Haryana

Ambala

CC/165/2022

Smt Baljeet Vohra - Complainant(s)

Versus

Postal Life Insurance - Opp.Party(s)

S Bhukal

13 Sep 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

 

                                                          Complaint case no.         :     165 of 2022

                                                          Date of Institution           :     26.05.2022

                                                          Date of decision    :     13.09.2022.

1. Smt. Baljeet Vohra w/o Late Sh. Vishal Vohra, Mob:89013-66999 (Aadhar No. 6845 7373 1209).
2. Chetanya Vohra s/o Late Sh. Vishal Vohra, Mob: 94163-76000 (Aadhar No. 3551 9867 8641).

Both residents of House No.32, Phase II, Jaggi Colony, Ambala City. Mob: 94163-76000.

          ……. Complainants

                                                Versus

Chief Post Master General (PLI Haryana Circle, Ambala) Staff Road, Ambala Cantt.

….…. Opposite Party.

Before:        Smt. Neena Sandhu, President.

                   Smt. Ruby Sharma, Member.            

Shri Vinod Kumar Sharma, Member.

 

Present:       Shri S.K.Bhuckal, Advocate, counsel for the complainants.

                   OP already ex parte.

         

Order:        Smt. Neena Sandhu, President.

1.                Complainants have filed this complaint under Section 35 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘OP’) praying for issuance of following directions to it:-

(i) To pay sum insured of Rs.20,00,000/-, alongwith interest @ 18% per annum from the date of filing of the compliant till its realization and other benefits regarding the policy in question.

(ii) To pay Rs.50,000/- as compensation on account of mental agony and physical harassment suffered by the complainant.

(iii) To pay Rs.22,000/- as litigation expenses.

OR

Grant any other relief this Hon'ble commission may deem fit.

 

