BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
Complaint No.: 134 of 2015.
Date of Institution: 29.4.2015.
Date of Decision: 26.02.2019.
Smt. Maya Devi widow of Shri Kirori Lal, resident of village Dangar, Post Office Jui Khurd, Tehsil & District Bhiwani.
….Complainant.
Versus
- Branch Manager, Max New York Life Insurance Corporation, 1st Floor, Biju Tower, Meham Gate, Bhiwani-127021. (Given up)
- Branch Manager, Max New York, Life Insurance Corporation, Operation Centre, Plot No.90A, Sector-18, Udyog Vihar Gurgaon-122015 (Haryana).
…...Opposite Party.
COMPLAINT UNDER SECTIONS 12 AND 13 OF
THE CONSUMER PROTECTION ACT, 1986.
Before: - Hon’ble Mr. Manjit Singh Naryal, President.
Hon’ble Mr. Parmod Kumar, Member.
Hon’ble Mrs. Saroj Bala, Member.
Present: Shri Gulshan Kohli, Advocate for the complainant.
Shri Gagandeep Makkar, Advocate for the OP No. 2.
OP No. 1 already given up.
ORDER:-
PER MANJIT SINGH NARYAL, PRESIDENT
The case of the complainant in brief, is that the complainant the husband of the complainant was posted as Beldar in the Irrigation department and has taken a Policy No.845476647 for Rs.4,50,023/- from the OP by paying Rs.16,280/- as premium and the complainant was the nominee of the above policy. It is alleged that the complainant is illiterate and her husband was died due to heart attack on 7.8.2011 at the house and he was not suffering from any other disease. It is further alleged that after several months from the death of the husband of the complainant, when she was searching some documents, the papers of the policy in question were found. It is further alleged that complainant approached the office of OP at Bhiwani and they assured for the payment of the amount of insurance policy. It is further alleged that complainant has moved an application with the office of the OP at Bhiwani, but no action was taken by the OP. It is further alleged that the complainant again visited the office of the OP at Bhiwani and they again demanded the application and on this complainant has moved the application again, but again the payment of insurance amount was made by the OP. It is further alleged that the complainant has got served a legal notice on 23.3.2015 through her Advocate Shri Gulshan Kohli, but to no effect. Thus, there is deficiency in service on the part of the OP. Hence, the complainant has to file the present complaint.
2. The notice to the OP No. 1 could not be served for want of correct address and after that ld. counsel for the complainant has given the OP No. 1 vide his statement dated 28.11.2016.
3. OP No. 2 appeared and has filed contested written statement alleging therein that the complaint is barred by limitation, because cause of action has arose with the repudiation of claim in February, 2012 and the complaint has been filed in the year 2015 i.e. much after the expiry of two years. It is further alleged that the claim of the complainant was repudiated on account of non-disclosure of material medical facts, as it has clearly been revealed from the treatment documents procured by the investigation that the deceased life assured was Paralysis and Adeno Carcinoma Prostrate i.e. Cancer i.e. prior to signing the proposal form and was undergoing chemotherapy on 22.1.2011 at O. P. Jindal Institute of Cancer & Research, Hisar. It is further alleged that the proposal form was filed by the deceased life assured on 26.4.2011 and on the basis of the same the policy was issued on 4.5.2011. It is further alleged that the deceased life assured was suffering from Cancer and it is clear that he was well aware of his medical condition at the time of signing of the proposal form, yet chose not to disclose the same. It is further alleged that the OP company has received the intimation on 23.1.2012 regarding the death of life assured on 7.8.2011 and the complainant has provided the death certificate of the deceased life assured alongwith death claim application form and other relevant documents. It is further alleged that the deceased life assured has expired on 7.8.2011 due to Paralysis and Cancer and not due to heart attack, as alleged by the complainant. It is further alleged that the deceased life assured was suffering from Paralysis and Adeno Carcinoma Prostrate i.e. Cancer since 2010 and was undergoing chemotherapy. It is further alleged that on the basis of the information procured during the investigation, the OP company rightly repudiated the mediclaim submitted by the complainant towards the policy in question. So, there is no deficiency in service on the part of OP. Hence, the complaint is liable to be dismissed with costs.
4. Ld. Counsel for the complainant has placed on record the documents Annexure C1 to C11 in evidence and closed the evidence.
