Haryana

Sonipat

CC/425/2015

Smt. Poonam W/o Rajender Singh - Complainant(s)

Versus

The Officer Incharge Office of Ambudsman Insurance - Opp.Party(s)

O.P. Bhardwaj

18 Jul 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SONEPAT.

 

                                Complaint No.425 of 2015

                                Instituted on:19.11.2015

                                Date of order:18.07.2016

 

Smt. Poonam wife of late Rajender Singh son of Shri Chander Singh, resident of Mohana, distt. Sonepat.

 

                                           ...Complainant.

                        Versus

 

1.The officer Incharge, office of Ombudsman (Insurance) SCO 101-103, Batra Building 2^nd Floor Sector 17D, Chandigarh.

2.The Marketing Manager, LIC of India, SCO No.3,4&5, Sector 1, HUDA, Rohtak.

3.The Additional Administrative Office, Senior Manager, LIC of India, Court road, Gohana, distt. Sonepat.

 

                                           ...Respondents.

 

COMPLAINT UNDER SECTION 12 OF

THE CONSUMER PROTECTION ACT,1986

 

Argued by: Shri OP Bhardwaj, Adv. for complainant.

           Respondent no.1 given-up.

Shri RP Antil, Adv.for respondent no.2 and 3.       

 

BEFORE-  NAGENDER SINGH, PRESIDENT.

        SMT.PRABHA WATI, MEMBER.

        J.L. GUPTA, MEMBER.

 

O R D E R

 

          Complainant has filed the present complaint against the respondents alleging therein that her husband Shri Rajender Singh had purchased a policy bearing no.179185519 for Rs.15,00,000/- from the respondents and unfortunately he had died on 7.9.2014.  After his death, the complainant has submitted all the relevant documents regarding the said policy to the respondent no.3, but it has not brought any fruitful result.  So, the respondent no.3 was served with legal notice on 15.1.2015, but no reply was sent by the respondent no.3 to the said legal notice.  The complainant, thus, has approached the respondent no.1 Lokpal Haryana Chandigarh, but no response was received by the complainant.  Again the complainant served all the respondents on 19.9.2015, but of no avail.  This wrongful act of the respondents have caused unnecessary mental agony and harassment to the complainant. So, she has come to this Forum and has filed the present complaint.

2.        The respondents no.2 and 3 have appeared and filed their written statement, whereas respondent no.1 was given-up by the ld. Counsel for the complainant vide his separate statement on 24.12.2015.

          The respondents no.2 and 3 have submitted in their written statement that the deceased Rajender Singh husband of the complainant had purchased the policy no.179185519 from the respondents no.2 and 3.  The complainant has lodged her claim with regard to the said policy after the death of her husband. The complainant has also furnished all the required documents with the respondents no.2 and 3. The case of the complainant was put to investigation being early death claim and during the investigation, it was found that at the time of effecting the assurance with the respondents no.2&3, the deceased LA in his personal statement dated 8.9.2012 regarding his health has given false and wrong answers. Whereas the deceased LA was suffering from Pul. KOCH & was on ATT for the last 2-3 years as per form 3816 furnished by the doctor of Jaipur Golden Hospital, New Delhi and thus, the deceased LA has concealed the facts at the time of effecting the assurance and he made deliberate incorrect statement and has with-held the correct information in his personal statement from the respondents no.2 and 3 regarding his health and thus, the claim  of the complainant was repudiated rightly and legally and the complainant was informed in this regard vide letter dated 25.8.2015.  The complainant was/is not entitled for any relief as there was no deficiency in service on the part of the respondents no.2 and 3 and thus, prayed for the dismissal of the present complaint.

3.        We have heard  ld. Counsel for both the parties at length and we have also gone through the entire relevant material available on the case file carefully & minutely.

4.        In the present case, it is admitted by the respondents no.2 and 3 that the deceased Rajender Singh husband of the complainant had purchased the policy no.179185519 from the respondents no.2 and 3.  The complainant has lodged her claim with regard to the said policy after the death of her husband. The complainant has also furnished all the required documents with the respondents no.2 and 3.

