Haryana

StateCommission

A/104/2017

BIRLA SUN LIFE INSURANCE CO. LTD. - Complainant(s)

Versus

SHYAM SUNDER - Opp.Party(s)

S.C.THATAI

30 Apr 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeals Nos: 104 & 184 of 2017

Date of Institution: 30.01.2017 & 17.02.2017

Date of Decision: 30.04.2018

Appeal No.104 of 2017

 

1.      Birla Sun Life Insurance Company Limited., G Group Tech. Park, 5^th and 6^th Floor, Kasar Ghodbunder Road, Thana West, Maharashtra through Ms. Aakriti Manocha, Deputy Manager-Legal.

2.      Birla Sun Life Insurance Company Limited, G.D. Plaza, Ist Floor Circular Road, near Bank of Baroda, Hansi Gate, Bhiwani.

                                      Appellants-Opposite Parties

Versus

 

Shyam Sunder son of late Shri Mohan Lal, Resident of House No.73, Ward No.19, in front of Kirori Mal Mandir, Bhiwani.

                                      Respondent-complainant

Appeal No.184 of 2017

 

Shyam Sunder son of late Shri Mohan Lal, Resident of House No.73, Ward No.19, in front of Kirori Mal Mandir, Bhiwani.

                                      Appellant-complainant

Versus

 

1.      Birla Sun Life Insurance Company Limited., G Group Tech. Park, 5^th and 6^th Floor, Kasar Ghodbunder Road, Thana West, Maharashtra.

2.      Birla Sun Life Insurance Company Limited, G.D. Plaza, Ist Floor Circular Road, near Bank of Baroda, Hansi Gate, Bhiwani, District Bhiwani.

                             Respondents-Opposite Parties

 

 

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

                             Mr. Balbir Singh, Judicial Member.

 

Argued by:          Shri S.C. Thatai, Advocate for Birla Sun Life Insurance Company Limited.

                             Shri J.S. Rana, Advocate for Shyam Sunder-complainant.

 

                                                   O R D E R

 

BALBIR SINGH, JUDICIAL MEMBER

 

        This order shall dispose of afore-mentioned two First Appeals bearing Nos.104 and 184 of 2017 having arisen out of common order dated December 27^th, 2016 passed by District Consumer Disputes Redressal Forum, Bhiwani (for short the ‘District Forum’), in complaint No.184 of 2014.     

2.                Mohan Lal Sarraf (since deceased and hereinafter referred to as the ‘life insured’) father of complainant – Shyam Sunder, was provided Life Insurance Policy No.005225638 dated 29^th November, 2011 from Birla Sun Life Insurance Company Limited (for short ‘Birla Sun Life’)-Opposite Parties, for a period of 14 years under product name BSLI Protector plan mentioning the total sum assured as Rs.10,00,000/-. Thereafter, the life insured was provided another insurance policy bearing No.005374455 dated 23^rd February, 2012 for a period of 14 years under the same plan mentioning the total sum assured as Rs.5,00,000/-. The life insured died on 22^nd April, 2012 due to Acute Respiratory Failure at J.B. Gupta Hospital, Bhiwani.

3.                The complainant, being nominee and legal heir of the deceased life insured, informed the opposite parties regarding death of the life insured immediately. The complainant submitted insurance claim which was repudiated by the Insurance Company vide letter dated 29^th June, 2012 mentioning that the life insured concealed material facts from the opposite parties at the time of submitting the proposal form and did not disclose regarding pre-existing disease, as the life insured got treatment for diabetes mellitus, giddiness and hypertension. The insurance claim has been wrongly repudiated by the opposite parties. It is pleaded that the life insured never misled the Birla Sun Life as mentioned in repudiation letter. Earlier regarding this dispute, the complainant filed an application under Section 22C of the Legal Services Authorities, Act, 1987 before the Permanent Lok Adalat for Public Utility Services which was dismissed as withdrawn on technical ground.

4.                The complainant filed complaint under Section 12 of the Consumer Protection Act, 1986 with a prayer to direct the opposite parties to pay the total sum assured of Rs.15,00,000/- to the complainant with interest at the rate of 18% per annum; to pay an amount of Rs.50,000/- on account of loss suffered by the complainant due to negligence of the opposite parties; to pay an amount of Rs.50,000/- to the complainant as compensation on account of un-necessary harassment and mental agony and Rs.5,000/- as litigation expenses.

