Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 09.
Instituted on : 04.01.2019.
Decided on : 06.01.2021.
Smt. Sudesh Devi age 52 years, wife of Late Sh. Dalbir Singh resident of House No.1770, Saman Tehsil Meham Distt. Rohtak.
………..Complainant.
Vs.
SBI Life Insurance Company Ltd., 1st Floor, SCF-13, HUDA Commercial complex, Rohtak(Haryana), Through is Manager.
……….Opposite party.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. RENU CHAUDHARY, MEMBER.
MS. TRIPTI PANNU, MEMBER.
Present: Sh.Paramdeep Sheemar, Advocate for complainant.
Sh. Gulshan Chawla, Advocate for opposite party.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that the husband of complainant namely Dalbir Singh had taken a policy bearing no.70000003903 for the period 25.08.2016 to 25.08.2021 for the sum assured Rs.650000/-. At the time of filing the proposal form, he had given all the required information regarding his health. Unfortunately the husband of the complainant has died on 03.11.2016 and the complainant being legal heir and nominee of the deceased has submitted her claim form with the opposite party. The complainant visited time and again to get the claim amount of said policy from the respondents but respondents are not paying the same. A letter dated 01.03.2017 was issued by the opposite party stating therein that Dalbir Singh was suffering from heart disease prior to the date of commencement of policy, which is wrong. The act and conduct of the opposite party is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite party may kindly be directed to pay the claim amount under the said policy amounting to Rs.650000/- alongwith interest, compensation and litigation expenses as explained in relief clause to the complainant.
2. After registration of complaint, notice was issued to the opposite party. Opposite party in its reply has submitted that late Mr. Dalbir Singh had applied for insurance coverage through membership form no.7006099397 dated 24.08.2016. Based on the information furnished in the membership form and believing the same to be true and correct, the DLA was granted insurance cover under Master Policy No.70000003903 for initial sum assured of Rs.650000/-. The answering opposite party had not conducted any medical examination before providing the insurance cover to the DLA. In the instant case, the insurance cover was granted on non-medical basis and medical examination was not conducted. The answering opposite party is not liable to pay the death claim amount under the policy as the deceased life assured did not disclose his pre-existing illness at the time of availing the insurance cover. The answering opposite party has conducted investigation under the said policy and it was fond that Mr. Dalbir Singh(DLA) was suffering from heart disease prior to the date of commencement of the insurance cover. Hence the contentions of the complainant that the deceased life assured was not suffering from any pre-existing disease and the answering opposite party has in arbitrary manner refused to pay the claim amount is denied. The answering opposite party is not liable to pay any amount and hence has not paid the same to the complainant as per the terms and conditions of the policy. The answering opposite party has refunded the premium amount on repudiation of the claim. Answering opposite party is not liable to pay any further amount and dismissal of complaint has been sought.
3. Ld. counsel for the complainant in his evidence has tendered affidavits Ex.CW1/A, documents Ex.C1 to Ex.C6 and has closed his evidence on dated 01.05.2019. Ld. Counsel for opposite party has tendered affidavits Ex.RW1/A & Ex.RW2/B and documents Annexure-A to Annexure-Q and closed his evidence on dated 04.06.2019.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. In the present case, as per certificate of insurance Ex.C1, life assured Sh.Dalbir singh had taken the policy bearing no.70000003903 having insurance cover start date 25.08.2016, COI insurance date 26.09.2016, date of disbursement of loan is 23.06.2016 and the life assured Sh. Dalbir Singh died on 03.11.2016. After the death of LA Dalbir singh, complainant filed the claim with the opposite party but the same has been repudiated by the opposite party on the ground that deceased LA was suffering from pre-existing illness i.e. heart disease at the time of availing the insurance cover. To prove this fact, opposite party has placed on record treatment record Annexure-a to Annexure-Q. As per Central Industrial Security Force Medical Board Proceedings Annexure-G, it is opined that HC/GD Dalbir Singh aged 44 years was a k/c/o CAD, old anti-wall MI(2008)SKT given. As per Discharge Summary of Meenakshi Mission Hospital & Research Centre placed on record as Annexure-H, the date of admission of Dalbir Singh is 12.07.2013 and discharge date is 20.07.2013 and he was diagnosed for Coronary Artery Disease-Single Vessel Disease and the same fact is also certified as per Annexure-J. As per Discharge summary Annexure-L, the date of admission of Dalbir Singh is 03.07.2014 and date of discharge is 11.07.2014. As per record of Jawahar Lal Nehru Port Hospital Annexure-N, dated 10.09.2015 to 21.10.2016, Dalbir Singh was diagnosed for CAD/Old MI etc. As per certificate Annexure-O of Jupiter Hospital also, the patient Dalbir Singh was admitted in Jupiter Hospital on 02.08.2016 for Ischemic Heart Disease. From all the above documents placed on record, it is proved that deceased Dalbir Singh was suffering from Heart disease and he had taken treatment from various hospitals prior to commencement of policy but he had concealed the same fact at the time of applying for the policy. As per the medical questionnaire given in proposal form Annexure-B, the LA has denied all the questions regarding his admission in any hospital for treatment of any disease prior to the date of proposal.
6. Hence from the documents placed on record, it is proved that the deceased/LA was suffering from heart disease prior to proposal of policy and he concealed the alleged fact at the time of availing the insurance cover. In view of the facts and circumstances of the case, present complaint is hereby dismissed with no order as to costs
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
06.01.2021.
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Nagender Singh Kadian, President
……………………………….
Renu Chaudhary, Member.
…………………………….
Tripti Pannu, Member.
