Haryana

Jind

CC/15/76

Smt. Sumitra Devi - Complainant(s)

Versus

Life Insurance Corporation - Opp.Party(s)

Sh. Rajinder Singh

29 Jul 2016

ORDER

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, JIND.
                            Complaint No. 71 of 2015
                            Date of institution:-1.6.2015
                            Date of decision:- 29.7.2016
Smt. Sumitra Devi w/o late Sh. Ramesh Kumar s/o Sh. Maha Singh VPO Butani, Tehsil Pillukhera, District Jind. 
                                       ..Complainant.
Versus
Life Insurance Corporation of India, LIC building District Shopping Centre, Jind through its Branch Manager.

                                          …Opposite party.
Complaint under section 12 of
                Consumer Protection Act, 1986.

Before:     Sh. Dina Nath Arora, President.
            Smt. Bimla Sheokand, Member.
            Sh. Mahinder Kumar Khurana, Member.  

Present:-    Sh. Rajinder Singh, Adv. for  complainant. 
        Sh. V.S. Lather, Adv.for opposite party.  
Order:-
         Brief facts of the complaint are that complainant’s husband namely  Late Sh. Ramesh Kumar got insured his life for a sum of Rs.55,000/- with the opposite party vide policy No.178270880 under T&T 75-20 commencing from 28.12.2012. The complainant’s husband had expired on 28.9.2013. The complainant is legal heir of deceased  Ramesh Kumar being wife and nominee in the above said policy. The complainant informed the opposite party immediately regarding the 
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death of her husband and submitted all the necessary documents. The complainant lodged a claim with the opposite party. The opposite party  has repudiated the claim of the complainant vide letter dated 20.10.2014 on the ground of concealment of facts at the time of taking the policy. At the time of taking the policy the life assured was not suffering from any disease. The complainant  moved an application dated 3.3.2015 to Ombudsman Insurance, Chandigarh for providing death claim  of Ramesh Kumar from the opposite party but all in vain. Deficiency in service on the part of the opposite parties is alleged. It is prayed  that the complaint be accepted and opposite party be directed to make the payment of Rs.55,000/-  as amount of claim besides other benefit along with interest @ 18% p.a., a sum of Rs.10,000/- as compensation on account of mental pain and agony  as well as to pay a sum of Rs.5,000/- as litigation expenses to the complainant.   
2.  Upon notice, the opposite party has appeared and filed the written statement by taking some preliminary objections such as  complaint is not maintainable in the present forum and this Forum has got no jurisdiction to entertain the present complaint. On merits, it is contended that  as per certificate in claim form No.3816 dated 14.7.2014 issued by doctor Rahul S. Jalaunia M.O. BPS Govt. Medical College for Women, Khanpur Kalan, District Sonipat, deceased life assured Ramesh Kumar was admitted on 25.10.2012 vide CR No.16100 and was discharged on 7.11.2012 , life assured was  suffering from Cough C Sputumprd 6-7 years and was also patient of Breathlessness, 
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Fever and Pain Epigestriumand.  The life assured had concealed the material facts about his health at the time of taking the policy, so the opposite party has rightly repudiated the claim of the complainant vide letter dated 20.10.2014. Therefore, there is no deficiency in service on the part of the opposite party. Dismissal of complaint with cost  is prayed for.
3.    In evidence, the complainant has  produced her own affidavit Ex. C-1,  copy of  repudiation letter dated 20.10.2014 Ex. C-2, application Ex. C-3, copy of  application dated 3.3.2015 Ex. C-4, copy of application dated 22.7.2014 Ex. C-5, copy of affidavit of complainant Ex. C-6, copies of status report  of policy Ex. C-7 and Ex. C-8,  copy of premium receipt Ex. C-9 and  copy of death certificate Ex. C-10and closed the evidence. On the other hand, the opposite party has produced the affidavit of Sh. Balihar Singh Manager  Ex. OP-1, copy of policy schedule Ex. OP-2, copy of repudiation letter dated 20.10.2014 Ex. OP-3, copy of letter dated 15.7.2014 along with endorsement of doctor regarding disease of Ramesh insured Ex. OP-4, copy of claim enquiry report Ex. OP-5 and copy of statement of Rajbir Ex. OP-6 and closed the evidence. 
