Haryana

StateCommission

A/679/2017

VEENA GOEL - Complainant(s)

Versus

MAX LIFE INSURANCE CO.LTD. - Opp.Party(s)

RAVI KANT

19 Jun 2024

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

                  

  Date of Institution:22.05.2017

                Date of final hearing:24.05.2024

                                                Date of pronouncement:19.06.2024

 

First Appeal No.679 of 2017

 

IN THE MATTER OF

 

1.      Veena Goyal widow of Shri Ved Parkash S/o Shri Om Parkash

2.      Pooja daughter of Ved Parkash

3.      Ritu daughter of Ved Parkash

 4.     Chiraj son of Ved Parkash

All residents of H.No.247/10, Ward No.13, New Ashoka Colony, Kaithal.

….Appellants.

Through counsel Mr.Ravi Kant, Advocate

 

Versus

 

1.  Max Life Insurance Co. Ltd., Plot No.90-A, Sector-18, Udyog Vihar, Gurgaon-122015 (Haryana).

2.  Max Life Insurance Co. Ltd., Head Office 11/12^th Floor DLF Square JACARANDA Marg DLF City, Phase-II, Gurgaon (Haryana).

…..Respondents.

Through counsel Mr. Nitesh Singhi, Advocate.

 

CORAM:   S.C. Kaushik, Member.

 

Present:-    Mr. Ravi Kant, counsel for the appellants.

                   Mr. Nitesh Singhi, counsel for respondents.

 

O R D E R

S.C. KAUSHIK, MEMBER:

 

 

                    Present appeal has been preferred against the order dated 17.04.2017, passed by learned District Consumer Disputes Redressal Forum, Kaithal (now ‘District Commission’), vide which complaint filed by the complainant was dismissed.

2.                The brief facts giving rise to the complaint are that the husband of complainant No.1-Smt.Veena Goyal (widow of Ved Parkash) and father of complainants No.2 to 4 namely Ved Parkash took one insurance policy bearing No.709080923 from the opposite parties (‘OPs’) on 14.03.2014.  It was alleged that the life assured died on 25.08.2014.  It was further alleged that the complainants lodged the claim with the OPs and submitted all the necessary documents but the OPs repudiated the claim of complainant vide letter dated 29.11.2014. The said repudiation of claim was wrong and illegal.  Thus, there was deficiency in service on the part of OPs.   

3.                Upon notice, OPs have appeared before learned District Commission and filed their written version submitting therein that it has clearly been revealed from the treatment documents procured in the investigation which revealed that the deceased life assured was suffering from CVA on 13.03.2014 and was taking OPD treatment in the hospital and was case of loss of appetite, recurrent vomiting, weight loss and headaches.  It was further submitted that during investigation, it was revealed from the progress sheet of PGI Hospital, Chandigarh that the DLA had a history of recurrent vomiting since 9 months, was suffering from diabetes i.e. T2DM from past 18 years and on 13.03.2014, the DLA developed sudden onset of weakness in the right side of body and was evaluated in Amar Hospital and also had altered Sensorium in March, 2014 after CVA.  Thus, there was no deficiency in service on part of OPs and prayed for dismissal of complaint.    

4.                After hearing the parties, learned District Commission did not find any merit and dismissed the complaint as mentioned in para 1^st (supra).

5.                Feeling aggrieved therefrom, appellants-complainants have preferred this appeal for setting-aside the impugned order passed by learned District Commission.

6.                Arguments have been advanced by Shri Ravi Kant, learned counsel for the appellants and Shri Nitesh Singhi, learned counsel for respondents. With their kind assistance the entire record including documentary evidence as well as whatever evidence had been led during the proceedings of the complaint had also been properly perused and examined.

7.                Learned counsel for appellants has argued that husband of appellant No.1 namely Shri Ved Parkash (deceased) took one insurance policy bearing No.709080923 from respondents on 14.03.2014 for a sum assured of Rs.5,48,900/- which covered the risk of death also. Unfortunately on 25.08.2014 suddenly Shri Ved Parkash died because he was suffering from fever since last 2-3 days before his death and when he was taken to hospital he died on the way as he suffered from heart attack.  He further argued that intimation regarding death of life assured was given to respondents because at the time of his death insurance policy was in force and the appellants fulfilled all the formalities. He further argued that the respondents vide their letter dated 29.11.2014 repudiated the claim illegally on the ground that at the time of taking the policy Shri Ved Parkash has concealed the facts that he is a diabetic and suffering from CEREBROVASCULAR accident with left hemi paresis.  He further argued that appellants again requested the respondents to release the claim amount, but they flatly refused to do. He further argued that there is deficiency in service on part of respondents and also prayed for directing the present respondents for releasing the claim amount of Rs.5,48,900/- with interest @ 18% p.a.  from the date of death of life assured (Shri Ved Parkash) and to pay an amount of Rs.50,000/- on account of physical and mental agony.

