Haryana

StateCommission

A/1080/2014

Canara HSBC Oriental Bank of Commerce - Complainant(s)

Versus

Raj Bala - Opp.Party(s)

16 Feb 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

 

                                                        First Appeal No.1080 of 2014

Date of Institution: 26.11.2014                                                              Date of Decision: 25.02.2016

 

1.      Canara HSBC Oriental Bank of Commerce, Life Insurance company Limited 2^nd Floor, Augusta Point, Sector-53, Golf course Road,Gurgaon-122003 Haryana, through its Authorized signatory.

2.      Canara HSBC Oriental Bank of commerce Life Insurance company Limited, Branch Office SCO 93, First Floor, Sector-7, Urban  Estate, Karnal 132001, Haryana, through its Branch Manager.

…..Appellants

Versus

1.      Raj Bala W/o Late Mr. Kuldeep Singh S/o Chandi Ram R/o H.No.140 village Gorakhpur, Block 3, Tehsil and Distt. Fatehabad 125112.

2.      Oriental Bank of Commerce, Branch Bhuna District Fatehabad-125111.

3.      Oriental Bank of Commerce, Head Office E-Block Connaught Place, New Delhi 110001.

                                      …..Respondent

CORAM:             Mr. R.K.Bishnoi, Judicial Member.

                             Mrs. Urvashi Agnihotri, Member.                                                                                                                                        

Present:               Shri U.K.Kanwar, Advocate counsel for appellant.

Shri Vaibhav Jain, Advocate counsel for the respondent No.1.  

Mr. Samrat Ahuja proxy counsel for Mr.A.K.Ahuja, Advocate counsel for the respondent Nos.2 and 3.

 

                                                   O R D E R

R.K.BISHNOI, JUDICIAL MEMBER:-

          Complainant’s husband was insured by the opposite parties (O.Ps.) for Rs.8,25,000/-. Unfortunately Deceased Life assured (DLA) -Kuldeep Singh died on 24.03.2013 due to heart attack.  Information was given to the O.Ps.  She also submitted all the documents as per instructions, but, they repudiated the claim on 29.07.2013.

2.      O.Ps. filed separate replies.  O.P.Nos.1 and 2 alleged that after understanding the terms and condition of the product Canara HSBC Oriental Bank of Commerce Life Insurance Grow Smart Plan, life assured obtained insurance policy after paying the premium. DLA was required to disclose all the medical details in the proposal form, but, he intentionally withheld the material information from them and they rightly repudiated the claim of the complainant.

3.      O.P.Nos.2 and 3 submitted that the claim of the complainant was repudiated on the ground that life assured misrepresented the material facts at the time of preparing proposal form. Life assured had died on 24.03.2013.  During the process of claim, it was revealed that DLA was having Chronic Liver Disease with portal HTN with Ascites with Esophageal varices Grade iv UGI bleed EVL done (5BT 4 FFP). As per test reports, it was found that deceased was having chronic liver disease with portal hypertension with mild splenomegaly and ascites.  DLA was hospitalized on 19.03.2013 and expired on 24.03.2013, whereas policy was issued on 23.03.2013.  They had refunded the amount of Rs.23,145.58/- to the complainant.

4.      After hearing both the parties, learned District Consumer Disputes Redressal Forum, Fatehabad (In short “District Forum”) allowed the complaint vide order dated 31.10.2014 and directed as under:-

“Hence, we allow the present complaint directing the Ops to pay a sum of Rs.8,25,000/- to the complainant with interest @ 6% per annum from the date of filing of the complaint till realization of the amount within one month failing which the complainant is at liberty to initiate proceedings against the Ops under section 25/27 of the C.P. Act.

5       Feeling aggrieved therefrom, appellants-O.Ps No.3 and 4. have preferred this appeal.

6.      Arguments heard. File perused.

7.      Learned counsel for the O.Ps. vehemently argued that while submitting proposal form Ex.R-2, DLA stated that he was not suffering from any ailment and never received any treatment, but, from the perusal of emergency certificate Ex.R-5 it is clear that he was Alcholic with HCV related CLD.  According to the test reports, attached and Ex. R-5 dated 12.10.2012, it is clear that he was suffering from the ailment and that is why he got the tests conducted.  When he has concealed the fact of previous ailment, he is not entitled for any compensation as opined  by Hon’ble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. 2009 8 SCC 316.  It is not necessary to submit the affidavit of the doctor as opined by Hon’ble National Commission in Divisional Manager, LIC of India and others Vs. Smt. Anupama and others, RP 3794-3796 of 2007 dated 17.04.2012.  learned District Forum wrongly allowed the complaint and impugned order dated 30.10.2014 be set aside.

8.      This argument is of no avail.  As per certificate Ex.R-5 DLA was admitted in the hospital on 19.03.2013 whereas proposal form was submitted on 15.03.2013. So, there is no question of any concealment.  As per test reports, attached with Ex.R-5, it does not mean that he was suffering from any ailment. There is no evidence on the file showing that he was suffering from any ailment.  One can go for routine check up and it does not mean that one is suffering from ailment. Ex.R-5 reveals that DLA was alcoholic, but, as per complainant DLA was not alcoholic. Unless proved by the doctor who prepared the same and proved that the history was told by the patient  this fact cannot considered as proved as opined by Hon’ble National Commission in revision petition No.2021 of 2009 titled as LIC of India & Anr. Vs. Smt. Chawali Devi decided on 03.12.2015. Para No.6 of above said judgment is important and is as under:-

“As far suppression of material facts regarding existing disease and treatment is concerned,  learned counsel for the petitioner has drawn my attention towards history of deceased noted by doctor in which it was mentioned that deceased was having breathlessness, caugh c expectoration etc. No doubt, this fact has been mentioned as patient’s history, but petitioner has failed to place any document on record regarding treatment of aforesaid breathlessness, caugh c expectoration etc. and has not filed any affidavit of concerned doctor who recorded history to prove that this history was given by deceased himself.  In such circumstances, only on the basis of recorded history of deceased, it cannot be held that deceased was suffering from breathlessness, cough expectoration etc. since last 10 years and had taken any treatment.”

Appellant cannot derive any benefit from the cited case law because the facts of the present case are altogether different.

9.      It is mentioned therein that if there is any concealment of facts or false or forged declaration is made then the claim can be repudiated. O.Ps. cannot get out of this policy. So these arguments are of no avail.

10.    Hence the appeal fails and the same is hereby dismissed.

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

 

February 25th, 2016

Mrs.Urvashi Agnihotri, Member, Addl.Bench

R.K.Bishnoi, Judicial Member Addl.Bench

S.K.