Haryana

StateCommission

A/755/2019

MAX LIFE INSURANCE CO. LTD. - Complainant(s)

Versus

SAROJ DEVI AND ANOTHER - Opp.Party(s)

RAJESH KAUSHIK

26 Oct 2020

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No.    755 of 2019

Date of Institution:  30.08.2019

Date of Decision:    26.10.2020

 

 

Manager, Max Life Insurance Co. Ltd., Plot No.90A, Sector 18, Gurugram, Tehsil & District Gurugram, Haryana.

 

 

 

Appellant-Opposite Party No.1

 

Versus

 

1.      Saroj Devi (aged 39 years) widow of Shri Dheeraj Kumar son of Shri Om Parkash,

 

2.      Atul (aged 22 years) son of Dheeraj Kumar son of Shri Om Parkash,

 

3.      Seema (aged 20 years) daughter of Dheeraj Kumar son of Shri Om Parkash,

 

          All residents of Village Amadal Shahpur, P.O. Akheri Madanpur, Tehsil Matanhail, District Jhajjar.

 

Respondents No.1 to 3-Complainants

 

4.      Manager, Axis Bank Limited, Main Market Road, Near Old Bus Stand, Jhajjar.

 

Respondent No.4-Opposite Party No.2

 

 

 

 

 

 

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

                   Shri Harnam Singh Thakur, Judicial Member.

                  

   

 

Present:     Shri Rajesh Kaushik, counsel for the appellant.

                    

                  

                            

O R D E R

 

 T.P.S. MANN, J.

 

Delay in filing of the appeal is condoned for the reasons specified in the miscellaneous application.

2.      Opposite party No.1-Manager, Max Life Insurance Company Limited has filed the instant appeal for challenging the order dated 01.07.2019 passed by learned District Consumer Disputes Redressal Forum, Jhajjar, whereby complaint filed complainant Saroj Devi, her son Atul and daughter Seema, was disposed of by directing the appellant to release the claim as per policy document Exhibit C-2 within a period of one month from the date of passing of the order failing which the amount would carry interest @ 9% per annum from the date of fling the complaint till its realization. It was further directed to pay Rs.21,000/- on account of mental agony and harassment suffered by the complainants due to negligent and deficient act and Rs.5,500/- on account of litigation expenses to the complainants.

3.      According to the complainants, on 01.07.2016, Dheeraj Kumar, husband of complainant Saroj Devi and father of Atul and Seema purchased a policy of Rs.12,95,018/- from the appellant through opposite party No.2-Manager, Axis Bank Limited and thereafter Dheeraj Kumar had been regularly paying the installments. Dheeraj Kumar expired on 11.09.2016. The complainants informed the opposite parties and in order to get the death claim, completed the requisite formalities. Complainant Atul was the nominee in the policy of his deceased father Dheeraj Kumar. The complainants enquired about the matter from the opposite parties a number of times but the opposite parties did not give any satisfactory reply. The complainants moved applications on 27.03.2017 and 18.07.2017 to the opposite parties but the opposite parties did not take any action on the said applications. Complainant No.2 sent legal notice to the appellant on 15.03.2018 and respondent No.2/opposite party No.2 on 20.04.2018 but his request was not entertained. Alleging deficiency and negligence in providing service on the part of the opposite parties, the complainants sought directions to the opposite parties to make payment of insurance compensation of Rs.12,95,018/- along with interest @ 12% per annum from the date of death to the complainants as per the scheme of the opposite parties and Rs.11,000/- as litigation expenses besides Rs.50,000/- as harassment and mental agony.

4.      Upon notice, the appellant/opposite party No.1 appeared and filed the written version and admitted the fact that the life assured died on 11.09.2016 and after his death his legal heirs submitted the claim. The matter was investigated and it was revealed that as per medical record obtained from CHC Jamalpur (Jhajjar), the life assured was diagnosed with pulmonary tuberculosis and was HIV positive and accordingly taking treatment from PGIMS, Rohtak from the last one year. The material information required by way of submitting the proposal form was concealed by the life assured and on account of non-disclosure of material information, the claim was rejected/repudiated by the competent authority. Accordingly, prayer was made for dismissal of the complaint.

