DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
(CENTRAL) ISBT KASHMERE GATE DELHI
CC No. 444/2016
No. DF/ Central/ Date
Krishan Lal Narang
S/o Late Sh. Sunder Das Narang,
R/O 7129, Sector - B, Pocket-10,
Vasant Vihar, New Delhi
.....Complainant
VERSUS
1. Reliance Life Insurance Company Limited,
Office at;
9th Floor, R-Tech Park,
Goregoan (E) Mumbai400063.
Also at; Branch office at;
16/ 1 7, Ist Floor, Padam Singh Road,
W.E.A. Karol Bagh, New Delhi-110005.
2. Anup Rau, Chief Executive Officer,
Reliance Life Insurance Company Ltd.
3. Srinivasan Iyengar
Chief Operating Officer
Reliance Life Insurance Company Ltd,
Both at; 9th Floor, R-Tech Park,
Goregoan (E), Mumbai400063.
Also at; Branch office at;
16/17, Ist Floor, Padam Singh Road,
W.E.A. Karol Bagh, New Delhi - 05.
…..Opposite Parties
Ms. Rekha Rani President
Sh. Vikram Kumar Dabas, Member Mrs. Manju Bala Sharma, Member
ORDER
Sh. Vikram Kumar Dabas
Instant complaint was filed on 22/12/2016 wherein the complainant has
alleged that he had purchased a Reliance life guaranteed money back plan policy No. 51479739 dated 05/02/2014 in the name of his son Mr. Rajiv Narang. A premium of Rs. 3,999/- per month was to be paid for a period of five years and on maturity of the policy the complainant was entitled to get Rs. 200,600/- only from the OP No.1. It is alleged that on 03/03/2014 son of the complainant Shri Rajiv Narang reported to Institute of Liver & Biliary Sciences , D-l, Vasant Kunj New Delhi for the first time as an outdoor patient and only at that time he came to know that his son was suffering from liver disease. On 17/7/2014 son of the complainant was admitted in the above said Institute as a case of Liver disease for the first time. Thereafter, the son of the complaint was admitted in the Institute of Liver and Biliary Sciences on 30/09/2014, 15/10/2014, 12/12/2014 and lastly on 19/01/2015 when he expired on 10/03/2015. The same was informed by the complainant vide his letter dated 26/04/2015 to OP 1. It is alleged by the complainant that his son neither suffered from any medical ailment like i.e. diabetes, high blood pressure, Kidney or liver disease nor he was taking any medicines or drugs for any of these ailments at the time of purchase of policy. The complainant has alleged that in reply to question no. 31 in the proposal form which was regarding taking of any medicine or drugs by his son at the time of taking of the policy and also in answer to question no. 33 which was regarding suffering from any ailment by the son of the complainant at the time of taking of the policy, the reply was “NO”. It is also alleged that doctors of Institute of Liver & Biliary Sciences in the discharge summaries of his son wrongly mentioned that his son was admitted in hospital in September 2013 and in December 2013. The complainant has alleged that in
September 2013 his son had a fever because of jaundice and he was completely cured from jaundice within a short spell of time. It is alleged that OP No. 1 vide its letter dated 19/08/2016 intimated the complainant that according to the policy terms and conditions of claims benefits will cease and all the premium will be forfeited for non disclosure of the chronic liver disease which ought to have been disclosed in the proposal form. The complainant has alleged deficiency in service on the part of OP and has prayed as under :
a) Pass a direction thereby directing the opposite parties to pay the whole policy amount of Rs. 200,600/- to the complainant with interest @ 24% per annum;
b) compensate the complainant with Rs. 5,00,000/- for harassment and mental agony;
c) impose an exemplary cost on the Opposite Parties as this Hon’ble Forum may deem fit and proper;
d) accept the complaint of the complainant and award damage to the tune of Rs. 5,00,000/-;
e) pass any order or further order(s), which this Hon’ble Forum may deem fit and proper, in the facts and circumstances of the present case, in the interest of justice.
