Haryana

StateCommission

A/41/2017

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

Versus

SUNITA DEVI - Opp.Party(s)

SANDEEP SURI

18 Dec 2019

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                                                 

                                                         First Appeal No.41 of 2017

                                                 Date of Institution: 13.01.2017

Date of Decision: 18.12.2019

 

1.      Birla Sun Life Insurance Company Limited, Vaman Centre, 4^th Floor, Makhwana road, Marol Naka, Off Andheri-Kurla Road,Andheri (East), Mumbai 400059, through its authorized signatory.

2.      The Branch Manager, Birla Sun Life Insurance Company Limited,  Parmeshwar Service Station, adjoining BPCL Petrol Pump, Dabwali Road, Sirsa, District Sirsa.

…..Appellants

Versus

Sunita Devi widow of Late Shri Surinder Kumar son of Shri Jagdish Parshad, R/o Opp. Main Bazar, Gandhi Chowk, Ellenabad, Tehsil Ellenabad District  Sirsa.

                   …..Respondent

CORAM:    Hon’ble Mr. Justice T.P.S.Mann, President   

Mr. Ram Singh Chaudhary, Judicial Member

 

Present:  Shri Sandeep Suri, Advocate for the appellants.

      Shri Dheeraj Narula, , Advocate for respondent.

                                                   O R D E R

RAM SINGH CHAUDHARY, JUDICIAL MEMBER:

          Delay of 83 days in filing the appeal is condoned for the reasons mentioned in the application for condonation of delay.

2.      Birla Sun Life Insurance Company Limited and its functionary- opposite parties (for short ‘Insurance Company’) are in appeal against the impugned order dated September 19^th, 2016 passed by District Consumer Disputes Redressal Forum, Sirsa (for short ‘District Forum’), whereby it directed the Insurance Company to pay the death claim/sum assured, maturity benefit; Rs.20,000/- compensation and Rs.5000/- litigation expenses to complainant Sunita Devi, widow of Surinder Kumar.

3.      The brief facts of the present complaint emerges as are under that on 04.03.2009, her husband (Surinder Kumar) purchased a life Insurance Policy from the opposite parties.  The premium of Rs.9988.32 ps was paid to the insurance company.  The basic sum assured was Rs.97,109.50 paise, the guaranteed maturity benefit was Rs.1,79,500/- and enhanced sum insured was Rs.9,20,000/-. The Deceased Life Assured (DLA) was medically examined by the O.Ps and thereafter, policy was issued.  On 30.10.2009, the husband of the complainant fell ill and he was referred to Dr. L.D. Bhardwaj in Jindal  Hospital. He was again admitted in Tantia Hospital, Sri Ganganagar (Rajasthan) on 06.11.2009 and was discharged on 12.11.2009 as he was referred to PGIMS, Chandigarh, where he was admitted on 13.11.2009 and was diagnosed as severe bronchitis asthma.  He was further admitted in Fortis Hospital, Mohali on 28.11.2009 till 09.12.2009.   On 11.12.2009, the husband of the complainant was expired in Tantia General Hospital due to “Immediate respiratory arrest”.  Being  a nominee, she lodged her claim with opposite parties at Sirsa for payment of sum assured and other benefits.  The O.Ps. illegally repudiated the claim of the complainant vide letter dated 30.01.2014.  She moved an application for re-consideration of their decision, but, the same was also rejected by the O.Ps. on 09.10.2010.  Thus there was deficiency in service on the part of the O.Ps.  Hence the  present complaint.

4.      The notice was issued against the O.Ps. The O.Ps. filed reply and alleged that at the time of obtaining the insurance policy, the DLA has suppressed the material facts.  The DLA was expired on 11.12.2009 due to respiratory arrest.  The deceased life assured was expired within 9 months from the date of issuance policy.  After death of the life assured, investigation was conducted and during investigation, the medical record reveals that the deceased life assured was suffering from diabetes militius with HTN (Hypertension), Bronchial asthma, lung cavity and septicemia. The complainant is not entitled for any claim amount.   The O.Ps. rightly repudiated the claim of the complainant. Thus there was no deficiency in service on the part of the O.Ps.

5.      After hearing both the parties, District Consumer Disputes Redressal Forum, Sirsa (In short “District Forum”) allowed the complaint and  directed the Insurance Company to pay the death claim/sum assured, maturity benefit of Rs.1,79,500/-; Rs.20,000/- compensation and Rs.5000/- litigation expenses to complainant Sunita Devi, widow of Surinder Kumar.

6.      Feeling aggrieved against the impugned order, O.Ps have preferred this appeal.

7.      This argument have been advanced by Sh.Sandeep Suri, the learned counsel for the appellants as well as Sh.Dheeraj Narula, the  learned counsel for the respondent. With their kind assistance the entire records as well as the original record of the District Forum including whatever the evidence has been led on behalf of  both the parties had also been properly perused and examined.

