.16
Coram:
Sh. N.K. Goel, President
Ms. Naina Bakshi, Member
O R D E R
Briefly stated, the case of the Complainant is that the Complainant’s husband Sh. Inder Parkash Narang (now deceased) had obtained an insurance policy No.113052268 “Jeevan Surakash Policy” from the OP covering the risk from 28.03.2001 for a period of 5 years. As per the terms and conditions of the policy Rs.10,000/- per annum was to be paid as premium for a period of five years and the insured person/nominee (in case of death of the insured) was to get a pensionary benefit of Rs.622/- per month after the maturity of the policy. Accordingly, two installments of Rs.10,000/- each were paid to the OP and the last premium was paid on 07.03.12. It is stated that at the time of obtaining the insurance policy the deceased was got medically examined by the OP and the policy was issued to the deceased only after the OP was satisfied that the deceased was a fit candidate for issuing the insurance policy. It was sometimes in April, 2002 when the deceased/insured was diagnosed as suffering from tubercular meningitis and during the course of treatment he developed several complications which led to his ultimate demise on 25.07.2002 from septic shock which occurred due to a hospital acquired chest infection. The Complainant being the legally wedded wife and as such the nominee of Late Sh. Inder Parkash Narang is thus entitled to get the pensionary benefits under the policy. She supplied all the requisite documents to the OP and also completed all the formalities but the OP on 27.07.2004 flatly refused to accede to the legitimate requests of the Complainant. Hence, pleading deficiency in service on the part of OP the complaint has been filed for the following reliefs:-
- Direct the OP to pay to the Complainant the pensionary benefits as per terms and conditions of the policy alongwith interest @ 18% per annum from the date of its due till the final realization of the whole amount,
- Direct the OP to pay to the Complainant forthwith damages of Rs.1 lac on account of short and deficient intentional services rendered by the OP in a negligent and careless manner and for causing a great mental tension agony and harassment to the Complainant,
- Direct the OP to pay to the Complainant a sum of Rs.5,500/- as litigation charges.
OP in the reply has stated that the deceased insured was guilty of violation of the doctrine “uberrima fida” (i.e. utmost good faith). It is denied that at the time of obtaining the insurance policy the deceased was medically examined by the OP and the policy was issued to the deceased only after the OP was fully satisfied that the deceased was a fit candidate for the insurance policy. It is stated that the deceased had intentionally concealed and not described about his medical ailment that he had suffered from hypothyrodism (i.e. heart problem) and had also undergone PPI in the year 1994. Hence, the deceased had procured the insurance policy in question from the OP by making deliberate misleading statements and by concealing the material information about his ill health. The repudiation of the claim was not done on any whimsical ground but on the criteria required for repudiation i.e. (a) the fraudulent intention (b) suppression of material facts of ailments (c) and knowledge of the deceased life insured about these at the time of proposal were all satisfied and, therefore, the OP had rightly repudiated the claim. OP has prayed for dismissal of the complaint.
Complainant has filed rejoinder to the written statement of OP and stated that there is no co-relation between hypothyroidism or PPI and the septic shock due to chest infection i.e. the cause of the death of the life assured. The cause of death was not only proximally but also remotely not connected with the cause of death as is evident from the cause of death certificate issued by Apollo Hospital and so the repudiation of the claim by the OP was not justified.
Complainant has filed her own affidavit in evidence while affidavit of Sh. Narender Chandhery has been filed in evidence on behalf of the OP.
Written arguments have been filed on behalf of the parties.
We have heard the arguments on behalf of the Complainant and have also gone through the file very carefully.
Admittedly, Complainant’s husband, namely, Sh. Inder Parkash Narang (now deceased) had obtained an insurance policy No.113052268 “Jeevan Surakash Policy” from the OP covering the risk from 28.03.2001 for a period of 5 years (copy Annexure-A) . Annexure-B is the copy of the insurance policy issued by the OP containing terms and conditions. The Complainant filed a cause of death paper issued by Indraprastha Apollo Hospital (copy Annexure-D) wherein the hospital has stated the cause of death as “acute infective Demyelinating poly neupathy with diabetis mellitus with Tubercular meningitis with Nephrotic Syndrome with hypotensive shock” and he was admitted with a past history of tubercular lymph adneopathy with tubercular meningitis on Anti tubercular treatment and steroids since March, 2012. The OP has filed the copies of medical papers of the deceased person when he was given medical treatment in Indraprastha for hypophyrodism and PPI. Copies of the record are Ex.RW1/A to Ex.RW1/12.
The insured, however, died due to acute infective Demyelinating poly neupathy with diabetis mellitus with Tubercular meningitis with Nephrotic Syndrome with hypotensive shock. Both these diseases i.e. hypothyrodism and PPI which took the life of the insured are not related to each other as the cause of death is different. OP rejected the claim in question vide letter dated 10.03.2004 (Copy Ex.RW1/A) on the ground that the insured while obtaining the policy in question had not mentioned details about his previous ailments i.e. hypothyrodism heart problem and PPI in 1994 and had made deliberate mis-statements and withheld material information from the OP regarding his health. It is very true that the Complainant has not adduced any evidence to the contrary to even show that before giving the policy in question to the insured, the OP had got conducted his detailed and thorough medical examination. Thus, we are in total agreement with the OP that while filling up the proposal form, the insured had given false information with regard to his health and also did not disclose that he had earlier suffered from hypothyrodism heart problem and had PPI in 1994. However, in the present case the immediate cause of death of the deceased insured was not hypothyrodism nor PPI. The immediate cause of his death was acute infective Demyelinating poly neupathy with diabetis mellitus with Tubercular meningitis with Nephrotic Syndrome with hypotensive shock. Thus, in our considered opinion, in these special circumstances of the present case, non-disclosure by the insured about having had suffered hypothyrodism heart problem and PPI in 1994 in the past was not a suppression of any material fact with regard to his health. Hence, in our considered opinion, the judgments referred to in the written submissions filed on behalf of the OP are not applicable to the special facts of the present case. Hence, the repudiation of the claim by the OP was totally unjust and improper which amounts to deficiency in service and unfair trade practice on the part of OP.
In view of the above discussion, we allow the complaint and direct the OP to pay to the Complainant pensionary benefit @ Rs.622/- per month as per the terms and conditions of the policy alongwith 9% interest from its due date till the realization of the amount and Rs.20,000/- as compensation for mental agony and harassment caused to the Complainant and Rs.5,000/- towards cost of litigation.
The order shall be complied within 30 days of receipt of copy of this order failing which OP shall become liable to pay interest @ Rs. 10% per annum from the due date till the date of realization.
Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations. Thereafter file be consigned to record room.
(Naina Bakshi) (N. K. Goel)
Member President
Announced on 30.09.16.