8.                On the other hand, learned counsel for respondents has argued that on 14.03.2014 an insurance policy bearing No.709080923 was issued in the name of Shri Ved Parkash (deceased) for a sum assured of Rs.5,48,900/- which also covered the risk of death. However, before issuing the insurance policy, proposal form was also signed by life assured-deceased. He further argued that the terms & conditions of insurance policy were duly communicated to him at time of signing the said proposal form and he declared himself fit and was not having any kind of disease. He further argued that the life assured-deceased died on 25.08.2014, which clearly shows the mala-fide intentions of policy holder. He further argued that upon intimation of death, necessary documents were obtained by respondents and it was clearly revealed from the treatment documents that deceased-life assured was suffering from CVA on 13.03.2014 and was taking OPD treatment in the Hospital and was a case of loss of appetite, recurrent vomiting, weight loss and headaches. During the investigation it was also revealed from the progress sheet of PGI Chandigarh that the deceased-life assured had a history of recurrent vomiting since 09 months and was also suffering from diabetes i.e. T2DM from past 18 months and on 13,03,2014 he developed sudden onset weakness in right side of body and was evaluated in Amar Hospital and had altered Sensorium in March, 2014 after CVA. He further argued that the life assured-deceased concealed these material facts at the time of obtaining the insurance policy and thus, the claim was rightly repudiated by respondents.

9.                It is an admitted fact that the husband of appellant No.1 namely Shri Ved Parkash (deceased) obtained one insurance policy bearing No.709080923 from respondents on 14.03.2014 for sum assured of Rs.5,48,900/- which covered the risk of death also. Premium of Rs.47,223/- paid by life assured-deceased at the time of obtaining the insurance policy was also admitted. It is also an admitted fact that on 25.08.2014 life assured-Ved Parkash died. It is also an admitted fact that at the time of death of life assured, insurance policy was in force and the appellants submitted their claim with the respondents after completing all the formalities. It is also an admitted fact that the respondents vide their letter dated 29.11.2014 repudiated the claim on the ground that life assured was having pre-existing disease and this fact was concealed by him at the time of signing proposal form. The only issue involved in the present case is as to whether the life assured-Shri Ved Parkash (deceased) was having any serious disease at the time of obtaining insurance policy or not?

10.             As per learned counsel for appellants-complainants, Shri Ved Parkash-life assured (deceased) was not having any previous disease history at the time of obtaining the insurance policy. On the other hand, as per the version of learned counsel for respondents-OPs, he had a history of diabetes prior to the signing of proposal form. However, it is nowhere mentioned in the death certificate that deceased-life assured died due to any kind of disease as well as it is nowhere mentioned in the treatment history of deceased that he was a diabetic patient. Moreover, perusal of insurance claim form clearly mentioned that he died due to heart attack and sudden breathlessness on way to hospital. However, learned District Commission failed to consider these facts. Moreover, to prove his contentions, learned counsel for appellants placed on record the judgment passed by this Commission in Appeal No.1249 of 2017 in case titled as “The Branch Manager, Max New York Life Insurance Co. Ltd. Vs. Sanjeet & Ors.” decided on 14.05.2024 and judgment passed by Punjab State Consumer Disputes Redressal Commission in First Appeal No.1385 of 2006 in case titled as “Life Insurance Corporation of India Vs. Satwinder Kuar” decided on 30.04.2008. Facts and circumstances of these judgments are fully applicable in the present case in hand.

11.              In view of the above observations and discussion, impugned order dated 17.04.2017, passed by learned District Commission, Kaithal is set-aside and present appeal stands allowed in aforesaid terms. Respondents-OPs are directed to release the claim amount of Rs.5,48,900/- in favour of appellants-complainants along with interest @ 6% p.a. from the date of repudiation of the claim till its realization.  Apart from this, the appellants are also entitled to an amount of Rs.21,000/- (Rs. Twenty one thousand only) on account of compensation for mental and physical agony and Rs.11,000/- (Rs. Eleven thousand only) as litigation charges. It is also made clear that in case of non-compliance of the aforesaid order by the respondents-OPs, the provisions enshrined under section 72 of the C.P. Act would also be attractable.

12.              A copy of this order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 2019. This order be uploaded forthwith on the website of the Commission for the perusal of the parties.

13.              Application(s), pending, if any, stands disposed off in terms of the aforesaid order.

14.              File be consigned to record room alongwith a copy of this order.

 

Pronounced on 19^th June, 2024                                        S.C Kaushik

                                                                                                            Member                                                                                                                                 Addl. Bench-III