Haryana

StateCommission

A/855/2014

TATA AIA Life Insurance Co. Ltd - Complainant(s)

Versus

Shishpal - Opp.Party(s)

Mr.S.C. Thathai, Advocate for the appellants

11 Nov 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                               

                                      First Appeal No.855 of 2014

                                      Date of Institution:26.09.2014

                                      Date of Decision: 11.11.2016

 

1.      TATA AIA Life Insurance Co. Ltd., (Formerly known as TATA AIG Life Insurance Co. Ltd.) Unit No.302, Building No.4, Infinity Park, Film City Road, Dindoshi Malad through Sh. Harsimran Singh, Assistant Manager-Legal.

2.      TATA AIA Life Insurance Co. Ltd. (Formerly known as TATA AIG Life Insurance Co. Ltd.) Branch at First Floor, Om Shubham Tower, Shop No.101, 102, 103, 107 & 108, Plot No.69 to 71, Neelam Bata Road, NIT, Faridabad (Haryana)-121001.

                                                …Appellants

 

Versus

 

Shishpal son of Bhisham Swaroop resident of House No.MCF-423, Sanjay Colony, Sector-22 & 23, Faridabad.

                                                …Respondent.

 

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

                   Mrs. Urvashi Agnihotri, Member

 

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

Mr.Vivek Kharwal, Advocate for the respondent.

 

                                       O R D E R

 

URVASHI AGNIHOTRI, MEMBER

 

1. Tata AIA Life Insurance co. Ltd. and Anr. -OPs are in appeal against the Order dated 12.02.2014, passed by the learned District Consumer Disputes Redressal Forum, Faridabad (for short ‘District Forum’), whereby the complaint of Shishpal has been allowed by directing the OPs to pay the insured amount of Rs.1,80,000/- to the complainant, for the death claim of his father Bisan Swaroop, with interest @9% p.a. from the date of complaint i.e.02.03.2009, till the date of payment alongwith Rs.5000/- towards litigation expenses and mental agony.
2. Briefly stated, according to the complainant, his father Bisan Swaroop obtained policy No.U015977539 dated 17.06.2008 from the respondent for a sum of Rs.1,80,000/-. The insured died on 02.08.2008 and the complainant being the son and nominee of insured Bisan Swaroop filed a claim with the OPs. However the claim was repudiated by the OPs by their letter dated 03.12.2008 on the ground that the insured was suffering from coronary obstructive pulmonary disease for the last 10 years which fact was not disclosed by him at the time of proposal application signed on 13.06.2008. OPs limited their liability only to an amount of Rs.1,511.64 being the payment of the account value at the bid price on the next valuation. On the contrary the  complainant alleged that it was mandatory for the agent of the OPs to get the insured medically examined and to insure him only if he was found medically fit. Therefore, there was nothing on record to suggest that the insured was suffering from any disease and so the claim was wrongly repudiated by the OP. Thus aggrieved against the repudiation, the complainant approached the District Forum for the redressal of his grievance against the deficiency in service. 
3. Pursuant to notice, the opposite parties appeared and filed the written reply pleading that the insured had submitted an application for insurance on 17.06.2008 in which he had replied to specific questions, acting upon which the applicant was insured.  But as the insured died after a short duration of obtaining the policy, the OPs found that the life assured was suffering from severe coronary obstructive pulmonary disease problem for the last about 10 years before his death and that he was a habitual alcoholic and had been receiving treatment at various hospitals. On that basis OPs sought to justify the repudiation of the claim. However, the learned District Forum rejected the pleas raised by the OPs and accepted the complaint vide order dated 12.02.2014 by granting the aforesaid relief. 
4. Against the impugned Order, the OPs/appellant have filed appeal before us reiterating their pleas as raised before the District Forum. We have heard the learned counsel for the parties and have gone through the record. From the perusal of the record, it is evident that whatever question were put by the insurance agent at time of issuing the policy, the insured Bishan Swaroop had replied the same. No query or clarification was made by the agent or the OPs. The statements on oath made by Sishpal and his mother before the District Forum fully corroborate the assertion of the complainant that the diseased was not suffering form any pre existing disease much less coronary problem.  The only cause of the death was Asthma which had developed during the last few months. To refute this evidence, the OPs have not been able to produce any documentary proof substantiate their plea of pre existing coronary problem or the treatment taken by the insured any hospital whatsoever. Therefore, the valid insurance claim could not be repudiated so lightly by the OPs without any proof documentary or otherwise. Hence, the conclusion arrived at by the learned District Forum is factually and legally correct and while agreeing with the same, we dismiss the appeal filed by the OPs and uphold the well  reasoned detailed order passed by the learned District Forum.
5. Statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellant against proper receipt and identification in accordance with rules, after the expiry of period of appeal and revision, if any filed in this case.

 

November 11^th,         Urvashi Agnihotri      R.K. Bishnoi

2016                            Member                       Judicial Member

                                    Addl. Bench                 Addl. Bench