5.      Opposite party No.2 however failed to put in appearance and was proceeded against ex parte.

6.      The complainants tendered in evidence affidavits (Exhibit CW1/A to Exhibit CW3/A) and documents (Exhibit C-1 to Exhibit C-14). On the other hand, opposite party No.1 tendered in evidence affidavit (Exhibit RW1/A) and documents (Exhibit R-1 to Exhibit R-8).

7.      After hearing learned counsel for the parties and on going through the record, learned District Forum disposed of the complaint by granting relief to the complainants, as mentioned above.

8.      After hearing learned counsel for the appellant and on going through the impugned order, the State Commission finds that the issue involved in the appeal is as to on what basis the claim set up by the complainants was repudiated by the insurance company. According to the appellant, deceased life assured was suffering from HIV since July, 2015, i.e. prior to signing of the proposal form. In order to establish the said fact, reliance was placed upon the report of Investigator but the appellant did not place the investigation report on record. The Investigator was also not examined to confirm the fact that the DLA had been suffering from pulmonary tuberculosis and being HIV positive. This casts a shadow of doubt in the stand taken by the appellant to deny the claim set up by the complainants and also about the investigation conducted in the complaint. The appellant also placed reliance on documents (Exhibit   R-7 and Exhibit R-8), which are OPD card of CHC, Jamalpur (Jhajjar) and treatment card of Revised National Tuberculosis Control Programme pertaining to DLA. OPD card (Exhibit R-7) is of dated 20.07.2016 and signed by the treating doctor. The same bears mention of signature of the treating doctor and it was mentioned thereupon that HIV test was pending. There was thus no specific finding arrived at by the treating doctor that the DLA was HIV positive, for which he was getting treatment from PGIMS, Rohtak. It was incumbent upon the appellant to place on record treatment of HIV positive, if any, undertaken by DLA from PGIMS, Rohtak. Merely stating that DLA was taking treatment from PGIMS, Rohtak for HIV positive since one year would not give support to the stand taken by the appellant. The appellant was under a duty to bring on record the treatment record of PGIMS, Rohtak pertaining to DLA for undergoing treatment of HIV positive to prove its case. Accordingly, repudiating the claim of the complainants by relying upon OPD card (Exhibit R-7) and treatment card (Exhibit R-8) but not bringing on record the documents pertaining to DLA having taken treatment for HIV positive, it can be held that the appellant acted in negligent and deficient manner to deny the genuine claim of the complainants on account of death of DLA.

9.      It may be worth its while to mention that when the complaint was pending consideration before the learned District Forum, an application was moved by the appellant-opposite party No.1 for summoning of Medical Officer/official CHC, Jamalpur (Jhajjar) along with complete treatment record of Dheeraj Kumar and concerned Clerk of Anganwadi Kender, Village Amadal Shahpur, District Jhajjar along with death record register containing the entry regarding cause of death of Dheeraj Kumar but the said application was dismissed on 28.03.2019 by the District Forum by observing that if opposite party No.1 wanted to summon any witness along with relevant record, it could do so at its own level. Subsequent thereto, no attempt was made by opposite party No.1 to examine further evidence. Even otherwise in the investigation report, it is not made out that the deceased was getting treatment for pulmonary tuberculosis and HIV positive. Further, in the register maintained by the Anganwadi Kender, mention was made that Dheeraj Kumar had died as he was sick. This entry in the death register also does not advance the case of the appellant.

10.    In view of the above, no case is made out for any interference in the impugned order passed by the learned District Forum. The appeal being devoid of any merit and, accordingly, dismissed.

11.    The statutory amount of Rs.25,000/- deposited by the appellant while filing the appeal shall be disbursed in favour of the complainants against proper receipt and identification subject to appeal/revision, if any, in accordance with law.

 

 

Announced 26.10.2020

(Harnam Singh Thakur) Judicial Member

(T.P.S. Mann) President

  D.R.