5. Ld. Counsel for the OP has placed on record documents Annexure R1 to R8 & closed the evidence.
6. We have heard both the parties at length and have gone through the case file carefully.
7. Learned counsel for the complainant reiterated the contents of the complaint. Ld. Counsel for the complainant has contended that merely the insurer had withheld correct information regarding cause of cataract is not sufficient to repudiate the claim. So, matter of repudiation of policy should not be dealt with a mechanical and routine way but should be one of the extreme care and caution. Hence, repudiation of claim of the complainant vide letter dated 23.2.2012 is illegal and liable to be set aside and the complaint of the complainant is liable to be accepted.
8. The main argument of ld. Counsel for the OP is that the complaint of the complainant is liable to be dismissed being time barred, as the claim was repudiated in February, 2012 and the complaint was filed on 29.4.2015 i.e. much after 2 years, so it is hopelessly time barred. He further argued that the life assured was not honest in making the disclosure about his state of health when the proposal form was filled up by him. He further contended that in view of these circumstances the claim of the complainant was rightly repudiated. Hence, the complaint of the complainant is liable to be dismissed.
9. In our view, the argument of ld. Counsel for the OP has merit, because the cause of action has arisen to the complainant firstly on 7.8.2011 the date of death of life assured and secondly in the month of February, 2012 i.e. the date of repudiation of claim. The complainant has filed the present complaint on 29.4.2015 i.e. after more than three years and two months from the date of cause of action, whereas the complaint could be filed within two years from the date when the cause of action has arisen, as per the Section 24-A of the Consumer Protection Act. Section 24-A of the C. P. Act is reproduced as under: -
“24-A. Limitation period. (1) The district Forum, the State Commission or the National Commission shall not admit a complaint unless it is filed within two years from the date on which the cause of action has arisen.
(2) Notwithstanding anything contained in sub-section (1), a complaint may be entertained after the period specified in sub-section (1), if the complainant satisfies the District Forum, the State Commission or the National Commission, as the case may be, that he had sufficient cause for not filing the complaint within such period.
Provided that no such complaint shall be entertained unless the National Commission, The State Commission or the District Forum, as the case may be, records its reasons for condoning such delay”.
No such application for condonation of delay has been moved nor request was made. So in view of the provisions laid down above, the complaint is hopelessly time barred, as mentioned above.
10. Moreover, on merit also, the complaint of the complainant deserves dismissal. It is admitted fact that husband of complainant had obtained insurance policy in question for a sum of Rs.4,50,023/-. It is also admitted fact that the life assured died on 7.8.2011. During investigation, it was revealed that the deceased life assured was suffering from Paralysis and Adeno Carcinoma Prostrate i.e. Cancer and was undergoing chemotherapy on 22.1.2011 at O. P. Jindal Institute of Cancer & Research, Hisar i.e. before he proposed for life insurance. The proposal form was filled up by the life insurer on 26.4.2011 and prior to obtaining the insurance policy he was diagnosed for the disease of Paralysis and Adeno Carcinoma Prostrate i.e. Cancer. It has come in evidence that he was admitted in the O. P. Jindal Institute of Cancer & Research, Hisar for chemotherapy.
So, from the treatment documents of O. P. Jindal Institute of Cancer & Research, Hisar, it is clear that all these answers made by the insured are false, as he had been suffering from Paralysis and Adeno Carcinoma Prostrate i.e. Cancer before proposal. Thus, he had made deliberate incorrect statement and withheld correct information from the OP regarding his health at the time of effecting insurance. So, the life assured concealed the material facts at the time of obtaining insurance policy and he had also given false answer to the questions and had made deliberate statement. Therefore, the proposer made false statement in the proposal form knowingly that he was making false statement and OP accepted the risk in the misconception that the false statement was in fact the true. Had the proposer made correct statements then the OP Company might have conducted more enquiries/medical investigation before accepting the proposal. Therefore, in view of the facts mentioned above, the life insured did not make a true disclosure of facts regarding the state of his health. The life assured indulged into suppression of material facts regarding the state of his health at the time he took the policy and filled up the proposal form. So, in view of the circumstances the repudiation of claim of the complainant is perfect, legal and valid. Hence, the complaint of the complainant is dismissed being time barred as well as on merits with no order as to costs.
Certified copies of the order be sent to parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: 26.02.2019.
(Saroj Bala) (Parmod Kumar) (Manjit Singh Naryal)
Member. Member. President,
District Consumer Disputes
Redressal Forum, Bhiwani.
