Per – Hon’ble Mr. P. N. Kashalkar, Presiding Judicial Member
This is a consumer complaint filed by the Complainants, father and mother whose son was insured with the Opponent No.1, namely – Max New York Life Insurance Co. Ltd. (hereinafter referred to as ‘the Insurance Company’ for the sake of brevity) and who expired on 20/8/2009. Since the death claim was not paid by the Insurance Company, the Complainants have filed this consumer complaint alleging deficiency in service on the part of the Opponents. Facts to the extent material may be stated as under:-
[2] The Complainants are the father and mother of their deceased son, namely – Mr. Jagdish Rajaram Ganbote who was working with a company, namely – Avaya (MNC) MagarpattaCity, Hadapsar, Pune for 05-06 years and having salary of `50,000/- per month. He was their only son. Their son had taken a life insurance policy from the Insurance Company by filing proposal form on 30/4/2009. Sum assured was of `20,00,000/- and the annual premium payable was `50,000/- but payable quarterly @ `12,500/- per quarter. Maturity of the said insurance policy was 12/5/2052. After medical check up of blood and urine, the Insurance Company found that Late Mr. Jagdish Rajaram Ganbote was fit to be given an insurance policy and, therefore, on 12/5/2009 life insurance policy was issued by the Insurance Company to the Complainant’s son, namely – Mr. Jagdish Rajaram Ganbote. The Complainants pleaded that their son Late Mr. Jagdish Rajaram Ganbote suffered pain in abdomen in left side and he was admitted to Ruby Hall Clinic, Pune on 12/5/2009 and he was discharged on 23/5/2009. Thereafter, Late Mr. Jagdish Rajaram Ganbote was admitted in Galaxy Care Laparoscopy Institute, Pune and was discharged on 2/7/2009. But unfortunately it was found that the Late Mr. Jagdish Rajaram Ganbote was suffering from ‘Renal Cell Carcinoma with Lung Metastasis’. Thereafter, Late Mr. Jagdish Rajaram Ganbote resumed duties and he was under treatment of Dr. Shimpi from Ruby Hall Clinic, Pune for ‘Renal Cell Carcinoma with Lung Metastasis’. Thereafter, Late Mr. Jagdish Rajaram Ganbote was admitted to PoonaHospital and Research Centre on 4/7/2009 for treatment but he expired in the said hospital on 20/8/2009. According to the Complainants, their son – Late Mr. Jagdish Rajaram Ganbote did never know that he was suffering from ‘Renal Cell Carcinoma with Lung Metastasis’ prior to purchasing of the insurance policy from the Insurance Company. After the death of their son, the Complainants informed the Insurance Company about the sad demise of their son, Mr. Jagdish by a letter dated 2/12/2009. The Insurance Company demanded certain documents. As per the requirement of the Insurance Company the Complainants had sent treatment certificate on 5/1/2010 for the past five years of Dr. S. Y. Dhende and in that certificate Dr. S. Y. Dhende nowhere revealed that for the past five years Late Mr. Jagdish Rajaram Ganbote was suffering from ‘Renal Cell Carcinoma with Lung Metastasis’. On 13/11/2009 the Complainants submitted Death Claim Form but, the Insurance Company sent a letter repudiating their claim by a letter dated 27/3/2010 on the ground of non-disclosure of medical treatment taken by their son and sent a cheque for `10,200.64ps., against the insurance policy and returned copy of the proposal form. The Complainants pleaded that repudiation of their insurance claim was improper. The Complainants alleged deficiency in service and filed this consumer complaint for claiming an amount of `20,00,000/-, the sum assured on account of death of their son Late Mr. Jagdish Rajaram Ganbote and also claimed first premium amount of `12,500/- together with interest thereon @ 9% p.a., besides an amount of `10,000/- by way of compensation towards mental agony and `10,000/- towards costs.
[3] Notices were issued to the Opponents. Relying upon service affidavit filed by Mr. Rajaram R. Ganbote, the Complainant No.1, in terms of Section 28-A of the Consumer Protection Act, 1986 and after seeing the postal acknowledgement receipts in respect of service of notices to the Opponents Nos.3, 4 and 5, this Commission was pleased to proceed without written version of the Opponents Nos.3, 4 and 5 and the Complainants were directed to take appropriate steps to ensure due service of notice to the Opponents Nos.1 and 2. An affidavit of service was filed by the Complainant No.1 on 10/1/2012 and it was revealed from the service affidavit that the Opponent Nos.1 and 2 were duly served and since the Opponents Nos.1 and 2 were absent they were proceeded without written version. Thereafter, we directed the Complainants to file evidence affidavit in terms of Section-13(4) of the Consumer Protection Act, 1986. Accordingly, the Complainant filed his evidence affidavit on 19/3/2012.
