Haryana

StateCommission

A/356/2014

LIC - Complainant(s)

Versus

Sukh Devi - Opp.Party(s)

25 Apr 2016

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

                  

                                                First appeal No.356 of 2014

Date of the Institution: 05.05.2014

Date of Decision: 25.04.2016

 

1. The Divisional Manager, Life Insurance Corporation of India, Karnal.
2. The Branch Manager, Life Insurance Corporation of India Building Near Mini Sectt. Bhiwani.

(through Life Insurance Corporation of India, through its Sr. Divisional Manager, Jeevan Parkash Building, Sector 17 B Chandigarh).

…..Appellants

Versus

 

Smt.Sukh Devi W/o Sh.Risal Singh R/o village Dhanana, District Bhiwani.

                                                                             .….Respondent

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

                    Mrs. Urvashi Agnihotri, Member

 

Present:-    Mr.Rajneesh Malhotra, Advocate counsel for the appellants.

                   Mr.Bhupender Ghangas, Advocate counsel for the respondent.

 

O R D E R

R.K.Bishnoi, JUDICIAL MEMBER:

 

 

It was alleged by the complainant that her son Azad Singh was having insurance policy No.172536692 of Rs.One lac for a term of 20 years, but, due to heart problem he expired on 15.04.2010.  All the necessary documents were submitted with the O.Ps, to give insurance amount, but, was repudiated without any reasonable cause.

2.      O.Ps. alleged that deceased life assured (DLA) ran his policy for nine years and seven days from the date of FPR and three months  and 2 days from the revival.  DLA was in abnormal condition since childhood and was getting handicapped pension since the year 2005, but,  this fact was not disclosed and it was declared that he was having a good health.  By concealment of this fact he got the policy revived and was not entitled for the insurance amount.  He was suffering from cpc mr 70% as per record submitted by Civil Surgeon, Bhiwani.  Had he disclosed the fact of handicap they would have called for full medical report.  So his claim was rightly repudiated.  Objections about maintainability of complaint, locus standi, jurisdiction of District Forum etc. were also raised and requested to dismiss the complaint.

3.      After hearing both the parties learned District consumer Disputes Redressal Forum,   Bhiwani (In short “District forum”) allowed the complaint and directed as under:-

“1.     To pay the insured amount alongwith interest @  12% from the date of repudiation till its final payment.

                    2.      To pay Rs.2200/- as cost of litigation.”

4.      Feeling aggrieved therefrom O.Ps. have preferred this appeal.

5.      Arguments heard. File perused.

6.      Learned counsel for the appellants vehemently argued that DLA run his policy for 9 years and seven days from the date of FPR and three moths two days from the date of revival of the policy he was handicap person as mentioned by Civil surgeon in his certificate.  This fact was concealed at the time of revival of insurance policy. Had this fact been told, the insurance policy might not have been revived or they might have obtained detailed medical report.  Due to concealment of fact no compensation can be awarded.  Learned District Forum failed to take into consideration this aspect and wrongly allowed the complaint so the impugned order be set aside and complaint be dismissed.

7.      This argument is devoid of any force.  DLA obtained insurance policy on 14.02.2001 for 20 years.  It is no where pleaded or proved that he was suffering from any ailment at that time.  It shows that this policy was to continue for 20 years.  O.Ps. have also failed to show that on which date the policy expired and due to what reason. Some documents are shown during the arguments, but, no document is placed on the file before the learned District forum.  The main stress of the O.Ps. is that he declared his health as good whereas he was handicap.  If a person is handicap it does not mean that he is not having a good health. One can lose his hand in any incident but it does not mean that his health has deteriorated. There should be some substantive evidence on the file to prove that DLA was having some problem.  O.Ps. have not produced any certificate issued by civil Surgeon Bhiwani about the state of health of DLA.  If their investigator has reported that he was having some problem it does not mean that this fact be presumed to be true. 

8.      More so it is mentioned in report that DLA was abnormal since child-hood.  If it was so then why insurance policy was issued in the year 2001 and continued upto the year 2010.  In the absence of any cogent evidence the claim of the L.Rs. of DLA cannot be drawn away.  The insurance company is trying to avoid payment without any basis.

9.      In this era, when there is a competition among the Insurance Companies for developing their business, unhealthy practices are developing to get maximum benefits and profits. It has become a common experience of the Insurance Companies to repudiate genuine claims of the insured on one pretext or the other. A common man is not supposed to know all the niceties and technicalities of law. The insured puts his hard earned money in taking Insurance of his vehicle with a hope and aspiration that in case of any mishap, he or his family shall get some immediate financial assistance but in most of the cases, his/her claim is rejected with just a stroke of pen that he/she did not abide the terms and conditions of the Insurance Policy, which conditions were never supplied by the Insurance Company. The policy entails the liability on both sides. 

10.    The findings of learned District Forum are well reasoned based on law and facts and cannot be disturbed.  The appeal fails and the same is hereby dismissed.

11.    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.

 

April 25th, 2016  Urvashi Agnihotri                             R.K.Bishnoi,                                              Member                                  Judicial Member                                       Addl. Bench                              Addl.Bench                 

S.K.