Haryana

StateCommission

A/528/2016

LIFE INSURANCE CORP.OF INDIA - Complainant(s)

Versus

SAROJNI - Opp.Party(s)

SATYAWAN AHLAWAT

17 Aug 2016

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

                  

                                                First appeal No.528 of 2016

Date of the Institution: 09.06.2016

Date of Decision: 17.08.2016

 

Life Insurance Corporation of India opposite Radio Station Subash Road Rohtak and Another through its Manager (Legal), Division Office, Chandigarh.

…..Appellant

Versus

 

1. Sarojini W/o Rajesh
2. Rajesh S/o Sh.Raj Singh both residents of village Makrouli Tehsil and Distt.Rohtak.

                                                                             .….Respondents

 

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

                    Mrs.Urvashi Agnihotri, Member

 

Present:-    Mr.Satyawan Ahlawat, Advocate counsel for the appellant.

                   Mr.Ramesh Hooda, Advocate counsel for the respondents.

 

O R D E R

R.K.Bishnoi, JUDICIAL MEMBER:

 

                    Complainants requested for compensation on account of death of their son Ravi Kumar who obtained policy No.179603061 for Rs.Five lacs.  At the time of issuance of policy he was examined by the doctors of opposite parties (O.Ps.)/appellants and no abnormality was found.  Unfortunately he fell ill and expired on 16.07.2013 in PGI MS Chandigarh. Their claim was repudiated on 31.03.2014 without any reasonable ground.

2.               In reply, O.Ps. admitted the policy but alleged that medical examination of deceased life assured (DLA) was not conducted by doctor. He did not disclose about any previous ailment at the time of obtaining insurance policy.  As per form No.3816 which is received from PGI Chandigarh, the DLA was suffering from Dilated Cardiomyopathy since the month of February 2013, whereas the insurance policy was commenced from 28.05.2013. He remained admitted in PGI MS, Chandigarh from 06.05.2013 to 28.05.2013 for this treatment. When the previous disease was not disclosed his claim was rightly repudiated.

3.                After hearing both the parties, learned District Consumer Disputes Redressal Forum, Rohtak allowed the complaint  vide order dated 25.04.2016 and directed as under:-

“In view of the facts and circumstances of the case it is observed that opposite parties shall pay the sum assured under the policy No.179603061 i.e. Rs.500000/- (rupees five lac only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 23.05.2014 till its actual realization, other benefits under the policy, if any and shall also pay an amount of Rs.3500/- (Rupees three thousand five hundred only) as litigation expenses to the complainants maximum within one month from the date of decision failing which the awarded amount shall carry further interest @ 12% p.a. from the date of decision. Complaint is allowed accordingly”

4.                Feeling aggrieved therefrom, appellant-O.P. has preferred this appeal.

5.      Arguments heard.  File perused.

6.      Learned counsel for appellant-O.P. vehemently argued that as per certificate of hospital treatment Ex.R-7 it is clear that complainant was suffering from 21.01.2014.  It is mentioned therein that complainant had this problem in the month of February 2013, whereas,  this policy was obtained on 28.05.2013.  He concealed this fact before obtaining insurance policy and claim was repudiated as he violated the terms and conditions of the insurance policy. As he concealed his disease, so impugned order dated 25.04.2016 be set aside and complaint be dismissed.

7.      This argument is of no avail. There is no cogent evidence to prove that he (DLA) was suffering from any ailment before obtaining the insurance policy.  As per history of the DLA, it cannot be presumed that he was having this ailment keeping in view expressed by Punjab State Commission, Chandigarh in Joginder Kaur & others Vs. Life Insurtance Corporation of India & another 2001 (3) CLT 633 and   Life Insurance Corporation of India & Anr. Vs. Raj Kumar Sharma II (2013) CPJ 60.         When O.P. has failed to prove that DLA was suffering from above said ailment the claim cannot be repudiated.  Impugned order passed by the learned District Forum is  well reasoned, based on law and facts and cannot be disturbed. Hence the appeal fails and the same is hereby dismissed.

8.      The statutory amount of Rs.25000/- deposited at the time of filing of the appeal be refunded to the appellant against proper receipt and identification.

August 17th, 2016       Mrs. Urvashi Agnihotri,                   R.K.Bishnoi,                                              Member                                 Judicial Member                                       Addl. Bench                           Addl.Bench                 

S.K.