BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, JALANDHAR.

Complaint No.519 of 2015

Date of Instt. 09.12.2015

Date of Decision: 11.10.2017

Gurpreet Kaur W/o Late Sh. Jaspal Singh, resident of VPO Jandir Via Bhogpur, District Jalandhar.

..........Complainant

Versus

The Divisional Manager, Life Insurance Corporation of India, Divisional Office, Jiwan Parkash, Model Town Road, Jalandhar City.

….….Opposite party

Complaint Under the Consumer Protection Act.

Before: Sh. Karnail Singh (President)

Sh. Parminder Sharma (Member)

Present: None for the complainant.

Sh. SC Sood, Adv Counsel for the OP.

Order

Karnail Singh (President)

1. This complaint filed by the complainant Gurpreet Kaur, wherein alleged that her husband had taken a policy bearing No.133515959 dated 23.08.2012, which was duly accepted by the OP for a sum of Rs.10,00,000/- and husband of the complainant had paid a premium of Rs.42,500/- to the OP, which the OP had accepted the same. At the time of obtaining the policy, the husband of the complainant was hale and hearty and was not suffering from any disease and was doing his duty in police regularly. The husband of the complainant had died on 16.10.2012, which was natural death. The complainant approached several times to the OP, but the OP did not accept the genuine request of the complainant and the OP has not reimbursed the sum assured i.e. Rs.10,00,000/- to the complainant, nor the OP has given proper replies to the complainant. The husband of the complainant was hale and hearty person and was serving in PAP, Jalandhar as Head Constable and never remained absented from his duties and was doing his duty with courage and honesty. The complainant and his family members were fully dependent upon the income of her husband and the OP legally liable to pay the sum assured i.e. Rs.10,00,000/- to the complainant, who is legally nominee of the deceased Jaspal Singh.

2. That the complainant served a legal notice dated 04.08.2015 upon the OP and called upon him to reimburse the policy amount. The notice was served through registered post but despite that the OP has failed to redress the grievances of the complainant. Finding the reply without any substance, the complainant adopted the legal recourse of filing the present complaint. The act of the OPs is clearly, illegal, arbitrary and complainant has suffered mental tension and agony and OP has committed deficiency in service and has adopted unfair trade practice and accordingly the instant complaint was filed with the prayer that the complaint of the complainant may be accepted and OP be directed to reimburse the insured amount on the death of the husband of the complainant with interest and other relief deems fit by the Forum.

3. Notice of the complaint was given to the OP and accordingly the OP appeared through his counsel and filed written reply, whereby contested the complaint by taking preliminary objection that there is no privity of contract between complainant and OP as the deceased took the policy by suppressing the material facts and obtained the policy by concealment of his ailments. It is further averred that the life insured adopted unfair trade practice while obtaining the policy, as such, the complainant has no right and title to file this complaint. There is no valid agreement and contract between the deceased and OP and as such, the complainant is estopped to file the present complaint. On merits, the factum in regard to purchase an insurance policy by the husband of the complainant is admitted but the premium paid by the husband of the complainant is Rs.27,527/-, on 24.08.2012 is denied and further alleged that the deceased insured was not keeping good health on the date of proposal and he died on 16.10.2012. The deceased/life insured was suffering from a suspected Liver Mass-Amoebic Liver Abscess prior to taking the policy. The life insured person was examined on 10.08.2012 in Modern Hospital, Sutehri Road, Hoshiarpur. The life insured was in the knowledge about the disease and took the medical treatment, but at the time of taking policy suppressed his ailment and accordingly, the claim of the complainant has been repudiated rightly and the same has been conveyed to the complainant, vide its letter dated 24.06.2015 and the other averments as made in the complaint are categorically denied and lastly prayed that the claim of the complainant is without merits and the same may be dismissed.

4. In order to prove the case of the complainant, the counsel for the complainant tendered into evidence affidavit of the complainant Ex.CA alongwith some documents Ex.C1 to Ex.C10 and closed the evidence.

5. Similarly, counsel for the OP tendered into evidence affidavit Ex.OA alongwith certain documents Ex.O1 to Ex.O14 and closed the evidence.

