Haryana

Ambala

CC/21/2018

Kusum Rani - Complainant(s)

Versus

The life Insurance - Opp.Party(s)

22 Mar 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AMBALA

 

 

                                                          Complaint case no.        : 21 of 2018

                                                          Date of Institution         : 11.01.2018

                                                          Date of decision   : 22.03.2019

 

 

Kusum Rani, aged 42 years, wife of Late Shri Rajesh Rana, resident of Village Barona Kalan, PO Raipur Rani, Tehsil and District Panchkula.

 

……. Complainant.

 

1.       The Life Insurance Corporation of India, Divisional Office Post Box No.106, Jeewan Parkash Building, 489, Model Town, Karnal.

2.       The Life Insurance Corporation of India, Branch Office, Netaji Subhash Chowk, Dehradun-Chandigarh Main Highway, Naraingarh, through its Branch Manager.  

 .…. Opposite Parties.

 

 

Before:-       Ms. Neena Sandhu, President.

Ms. Ruby Sharma, Member.

Sh. Vinod Kumar Sharma, Member.

 

 

Present:       Sh. Dharam Singh, counsel for complainant.

                   Sh. G.S.Antal, counsel for Ops.

 

Order:         Smt. Neena Sandhu, President.

Complainant has filed this compliant under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Parties(hereinafter referred to as ‘Ops’) praying for issuance of  following reliefs:-

1. To pay Rs. 2,00,000/- to the complainant along with  interest  @18% from the date of submission of the claim till actual realization. 
2. To pay of Rs.20,000/- as compensation for mental agony and physical harassment suffered by her.  
3. To pay Rs.11,000/- as cost of litigation.

 

                   In nutshell, brief facts of the present complaint are that the husband of the complainant (now deceased) had obtained a Health Plus policy bearing policy No.174776307 on 13.09.2006 from OP No.1 and made the complainant as his nominee. The husband of the complainant was regularly paying the premium, but due to some financial crisis the deceased/life assured could not pay the premium due on 09/2012 to 09/2014. The policy was got revived on 29.09.2014 and the deceased paid the due premium to the Ops. At the time of revival of the policy the officials of the Ops obtained his  signatures, on blank proforma and it can be seen from the revival form, it was filled in English  by the  official of the OPs and signed by Life Insured  in Hindi.  Unfortunately, the husband of complainant was died on 17.10.2015. At the time of taking the policy, the husband of complainant was fit and fine. After the death of the husband of the complainant Late Shri Rajesh Rana, she being the nominee, lodged the claim but the Ops repudiated the claim on false ground vide letter dated 04.05.2017. The complainant visited the office and requested to pass the claim but they did not pay any heed to her genuine request. Hence, the present complaint.

2.                 Upon notice, OP Nos.1 & 2 appeared through counsel and filed written version, raising preliminary objections qua complaint is not maintainable and concealed the material facts. On merits, it is stated that at the time of revival of said policy, the life assured was suffering from Cancer and was getting treatment from PGI, Chandigarh. Had the life assured disclosed this fact then the OPs would have never revived the policy on 13.09.2014. It is stated that the life assured was also insured under another policy bearing No.177897405 for sum assured of Rs.1,10,000/- under plan and term 175-09-01 having date of commencement, 15.12.2012. In this policy, the claim amount of Rs. 93,500/- was paid through NEFT on 07.09.2016 as the policy was taken on 19.02.2013 and on review of the case, it was found that at that time  deceased life assured was not suffering from the said disease, before the date of inception of the policy. It is stated that DLA had obtained policy No.174776307 on 13.09.2006 for Rs.2,00,000/- under table term 179-16-16, on yearly basis and the premium of the policy was of Rs.11,548/- and the complainant Smt. Kusum Rani is nominee under the said policy. It is denied that the DLA was regularly making the payment of premium of the policy, even the complainant herself admitted that the life assured could not pay the premium due on 09/2012 to 09/2014.  It is stated that the policy was lapsed in the month of 2011. The policy was revived on 29.09.2014 on the basis of DGH in which DLA has mentioned that he was not suffering from any illness and his health condition was good. The husband of the complainant expired on 17.12.2015, due to Cancer after taking treatment from PGI, Chandigarh for the last one and half year prior to death as is evident from Form No.3816 dated 26.06.2014 filled by PGI, Chandigarh.  The complainant visited the office to get the death claim.  After due process of investigation, it was found that during revival, the policy holder was suffering from progressive Dysphyxia and was not keeping good health but the life assured did not disclose this fact at the time of revival of the policy. Claim was repudiated vide letter dated 04.05.2017. An amount of Rs.8,088 was payable and this was conveyed in the said letter dated 04.05.2017. Prayer has been made for dismissal of the complaint with cost.  