The OP has contested the complaint and have filed their written statement. It is stated by OP that the complaint is false, incorrect, baseless, malicious and malafide. It has claimed that the complainant had approached this Forum with unclean hands by suppressing material facts regarding this case. It is stated that the
OP 1 issued the Policy No. 51479739 dated 05/02/2014 in the name of Mr. Rajiv Narang and a premium of Rs. 3,999/- per month was to be paid for a period of 05 years.
It has stated that the complainant had signed the proposal form after reading and understanding the terms and conditions of the Insurance Policy without any inducement on the part of the OP. It is stated that OP had issued the said policy relying on the statements made by the insured in the said proposal form for life insurance. OP has stated that on examination of the documents of the claim alleged by the complainant it was revealed that the insured was treated for chronic liver disease prior to the date of filling of proposal form which fact was not disclosed.
It is stated that claim of the complaint was repudiated vide its letter dated 27/07/2015 on the ground of suppression of material facts i.e. pre existing disease. It is also stated that the complainant had willfully concealed vital information at the time of filling up the proposal form and since the contract of Insurance is based on
Uberrma fide i.e utmost good faith, the claim of the complainant was repudiated. OP has prayed the complaint therefore has no merits and is liable to be dismissed.
The complainant has filed its evidence by way of affidavit wherein it has reiterated the contents of the complaint. OP has also filed its affidavit of evidence and has corroborated the contents of the written statement.
We have perused the record and have heard arguments advanced at the bar:
The learned counsel for the OP has taken us through the discharge summary dated 18/08/2014 prepared at Institute of Livery & Biliary Sciences in respect of the Insured (deceased). Under the head history the following has been recorded :
‘’Mr. Rajiv Narang 44 Year old gentleman, a chronic smoker and chronic alcoholic (last intake 5 days back) and a known Hypertensive and is a known case of Cirrhosis of liver with the index presentation of jaundice in Sep 2013 for which he was managed conservatively. Patient continued to drink and had h/o pedal edema since Dec 2013 associated with mild facial puffiness which was modified with diuretics. No h/o ascites at that time. Patient continued to drink. He was apparently well till 5-7 days back when he c/o progressive abdominal distension followed by bilateral swelling of lower limbs. There is no h/o hemetemesis, malena, altered sensorium, decreased urine output. No h/o cough, fever, breathlessness. No h/o DM II/CAD/CVA/TB/Thyroid Disorder.’’
A perusal of the aforesaid extracted portion of the discharge summary shows that in September 2013 the Insured had suffered from jaundice due to liver cirrhosis. The
discharge summary also shows that the Insured was a known case of Hypertension & liver cirrhosis under the head diagnosis the discharge summary records as
follows :
‘’Portal Hypertension – Non bleeder, low risk small Esophageal varices, Severe GAVE- Status post APC, Portal enteropathy)
Chronic liver disease – Ethanol related (last intake 5 days prior to admission)
Decompensated with ascites – no SBP; jaundice, hepatic encephalopathy – Grade I (settled)
Hepatorenal Syndrome type II (S. Creat -1.2)
CTP - 11/15, MELD – 22, MELD Na – 29
Comorbidities – HTN (on treatment), Asthma (on intermittent treatment)’’
The diagnosis of the Insured therefore shows that he was a case of chronic liver disease. The diagnosis further shows that the Insured was also a case of Portal Hypertension decompensated with ascites - no SBP Jaundice hepatic encephalopathy grade I (settled). All these are related to liver disease.
Having considered the discharge summary we are of the considered opinion that the Insured suffered from a pre-existing disease at the time of purchase of the policy. We also hold that the complainant had made a misstatement in the proposal form about the state of health of the Insured and has also suppressed the fact that he was suffering from a chronic liver problem at the time of purchase of the policy. We are of the opinion that the Insurance company had rightly repudiated the claim of the complainant. The complainant is without merits and is hereby dismissed. Copy of the order be sent to the parties as per rules. File be consigned to record room.
Announced on this 13th day of April 2018.