8.      As per the contentions raised by the learned counsel for the parties, the basic and foremost question which requires adjudication of this Commission is as to whether the complainant is entitled to get the assured amount inspite of the fact that life insured has not disclosed certain medical ailments at the time of obtaining the insurance policy?

9.      While unfolding the arguments, it has been vehemently argued by Sh.Sandeep Suri, the learned counsel for the appellants that in fact the insured is not entitled to get the assured amount as the complainant was suffering from pre-existing disease which included diabetes militius with HTN (Hypertension), Bronchial asthma, lung cavity and septicemia.  It was incumbent and obligatory on the part of the DLA to disclose each and every material facts and as a matter of fact, purchasing the insurance policy basically depends upon the faith and belief of each other.  If there is mis-representation or concealment of the material facts, in that eventuality, the complainant would not be entitled to get any amount of the compensation. In order to substantiate his contentions, the learned counsel for the appellants have placed reliance upon  opinion of Hon’ble National Commission in Revision Petition No.2877 of 2013 titled as  M/s Aviva Life Insurance Co. Ltd. Vs. Phool Kanwar decided on 04.08.2015.  It has been observed by Hon’ble National Commission that since the deceased life insured was suffering  from Diabetes Mellitus and Hypertension for over two years but he did not disclose these facts while submitting the proposal form and has violated the terms and conditions of the insurance policy, therefore, respondent-wife of life insured, is not entitled for any insurable benefits.

10.    Sh.Sandeep Suri, the learned counsel for the appellants have also referred to the medical record, which  has also been relied upon by the complainant  and perusal of the entire medical record reveals that the complainant was suffering from pre-existing disease for the last more than 5-6 years and she was regularly taking the medical treatment and as such, it is further been prayed that the complaint being devoid of merits or for concealment of the material facts regarding the pre existing disease, the learned District Forum has wrongly allowed the complaint and as such while accepting the appeal in toto, the impugned order be set aside and complaint be dismissed.

11.    On the other hand, it has been strenuously argued by Sh.Dheeraj Narula, the learned counsel for the respondent-complainant that infact all the material facts were disclosed by the husband of the complainant-life assured at the time of taking the policy and he was not suffering from pre-existing disease.  The documents which have been relied upon by complainant cannot be taken into consideration favouring the insurance company.  There is absolutely no medical evidence, which could be established the factum of pre-existing disease.  The learned District forum rightly allowed the complaint and the amount of the compensation has also rightly been allowed. The counsel for the respondent-complainant prayed that the appeal may be dismissed.  In order to support his contentions, the learned counsel for the respondent has placed reliance upon celebrated authorities of the Hon’ble  Supreme Court titled as P. Vankat Naidu Vs. LIC 2011 (3) CPC 250 and that of Hon’ble National Commission in United India Insurance Co. Vs. S.K.Gandhi 2015 (2) CLT 71, Praveen Damani Vs. OIC 2007 (1) CPC 141 and LIC vs Pankaj Pandey 1 (2016) CPJ 322 (NCC).

12.    Having considered the submissions made by the learned counsel for the appellants as well as that of the respondent, this Commission is of the considered opinion that the life assured was suffering from pre-existing disease i.e. diabetes militius with HTN (Hypertension), Bronchial asthma, lung cavity and septicemia, which amounts to concealment of the material facts.  Even otherwise also, there is a sufficient  documentary evidence available on the record and has been produced by the complainant herself, which makes it evident that the DLA was suffering from pre-existing  disease for the last 5-6 years. DLA has been taking regular treatment at the time of submitting the proposal form.  DLA had concealed the material facts about the existence of the pre-existing disease and it is settled proposition of law that one who conceals the material facts is not entitled for  any discretionary relief.   Even otherwise also after placing reliance upon of the ratio laid down by the Hon’ble  National Commission  in M/s Aviva Life Insurance Co. Ltd. Vs. Phool Kanwar (supra) case, the question is answered in negation accordingly and as a result thereof, the complainant is not entitled to get any amount of the compensation on account of suffering from pre-existing disease.  The authority referred by the counsel for the respondent does not render any help to the respondent-complainant in any manner. The learned District forum gravely and manifestly erred while allowing the complaint and awarding the amount of compensation.  Hence, while accepting the appeal, the impugned order dated  19.09.2016 passed by the learned District Forum, Sirsa is set aside for all intents and purposes and the complaint is accordingly stands dismissed.

13.    The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

December 18th, 2019      Ram Singh Chaudhary,             T.P.S.Mann,                                        Judicial Member                        President                                  

S.K.(Pvt.Secy)