3.                To prove her version complainant tendered her affidavit as Annexure C-A along with documents as annexure C-1 to C-17 and closed her evidence. On the other hand, counsel for the Ops has also tendered affidavit as Annexure R-A alongwith documents as Annexure R-1 to R-7 and closed his evidence.

4.                We have heard counsel for the partie and carefully gone through the case file.

5.                Admittedly,  the husband of the complainant late Sh. Rajesh Kumar Rana(hereinafter referred to as Deceased Life Assured i.e. DLA), had obtained an insurance policy from the OPs  for  sum assured of Rs. 2,00,000/- for the period from 13.09.2006 to 13.09.2021. Due to non- payment of premium, the policy was lying in a lapsed condition. DLA got it revived by paying Rs. 37,668/- vide receipt dated 29.09.2014, Annexure R-4. From the perusal of the revival form Annexure C-14, it is evident that DLA got the policy revived on 29.09.2014. The question regarding the personal history with regard to health, mentioned at serial no. 2 & 3 of the said revival form, the DLA had given answers in negative to all the questions and to the question, ‘status of health’ mentioned at serial no.4, the DLA had given answer ‘yes and good’, The plea of the OPs is that in fact, DLA was suffering from cancer but he did not disclose this fact at the time of revival of the policy. To corroborate this fact, the OPs have placed on record the claim inquiry report Annexure R-5 and certificate of hospital treatment Annexure R-6. From the perusal of the aforesaid documents, Annexure R5 & R-6, it is evident that the DLA was suffering from cancer and was taking treatment from PGIMR, Chandigarh from 26.06.2014. The certificate, Annexure C-6, has been issued by the Senior Resident Doctor, Department of General Surgery, PGIMR, Chandigarh, as per the record of the hospital. No doubt , the OPs have not produced the affidavit of the concerned doctor, who issued the medical certificate, but the said medical certificate cannot be discarded merely on this ground because the complainant  has not produced any material on record from which an inference can be drawn that DLA never got treatment from PGIMR, Chandigarh for Cancer or any other problem in the month  of June, 2014. The Hon’ble State Commission, Punjab, in the case of Life Insurance Corporation of India & Vs. Jeevan Lata decided on 11.05.2015, by making reference of the case of Life Insurance Corporation of India Vs. Darshna Devi & another decided on 20.12.2013 the Hon’ble State Commission of Punjab has held that a certificate of hospital treatment is admissible in evidence without any affidavit of the concerned signatory. In the case of Satwant Kaur Sandhu Vs. New India Assurance Company Limited, (2009) 8 SCC 316, the Hon’ble Supreme Court of India has held that a certificate of hospital treatment is admissible and sufficient for proving the pre-existing disease. In the medical certificate, it is clearly mentioned that DLA was suffering from cancer from 26 June, 2014. By giving answer in negative to the questions mentioned at serial no. 2 & 3 and by giving answer in affirmative to the question mentioned at serial no.4 of the revival form, the DLA concealed the material information which he was required to disclose at the time of revival of the policy i.e. 29.09.2014. In this view of the matter, the insurance company by repudiating the claim of the complainant has not committed any deficiency in service and the complaint filed by the complainant is liable to be dismissed being devoid on merits.

6.                In view of the aforesaid discussion, we hereby dismiss the present complaint being devoid of merits. The parties are left to bear their own cost. Certified copies of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

Announced on : 22.03.2019

 

 

 

          (Vinod Kumar Sharma)              (Ruby Sharma)     (Neena Sandhu)

                      Member                     Member                       President