[4] We heard submissions of Adv. Vinayak G. Kulkarni on behalf of the Complainants. None appeared on behalf of the Opponents.
[5] We are finding that proposal was submitted by Late Mr. Jagdish Rajaram Ganbote, son of the Complainants on 30/4/2009 and insurance policy was issued on 12/5/2009 by the Insurance Company. On 12/5/2009 itself life assured was admitted in Ruby Hall Clinic, Pune and from that date till 23/5/2009 he was an indoor patient of Ruby Hall Clinic, Pune as is revealed from the Discharge Card. On 12/5/2009 itself life assured was diagnosed with ‘Renal Cell Carcinoma with Lung Metastasis’. Even after discharge of Late Mr. Jagdish from Ruby Hall Clinic, Pune he was taking treatment in various hospital and ultimately he was admitted to Poona Hospital and Research Centre on 4/7/2009 and he expired on 20/8/2009 while taking treatment at Poona Hospital and Research Centre as is clear from the Case/Death Summary issued by Poona Hospital and Research Centre which is appended to affidavit at page (84). The Insurance Company sent repudiation letter on 27/3/2010 wherein it was mentioned that it had received proposal form from Late Mr. Jagdish at their office on 30/4/2009 and insurance policy was issued on 12/5/2009. In the proposal form Late Mr. Jagdish Rajaram Ganbote gave a declaration that he had made complete, true and correct disclosure of facts and circumstances as may be relevant for acceptability of the proposal form. However, he had answered Part-D of the proposal form in the negative. He was specifically asked –
“Q3. Have you ever been investigated, treated or diagnosed with any of the following conditions, if yes, please provide the details including doctor’s name and dates (or attach relevant questionnaire)
x) Any tumor or growth (Malignant or benign)”
[6] According to repudiation letter admission-cum-discharge card issued by Ruby Hall Clinic mentioned that life assured was admitted in Ruby Hall Clinic on 12/5/2009 and was diagnosed for ‘Renal Cell Carcinoma with Lung Metastasis’. Thus, according to the Insurance Company’s repudiation letter, the life assured was a case of ‘Renal Cell Carcinoma with Lung Metastasis’ prior to issuance of insurance policy and as the effective date of the insurance policy was 12/5/2009, in the proposal form dated 30/4/2009 Late Mr. Jagdish Rajaram Ganbote had not disclosed that he was suffering from ‘Renal Cell Carcinoma with Lung Metastasis’ which was prior to the signing of the proposal form and hence, the Insurance Company was returning an amount of `10,200.64ps., against the insurance policy issued to Late Mr. Jagdish Rajaram Ganbote. We are also finding that the employer of Late Mr. Jagdish Rajaram Ganbote had issued a certificate to the Insurance Company which is appended at page (102) of the complaint compilation wherein it has been mentioned that Late Mr. Jagdish was on leave for a period of 33 days from 5/5/2009 to 19/6/2009. Then again he was on leave for a period of 20 days from 29/6/2009 to 24/7/2009. Thereafter he was again on leave for a period of 05 days from 27/7/2009 to 31/7/2009. What is pertinent to note is the fact that immediately after he had signed proposal form on 30/4/2009, on the fifth day before the insurance policy was issued, Late Mr. Jagdish was on leave for a period of 33 days and during the leave period, on 12/5/2009 he was issued an insurance policy by the Insurance Company, covering his life. It was his duty to disclose at-least on 5/5/2009 that he was on a long leave for a period of 33 days. Before issuance of insurance policy on 12/5/2009 Late Mr. Jagdish Rajaram Ganbote was already availing a long leave for the obvious reason that he was suffering from ailment which he had not disclosed to the Insurance Company. What is pertinent to note is the fact that on the day when the insurance policy was issued, Late Mr. Jagdish Rajaram Ganbote was already admitted to Ruby Hall Clinic, Pune for treatment of ‘Renal Cell Carcinoma with Lung Metastasis’. When these are the facts disclosed by the documents produced on the record by the Complainants themselves we are of the view that the Insurance Company was justified in repudiating the insurance claim preferred by the Complainants on account of death of their son, Late Mr. Jagdish Rajaram Ganbote. We are finding that this is not a case wherein we can safely hold the Insurance Company was guilty of deficiency in service in repudiating the claim lodged by the Complainants. Circumstances on the record do create voluminous doubt about the authenticity and truthfulness of the insurance claim preferred by the Complainants with the Insurance Company. So, though the Opponents have been proceeded ex-parte, we are not inclined to allow this consumer complaint.
Hence, we pass the following order:-
ORDER
The complaint stands dismissed.
No order as to costs.
Inform the parties accordingly.
Pronounced on 23rd April, 2012
