BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KAITHAL.
Complaint no.82/16.
Date of instt.: 28.03.2016.
Date of Decision: 17.04.2017.
1. Veena Goyal wd/o Sh. Ved Parkash, s/o Sh. Om Parkash 2. Pooja 3. Ritu ds/o Ved Parkash 4. Chiraj s/o Ved Parkash
..all residents of H.No.247/10, Ward No.13, New Ashoka Colony, Kaithal.
……….Complainants.
Versus
- Max Life Insurance Co. Ltd., Plot No.90-A, Sector-18, Udyog Vihar, Gurgaon-122015 (Haryana).
- Max Life Insurance Co. Ltd., Head Office 11/12th Floor DLF Square JACARANDA Marg DLF City, Phase-II, Gurgaon (Haryana).
..……..Opposite Parties.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Sh. Jagmal Singh, President.
Sh. Rajbir Singh, Member.
Smt. Harisha Mehta, Member.
Present : Sh. Vinay Verma, Advocate for complainants.
Sh. Manoj Ichhpilani, Advocate for the Ops.
ORDER
(JAGMAL SINGH, PRESIDENT).
The complainants have filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that the husband of complainant No.1 and father of complainants No.2 to 4 namely Ved Parkash took one insurance policy bearing No.709080923 from the Ops on 14.03.2014. It is alleged that the life assured died on 25.08.2014. It is 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 dt. 29.11.2014. The said repudiation of claim is wrong and illegal. This way, the Ops are deficient in service. Hence, this complaint is filed.
2. Upon notice, the opposite parties appeared before this forum and filed reply raising preliminary objections with regard to maintainability; cause of action; locus-standi; that the claim of complainants was repudiated on account of non-disclosure of material medical facts; that it has clearly been revealed from the treatment documents procured by 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 is pertinent to mention here 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 weakness in the right side of body and was evaluated in Amar Hospital and also had altered Sensorium in March, 2014 after CVA. There is no deficiency in service on the part of answering Ops. On merits, the contents of complaint are denied and so, prayed for dismissal of complaint.
3. In support of their case, the complainants tendered in evidence affidavit Ex.CW1/A and documents Ex.C1 to Ex.C3 and Mark-C1 and closed evidence on 19.12.2016. On the other hand, the Ops tendered in evidence affidavit Ex.RW1/A and documents Annexure-R1 to Annexure-R7 and closed evidence on 23.02.2017.
4. We have heard ld. counsel for both the parties and perused the case file carefully and minutely and have also gone through the evidence led by the parties.
5. Ld. Counsel for the complainants reiterated all the points mentioned in the complaint. He argued that the husband of complainant No.1 and father of complainants No.2 to 4 namely Ved Parkash took one insurance policy bearing No.709080923 from the Ops on 14.03.2014. He further argued that the life assured died on 25.08.2014 and the complainants lodged the claim with the Ops and submitted all the necessary documents but the Ops repudiated the claim of complainant vide letter dt. 29.11.2014. On the other hand, ld. Counsel for the Ops argued 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 weakness in the right side of body and was evaluated in Amar Hospital and also had altered Sensorium in March, 2014 after CVA. He further argued that the diseased life assured (DLA) had not disclosed the material facts regarding his health at the time of purchase of the policy in question. He further argued that the DLA had concealed the material facts and gave wrong information in the proposal form at the time of purchase of the policy. He further argued that the insurance policy was issued on the basis of information and disclosure provided in the proposal form by the DLA. Ld. Counsel for the Ops referred the authorities which were mentioned in the reply i.e. P.C.Chacko Vs. Chariman, LIC & others (2008) 1 SCC 321 and Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd., SC 2776 of 2002.
6. From the pleadings and evidence of the parties, it is clear that the claim of the complainants has been declined by the Ops on account of non-disclosure of material medical facts. The Ops have got investigated the case of DLA from NNB Services Pvt. Ltd., New Delhi and the investigator found that the life assured was suffering from CVA since 13.03.2014, DM and HTN and taken treatment from PGI, Chandigarh as an OPD patient and the life assured was suffering from DM since the last 18 years. The Ops have placed on the file a photo-copy of treatment record of PGI Chandigarh as Annexure R6. In Annexure-R6, it is mentioned that CVA on 13.03.2014 on its second page CVA (Old) is mentioned. From Annexure R-6, it is clear that the DLA was suffering from CVA (Old) prior to purchase of the policy in question. From Annexure-R6 it is also clear that the DLA was having T2 DM for the last about 18 months. The Ops have referred the proposal form Mark-C1, the clause E(3) of which runs as under:-
Clause E(3): Have you ever been investigated, treated or diagnosed for:
- Chest pain, heart attack, stroke, reheumatic fever, heart mumur, palpitation, shortness of breathe or any other heat condition.
- Diabetes
This was duly answered “No’ by the deceased life assured.
From the proposal form, it is clear that the DLA has given wrong information in the proposal form. The policy in question was issued on the information provided by the DLA in the proposal form. The insurance is a contract. Every material fact must be disclosed in the proposal form, otherwise, there is a good ground for recession of the contract. The proposal form is to be filled in by the proposer for insurance for furnishing all material information required by the insurer to decide whether to accept or decline to undertake the risk. If the proposer furnished correct information, then it was for the insurer whether to insured the life of the proposer or not. In the present case, the insurance policy was obtained by the DLA by mis-representation of material medical facts. So, we found force in the contention of the Ops. In the facts and circumstances of the case, we are of the considered view that the Ops have rightly declined the claim of complainants.
7. Thus, as a sequel of above discussion, we find no merit in the complaint and the same is hereby dismissed. No order as to costs. A copy of this order be sent to both the parties free of costs. File be consigned to the record room after due compliance.
Announced.
Dt.17.04.2017.
(Jagmal Singh),
President.
(Harisha Mehta), (Rajbir Singh),
Member. Member.
