Haryana

StateCommission

A/170/2015

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

Versus

SONU - Opp.Party(s)

NITIN THATAI

11 Nov 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

                  

                                                First appeal No.170 of 2015

Date of the Institution: 06.02.2015

Date of Decision:11.11.2016

 

1.      Birla Sun Life Insurance Company Limited through its Branch office above Canara Bank, G.T. Road, Fatehabad District Fatehabad through Ms. Aakriti Manocha, Assistant Manager-Legal.

2.      Birla Sun Life Insurance Company Limited SCO 149-151, Red Square Market, Near Menrwa Hotel, Hisar through its Branch Manager.

3.      Birla Sun Life Insurance Company Limited through its Registered 6^th floor, Vaman Centre, Makhwana road Off. Andheri-Kurla Road, Near Marol Nakka, andheri (E) Mumbai through its Signatory Authority.

…..Appellants

Versus

Sonu S/o Suresh Kumar resident of village Bhuthan Kalan, Tehsil & District Fatehabad, Haryana.

                                                                             .….Respondent

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

                    Mrs.Urvashi Agnihotri, Member

 

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

                   Mr.Narender Kaajla, Advocate counsel for the respondent.

O R D E R

R.K.Bishnoi, JUDICIAL MEMBER:

It was alleged by the complainant that his father obtained insurance policy number 005776932 for Rs.10 lakhs on 30.09.2012  from the Opposite parties (O.Ps.) Due to heart attack he died on 17.07.2013.  He submitted claim form and completed all the formalities, but, his claim was repudiated on the ground of concealing previous ailment, which was altogether wrong. So they be directed to pay the insured amount alongwith other compensation as alleged.

2.      In reply, it was alleged by O.Ps. that deceased life assured (DLA) was suffering from diabetes mellitus and pallor.  He was receiving treatment about that ailment, but, concealed this fact at the time of obtaining insurance policy, so claim was rightly rejected. Objections about maintainability of complaint, locus standi, territorial jurisdiction etc. were also raised and requested to dismiss the complaint.

3.      After hearing both the parties, learned District Consumer Disputes Redressal Forum, Fatehabad (In short “District Forum”) allowed the complaint  vide order dated 05.01.2015 and directed as under:-

“xxxx we allow the present complaint directing the Ops to pay a sum of Rs.10/- lacs to the complainant with interest @ 6% per annum from the date of filing of the complaint till realization of the amount within one month. The Ops are further directed to pay a sum of Rs.5,000/- as litigation expenses, harassment and mental agony.”

5.      Feeling aggrieved therefrom, appellants-O.Ps. have preferred this appeal.

6.      Arguments heard.  File perused.

7.      Learned counsel for complainant-respondent vehemently argued that O.Ps. did not  produce the original documents about previous ailment that is why documents Ex.R-4 and R-5  were rightly disbelieved by learned District Forum. There is no other evidence on the file about previous ailment.  Learned counsel for the complainant also argued that there is no nexus in between the death and the diseases. He died due to heart attack whereas treatment was given for different problem. So his claim cannot be rejected and appeal be dismissed. In support of his arguments he placed reliance upon the opinion of Hon’ble Supreme Court  in P.Vankat Naidu Vs. Life Insurance Corporation of India and Anr. 2011 (3) CPC 350, opinion of Hon’ble National Commission in Sahara India Life Insurance Co. Ltd. & anr. Vs. Smt. Hansaben Deepak Kumar Pandya 2012 (3) 396, Life Insurance Corporation of India & Ors. Vs. Kunari Devi  2008 (3) CLT 650, Revision petition NO.4172 of 2011 in Smt. Praveen Dalal Vs. Oriental Insurance Company AND National Insurance Co. Ltd. & Anr. Vs. Girin R.Shah 2012 (4) CLT 624.

8.      This argument is devoid of any force. It is also well settled that Evidence Act, 1872 (In Short “Evidence Act”) is not strictly applicable in consumer complaints as per view of Hon’ble National Commission in first appeal No.512 of 2013 titled as Sheela R.Ohri Vs.Bajaj Aallianz General Insurance decided on 11.11.2014.  Documents are not to be proved as in the civil cases.  Ex.R-4 is the application submitted by wife of deceased before Deputy Commissioner, Fatehabad and it is obtained from that office. Ex.R-5 is the copy of the treatment received at General Hospital, Fatehabad which is also attested by the doctor. This is public document and there is no necessity to call the doctor to prove the same. Complainant has no-where alleged that this application was not moved by the wife of the deceased or that Bedhead ticket Ex.R-5 is not pertaining to his father.  Learned District forum fell in error while ignoring  these documents. As per these documents it is clear that DLA was suffering from this ailment since 11.07.2012 and concealed this fact when proposal form was submitted on 29.09.2012. When complainant concealed this fact, he is not entitled for claim. 

9.      Now the question comes about nexus in between death and treatment.  Hon’ble National Commission has clearly opined in  Revision Petition No.1184 of 2008 titled as Life Insurance Corporation of India Vs. Veena decided on 14.03.2014,LIC of India & Ors. Vs.Ramamani Patra & Anr. 2015 (3) CLT 487 (case laws cited by counsel for the appellants) that even if there is no nexus in between death and treatment even then claim is to be repudiated if the fact of ailment is concealed at the time of obtaining of insurance policy.  So these arguments are of no avail.  Learned District forum fell in error while allowing the complaint.  Resultantly impugned order dated 05.01.2015 cannot be   sustained and the same is hereby set aside. Appeal is allowed and complaint is dismissed.

10.    The statutory amount of Rs.25000/- deposited at the time of filing of the appeal be refunded to the appellants against proper receipt and identification.

November 11th, 2016 Urvashi Agnihotri                   R.K.Bishnoi,                                                        Member                        Judicial Member                                                Addl. Bench                  Addl.Bench                 

S.K.