5.                The opposite parties in their written version have taken plea that the complaint is not maintainable in the present form; that the complainant has concealed and suppressed material and relevant facts from the opposite parties; that the contract of insurance is ab initio as the complainant concealed the material facts and that it is not a case of deficiency in service and the District Forum has no jurisdiction to decide this complaint. The opposite parties repudiated the insurance claim under the above mentioned two insurance policies by passing speaking order mentioning specific reasons. The life insured at the time of submitting proposal form did not disclose that he was diagnosed of diabetes mellitus, giddiness and hypertension prior to the purchase of the insurance policies. The life insured was already undergoing treatment. Moreover, the life insured died on 22^nd, April, 2012 within five months from the date of commencement of the first policy and within a period of two months from the date of issuance of the second policy. In this way, the insurance claim has been rightly repudiated by the Insurance Company. The complainant has failed to set up a nexus between the damages claimed in the present complaint and damage suffered by her. It is also pleaded that the life insured detained the insurance policies and did not return the same to the Insurance Company for cancellation from free-look period. The complainant is bound by the terms and conditions mentioned in the insurance policies. The opposite parties are not liable to pay any amount to the complainant and prayed that the complaint filed by the complainant be dismissed.

6.                Parties led evidence in support of their respective claims before the District Forum.

7.                After hearing arguments, vide impugned order dated 27^th December, 2016 passed by the learned District Forum, the complaint filed by the complainant was allowed directing the opposite parties to pay the total sum assured of both the insurance policies to the complainant. The opposite parties were also directed to comply with the order within 90 days from the date of passing of the order.

8.                Aggrieved with the impugned order dated 27^th December, 2016 passed by the learned District Forum, the opposite parties have filed First Appeal No.104 of 2017 with a prayer to set aside the impugned order and to dismiss the complaint filed by the complainant.

9.                The complainant has filed First Appeal No.184 of 2017 with a prayer to modify the impugned order dated 27^th December, 2016 passed by the learned District Forum. It is pleaded that while passing award learned District Forum did not grant interest on the awarded amount and also did not grant compensation on account of un-necessary harassment, mental agony as well as litigation expenses.

10.              As per version of the complainant as the delay has been caused regarding payment of the sum assured to the complainant due to faults of the opposite parties, the complainant is entitled to receive interest at the rate of 18% per annum from the date of death of the life assured.

11.              We have heard learned counsel for the parties and perused the case file.

12.              During the course of arguments, there was no controversy of any type that Mohan Lal Sarraf-father of the complainant was provided two life insurance policies viz. Policy No.005225638 dated 29^th November, 2011 from the Opposite Parties, for a period of 14 years under product name BSLI Protector plan mentioning the total sum assured as Rs.10,00,000/- and Policy No. 005374455 dated 23^rd February, 2012 for a period of 14 years under the same plan mentioning the total sum assured as Rs.5,00,000/-. It is also admitted fact that the life insured died on 22^nd, April, 2012 during the insurance period i.e. within five months from the date of issuance of the first insurance policy and after a period of two months from the date of issuance of the second policy, as mentioned above. Death Certificate issued by Registrar Birth and Death is (Annexure C-3). The complainant informed the opposite parties regarding death of the life insured and also submitted insurance claim before the opposite parties. The claim of the complainant was repudiated by the Birla Sun Life vide letter dated 29^th June, 2012 (Annexure R-5), after obtaining death claim investigation report from the investigator, on the ground that the Birla Sun Life was misled by the life insured before issuance of the above mentioned policies by not disclosing about his state of health. The life insured concealed that he was diagnosed and got treatment for diabetes mellitus, giddiness and hypertension.

