Haryana

StateCommission

A/361/2015

TATA AIA LIFE INSURANCE CO. - Complainant(s)

Versus

SHALLEJ SINGH AND ANR. - Opp.Party(s)

S.C.THATAI

02 Mar 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

 

 

First Appeal No.361 of 2015

Date of the Institution:22.04.2015

Date of Decision:02.03.2017

 

1.      TATA AIA Life Insurance Co. Ltd., (Formerly known as TATA AIG Life Insurance Co. Ltd.) Unit 302, Building No.4, Infinity IT Park Film City Road Dindoshi Malad-East Mumbai 400097 through its Managing Director.

2.      TATA AIA Life Insurance Co. Ltd., (Formerly known as TATA AIG Life Insurance Co. Ltd.) Registered and Corporate Office 6^th Floor, Peninsula Towers, Peninsula Corporate Park, Ganpatrao Kadam Marg, Lower Parel (W) Mumbai through its Manager.           

3.      TATA AIA Life Insurance Co. Ltd., (Formerly known as TATA AIG Life Insurance Co. Ltd.)789, Lotus Tower, New Friends Colony, Community Centre, new Delhi through its Manager.

4.      TATA AIA Life Insurance Co. Ltd., (Formerly known as TATA AIG Life Insurance Co. Ltd.) SCO N o.151-152, Sector 8-C, Chandigarh near Axis Bank, Chandigarh, now new address SCO No.107-108, 2^nd Floor Sector-43B, Chandigarh through its manager.

5.      TATA AIA Life Insurance Co. Ltd., (Formerly known as TATA AIG Life Insurance Co. Ltd.)SCO N o.244, 245, 246, Second Floor, Sector-12, Kanral through its Manager.                                                                     

.….Appellants

Versus

1.      Shallej Singh son of Surat Singh resident of House No.1278, Sector-7, Urban Estate, Kurukshetra, Tehsil Thanesar, District Kurukshetra.

                                                          Respondent No.1.

2.      Gaurav Kumar agent TATA AIG Life Insurance Co. Ltd., House No.345, Ward No.2, Pundri, District Karnal.

                                                                        .….Proforma Respondent

 

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

                    Mrs. Urvashi Agnihotri, Member

 

 

Present:-    Mr.S.C. Thathai, Advocate for the appellants.

                    Mr.Ramandeep Singh, Advocate for the respondent No.1.

 

O R D E R

 

URVASHI AGNIHOTRI, MEMBER:

 

1.      M/s Tata AIA Insurance Co. Ltd. and Ors.-OPs are in appeal against the Order dated 10.03.2015 passed by the learned District Consumer Disputes Redressal Forum, Karnal (for short ‘District Forum’), whereby the complaint of Shallej Singh has been allowed directing the OPs as under:-

“OP No.1 to OP No.5 to make the payment of the sum insured to the complainant alongwith the interest @ 9% per annum from the date of filing of the present complaint i.e. 19.08.2009 till its actual realization. The complainant shall be also entitled for a sum of Rs.10,000/- for the harassment caused to him and a sum of Rs.2200/- towards legal fee and legal expenses.”

 

2.      Briefly stated,  he was insured by the OPs vide insurance policy No.0017662402 on 28.07.2008 for a sum of Rs.1,50,000/-. The complainant was got examined medically from their own doctor, who opined that the complainant was having no disease of any kind. After issuance of the Policy, the complainant suffered liver problem. Liver plantation of the complainant was done but he suffered stomach problem. The complainant spent Rs.4,00 lacs for which the complainant submitted all the bills to the OP, but the OP refused to make the payment. Aggrieved by this, the complainant approached the District Forum for redressal of his grievance.

3.      Pursuant to notice, the opposite parties appeared and filed the written reply pleading that the life insured was suffering from alcoholic liver disease , cirrhosis of liver, porial hypertension and esophageal various disease prior to obtaining of the insurance cover and the complainant was hospitalized in the year 2006. The factum of pre-existing disease was not disclosed at the time of application dated 18.07.2008 for correctly. As such on account of suppression of facts the said claim had been repudiated as there was no deficiency in service on the part of the opposite parties. However, the learned district Forum rejected the pleas raised by the OPs and accepted the complaint vide order dated 10.03.2015 by granting the aforesaid relief to the complainant.

4.      Against the impugned Order, the OP/appellants have filed present appeal before us reiterating the same pleas, as raised before the District Forum. We have heard the learned counsel for the parties and have also gone through the record. From a perusal of the record, it is evident that  the complainant was in fact suffering from alcoholic liver disease, cirrhosis of liver, porial hypertension and esophageal various disease prior to obtaining of the insurance cover for which the complainant was hospitalized in the year 2006 from 18.07.2006 to 24.07.2006 in Fortis Hospital, Mohali. At that time the hospital authority diagnosed the ailment and recorded the same as under:-

                   “Present illness

Patient is 30 years old male who is a chronic alcoholic and K/C/O and with cirrohsis  /PHT/ascitis presented with acute H/O of massive upper GI bleed 1^st episode in the morning (200ml) and 2^nd episode in the evening on 18.07.2006, malena+nt.

He has H/o jaundice on & off for past 2 years. H/o-generalized weakness, lethargy+nt”.

 

5.       The complainant could not refute the aforesaid version of the OPs in the face of authentic documentary proof against him, except by contending that he had already been medically examined by the medical officer deputed by the insurance company before issuing policy.

6.      This arguments is wholly weak and untenable in law as the medical examination before issuance of policy is not a through medical version can only be verified if the answer to the questionnaire are rightly and truthfully given by the insured. But in the present case, the insurance company has vehemently pleaded with reference to documentary proof that the answer given by the complainant to the questionnaire were ultimately  found incorrect. Thus, there is total suppression and concealment of material facts on the part of the complainant, which fully justified the repudiation of his claim.

7.      Consequently, we do not find any merit in the complaint filed by complainant and we allow the appeal of insurance company with no order as to costs.

8.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification in accordance with rules.

March 02nd, 2017

Urvashi Agnihotri, Member, Addl.Bench

R.K.Bishnoi, Judicial Member Addl.Bench