BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
Complaint No.:246 of 2013.
Date of Institution: 25.04.2013.
Date of Decision:01.07.2016
Archana Devi, aged 34 years widow of Late Sh. Girish Kumar, resident of House No. 154, Ward No. 14, Nirmalan Mohlla Charkhi Dadri, District Bhiwani.
….Complainant.
Versus
- Reliance Life Insurance Company Limited, Reliance House No. 6, 6th Floor Haddows Road, Chennai-600006, Tamilnadu through its Managing Director.
- Branch Manager, Reliance Life Insurance, IInd Floor, Ahalwat Complex, Meham Gate, Bhiwani, District Bhiwani.
…...Opposite Parties.
COMPLAINT U/S 12 & 13 OF CONSUMER PROECTION ACT
BEFORE: - Shri Rajesh Jindal, President
Ms. Anamika Gupta, Member
Present:- Shri Neeraj Bhardwaj, Advocate, for complainant.
Shri J.P. Tanwar, Advocate for OPs.
ORDER:-
Rajesh Jindal, President:
The case of the complainant in brief, is that the husband of the complainant had purchased a ‘life insurance policy’ vide policy no. 13173632 on dated 08.12.2008 for a period of 20 years for a sum of Rs. 1,00,000/- from OP no. 1. It is alleged that the annual premium of the said policy was Rs. 10,000/- and the complainant was nominee of her husband. It is alleged that the complainant deposited his premium regularly with the office of OP no. 1 and no premium is due. It is alleged that the husband of the complainant was died on 05.06.2010 at AIIMS Hospital, New Delhi and the complainant submitted all the required documents regarding taking the benefit of insurance policy of her husband but the Ops denied to pay total insured amount. It is alleged that the complainant refused to accept the proposal of the Ops vide her letter dated 20.11.2010 and requested the OP no. 2 to pay all the benefits of policy of her husband. Thereafter again the complainant sent a letter to OP no. 2 on dated 04.02.2011 but till date the OP no. 2 did not make any payment regarding the policy. Hence, it amounts to deficiency in service on the part of opposite parties and as such, she had to file the present complaint for seeking compensation.
2. On appearance, the OPs filed written statement alleging therein that the said policy was obtained by suppression of material facts of the health condition. It is submitted that had the opposite party been aware of the correct health conditions of the DLI at the time of signing of the proposal form for insurance the said policy would not have been issued to the DLI at the first place. It is submitted that the petitioner has not approached this Forum with clean hands and suppressed the material facts. It is submitted that the petitioner has no ‘locus standi’ to claim any alleged sum assured, as the insurance policy was obtained by the DLI by misrepresenting the material facts in order to defraud the opposite party and as such the contract of insurance is void, and not tenable in the eyes of law as it is entered by DLI to defraud the opposite party. It is submitted that on receipt of the information regarding the death of the Life assured and the documents submitted by the complainant i.e. Claim Form and Medical Attendant Certificate issued by Senior Resident AIIMS-Rohtak, it came to the knowledge of the life assured was suffering from “moyamoya” disease for the last eight years i.e. prior to inception of policy. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of opposite parties and complaint of the complainant is liable to be dismissed with costs.
3. In order to make out his case, the complainant has placed on record affidavit Exhibit CW1/A, documents Exhibit C-1 & Exhibit C-2 and documents Mark C1 to Mark C7.
4. In reply thereto, the opposite parties placed on record Annexure R1 to Annexure R5.
5. We have gone through the record of the case carefully and have heard the learned counsels for the parties.
6. Learned counsel for the complainant reiterated the contents of the complaint. He submitted that the husband of the complainant died on 05.06.2010 at AIIMS New Delhi. The claim was lodged by the complainant with the Ops. The Ops offered only Rs. 22993/- in lieu of the claim of the complainant for insured amount of Rs. 1 lakh.
7. Learned counsel for the Ops reiterated the contents of the reply. He submitted that the claim of the complainant was repudiated because the husband of the complainant at the time of taking of the policy in question suppressed the material fact of his prior disease “moyamoya”. In support of his contention he referred the certificate of hospital Annexure R-3. The claim of the complainant was repudiated vide repudiation letter dated 20.10.2010 Mark C-5, as per the terms and conditions of the policy. He referred the following judgments:-
I Life Insurance Corporation of India Versus C. Venkataramudu II (2014) CPJ 190 (NC).
II Max New York Life Insurance Co. Ltd. Versus Amaresh Reddy II (2014) CPJ 67 (NC).
III Suresh Kumar S.S. Versus Iffco-Tokio General Insurance Co. Ltd. & Anr. II (2014) CPJ 69 (NC).
IV Life Insurance Corporation of India Vs. Veena & Ors. II (2014) CPJ 95 (NC).
8. In the light of the pleadings of parties and arguments of the parties, we have examined the relevant material on file. The Ops vide repudiation letter dated 20.10.2010 has mentioned that Dinesh Kumar in the proposal form on 04.12.2008 has given the answer to question No. 29 in negative. On this ground, the OP held that the insured has not disclosed “moyamoya” disease while giving the answer to question No. 29. The question No. 29 as mentioned in the letter dated 20.10.2010 of the OP is reproduced below:-
Question 29: ‘Do you suffer from any medical aliments, eg., diabetes, high blood pressure, cancer, respiratory disease, kidney or liver disease, stroke, any blood disorder, heart problems, Hepatitis, or Tuberculosis, psychiatric disorder, depression, HIV/AIDS or a related infection?” Answer: No.
From the perusal of question No. 29, it is obvious that this question is related to the various diseases specified in this question and has sought the answer that do you suffer from any of these disease and the answer to this is in negative on behalf of the insured Dinesh Kumar. There is no mention of “moyamoya” disease in this question, nor any of the disease described in this question were suffered by the insured deceased. From the bare perusal of this question, it cannot said that reply of the insured to this question in negative is non-disclosure of “moyamoya” disease. In view of our discussion, we hold that the repudiation of the claim of the complainant by the Ops is not justified. The Ops, however has offered to pay Rs. 22993/- as fund value of the policy to the complainant. Considering the facts of the case, we partly allow the complaint of the complainant and direct the Ops to pay Rs. 1 lakh the insured amount to the complainant. This order be complied with by the Ops within 60 days from the date of passing of this order, otherwise the Ops shall be liable to pay the interest at the rate of 8 per cent per annum from the date of passing of this order till the date of payment. Certified copies of the order be sent to the parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: 01.07.2016.
(Rajesh Jindal)
President,
District Consumer Disputes
Redressal Forum, Bhiwani.
(Anamika Gupta)
Member
