Complaint Case No. 117/2013

Pratibha Sharma W/o Late Sri Raj Kumar Sharma R/o Dabha Distt. Aligarh

V/s

Senior Divisional Manager, Life Insurance Company Ltd, Divisional office Masudabad,Aligarh By Branch Sikandrarao .

CORAM

 Present:

1. Shri Hasnain Qureshi, President
2. Shri Alok Upadhayay, Member
3. Smt. Purnima Singh Rajpoot, Member

PRONOUNCED by Shri Hasnain Qureshi, President

JUDGMENT

1. The present complaint has been filed by the complainant before this commission for  payment of insured sum Rs.200000/.  
2. Complainant has stated that her husband Raj Kumar Sharma got himself insured through agent and the insurance policy no. 563758569. The half yearly premium was Rs.9755/. He had paid three premium prior to his death  and the last premium was paid on 11.8.2011 prior to his death on 19.12.2011. Complainant’s husband had paid total amount Rs.29265/.   Complainant filed the claim which was rejected on 26.6.2013. Complainant’s husband was medically examined by the empaneled doctor of the LIC who had issued health certificate. Her husband have not be suffering from any disease prior to his death. The claim was improperly rejected.
3. Op submitted in WS that the complainant’s husband had been suffering form the disease of cancer prior to subscribing the policy and he had obtained the policy concealing the material fact and policy is hit by section 45 insurance Act. Complainant’s husband was not thoroughly examined by the doctor   and if he had been thoroughly examined, the policy would not granted due to disease of Cancer. 
4. Complainant has filed his affidavit and papers in support of his pleadings. Op also filed his affidavits and papers in support of his pleadings.
5. We have perused the material available on record and heard the parties.
6. The first question of consideration before us is whether the complainant is entitled to any relief?
7. Admittedly  , Complainant’s husband was medically examined  by the doctors prior to issuing policy and the objection raised by OP is that diseased life assured was not thoroughly examined by the doctors. It is no reason as to why the disease life assured was not thoroughly examined by the doctor while undergoing medical examination. The complainant’s husband was issued policy having satisfied with the medical fitness of the deceased , now the insurance company is estoppped   from escaping the liability. Moreover It cannot be said to have knowledge of the disease like Cancer and its concealment at the time of taking the policy by the complainant’s husband. In view of medical papers submitted by op which contains only the treatment of therapy. In view of facts and circumstances of the case, policy is not hit by section 45 of the Act and complainant is entitle to the insurance sum Rs.200000/
8. Question is formulated in favor of complainant.       
9. We hereby direct the Op to the complainant Rs.200000/ with penedenti lite and future interest @9% per annum.
10. A copy of this judgment be provided to all the parties as per rule as mandated by Consumer Protection Act, 2019. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties.
11. File be consigned to record room along with a copy of this judgment.