Haryana

StateCommission

A/622/2019

LIFE INSURANCE CORPORATION OF INDIA AND ANOTHER - Complainant(s)

Versus

RATIPAL SINGH TANWAR - Opp.Party(s)

S.C.THATAI

27 Jan 2023

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

 

  Date of Instituion:10.07.2019

                Date of final hearing:27.01.2023

                                                 Date of pronouncement:27.01.2023

 

FIRST APPEAL No.622 of 2019

 

1.      Life Insurance Corporation of India, Divisional Office, SCO 3-4-       5, Sector-1, Rohtak through its Senior Divisional Manager.

2.      Life Insurance Corporation of India, having its Branch Office at        Jeevan Jyoti, B-1/B-2, HUDA City Center, Near Mini   Secretariat, Bhiwani-127021 through its Manager.

          Presently the appeal is filed through Sh. Jai Bhagwan Bansal,         Manager (L&HPF), Divisional Office, Jeevan Prakash Building,     Sector 17-B Chandigarh.

                                                                                            .….Appellants

Versus

 

Ratipal Singh Tanwar son of Sh. Kanwar Singh, resident of village & post office Palwas, Tehsila & District Bhiwani.

…..Respondent

CORAM:    Hon’ble Mr. Justice T.P.S. Mann, President. 

                   Mrs. Manjula, Member.

 

Present:-    Ms. Monika Thatai proxy counsel for Mr. S.C. Thatai, Advocate for the appellants.

                   Mr. Amarjeet Beniwal, Advocate for the respondent.

                  

O R D E R

Per Manjula, Member:

 

Delay of 25 days in filing the present appeal is hereby condoned for the reasons stated in the application for condonation of delay.

2.      The brief facts of the present case are that complainant’s wife Smt. Suman Tanwar (deceased-life assured) had taken insurance policy from the Ops commencing from 14.03.2015 for the sum assured Rs.5,00,000/- and was paying premium of Rs.39,601/- annually. It is alleged that on 15.05.2015, the life assured suddenly suffered from fever/stomach pain and prior to reaching the doctor, she expired in her house. Being nominee, after completing all the formalities, the complainant lodged the death claim of the life assured with the opposite parties. It is also submitted that OP No.1 asked the complainant to submit the form No.3784 and 3816, because during investigation, it was found that the deceased was suffering from chronic kidney disease, as per outdoor patient register, DMR opinion and F.No.3816 record dated 08.01.2015 of Patanjali Hospital, Haridwar. The complainant sent reply that his wife had never suffered from any disease prior to 15.05.2015 and that she never got admitted in the hospital. It is further submitted that at the time of taking the policy, the medical examination of the deceased-life assured was got done and she was found healthy. Thus, the opposite parties wrongly repudiated the claim on the ground that the deceased had withheld correct information regarding her health at the time of taking the policy.

3.      The complaint was resisted by the opposite parties by filing its reply before the District Commission. It was alleged that life assured Suman Tanwar had not expired due to stomach pain and that she was suffering from chronic kidney disease. She remained under treatment for this disease with Patanjali Hospital, Haridwar as outdoor patient as per record dated 08.04.2015 and form No.3816 and DMR opinion. It is further alleged that the deceased-life assured had not mentioned the material facts regarding her health in the proposal form. As the deceased-life assured concealed the material information from the opposite party at the time of taking of said policy, so the opposite party was not liable to pay any claim under the said policy. Thus, there was no deficiency in service on its part and requested for dismissal of the complaint.  

4.      The District Commission, Bhiwani after taking into consideration the material available on record allowed the complainant vide order dated 08.05.2019, whereby it held as under:

          “the Ops are directed :-

(i)      To pay the insured amount of the policy i.e.   Rs.5,00,000/- (Five lacs only) along with interest @   9% p.a. from the date of filing of the complaint till      its realization.

(ii)      To pay Rs.50,000/- (Fifty thousand only) as   compensation on account of mental agony,     physical harassment & hardship, due to deficiency in service & mal trade practice on the part of Ops   and punitive damages.

(iii)     To pay Rs.7000/- (Seven thousand only) as counsel fee as well as the litigation charges.

          The compliance of the order shall be made within 30 days from the date of order.”

 

5.      Feeling aggrieved by the order of learned District Commission, Bhiwani, Opposite parties-appellants have preferred this appeal before the State Commission.

6.      The arguments have been advanced by Mrs. Monika Thatai, proxy counsel for Mr. S.C. Thatai, Advocate for the appellants and Mr. Amarjeet Beniwal, Advocate for the respondent. With their kind assistance the entire appeal has been properly perused and examined.            

7.       It is not disputed that the deceased-life assured had taken the policy with the date of commencement as 14.03.2015 and premium of the same was Rs.39,601/- payable annually. It is also undisputed that the deceased-life assured had died on 15.05.2015. Being nominee, complainant lodged the claim but the OPs repudiated the same on the ground that deceased-life assured had concealed the correct information regarding her health. The plea of the opposite parties is that the deceased-life assured was suffering from chronic kidney disease prior to taking the policy in question and that the deceased concealed this fact in her proposal form. In support of their plea, they placed on record Form No.3816, DMR opinion and record dated 08.01.2015. This plea of the opposite parties cannot be taken into consideration, because from these documents, it is not proved on record that the disease was chronic one, as no history of dialysis treatment of the life assured had been placed on record by the Ops. The dialysis treatment is very much necessary for the patient of chronic kidney disease, but the Ops have failed to produce on record, copy of dialysis treatment in support of their plea. Moreover, the Ops have also failed to place on record some documentary evidence to prove that the cause of death of life assured was chronic kidney disease. Moreover, Ops have accepted the proposal form at the time of issuing the policy. It is the duty of Ops to complete all the necessary formalities before issuing the policy to avoid unnecessary harassment to the life assured. Hence, deficiency in service on the part of OPs is clearly proved.

8.      The learned District Commission has rightly allowed the complaint of the complainant. The State Commission finds no reason or ground to interfere with the order of learned District Commission. Hence, the appeal being devoid of merits, stands dismissed.

9.      Application(s) pending, if any, stand disposed of in terms of the aforesaid Order.

10.    A copy of this order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986/2019. The Order be uploaded forthwith on the website of the commission for the perusal of the parties.

11.    File be consigned to record room along with a copy of this order.              

 

 

                                                                                      (T.P.S. Mann)

                                                                                       President

 

 

 

                                                                                                            (Manjula)

                                                                                        Member

 

Pronounced On: 27.01.2023                                                                   

 

M.S.