Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 192
Instituted on : 22.04.2019
Decided on : 12.06.2024
Sunil Kumar (aged 26 years) s/o Budh Ram s/o Manak Chand r/o Vill. Pharal Tehsil Pundri Distt. Kaithal.
……….………….Complainant.
Vs.
Tata AIA Life Insurance Co., Ltd. 1st floor Shivalik Apts. SCF-14, HUDA Complex, Civil Road, Rohtak through its Manager.
...........……Respondent/opposite party.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT, 1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR. VIJENDER SINGH, MEMBER
Present: Sh. Vikram Bhardwaj, Advocate for the complainant.
Sh.Gulshan Chawla, Advocate for the opposite party.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case as per the complainant are that complainant’s father namely Budh Ram had insured his life with the opposite party under policy No.214261017 dated 12.10.16 of Tata AIA Life Insurance Co. amounting to Rs.385000/-. The father of complainant had died on 30.03.2017 and the complainant being nominee and legal heir of his father submitted his claim file alongwith all original documents to get the insurance claim before the opposite party but the opposite party had repudiated the claim of the complainant on 17.06.2017 by levelling the false allegations of concealment of facts whereas the insurance policy was issued to Budh Ram after due verification and enquiry conducted by the opposite party. The complainant served a legal notice dated 17.01.2019 through his counsel upon the opposite party but to no effect. The act of opposite party is illegal and amounts to deficiency in service. Hence this complaint and it is prayed that opposite party may kindly be directed to pay the amount of Rs.385000/- alongwith interest, compensation of Rs.50000/- on account of mental agony and harassment to the complainant.
2. After registration of complaint, notice was issued to the opposite party. Opposite party filed its written statement submitting therein that opposite party made an investigation in the policy to get the information provided in the proposal form verified and found that the insured has already died in the month of March 2017. The policy in question was issued on 12.10.2016 whereas deceased life assured had expired on 30.03.2017, within a span of approximately 5 months from the issuance of the policy, the investigation was got done and during the investigation it came to the knowledge that Budh Ram was suffering from cancer for last 2-3 years and was under treatment for the same, prior to the submission of the proposal form. Hence there has been concealment of the material facts by the life assured, regarding the state of health and the same was not disclosed intentionally in the proposal form. Hence the policy in question was voided since inception vide letter dated 17.06.2017, duly served upon the complainant. It is further submitted that the respondents never received the death claim intimation from the complainant. All the other contents of the complaint were stated to be wrong and denied. There is no deficiency in service on the part of opposite party and dismissal of complaint has been sought.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C9 and has closed his evidence on dated 11.03.2020. On the other hand, Ld. counsel for the opposite party has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R4 and closed his evidence on dated 15.04.2021.
4. We have heard learned counsel for the parties and have gone through the material aspects of the case very carefully.
5. The present complaint has been filed by the son of deceased LA . In this complaint the respondent insurance company has submitted that the policy has been issued by the respondent officials on dated 12.10.2016 whereas the deceased life assured has been died on 30.03.2017 i.e. within a span of approximately 5 months from the inception of policy. It has been further submitted by the insurance company that the deceased Budh Ram was suffering from cancer for last 2 or 3 years and he was under treatment for the same. It has been further submitted that deceased LA was suffering from cancer prior to the submission of proposal form and hence there is suppression of material fact so the claim of the complainant has been repudiated by the insurance company. We have minutely perused the documents placed on record by the insurance company. The insurance company has placed on record standard proposal form as Ex.R2, letter dated 13.12.2016 as Ex.R2, investigation for Ex.R3 and letter dated 17.06.2017 Ex.R4. We have minutely perused the investigation report. This report has been issued by the ‘Lancers’ investigator. Opposite party has merely placed reliance upon the investigation report Ex.R3, as per which investigator has submitted that cause of death of deceased was ‘Cancer’. No other document has been attached with this report to prove the fact that deceased was suffering from cancer at the time of proposal for the policy. Investigator in his report Ex.R3 has submitted in conclusion para that : “Investigation was conducted and it was found that LA expired due to cancer. He was taking treatment from Mittal Hospital, Kaithal. The Anganwari worker Mrs. Parmeshwari and the neighbours Mr. Ajit Vikas Sharma, Sunil Kumar and Raghubeer also confirmed the same. The Sarpanch also provided the written statement that LA was suffering from Cancer since 2-3 years and he expired due to the same in the village.” But neither the treatment record of deceased nor the affidavit of any of the alleged persons has been placed on record to prove the fact. Hence no authentic evidence has been placed on record by the opposite party to prove that deceased was suffering from cancer at the time of commencement of the policy. As such repudiation of claim on this ground is illegal and amounts to deficiency in service. Hence the opposite party is liable to pay the claim amount to the LRs of deceased. However, the L.Rs of deceased are not disclosed by the complainant.
6. In view of the facts and circumstances of the case we hereby allow the complaint and direct the opposite party to pay Rs.385000/-(Rupees three lac eighty five thousand only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e. 22.04.2019 till its realisation and also to pay a sum of Rs.5000/-(Rupees five thousand only) on account of deficiency in service and Rs.5000/-(Rupees five thousand only) as litigation expenses to the legal heirs of deceased. Complainant is directed to submit the list of legal heirs issued by the Tehsildar with the insurance company within 30 days and after that insurance company will pay the awarded amount in equal share to all the LRs of the deceased within one month. If the complainant fails to place on record the list of LRs within 30 days, complainant and legal heirs will not be entitled for the future interest from the date of award.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
12.06.2024.
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Nagender Singh Kadian, President
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Tripti Pannu, Member.
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Vijender Singh, Member