13.              As per version of the opposite parties, the complainant was required to give correct information regarding his health before accepting the proposal forms and regarding any treatment provided to him before issuance of the insurance policies. As per ‘Medical Attendant’s Certificate’ (Annexure R-3) the life insured – Mohan Lal Sarraf died due to acute respiratory failure. As per death claim investigation report prepared by ‘Transparent World’ Annexure R-4 the life insured was suffering from blood pressure, sugar DMT2 & giddiness prior to the purchase of the insurance policies and he remained admitted in JB Gupta’s Hospital and KM Hospital, Bhiwani. In the OPD slip dated 27^th August, 2011, it is mentioned that Mohan Lal was suffering from Giddiness, diabetes mellitus. Similarly, in the OPD slip issued from K.M. Hospital dated 19^th September, 2011 Mohan Lal is mentioned as suffering from blood sugar. The opposite parties did not adduce any evidence regarding sugar level. Test report from Dr. Khetarpal Pathology Lab dated 27^th August, 2011 is placed on the file wherein level of Blood Sugar (Random) is mentioned as 147.0 mg against the normal range of 140 mg. In fact, except the above mentioned test report, there is no other record on the file to show that blood sugar of the life insured was found more than the normal range after pathology lab test. Merely mentioning in the OPD slips words diabetes mellitus, giddiness and hypertension, is not enough to hold that the life insured was diabetic or he was a patient of hypertension. At the time of preparation of the test report after obtaining blood sample of the life insured the range of the blood sugar at random was found 147 mg against the normal range of 140 mg%. Considering all these circumstances, observation can be made that on that particular date when sample was obtained, the life assured was a border line case of diabetes.

14.              Apart from it, the disease of hypertension also cannot be taken so serious as the life insured was a border line case of diabetes. Merely due to border line diabetic, hypertension cannot be considered as dangerous to life.  Similarly, giddiness also cannot be considered as dangerous to life in any way.

15.              Moreover, this fact also cannot be overlooked that the life insured was examined by a doctor on the panel of the Birla Sun Life before providing the insurance policy. If a doctor on the panel of the insurance company cannot give opinion regarding hypertension, blood pressure or sugar level, certainly we feel there is no use to get the insured examined from the doctor on the panel of the insurance company and to receive his report on making un-necessary payments. A physician certainly is in a position to give opinion within few minutes by using needed apparatus with latest technology regarding blood sugar level, blood pressure, giddiness and hypertension. If the insurance companies are so serious regarding the above mentioned diseases, the Insurance Company should decline prayer of the insured immediately after receiving test reports and opinion of the doctors regarding sugar level, hypertension etc.  

16.              It appears that when proposal form is submitted, the insurance company is always found in haste to provide insurance policy so that the insurance company may be able to receive premium and may be able to increase business of the company. As and when the insured/claimant submits insurance claim, then such type of objections are raised as in the case in hand so that the insurance company may be able to avoid payment of the insured amount. Keeping in mind all the above mentioned circumstances, we feel the repudiation of the insurance claim of the complainant by the opposite parties was illegal and totally unjustified. We have no hesitation in holding that the complainant is entitled to receive the total sum assured of Rs.15.00 lacs from the opposite parties. We find no illegality and invalidity in the impugned order passed by the learned District Forum regarding awarding payment of the total sum assured.

17.              The complainant has filed First Appeal No.184 of 2017 with a prayer to modify the impugned order passed by the learned District Forum and to award interest to the complainant at the rate of 18% per annum on the awarded amount and also to award compensation amount on account of un-necessary harassment, mental agony and litigation expenses.  Keeping in mind all the circumstances mentioned above, we feel the complainant had to face un-necessary harassment, mental agony and also had to spend lot of money in this litigation due to faults of the opposite parties. The delay in making payment of the awarded amount is also due to faults of the opposite parties. Keeping in mind all these circumstances, it will be justified to direct the opposite parties to pay interest to the complainant on the total sum assured of Rs.15.00 lacs at the rate of 9% per annum from the date of filing of the complaint. It will also be justified to award an amount of Rs.10,000/- to the complainant on account of un-necessary harassment, mental agony and litigation expenses.  

18.              As a result as per discussions above in detail, we find no merit in First Appeal No.104 of 2017 filed by the opposite parties and the same stands dismissed. First Appeal No.184 of 2017 filed by the complainant is partly allowed as indicated above and the impugned order passed by the learned District Forum is modified accordingly. The opposite parties are directed to pay total sum assured amount of Rs.15.00 lacs to the complainant with interest at the rate of 9% per annum from the date of filing of the complaint; to pay an amount of Rs.10,000/- on account of un-necessary harassment and mental agony as well as costs of litigation.

19.              The statutory amount of Rs.25,000/- deposited at the time of filing First Appeal No.104 of 2017 be refunded to the complainant against proper receipt and identification in accordance with rules, after expiry of period of appeal/revision, if any.

 

Announced: 30.04.2018

(Balbir Singh) Judicial Member

(Nawab Singh) President

 

CL