Haryana

StateCommission

A/617/2014

Reliance Gen. Ins. Co. - Complainant(s)

Versus

Shreya - Opp.Party(s)

01 Aug 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

                                                         First Appeal No.617 of 2014

Date of Institution: 18.07.2014

                                                               Date of Decision: 01.08.2016

 

1. Reliance Life Insurance Company Ltd., City Centre Building Ground Floor Opposite I.B.college, G.T.Road, Panipat, through its Branch Manager.
2. Claim Manager, Reliance Life Insurance Company No.6 Ltd., Reliance House 6^th Floor Haddow Road, NungambakkamChennai-600006.

…..Appellants

Versus

 

Shorya (minor) son of Ramehar Singh S/o Sh. Pyare Lal R/o VPO Sultana H.No.98 Tehsil Madlauda,Distt. Panipat through his grand mother Smt.Sumitra Devi mother of Ramehar as his natural guardian and next friend.

                                      …..Respondent

 

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

                             Mrs. Urvashi Agnihotri, Member.                                                                                                                                        

Present:              Shri Rohit Goswami, Advocate counsel for appellants.

                             Rasna mother of respondent in person.

 

                                                   O R D E R

R.K.BISHNOI, JUDICIAL MEMBER:

          A minor boy filed this complaint through her widow mother for claim after death of his father.  It was alleged that his father obtained insurance policy on 12.03.2011 for sum of Rs.Two lacs.  He was hale and hearty but on 31.03.2012 he had chest pain and lost his life.  Claim was submitted with the opposite parties (O.Ps.) for insurance amount, but, the same was repudiated on the ground that life assured (DLA) Ram Mehar Singh concealed the psychiatric problem for which he received treatment since the year 2008, but, he was not suffering from any such ailment.

2.      O.Ps. filed reply controverting his averments about illness and alleged that during investigation by surveyor it was found that DLA received treatment about psychiatric problem from Dr. Ashok Kumar Aggarwal since the year 2008.  This fact was not disclosed at the time of obtaining insurance policy.  Keeping in view the opinion of Hon’ble Supreme Court in so many cases, his claim was repudiated on the ground of suppression of material facts.

3.      After hearing both the parties, learned District Consumer Disputes Redressal, Forum, Panipat (in short “District Forum”) allowed the complaint and directed as under:-

“We hereby allow the present complaint with a direction to opposite party to pay Rs.2,00,000/- to the complainant with interest @ 9% per annum from the date of filing the complaint till realization. This order shall be complied within 30 days from the announcement of this order.  Cost of litigation quantified at Rs.2200/- is also allowed to be paid by opposite party to the complainant.”

4.      Feeling aggrieved therefrom, O.P.Nos.1 and 2/appellants have preferred this appeal.

5.      Arguments heard.  File perused.

6.      Before coming to discussion it will be better to reproduce the questions  and answers relied by O.Ps. to repudiate claim mentioned in the grounds of appeal which are as under:-

“Question 28:- ‘Are you currently taking any medication or drugs, other than minor conditions, (eg cold and flu), either prescribed by a doctor, or have you suffered from any illness, disorder, disability or injury during the past 5 years which has required any form of medical or specialized examination (including chest X-rays, gynecological investigations, pap smer or plod tests), consultation, hospitalization or surgery?

                   Answer:     No.

Question 30:- Do you suffer from any medical ailment eg Diabetes, High Blood pressure, Cancer Respiratory disease (including Asthma), kidney or liver disease, stroke or any blood disorder, heart problem, hepatitis B or tuberculosis, psychiatric disorder, depression, HIV Aids or a related infection?

                   Answer: No.”

7.      Learned counsel for the appellants vehemently argued that when the matter was investigated by surveyor it was told by his wife i.e. mother of the complainant that in the year 2010 her husband was having some mental problem and consulted doctor at Panipat and Karnal.  DLA was suffering from schirophrenia as mentioned in the report  Ex.R-3 by surveyor.  As per record of doctor Ex.R-4 DLA was receiving treatment since the year 2008 i.e. before obtaining insurance policy. When DLA concealed previous  illness claim was rightly repudiated. He (Complainant) is not entitled for compensation because cardinal principle of contract of life insurance is uberrema fides i.e. utmost good faith.  In support his arguments he placed reliance upon the opinion  of Hon’ble National Commission expressed in revision petition Nos.3794-3796 of 2007 titled as Divisional Manager, LIC of India & Ors. Vs. Smt. Anupama & Ors. Decided on 17.04.2012.

8.      Firstly the statement of complainant’s mother attached with surveyor report cannot be used against her because surveyor was not examined to prove that statement.  He was the best person to prove this fact.  In the absence of any evidence it cannot be presumed that mother of complainant made such statement. She was not confronted with  statement when she tendered her affidavit Ex.CW-1 in evidence..  Moreover, as per statement it is clear that he was little bit disturbed.  This disturbance can be due to tension on account of any reason.  If one is  over sensitive even a minor incident can cause tension, but, it does not mean that he is suffering from psychiatric problem.  When the person who recorded the statement is not examined and the statement is also not put to mother of complainant the same cannot be used against him.  Further, it has no-where come on the file that Ram Mehar died due to alleged ailment.  As per statement of member panchayat, Sarpanch etc. he had pain in chest and breathed his last.  The alleged disease is not related to death in any manner. 

9.      Now the question comes whether he was having treatment for schirophrenia or not.  In Ex.R-4 it is no where mentioned that he was having any psychiatric disorder.  If medicines are taken in routine it  does not  mean that he was having some serious ailment and concealed the same.  To prove this fact insurance company should have examined the doctor.  More so, in Ex.R-4 only Ram Mehar is mentioned, parentage and place of residence are not mentioned. This record is not connected with the father of the complainant. Without any cogent evidence it cannot be presumed that Ram Mehar father of complainant was having any psychiatric problem and concealed the same at the time of obtaining insurance policy.    So these arguments are of no avail.  Just on the basis of suspicion, right of minor, who is being looked-after by widow mother, cannot be jeopardized. So these arguments are of also not avail.  The findings of learned District forum are well reasoned based on law and facts and cannot be disturbed.  Resultantly appeal fails and the same is hereby dismissed.

10.    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.

 

August 1st, 2016         Urvashi Agnihotri                                R.K.Bishnoi,                                                               Member                                              Judicial Member                                                         Addl. Bench                                        Addl.Bench                

S.K.