Haryana

StateCommission

A/581/2015

MAX NEW YORK LIFE INSURANCE CO.LTD. - Complainant(s)

Versus

SUNITA - Opp.Party(s)

RAJNEESH MALHOTRA

19 Jan 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

 

First Appeal No.581 of 2015

Date of Institution:06/10.07.2015

 Date of decision:19.01.2016

 

1.      Branch Manager, Max New York, Life Insurance Corporation Limited, Ist Floor, Biju Tower, Meham Gate, Bhiwani.

2.      Branch Manager, Max New York, Life Insurance Corporation Operation Centre, Plot No.90-A, Sector 18, Udyog Vihar, Gurgaon.

…Appellant

Versus

 

Smt. Sunita wife of Sh.Sat Pal resident of village Nimriwali, Tehsil and District Bhiwani.

…Respondent

 

CORAM:   Mr. R.K.Bishnoi, Judicial Member.
                   Mrs. Urvashi Agnihotri, Member.

 

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

                    Mr. Mukesh Yadav, Advocate counsel for the respondent.

 

                                      O R D E R

 

R.K.BISHNOI, JUDICIAL MEMBER:

 

          It was alleged by the complainant that her husband purchased death claim policy from opposite parties (O.Ps.) branch office at Bhiwani in the month of July  2010       for Rs.9,50,000/- and paid premium of Rs.4840/-.  He died on 05.08.2010 after issuance of policy from the registered office of O.Ps.  She submitted claim for compensation, but, nothing was paid.

2.      O.Ps. filed reply admitting the policy but controverting the right of the complainant to avail compensation alleging that husband of complainant obtained insurance policy through their agent Mr.Manoj Kumar.  Two other persons namely Rakesh Kumar and Mrs. Chander Kalan also obtained policies through him who had also expired within one month after issuance of policy. Deceased life assured (DLA) obtained insurance policy by concealing the previous ailment.  He had undergone tuberculosis treatment CAT 02 (CAT II) on 12.05.2010  at Community Health Centre (CHC) Manheru Hospital, Bhiwani before signing the proposal form, but, concealed this fact. Her claim was rightly repudiated because he obtained insurance policy by concealment of material fact.  Other averments were also denied and requested to dismiss the complaint.

3.      After hearing both the parties, learned District Consumer Disputes Redressal Forum, Bhiwani (for short “District Forum”) allowed the complaint vide impugned order dated  06.02.2015 and directed as under:-

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

                    2.      To pay Rs.2200/- as litigation charges.”

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

5.      Arguments heard.  File perused.

6.      Learned counsel for the complainant vehemently argued that on the basis of aforesaid treatment it cannot be opined that she was not entitled for compensation because as per report  Ex.OP-3 he died due to heart attack. This disease was not the result of his death.  So learned District forum rightly allowed the claim.

7.      This argument is devoid of any force. From the perusal of proposal form O.P.-1 it is clear that the complainant did not disclose about previous treatment. In clause No.III the questions were put about previous ailment or treatment, but, he answered in negative.  This form was filled on 14.07.2010.  From the perusal of the information provided by medical office of CHC of Manheru dated 16.01.2011 it is clear that DLA received treatment of CAT II on 12.05.2010 at sub Centre Namriwali he obtained only one wrapper of the medicine and thereafter he did not turn up he expired on 05.08.2010.  It shows that he was chronic patient of tuberculosis and was well aware about his fate.  That is why he did not continue with the treatment and conspired to obtain insurance policy. Within 20 days of obtaining insurance policy he breathed is last.  The O.Ps. denied her right on the basis of concealment and not the cause of death. She is not entitled for compensation because cardinal principle of contract of life insurance is uberrema fides i.e. the principle of utmost good faith.  These views are fortified by the opinion  of our Hon’ble National Commission in revision petition Nos.3794-3796 of 2007 titled as Divisional Manager, LIC of India & Ors. Vs. Smt. Anupama & Ors. Decided on 17.04.2012. It is medically well established that if anyone has been given treatment for tuberculosis CAT-II it is to be presumed that this disease was existing since long as it could not development over-night. Hon’ble National commission has also opined in LIC of India Vs. Krishan Chander Sharma II (2007) CPJ 53 (NC) that mere absence of an affidavit of concerned doctor is not an adequate reason to reject the proof.  Learned District Forum failed to take into consideration this aspect.  So the impugned order cannot be sustained. Hence impugned order dated 06.02.2015 is set aside.  Appeal is allowed and complaint is dismissed.

8.      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.

 

January 19th, , 2016	Urvashi Agnihotri Member Addl. Member		R.K.Bishnoi, Judicial Member Addl. Member
S.K