Haryana

StateCommission

A/260/2017

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

Versus

MUKESH KUMAR - Opp.Party(s)

S.C.THATAI

19 Jul 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

         

                                       

First Appeal No  :      260 of 2017

Date of Institution:      07.03.2017

Date of Decision :       19.07.2018

 

1.     Birla Sun Life Insurance Company Limited, SCO No.149-151, First Floor, Red Square Market, Hisar through Ms. Aakriti Manocha, Deputy Manager-Legal.

2.     Birla Sun Life Insurance Company Limited, Claims Department, ‘G’, Corp. Tech Park, 6^th Floor, Kasar Wadavali, Ghodbunder Road, Thane-400601, Maharashtra through Ms. Aakriti Manocha, Deputy Manager, Legal.

                                      Appellants-Opposite Parties

Versus

 

1.      Mukesh Kumar son of Sh. Jagdish.

2.      Jagdish son of Sh. Budh Ram

          Both residents of Village Kohli, Tehsil Adampur, District Hisar.

                                      Respondents-Complainants

 

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri Balbir Singh, Judicial Member.                                                                                            

                                     

Present:               Shri S.C. Thatai, Advocate for appellants.

                             Shri Sanchit Punia, Advocate for respondents-complainants  

 

                                                   O R D E R

 

NAWAB SINGH J.(ORAL)

 

By filing this appeal, Birla Sun Life Insurance Company Limited and its functionary-opposite parties (for short ‘Insurance Company’) have challenged the order dated January 18^th, 2017 passed by District Consumer Disputes Redressal Forum, Hisar (for short ‘District Forum’), whereby it directed the Insurance Company to pay Rs.2,56,000/- alongwith interest at the rate of 9% per annum from the date of filing of the complaint, that is, January 24^th, 2013 till its realization to Jagdish-brother of Om Parkash-life insured on account of death of Om Parkash. Amount of Rs.1000/- for harassment and Rs.500/- litigation expenses was also directed to be paid to Mukesh Kumar-complainant No.1.

2.      Learned counsel for the Insurance Company has urged that vide medical record (Annexure A-5) of Maharaja Agrasen Medical College and Hospital, Agroha (Hisar), Om Parkash was an alcoholic and he died because of Alcoholic Liver Disease (ALD) on February 15^th, 2012, so, the Insurance Company was not liable to indemnify the complainants.

3.      Shri Ram Kumar Saini and Shri R.S. Bhatti, Advocates for the respondents-complainants have urged that the alleged medical record relied upon by the Insurance Company was not qua Om Parkash, it was in the name of Om Parkash, resident of VPO Toli, Adampur, District Hisar, whereas, Om Parkash-life insured was resident of VPO Kholi, District Hisar, which is at a distance of about 10 Kilometer from Village Toli. There is also a cutting in the medical record to this effect.

4.      The medical record (Annexure A-5) of Maharaja Agrasen Medical College and Hospital, Agroha (Hisar) obtained by the Insurance Company under the Right to Information Act sent by the hospital by post shows that Om Parkash, resident of Village Kholi, District Hisar was admitted in the hospital on December 12^th, 2010 (prior to the purchase of the insurance policy) as a case of ALDC with Ascites.  There was a consent letter duly signed by Kuldeep Singh, nephew of Om Parkash and in that also, it is mentioned that Om Parkash was resident of Village Kholi and not Toli.  At the time of purchase of the insurance policy, the complainant did not disclose that he remain admitted in hospital and took the treatment of ALDC with Ascites.  There was clear suppression of material fact in regard to the health of the complainant.

5.      For the reasons recorded supra, the appeal is accepted, the impugned order is set aside and the complaint is dismissed.

6.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

 

 

Announced 19.07.2018

(Balbir Singh) Judicial Member

(Nawab Singh) President

UK