2.             Brief facts of this case are that complainant No.1 is the widow of the deceased (insured ) Vishal Vohra and complainant No.2 is the son of deceased Vishal Vohra, who were dependent upon the deceased. The deceased Vishal Vohra was employed in BSNL Office posted at Kurukshetra as Junior telecom Officer (E). The deceased was hale and hearty having cheerful personality and was having no diseases. The deceased in his lifetime on 04.02.2019 purchased a policy No.0000002755409 (Suvidha Convertible Whole Life Assurance) from the OP for the sum assured of Rs.20 lakhs, on making payment of premium of Rs.11,900/-. The policy was issued on 26.02.2019 and a letter was sent by the OP to Vishal Vohra (since deceased) on 28.02.2019 in which it was mentioned that "we are happy to inform that your proposal dated 04.02.2019 for Postal Life Insurance has been accepted on 26.02.2019 with this, the risk of your life under written w.e.f  26.02.2019. The money paid by you on 04.02.2019 has been adjusted as your first payment". On 03.11.2019 at around 12:00 PM, Vishal Vohra, suffered a massive heart failure and he died on the same day while way to hospital Holy Nursing Home, Ambala. At that time,  the age of Vishal Vohra was about 49 years. The nominee Smt. Baljeet Vohra submitted the claim with the OP alongwith all the relevant documents. It was assured by the OP that the amount of claim of the policy will be paid to the complainants within few days but it failed to do so, However, the complainants were surprised  when they received a letter dated 05.08.2021 from the OP, whereby it revealed that the claim filed by them has been rejected on false grounds. In the letter dated 05.08.2021 it was mentioned that "In reference to your application dated nil received in this office on dated 08.07.2021, it is informed that the competent authority has rejected your above said application due to suppression of material facts about diseases of Hypertension and Diabetes while taking the policy No. 0000002755409".  Hence, the present complaint.
3.           Upon notice, the opposite party did not appear before this Commission and proceeded against ex parte vide order dated 04.08.2022.
4.           Learned counsel for the complainants tendered affidavit of complainant No.1 as Annexure CW1/A alongwith documents as Annexure C-1 to C-14 and closed the evidence on behalf of the complainant.
5.           We have heard the learned counsel for the complainants and carefully gone through the case file.
6.           Learned counsel for the complainants submitted that though Vishal Vohra, (deceased), who had taken the policy in question was hale and hearty, but, he died of heart failure on 03.11.2019. The complainants being the legal heirs of the Late Vishal Vohra are entitled to get the sum assured of Rs.20,00,000/- alongwith other benefits, under the policy in question. However, the OP repudiated the claim on false and flimsy grounds to the effect that Vishal Vohra, (deceased), had suppressed that he was suffering from hypertension and diabetes. By repudiating the claim the OP has committed deficiency in providing service.  
7.           From the perusal of policy document Annexure C-7, it is evident that the Late Vishal Vohra was insured under the policy for sum assured of Rs.20,00,000/-. The complainants to prove their case that the Vishal Vohra (deceased) was not suffering from any major health problem and it was on account of sudden heart failure, he died on 03.11.2019, have placed on record, the medical record dated 17.12.2019, Annexure C-4, of the treating Doctor-Dr.Deepak Saxena of Holy Family Nursing Home. From the perusal of the same it is evident that the treating doctor opined that Vishal Vohra (deceased) was not suffering from any major health problem and he died due to sudden heart failure. Perusal of contents of repudiation letter dated 05.08.2021, Annexure C-5, reveals that the claim of the complainants was repudiated on the ground that there was suppression of material facts about disease of hypertension and diabetes suffered by Vishal Vohra (deceased), at the time of taking the policy in question.
8.           It may be stated here that the despite service none appeared on behalf of OP and as such, it was proceeded against ex parte. The non-appearance of the OP shows that it has nothing to say in its defence against the allegations levelled by the complainants. Therefore, the assertions of the complainants go unrebutted & uncontroverted. It is significant to mention here that in the case of Satish Chander Madan Vs. M/s Bajaj Allianz General Insurance Co. Ltd. decided on 11.01.2016, the Hon’ble National Commission has held that hypertension is a common ailment and it can be controlled by medication and it is not necessary that person suffering from hypertension would always suffer a heart attack. Treatment for heart problem cannot be termed as a claim in respect of pre existing disease. Claim was wrongly repudiated. The Hon'ble Delhi State Consumer Disputes Redressal Commission, New Delhi in the case of Life Insurance Corporation of India Vs. Sudha Jain 2007(2) CLT 423, has drawn conclusions in para 9 of the order and the relevant clause is 9(iii), which is reproduced as under:-

"9(iii) Malaise of hypertension, diabetes occasional pain, cold, headache, arthritis and the like in the body are normal wear and tear of modern day life which is full of tension at the place of work, in and out of the house and are controllable on day-to-day basis by standard medication and cannot be used as concealment of pre-existing disease for repudiation of the insurance claim unless an insured in the near proximity of taking of the policy is hospitalized or operated upon for the treatment of these diseases or any other disease."In the present case there is nothing on the record to show that the insured Late Shri Vishal Vohra was hospitalized and treated for hypertension or diabetes before taking the policy in question. Taking all the facts and circumstances of the case into consideration and the law laid down by the superior Courts, in the cases referred to above, we do not hesitate to conclude that OP was not justified in repudiating the claim and is thus liable to pay the sum assured alongwith other benefits, if any under the policy in question to the complainants.

9. 1. To pay Rs.20,00,000/-, the sum assured alongwith other benefits, if any, under the policy in question, to the complainants alongwith interest @4% p.a. from the date of repudiation of the claim i.e. 05.08.2021, till realisation.
   2. To pay Rs.3,000/- as compensation for the mental agony and physical harassment suffered by the complainants.
   3. To pay Rs.2,000/- as cost of litigation.

                   OP is further directed to comply with the order within a period of 45 days from the date of receipt of a certified copy of this order, failing which the amount mentioned in para No.9 (a & b) shall carry interest @ 6% p.a. from the date of default till realization. Certified copy of this order be sent to the parties concerned forthwith, free of costs, as permissible under Rules. File be indexed and consigned to the Record Room.

Announced on: 13.09.2022.

 

          (Vinod Kumar Sharma)  (Ruby Sharma)               (Neena Sandhu)

              Member                         Member                       President