Haryana

StateCommission

A/370/2016

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

Versus

SHAKUNTALA DEVI - Opp.Party(s)

RECEIVED FROM NCDRC,NEW DELHI

13 Jul 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

                                      Appeal No                              :         370 of 2016

                                      Date of Institution        :         25.04.2016

                                      Date of Decision          :         13.07.2017

 

MetLife India Insurance Company Limited, Office at Brigade Seshamahal, 5, Vani Vilas Road, Basavanagudi, Bangalore-560004, Karnataka also at MetLife India Insurance Company Limited, 1^st Floor, Himalaya House, 23, Kasturba Gandhi Marg, New Delhi.

                                      Appellant-Opposite Parties No.1 & 2

 

Versus

 

1.      Mrs. Shakuntala Devi wife of Onkar Nath Garg, resident of House No.1851/1, Indira Colony, Rohtak.

Respondent-Complainant

2.      Punjab National Bank, through its Branch Manager, Indira Colony Branch, Rohtak.

                                      Respondent-Opposite Party No.3

 

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri Balbir Singh, Judicial Member.                                                                                                                                            

Argued by:          Shri Vaibhav Jain, Advocate for appellant.

                             Shri B.S. Bairagi, Advocate for the respondent

                             No.1-complainant

                             None for the respondent No.2

                                   

O R D E R

 

NAWAB SINGH J.(ORAL)

 

          Vide order dated October 12^th, 2010 complaint bearing No.286 of 2010 titled Mrs. Shakuntala Devi versus MetLife India Insurance Company Limited and others, was allowed by the District Consumer Disputes Redressal Forum, Rohtak (for short ‘District Forum’). MetLife India Insurance Company Limited-opposite parties No.1 and 2 (for short, ‘Insurance Company’) was directed to pay Rs.2,00,000/-, that is, sum insured alongwith interest at the rate of 9% per annum from the date of filing of the complaint till its realization and Rs.2500/- litigation expenses to Mrs. Shakuntala Devi-complainant on account of death of her husband Onkar Nath Garg.   

2.      Against the said order, the Insurance Company filed appeal No.1902 of 2010 before this Commission, which was accepted vide order dated April 07^th, 2011 by Hon’ble Mr. Justice R.S. Madan, President (as he then was) on the ground that the complaint filed by the complainant before the District Forum was time barred. 

3.      Aggrieved of the aforesaid order, complainant filed revision petition No.1900 of 2012 before the Hon’ble National Consumer Disputes Redressal Commission, New Delhi.  The revision petition was allowed vide order dated March 30^th, 2016 and the matter was remanded to this Commission for disposal of appeal on merits after due notice and hearing the parties.

4.      Onkar Nath Garg, husband of complainant (hereinafter referred to as ‘Insured’) was having bank account with Punjab National Bank, Rohtak-opposite party No.3.  The insured became member under a scheme of group insurance and purchased two policies of Rs.1.00 lac each.  The date of commencement of the policies was November 06^th, 2006. The complainant was the nominee.  The insured died on May 25^th, 2007.  The complainant filed claim with the Insurance Company but the same was repudiated on the ground that Onkar Nath Garg was suffering from Acute Myocardial Infarction and undergone treatment for the same prior to November 2006.  He did not disclose this fact at the time of purchasing the policies. 

5.      It is not in dispute that the insured died during the subsistence of the insurance policies.  The Insurance Company repudiated the claim only on the short ground that the insured did not disclose that prior to the purchase of the insurance policies, he was suffering from Acute Myocardial Infarction and undergone treatment for the same.  In order to prove the same, the Insurance Company has relied upon photocopy of prescription of a private doctor Dr. Ravi Mohan.  The prescription was not legible and it cannot be said that the same was in respect of the insured Onkar Nath Garg.  The Insurance Company did not examine Dr. Ravi Mohan in it’s evidence before the District Forum.  Merely by producing a photocopy of prescription of a private doctor that too not legible, cannot lead to an inference that the insured was suffering from Acute Myocardial Infarction before taking the policy. Thus, the Insurance Company wrongly repudiated the claim of the complainant.  The impugned order passed by the District Forum is perfectly right and requires no interference.  The appeal is dismissed.

6.      The amount of Rs.1,93,916/- deposited by the Insurance Company be refunded to the complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.  

 

Announced 13.07.2017

(Balbir Singh) Judicial Member

(Nawab Singh) President

UK