Delhi

New Delhi

CC/28/2017

Rehka Jain - Complainant(s)

Versus

M/s Life Insurance Corporation Of India - Opp.Party(s)

13 Dec 2019

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTRICT NEW DELHI,  M-BLOCK, 1^ST FLOOR,

VIKAS BHAWAN, I.P. ESTATE. NEW DELHI-1100001.

 

C.C.No.28/2017

 

Smt. Rekha Jain,

W/o Sh. Naresh Chand Jain,

R/o House No.F-67, West Jwaher Park,

Gali No.10, Laxmi  Nagar, Delhi-92.                                                                       

….Complainant

Vs.

 

1. Life Insurance Corporation of India Ltd.,

         Through its Managing Director/s

        Zonal Manager, LIC,

         Northern Zonal Office,

       Connaught Circus, New Delhi-110001.

 

2. Sr. Divisional Manager of LIC,

         Divisional Office, 

        9^th Floor, Scope Minar,

        Laxmi Nagar, Delhi-92.

    …Opposite Party

NIPUR CHANDNA, MEMBER

 

O R D E R

 

 

The complainant has filed the  present complaint under section 12 of Consumer Protection Act.  The gist of the complaint is that the complainant is the nominee of the DLA(Deceased Life Assured) in policy bearing No.126182683 issued by the OP. The DLA Mr. Rahul Jain had died on 10.6.2014 leaving behind the complainant i.e. mother, Sh. Naresh Jain, father and his son, Master Shanshak, 9 years old.  Death of the DLA was a natural death and the complainant and her husband are only to look after his minor son. The DLA had paid the premium of the policy in question regularly without any default.   After his death, the complainant being the nominee applied for assured amount of policy taken by her son to the OP.  The OP already cleared the insured amount of policy bearing No.126175119 for a sum of Rs.5,95,000/- to the  complainant.  She  also applied for release of assured amount of Rs.10 lacs under the policy in question.  The complainant completed all the formalities and submitted all the required documents  including medical treatment paper of DLA with OP but OP repudiated the claim of complainant  on false, baseless and flimsy  ground vide letter dt.12.3.2015. Despite several requests and follow up OPs failed to resolve the matter of complainant, hence this complaint.

 

2.     Complaint has been contested by the OP. OP denied any deficiency in service on its part. It is further stated that the complainant has concealed the material facts from OP at the time of taking the policy bearing No. 126182683 on 28.8.2011.  It is submitted that DLA was suffering from pre-existing diseases i.e.   hypothyroidism and diabetes before the inception of the policy and got the treatment for the same in the hospital at AIIMS, New Delhi. Therefore, present complaint is not maintainable and her claim is rightly repudiated vide letter dt.12.3.2015 due to concealment of material facts and pre-existing disease. The complaint be dismissed on this ground alone.

3.     Both the parties have filed their respective evidence by way of affidavits.

4.     We have heard arguments advance at the bar and peruse the records.

5.     Some facts are not denied by the OP  such as the policy documents, death of DLA, the sum insured paid against policy bearing No. 126175119 for a sum of Rs.5,95,000/- .  The OP, however, rejected the claim of the complainant arising out of the policy bearing No. 126182683 on the ground of suppression of material facts by the DLA  in the Proposal Form submitted while taking the policy in question. 

6.        It is argued on behalf of complainant that the Proposal Forum signed by the DLA was also verified by the OP. 

   If the  insurance company was not satisfied with the information, the OP ought to got the insured medically examined 

and after being satisfied that insured was hale and hearty and was not suffering with any disease, policy was issued to 

the insured, but the OP failed to do so and raising the false and frivolous plea to escape from the liability. 

7.      In order to prove that deceased was suffering from earlier ailment and was treated for that, 

   the insurance company has relied upon the General Registration Record of AIIM, New Delhi, which it has placed on record. 

 The perusal of the same shows that the copies of the record does not bear the signature of treating doctor. 

 This document on which the insurance company is relying in order to prove earlier admission of the deceased insured for

 this treatment also does not bear the stamp of the doctor.  No admission document or discharge certificate has been 

produced on record.  No certificate of treating Doctor of hospital has been placed on record.   No substantive evidence 

to prove the earlier treatment of insured in any hospital prior to issuance of insurance policy has been placed on record

 by the OP to substantiate their contention.  

8.     In view of the above document, we come to the conclusion that the DLA  was physically fit, hale and hearty and not suffering with any disease on the date when the policy was issued.  It may be noted that at the time of earning profit O.P. accepted the said proposal form. However, as soon as liability arose, O.P. went to disbelieve the same.

9.     Thus we are of the considered view that the policy in question was issued on the basis of physical condition of the deceased and he had been found physically fit and, therefore, it cannot be said that any suppression or any earlier ailment had vitiated the contract of issuing policy to the deceased insured.  A contract of this nature cannot be termed bad and be terminated on ground of having obtained by fraud or can be declared as vitiated on facts which were not in existence on the day of contract.  There is no evidence that the deceased insured was suffering with any disease on the day the policy was issued to him. Reliance has been placed on the recent judgment of Hon’ble National Commission titled as Ratna Vs. LIC & 2 in RP. No.1151/2017 dt. 7.11.2019.

10.    In view of the above discussion and the judgment cited above, the repudiation of claim of the complainant by OP is unjustified amounting to deficiency in services on its part.  We therefore, hold OP guilty of deficiency in services and direct it as under:

1. Pay to the complainant for a sum of Rs.10,00,000/-(sum assured) alongwith 9% interest from the date of filing of complaint i.e. 18.1.2017 till realization.

 

2. Pay to the complainant  a sum of Rs. 10,000/- on account of mental agony and harassment which will also include the cost of litigation.

 

The order shall be complied within 30 days of the receipt of the order. If the said amount is not paid by the OP within a period of one month from the date of receipt of this order, the same shall be recovered by the complainant along with simple interest at the rate of 9% per annum from the date of this order till recovery of the said amount. This final order be sent to server (www.confonet.nic.in ). A copy each of this order each be sent to both parties free of cost by post. File be consigned to Record Room.

 

Announced in open Forum on  13/12/2019.

 

 

 

      (ARUN KUMAR ARYA)

  PRESIDENT

                        (NIPUR CHANDNA)                                                (H.M. VYAS)

                            MEMBER                                                                MEMBER