Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 192
Instituted on : 08.06.2020
Decided on : 13.06.2023
Sumitra age 43 years wd/o Wazir Caste Chamar R/o Village Bhaini Mato Tehsil Meham District Rohtak.
……….………..Complainant.
Vs.
- Life Insurance Corporation of India (LIC), Divisional Office 3,4,5, SCO, Sector-1, Roghtak-124001 through Divisional Manager.
- Life Insurance Corporation of India(LIC) Branch Office: Opposite Civil Hospital, G.T.Road, Hansi District Hisar through its Manager
- Life Insurance Corporation of India(LIC), Zonal office at Jeevan Bharti, Connaught circus, New Delhi through Zonal Manager.
..…….……….Opposite party.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR.VIJENDER SINGH, MEMBER.
Present: Sh.S.S.Badgujar, Adv. for the complainant.
Sh.Krishan Lal, Adv. for opposite parties.
ORDER
NAGENDER SINGH KADIAN PRESIDENT:
1. Brief facts of the case as per complainant are that son of complainant namely Neetu was a Government servant and working as W.P.O.II in the Public Health Department. On 04.12.2018, said Neetu had obtained a Life Insurance policy vide policy no.119042830 from the opposite party No.2 for the sum assured Rs.1000000/-. Complainant is nominee in the said policy. The said Neetu had expired on 11.03.2019 and the complainant being the nominee approached the opposite party and requested to pay the sum assured under the policy. Complainant visited the office of opposite parties time and again for getting the amount of policy but the opposite parties did not pay any heed to the requests of the complainant and had repudiated the claim vide letter dated 24.01.2020 on false grounds. Complainant also sent a legal notice dated 17.03.2020 but the same was not replied. The act and conduct of the opposite parties is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite parties may kindly be directed to pay the amount of Rs.1000000/- alongwith interest, compensation and litigation expenses to the complainant.
2. After registration of complaint, notice was issued to the opposite parties. Opposite parties appeared and filed their reply submitting therein that the policy has run over only for a period of three months. The above claim was an early death claim and was examined in view of provisions under Section 45 of Insurance Act 1938. The deceased life assured was taking treatment from Holy Help hospital. Deceased life assured was a patient of TIDM at the time of proposal. The competent authority has repudiated the liability under the above policy on genuine grounds. The above policy has not completed three years from the date of FPR i.e. 04.12.2018 to the date of death of life assured. The deceased life assured was suffering from TIDM as per form 3816 received from Holy Help hospital, Hisar duly signed by Dr. Sandeep Suri. DLA was old case of T1 diabetes since 2 years which was not disclosed by deceased life assured. The deceased life assured did not disclose this adverse history in proposal form. This suppression of material facts, which have had a bearing on the granting of risk, was clearly done with intent to mislead the corporation, hence it has been decided to repudiate all the liabilities in terms of provision of Section 45 of Insurance Act 1938 and refunded premiums paid under the policy towards full and final settlement of the above claim. Hence the opposite parties have rightly repudiated the claim of the complainant. All the other contents of the complaint were stated to be wrong and denied and opposite parties prayed for dismissal of complaint with costs.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex. CW1/A, documents Ex.C1 to Ex.C14 and closed the evidence on dated 26.02.2021. On the other hand, Ld. Counsel for the opposite parties has tendered affidavit Ex.RW-1/A and documents Ex.RW1 to Ex. Rw5 and closed his evidence on 08.04.2021.
4. We have heard learned counsel for the parties and have gone through the written arguments filed by both the parties as well as material aspects of the case very carefully.
5. In the present case the respondent officials believed the treatment history of Holy Help Hospital, Hisar and repudiated the claim of the complainant. To prove this fact the respondents have placed on record document Ex.RW3, a certificate issued by Dr. Sandeep Suri M.D, Medicines, Holy Help hospital to the respondents’ officials. The perusal of this document itself show that deceased Neetu was admitted in the hospital on 04.03.2019 in unconscious condition having fever from 3 days and he was suffering from diabetes since 2 years. This certificate was issued on dated 08.01.2020. After perusal of this documents, some technical defects found in this certificate. Firstly the date of discharge has not been mentioned in this document, secondly this document is not supported with any affidavit of Dr.Sandeep Suri. Thirdly it has been mentioned on the page no.2 that “The name and relationship of the person who reported the history” and the answer is given as “someone else”. Meaning thereby the history has not been told by the family member of the deceased. Moreover the person who disclosed the ailment of the deceased was not a close relative of the deceased because in the head of occupation the occupation of the deceased is written as ‘not known’. In fact the deceased was a Govt. Employee. This act of the informer shows that when he was not aware about the fact that deceased was govt. employee and how he can say that deceased was suffering from diabetes for the last 2 years. On the other hand, we have perused the document Ex.C4 a death/discharge summary issued by CMC Muiltispeciality hospital. The perusal of this document shows that the cause of death of the deceased was AKI(Acute Kidney injury)/Renal Failure. Under the head of chief complaint it has been mentioned that the patient was having fever, pain in abdomen, breathing difficulty and under the head of past history “Nil”. Meaning thereby the patient had lastly took treatment from CMC multispecialty hospital and in this treatment record it has not been mentioned anywhere that deceased was suffering from diabetes or there was any history of diabetes of the deceased. One more document Ex.C9 is also placed on record which is also issued by CMC Hospital, in which detailed history of deceased Neetu is mentioned and in column no.4 it is mentioned that : “What at the time of admission was? a) the nature of the complaint and the answer is: “Breating difficulty, Pain abdomen vomiting, fever” and b)the duration of the complaint as reported by him? and the answer is “5 days”. This document is issued by the hospital just after the death of deceased on 07.05.2019 and this report has been obtained by the investigating agency of the respondents’ officials. One more document Ex.RW3 is also placed on record which is issued on 08.01.2020 i.e. after 7 months of the death of deceased and as per this document the deceased was suffering from TiDM 2 years but to prove this fact no past history of admission of deceased in any hospital is placed on record by the opposite parties. Hence the opposite parties failed to prove the fact that deceased Neetu was suffering from diabetes at the time of proposal of policy. Hence the law cited by ld. counsel for the opposite parties i.e. 2011(1)CPC 265 of Hon’ble National Commission titled as Sunita Rani & Ors. Vs. Life Insurance Corporation of India and order, dated 25.02.2021 of Hon’ble National Commission in Appeal no.437 of 2021 titled as Life Insurance Corporation of India Vs. Jagdish Parsad are not fully applicable on the facts and circumstances of the case. On the other hand, law cited by ld. counsel for the complainant in (2021) 3 CPJ188 of Hon’ble National Commission, titled as Bajaj Allianz Life Insurance co. Ltd. and Anr.Vs. Mudapaka Rama Rao is fully applicable on the facts and circumstances of the case. As such opposite parties are liable to pay the claim amount under the policy to the complainant.
6. In view of the facts and circumstances of the case, we herby allow the complaint and direct the opposite parties to pay the amount of Rs.1000000/-(Rupees ten lacs only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 08.06.2020 till its realization and shall also to pay Rs.5000/-(Rupees five thousand only) as compensation on account of deficiency in service and Rs.5000/-(Rupees five thousand only) as litigation expenses to the complainant within one month from the date of decision.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
13.06.2023
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Nagender Singh Kadian, President
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Tripti Pannu, Member.
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Vijender Singh, Member