4.    We have heard Ld. counsel of both the parties and also perused the record placed on file. The counsel for complainant argued that the complainant’s husband  had purchased one life insurance policy from opposite party  on 28.12.2012 for a sum assured of Rs.55,000/-. Unfortunately, the complainant’s husband had died on 28.9.2013. During taking of the  policy the life insured was  not  suffering from 
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any disease. The opposite party has repudiated the claim of the complainant on the ground that complainant has with held the correct information regarding his health at the time of effecting the assurance and he has filled up the proposal form for assurance dated 30.3.2013 he has concealed the disease at the time of taking the policy. Whenever husband of complainant was not suffering  from any disease and prior to issue the policy each and every facts verified and confirmed by the official/agent of the opposite party and said Ramesh Kumar deceased did not conceal any facts. In this way opposite party has wrongly repudiated the claim of the complainant on the false ground. 
5.    On the other hand, the counsel for opposite party argued that the claim of the complainant was rightly repudiated on the ground of concealment of facts about his health. The insurance is a contract of utmost good faith and insured is bound to disclose all the information regarding his health truthfully in the proposal form but the life assured during  taking of the policy has concealed that he is suffering from  any disease and as such the complainant is not entitled for any claim. It is further argued that  as per investigation the deceased was admitted  on 25.10.2012 vide CR No.16100 and was discharged on 7.11.2012 as per  the certificate in claim form No. 3816 dated 14.7.2014 issued by Dr. Rahul  Ex. OP-4 and that form has been obtained by their investigator. It is clear from that report the  life assured was  suffering from Cough C Sputumprd 6-7 years and was also patient of Breathlessness, Fever and Pain Epigestriumand. In this 
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way deceased has concealed the true and material fact about his health and prayed for dismissal of complaint. 
6.    After hearing Ld. counsel of parties, we have  gone through the record there is no proposal  form on the file from which we can ascertain that the deceased had given wrong declaration while giving answers to the various questions in writing as mentioned in the  repudiation letter Ex. OP-3 in which it is mentioned that complainant had given wrong declaration regarding his disease.   There is no corroborative  evidence to connect the evidence  that  whether the complainant had concealed the material facts regarding  disease which is mentioned in Ex. OP-4 i.e. certificate of hospital treatment given by the doctor at the time of supplying the information to the opposite party when he had obtained the policy. So there is no justification to repudiate the claim of the complainant on the ground that the insured has concealed the material facts at the time of taking the policy in question. Hence the opposite party has wrongly repudiated the claim of the complainant. Deficiency in service is established on the part of the opposite party. Resultantly, the complaint of the complainant is allowed and opposite party is directed to pay the insured claim amount of Rs.55,000/-(Rs. fifty five thousand only) to the complainant within 3o days, failing which the opposite party is directed to pay  interest @ 9% p.a. to the complainant from the date of  filing of the complaint i.e. 25.5.2015 till its final realization. We assessed as Rs.2200/-

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(Rs. twenty two hundred only) as litigation expenses to the complainant.  Copies of order be supplied to the parties under the rule. File be consigned to the record-room.
Announced on: 29.7.2016

                                  President,
    Member        Member                   District Consumer Disputes                                           Redressal Forum, Jind

 

 

 

 

 

 

 

 

 

 

 

                               Sumitra Devi Vs. LIC
                    
 Present:-    Sh. Rajinder Singh, Adv. for  complainant. 
        Sh. V.S. Lather, Adv.for opposite party.  
        Arguments heard. Order announced. Vide our separate order of the even date, the complaint is allowed. File be consigned to the record room after due compliance. 
                                                                                             President,
        Member             Member                               DCDRF/Jind
                                          29.7.2016