NCDRC

NCDRC

RP/1930/2008

BIRLA SUN LIFE INSURANCE CO. LTD - Complainant(s)

Versus

MS. SUDHA DHARMENDRA THAKUR & ANR - Opp.Party(s)

MR. PANKAJ SETH

01 Apr 2010

ORDER


NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSIONNEW DELHIREVISION PETITION NO. 1930 OF 2008
(Against the Order dated 31/05/2007 in Appeal No. 679/2007 of the State Commission Maharastra)
1. BIRLA SUN LIFE INSURANCE CO. LTD KAPILA TOWER, C - GR. F/R, 1ST R. T. O., DR. AMBEDKAR ROAD, PUNE - 411001 ...........Petitioner(s)
Versus
1. MS. SUDHA DHARMENDRA THAKUR & ANR RESIDENT OF VIDTASAGAR COLONY, SAISBURY PARK, PUNE - 4110372. MS. ANUPAMA DHARMENDRA THAKURRESIDENT OF VIDYASAGAR COLONY,SAISBURY PARK,PUNE - 411037 ...........Respondent(s)

BEFORE:
HON'BLE MR. JUSTICE B.N.P. SINGH ,PRESIDING MEMBERHON'BLE MR. S.K. NAIK ,MEMBER
For the Petitioner :NEMO
For the Respondent :NEMO

Dated : 01 Apr 2010
ORDER

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Deceased Dharmendra Thakur, husband of respondent No. 1 and father of respondent No. 2 who was in employment of Cosmos Co-operative Bank Ltd having secured loan from Bank, availed insurance coverage of petitioner – insurance company provided to individuals and group of individuals, there being a tie-up between Goel Group and Citi Bank, covering risk of such borrowers. Risk covered by insurance company in case of deceased under policy, was for Rs. 9,55,000/- and it was effective for 24 months terminating in September, 2006. As ill-luck would have it, insured died of heart-attack on 29.08.2004. Widow of deceased - insured submitted her claim with petitioner – insurance company through Citibank, which was repudiated holding that insured had suppressed material information as for ‘pre-existing disease’ and submitted false health declaration as for ‘status of his health’. Aggrieved with repudiation, a consumer complaint was filed which was resisted by petitioner – insurance company denying deficiency in service on their part. District forum, however, having over-ruled contentions raised on behalf of petitioner – insurance company, accepted complaint, directing insurance company to pay assured value to claimants along-with interest. Appeal too, preferred by insurance company did not find favour with State Commission, there being no affidavit of Doctor who treated deceased – insured for ailment which he is shown to have suffered. State Commission while upholding finding of District Forum, also took notice of contentions raised on behalf of respondents that though two death reports suggesting cause of death of insured had been put on record purported to have been issued by N.M. Wadia Institute of Cardiology, while in first report, deceased having suffered Diabetes Mellitus was conspicuously wanting, it was very much eloquent in subsequent death report, and that apart, there was no affidavit of a Doctor who issued these reports. We too share anxiety of respondents that when genuineness of death report was seriously disputed, in all fairness, there should have been affidavit of doctor issuing these reports, or of even personnel of hospital. Counsel appearing for petitioner – insurance company would draw our attention to treatment papers put on record issued by N. M. Wadia Institute of Cardiology in which insured is shown to have been admitted on 29.08.2004. Records do show that since deceased did not respond to treatment and died in hospital on 29.08.2004 itself where he was admitted, having brought from Pune. Though it was sought to be urged on behalf of respondents that subsequent death report in which, along-with Cardio-respiratory arrest, Diabetes Mellitus too, was also suggested to be cause of death, last two words occurring therein “Diabetes Mellitus” was a subsequent addition in a different handwriting, we do not wish to give much credence to them, there being other vital issues meriting consideration. Claim of respondents was repudiated by insurance company on premises of suppression of material information as for ‘status of health’ of insured and also, deceased having suffered ‘diabetes mellitus’. Though treatment papers issued by N.M. Wadia Institute do show treatment of deceased in hospital on 29.08.2004, there was no treatment paper worth consideration put on record by insurance company suggesting insured having undergone treatment for such ailment preceding 29.08.2004. Since health declaration was made by insured on 13.08.2004, for repudiating claim on premises of suppression of material information as for ‘pre-existing disease’, insurance company was burdened with responsibility to put credible evidence on record to draw a conclusion that not only that he was aware of such disease but also that he had secured treatment for such treatment before making health declaration on 13.08.2004. We must say that insurance company has not discharged its obligations to put on record evidence of such unimpeachable character. Once parties have entered into a contract of insurance, genuine claim of insured cannot be rejected simply on suspicion and untenable premises. While fighting losing battle, learned counsel for insurance company would lastly urge that since it was a group insurance scheme, there was no individual medical check-up by panel doctor of company and had deceased been medically examined, insurance coverage would not have been provided. This argument does not impress us as we have to accept situation as it is without speculating as to what would have been had there been different situation. Findings so recorded by State Commission cannot be faulted and hence we affirm concurrent findings and dismiss the revision petition accordingly, with no order as to cost.



......................JB.N.P. SINGHPRESIDING MEMBER
......................S.K. NAIKMEMBER