6. We have heard the learned counsel for the OP and also gone through the case file very minutely.

7. As the counsel for the complainant did not appear for argument on so many dates and accordingly, we have analyzed the case of the complainant themselves and find that the complainant alleged in the complaint that the husband of the complainant Jaspal Singh was employee in the police department and who got an insurance policy on 23.08.2012 and paid a premium of Rs.42,500/-, the sum insured of the policy is Rs.10,00,000/-. At the time of purchase of the policy, the husband of the complainant was hale and hearty and was not suffering from any disease and was doing his duty in police regularly. He never remained absent from his duty but unfortunately, the husband of the complainant died on 16.10.2012 and death of the insured was natural death and after the death of insured Jaspal Singh, the complainant being nominee/wife of the insured Jaspal Singh, filed an insurance claim but the same was repudiated by the OP and further claimed the insured amount of Rs.10,00,000/- alongwith interest.

8. The case of the complainant meets by the OP , simply on the ground that the husband of the complainant insured Jaspal Singh had concealed the previous ailment at the time of taking an insurance policy and as such, the claim of the complainant was rightly repudiated, vide letter dated 24.06.2015.

9. In order to dispose of this complaint, we have gone through the documentary evidence brought on the file by both the parties and find that the complainant Gurpreet Kaur tendered her affidavit Ex.CA, whereby reiterated the entire facts as detailed in the complaint. Apart from that, she has brought on the file Legal Notice Ex.C-1 and Post Mortem Report Ex.C-3 and Police Proceedings Ex.C-4 to Ex.C-9 and Repudiation Letter Ex.C-10 and further OP brought on the file affidavit Ex.OA and certificate issued by the doctor of Modern Hospital, who examined the deceased Jaspal Singh on 10.08.2012 and 17.08.2012, the said certificate is Ex.O-1 and Insurance Policy Ex.O-2, Repudiation Letter Ex.O-3 and information sought by the OP through RTI in regard to leave of the insured deceased Jaspal Singh, the same is Ex.O6 to Ex.O12 and further affidavit of the Dr. Anoop Kumar, Modern Hospital is Ex.O13/A. The complainant alleged in the complaint that the husband of the complainant was hale and hearty and was not suffering from any disease and was doing his duty in police regularly. He never remained absent from his duty and his death was natural death but these factums are not true because as per the evidence adduced by the OP, the husband of the complainant was not hale and hearty, at the time of getting an insurance policy, an insurance policy was obtained by the insured Jaspal Singh on 23.08.2012 and died on 16.10.2012, whereas as per medical certificate, issued by the doctor of Modern Hospital, the said certificate is Ex.O-1 and as per certificate, the doctor has examined the deceased insured Jaspal Singh on 10.08.2012 and 17.08.2012 and diagnosed that the deceased Jaspal Singh was having Liver Mass and Amoebic Liver Abscess and then certificate Ex.O-1 is further corroborated with an other evidence, produced on the file by the complainant herself i.e. Post Mortem Report Ex.C-3, wherein the cause of death has been mentioned due to liver problem, not so the complainant Gurpreet Kaur suffered a statement for the police officer on 16.10.2012, which is Ex.C-5, wherein she again stated that her husband was having liver problem and he was on leave from the department and getting a treatment but due to that reason, he has died, further more the complainant alleged that her husband never remained absent from the duty but as per documents produced on the file, the husband of the complainant applied for a leave from 13.08.2012 to 15.10.2012 and that leave was taken on medical ground, though record relating to leave of the deceased Jaspal Singh is available on the file Ex.O-6 to Ex.O-12 and even the OP has examined Dr. Anoop Kumar, M.S, Principal Raj Kumar Memorial Modern Hospital, Opp. Govt. College, Sutehri Road, Hoshiarpur, whose affidavit is Ex.O13/A, wherein he categorically deposed that he examined insured Jaspal Singh on 10.08.2012 and 17.08.2012, these dates are very crucial because the examination of the deceased Jaspal Singh was conducted by the doctor, prior to taking an insurance policy i.e. on 23.08.2012, when the deceased Jaspal Singh became aware about his lever problem on 10.08.2012 and 17.08.2012, then why he did not disclose these facts to the insurance employee at the time of taking insurance policy on 23.08.2012. So, it is clearly established that the deceased Jaspal Singh insured had intentionally and deliberately suppressed the material facts in regard to his previous ailment in the proposal form and copy of the proposal form attached with the insurance policy is Ex.O-2. So, under these circumstances, we are of the considered opinion that the claim of the complainant has been rightly repudiated by the OP, on the ground of suppressing of material facts in regard to previous ailment and as such, we do not find any substances in the complaint of the complainant, therefore, the same is dismissed with no order of cost. Parties will bear their own cost. The complaint could not be decided within stipulated time frame due to rush of work.

10. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated Parminder Sharma Karnail Singh

11.10.2017 Member President