Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 637.
Instituted on : 09.11.2017.
Decided on : 07.08.2019.
Smt. Saroj age 46 years, wd/o Sh. Ajit Singh r/o VPO Farmana Khas Tehsil Meham District Rohtak.
..………..Complainant.
Vs.
- Shri Ram Life Insurance Company Limited situated at Plot No.31 & 32, 5th & 6th Floor, Ramky Selenim, Beside Andhra Bank Training Centre, Financial District, Gachibowli, Hydrabad-500032 through its authorized signatory.
- Shri Ram Life Insurance Company Limited through its Branch Manager situated at Ashoka Plaza, Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
SH. VED PAL, MEMBER.
DR. RENU CHAUDHARY, MEMBER.
Present: Sh.Gaurav Khurana, Advocate for the complainant.
Sh. Gulshan chawla, Advocate for opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. The present complaint has been filed by the complainant with the averments that she is widow of Ajit Singh(insured) since deceased. That complainant’s husband had insured himself with the respondent No.1 vide policy No.NN131400082175 on 07.08.2014 for Rs.5 lacs, term 25 years. That complainant was appointed as nominee in the alleged policy. That unfortunately, Ajit Singh died on 07.04.2016 leaving behind complainant as well as his other legal heirs. That respondent no.1 was duly informed by the complainant/nominee after last rites of deceased Ajit Singh with a request to pay the insurance claim. That complainant furnished all requisite documents and form for passing of claim. But the opposite party No.1 has repudiated the claim of the complainant on the ground that claim has been investigated and during investigation and enquiries made, it has come to their notice that deceased/life assured was suffering from pre-existing cancer as per the evidence obtained. The deceased taken the policy and as per rules of the company before issuing the policy, the doctor and hospital on panel, checked the insured and during that time, no ailment was found suffered by the deceased. Thus, there was no fault or negligence or concealment on the part of insured person. Moreover, the deceased Ajit Singh had died his natural death and was not suffering from cancer. It is averred that the act of opposite parties is illegal and amounts to deficiency in service. As such, it is prayed that opposite parties may kindly be directed to pay Rs.500000/- alongwith interest, compensation and litigation expenses to the complainant.
2. On notice opposite parties appeared and filed their written reply submitting therein that the proposal form was received in the office of answering respondent, wherein proposer has proposed for “Shriram Life Cash Bank Term Plan”. That believing the information as regard to profession/business, income, state of health and other information given in the proposal form to be correct, answering respondent issued the policy No.NN131400082175 on 14.08.2014 for the policy term 25 years and for basic sum insured Rs.500000/-. That in the month of August 2016, the company received a death claim from the nominee/complainant and since the death occurred within short period from the date of commencement of policy, the same was got investigated through Independent Investigator M/s Centre point services and as per the report, the deceased life assured was a patient of cancer and was under treatment from PGIMS, Rohtak. It is further submitted that the deceased life assured, who alleged himself to be a farmer and earning of Rs.200000/- p.a. purchased 7 insurance policies from different insurance companies within a span of 10 months starting from 13.05.2014 to 19.03.2015 for the total Sum Assured of Rs.6538523/- and he concealed the factum regarding having policy from other insurance companies and his state of health. That the claim of the complainant has been rightly repudiated, as the deceased Life Assured initially concealed the material facts regarding his state of health and concealment of holding multiple insurance policies from other insurance companies. It is averred that there is no deficiency in service on the part of opposite parties and it is prayed the claim may kindly be dismissed with costs.
3. Both the parties led evidence in support of their case.
4. Ld. Counsel for the complainant in his evidence has tendered affidavits Ex.CW1/A, Ex.CW1/B, documents Ex.C1 to Ex.C4 and closed his evidence on dated 25.10.2018. On the other hand, ld. Counsel for the opposite parties has tendered affidavit Ex.RW1/A, Ex.RW2/A, documents Ex.R1 to Ex.R6 and has closed his evidence on 31.01.2019.
5. We have heard ld. counsel for the parties and have gone through the material aspects of the case carefully.
6. In the present case, the claim of the complainant has been repudiated by the opposite parties vide their letter Ex.R5 on the ground that life assured was suffering from cancer prior to commencement of policy and he has not disclosed the pre-existing insurance policies. In this regard it is observed that opposite parties have not placed on record any document to prove the pre-existing disease of LA. However, investigation report Ex.R3 has been placed on record by the respondent officials to prove the fact that matter was deeply investigated by the insurance company and after investigation, they came into the conclusion that deceased LA was suffering from cancer. During investigation, the statement of Smt. Saroj was recorded and another certificate was also issued by Sarpanch of Village Pharmana on dated 14.09.16 to prove the fact that deceased was died due to natural death on 07.04.2016. The investigator also prepared a panchnama during the investigation and more persons signed the Panchnama and in this Panchnama, it has been mentioned that the deceased LA died on 07.04.2016 and the last rites was conducted in the village.
7. In the present complaint, respondent counsel also argued on the point that deceased was suffering from cancer and to prove this fact, he has placed on record some emails and documents Ex.R4 to Ex.R6. It is further argued that it was within the knowledge of deceased LA that he was suffering from major disease and he obtained so many policies in a short period. First policy was issued on dated 13.05.2014 by HDFC Life Insurance Co. having sum assured 12 lacs. Thereafter, an another policy was purchased by the deceased LA on 30.06.2014 from PNB Met Life Insurance having sum assured Rs.910000/-. Thereafter, complainant purchased the present policy for sum assured Rs.500000/- and after this policy, life assured purchased 4 another policies from different life insurance companies. The main contention of respondent counsel is that in the proposal form, the income source of deceased is disclosed as farmer and he disclosed the annual income as Rs.2 lacs. Moreover, diseased LA failed to disclosed the detail of existing life insurance policies, if any in the column no.8 and mentioned N.A. In this regard, ld. counsel for the respondent has placed reliance upon the judgment dated 24.04.2019 of Hon’ble Supreme Court in Civil Appeal no.4261 of 2019 titled as Reliance Life Insurance Co. Ltd. & Anr. Vs. Rekhaben Nareshbhai Rathod, whereby Hon’ble Suprme Court has held that: “We are not impressed with the submission that the proposer was unaware of the contents of the form that he was required to fill up or that in assigning such a response to a third party, he was absolved of the consequence of appending his signatures to the proposal. The proposer duly appended his signature to the proposal form and the grant of the insurance cover was on the basis of the statement contained in the proposal form. Barely two months before the contract of insurance was entered into with the appellant, the insured had obtained another insurance cover for his life in the sum of Rs.11 lakhs. We are of the view that the failure of the insured to disclose the policy of insurance obtained earlier in the proposal form entitled the insurer to repudiate the claim under the policy.”
8. In view of the aforesaid law which is fully applicable on the facts and circumstances of the case, we hereby dismiss the complaint with no order as to costs.
9. 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:
07.08.2019.
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Nagender Singh Kadian, President
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Ved Pal Hooda, Member.
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Renu Chaudhary, Member.