          The reason for repudiating the claim of the complainant as per the respondents no.2 and 3 are that the case of the complainant was put to investigation being early death claim and during the investigation, it was found that at the time of effecting the assurance with the respondents no.2&3, the deceased LA in his personal statement dated 8.9.2012 regarding his health has given false and wrong answers. Whereas the deceased LA was suffering from Pul. KOCH & was on ATT for the last 2-3 years as per form 3816 furnished by the doctor of Jaipur Golden Hospital, New Delhi and thus, the deceased LA has concealed the facts at the time of effecting the assurance and he made deliberate incorrect statement and has with-held the correct information in his personal statement from the respondents no.2 and 3 regarding his health and thus, the claim  of the complainant was repudiated rightly and legally and the complainant was informed in this regard vide letter dated 25.8.2015.

          Ld. Counsel for the complainant has relied upon the case law titled as LIC of India Vs. Gowramma 2009(III) CPJ 25(NC),  Veena Sharma Vs. LIC of India LJR 1999(2) Page 484, LIC of India Vs. Smt. GM Channabasamma  LJR 1992(2) page 200, LIC of India Vs. Chandra Kanta Lohande CPJ 2008 (June) page 300, PC Chacko and another Vs. LIC of India, CPJ 2008(Sep)  page 78, LIC of India Vs. Priya Sharma and others CPJ 2012(IV) page 646(NC), LIC of India Vs. Badri Nageswaramma and others CPJ 2005(II) Page 9(NC),  LIC of India Vs.S.Hymavathi CPJ 1995(III) page 42 (NC), Surender Kaur and others Vs. LIC of India, CPJ 2005(II) page 32(NC), LIC of India Vs. Joginder Kaur and others CPJ 2005(II) Page 78(NC), Rasheeda Khatoon Vs. LIC of India CPJ 2009(III) Page 91 (NC), Bajaj Allianz Gen. Ins. Vs. Valsa Jose CPJ 2012(IV) page 839 (NC), Madan Lal Vs. LIC of India, CPR 2009(1) page 142,  LIC of India Vs. Laddu Lal Luhar CPJ 2010(III) Page 227, United India Ins. Co. Vs. Anumolu Rama Krishna  CPR 2009(1) page 307, Murala Subba Lakshmi Vs. LIC of India CPJ 2010(III) Page 1 and LIC of India Vs. Uma Devi CPJ 1991 page 516.

          Similarly ld. Counsel for the respondents no.2 and 3 has relied upon the case law titled as LIC of India Vs. Lachha Devi order passed by Hon’ble National Commission in Revision petition no.2025 of 2011 and LIC of India Vs. Smt. Maya Devi order passed by Hon’ble National Commission in Revision petition no.1327 of 2008.

          Now the main question arises for consideration before this Forum is whether the repudiation of the claim  by the respondents no.2 and 3 are legal or it is wrong, illegal and unjustified?

          But we find no force in the contentions raised by the ld. Counsel for the respondents no.2 and 3.

          We have perused the report mentioned on the document Ex.R5 i.e. Claim Form No.3816 (Certificate of Hospital Treatment) very carefully.  But no affidavit of the person, who has tendered this report, is available on the case file.  This report without affidavit has little evidentiary value in the eyes of law. Further more, no medical report or any other evidence obtained from Jaipur Golden Hospital New Delhi to prove that the deceased LA was suffering from Pul. KOCH & was on ATT for the last 2-3 years.

          In our view, the law requires the quality of evidence and not the quantity of evidence.  The repudiation of the claim on the basis of report mentioned in document Ex.R5 is patently illegal, unjustified and amounts to a grave deficiency in service on the part of the respondents no.2 and 3.  The respondents have repudiated the legal and genuine claim of the complainant, to which, the complainant was entitled to.

          Thus, we hereby direct the respondents no.2 and 3 to pay the amount of Rs.1500000/- (Rs. Fifteen lacs) to the complainant within a period of 60 days from the date of passing of this order, otherwise, the said amount shall fetch interest at the rate of 09% per annum from the date of passing of this order till its realization.

          With these observations, findings and directions, the present complaint stands allowed.

          Certified copy of this order be provided to both the parties free of cost.

File be consigned to the record-room.

 

 

(Prabha Wati Member) (J.L.Gupta Member)(Nagender Singh-President)

                                          DCDRF, Sonepat.

 

Announced:18.07.2016