Delhi

New Delhi

CC/993/2010

Urmila Makkar - Complainant(s)

Versus

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

23 Nov 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI),

 ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN, I.P.ESTATE, NEW DELHI-110001.

 

 

Case No.C.C./993/10              Dated:

In the matter of:

Urmila Makkar

W/o Late Sh. Raj Kumar Makkar,

R/o House No.C-157,

Naraina Industrial Area, Phase-I,

New Delhi

 

……..COMPLAINANT

VERSUS

THE LIFE INSURANCE CORPORATION OF INDIA

REPRESENTED THROUGH ITS CHAIRMAN

Having its Registered Office at:

“YOGAKSHEMA”

JEEVANBIMA MARG,

MUMBAI-400021

 

And having its Zonal Office at:

 

“JEEWAN BHARTI”

P.B. NO. 630

CONNAUGHT CIRCUS

NEW DLEHI – 110 001

 

And having its Delhi Divisional Office-II at

 

9^TH FLOOR, “SCOPE MINAR”

LAXMI NAGAR

DELHI-110 092

 

And having its branch office at:

 

IIP, WAZIRPUR

DELHI.

 

      ............ OPPOSITE PARTY

 

ORDER  

President: C.K. Chaturvedi

        This complaint is against repudiation of claim of husband of complainant, who was insured with OP in 2005, and unfortunately died in 2007, due to 3^rd stage of Chronic Kidney Disease, which presented as a cancer and he died after Chem otherapy Treatment, as shown by Fortis Hospital Deptt, of Nephrology – Discharge Summary.  The claim made by nomine wife was repudiated on the ground that deceased while taking policy had suppressed the PCNL of left kidney done in 2005 for removal of stones.  Earlier in 1990, he had undergone the same procedure for right kidney. But in the proposal form, and in the medical examination/test conducted at the time of issue of policy, he did not disclose these facts, and stated that there was no kidney disease, by writing ‘No’ again the column needing this information.

        The case of the complainant was that he was medically examined by OP and cleared before taking policy.  It is also argued that OP can not repudiate the claim under section 45 of the Insurance Act, after 2 years of the policy.  The complainant has placed all the documents on record which are Exhibit 1.   

        We have considered the rival case and pursued the records.  The sole question for consideration is whether OP made a material suppression of information, by not mentioning PCNL of left of kidney in 2005, before taking the policy.  There is no dispute on the Discharge Summary issue by Fortis Hospital on 7/5/2007 and death on 30/5/2007.

        The question for consideration is whether the  PCNL, which is surgical procedure for removal of stone done in 1990 and 2005, could be called a ‘disease’ and its non-disclose whether amount to material suppression  within the mentioning of Section 45 of the Insurance Act  which permit repudiation in such case of material suppression of facts.  In our considered view, keeping in view the severe nature of kidney disease of both kidneys, which developed to the stage of Cancer, it was criminal on the part of proposer of insurance to keep silent  and to give a ‘No’ reply.  It was a deliberating suppression of facts.  The OP cannot be said to be deficient in the fact of these facts for repudiating claim.  The complaint is dismissed. 

       

 

 

In view of these facts, the OP   could be faulted and no deficiency is committed.    

        The complaint is dismissed.

        File be consigned to Record Room.

                                                                                                                          

(C.K.CHATURVEDI)

President

 

 

 

(RITU GARODIA)

Member