BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, JIND.
Complaint Case No. : 290 of 2019
Date of Institution : 05.11.2019
Date of Decision : 12.09.2022
Smt. Bala widow of Sh. Satyawan S/o Sh. Amar Singh R/o village Kharenti Tehsil Julana, District Jind.
….Complainant
Versus
1. The Zonal Manager, LIC of India, Jeevan Bharti, Tower-II, 124, Cannaught Circus, P.B. No.630, New Delhi.
2. The Divisional Manager, Life Insurance Corporation of India, Divisional Office, B.O. Box No.106, “Jeevan Parkash” 489, Model Town, Karnal -132001.
3. Life Insurance Corporation of India, Jeevan Jyoti, B-23-24, District Shopping Complex, Urban Estate, Jind through its Manager.
……Opposite Parties
Complaint under Section 12 of the Consumer Protection Act, 1986.
CORAM: SH. MUKESH BANSAL, PRESIDENT.
SMT. NEERU AGARWAL, MEMBER.
SH. G.D. GOYAL, MEMBER.
Present: Sh. Ravinder Kumar, learned counsel for complainant.
Sh. V.S. Lather, learned counsel for Ops.
ORDER:
Facts giving rise to filing of this complaint are that complainant’s husband Satyawan had purchased Life Insurance Policy bearing no.479008019 from OP which got commenced on 28.05.2014 for a sum assured value of Rs.15.00 lac on payment premium of Rs.29974/- half yearly to the Ops. In this policy, the complainant being wife was nominee of the policy holder. Policy premium used to be paid by the complainant’s husband regularly however he could not deposit 2-3 premiums due to financial constraints and later on was revived on 17.08.2017 on approval of the OP by payment of entire premium amount with late fees and medical report. At this time, medical examination was also conducted by the empanelled Dr. Meenakshi Jain at Jind and husband of complainant was found hale and hearty. The complainant’s husband had deposited last premium of Rs.29974/- on 29.05.2018 and next premium due on 28.11.2018. Unfortunately, the complainant’s husband expired on 10.11.2018. The complainant informed the Ops about the death of her husband policy holder. Ops visited the complainant’s house for verification and had taken original documents of the policy to settle the claim. It was assured that claim of the complainant’s husband will be processed at the earliest. Despite waiting for considerable time of one year the complainant’s husband received letter no.Claims/Rep/M/19-20/8 dated 19.08.2019 received on 28.09.2019 whereby her claim was repudiated by the Ops on the ground that complainant’s husband being chronic smoker and alcoholic. According to the complainant, the claim of her husband’s death had been repudiated by the Ops arbitrarily and wrongly whereas her husband was not chronic smoker nor alcoholic. The complainant has claimed amount of Rs.15.00 lac alongwith interest from the date of death of her husband. In this regard, legal notice was also served upon the OP by the complainant through her lawyer on 01.10.2019 through registered post. It was not replied by the OP. Against aforesaid background, complainant has claimed sum of Rs.15.00 lac alongwith interest @ 12% per annum and Rs.10.00 lac as compensation on account of mental pain and agony.
2. Ops were served on receipt of complaint. Reply was filed wherein preliminary objections has been taken by the Ops regarding maintainability, locus standi, cause of action and that the complaint is bad for non-joinder and mis-joinder of necessary parties. Further the complainant is estopped by her own act and conduct. The Ops denied the averments of the complainant and contended that her husband Satyawan policy holder died on account of being chronic smoker and alcoholic. According to the Ops, the claim of the complainant in this regard was rightly repudiated. Further the policy holder suffered on account of being chronic smoker even prior to the renewal of the policy. It is also averred that complainant’s husband had given wrong and false information while filling up the proposal form. The Ops prayed for dismissal of the complaint.
3. The complainant in order to buttress the complaint filed her affidavit Annexure CW1/A and also documents Annexure C-1 to C-22. In the affidavit Annexure CW1/A, complainant reiterated the contents of the complaint.
On the other hand, with a view to rebut the case of the complainant filed affidavit Annexure OPW1/A of Manager (Legal & HPF) Sh. Puneet Kumar and apart from this plethora of documents Annexure OP1 to OP-12.
4. We have heard learned counsel for both the parties at length and have gone through entire material on record.
5. While scanning the material on record, we find that the cardinal point which requires determination in this case is that whether the complainant’s husband Satyawan the policy holder died on account of being chronic smoker and alcoholic as being alleged by the Ops. Further, it is also to be seen whether he became victim on account of the disease as referred to in OP-10 prepared by the Assistant Professor, Department of Medicine, PGIMS, Rohtak on 09.04.2019 i.e. after his demise.
6. It is also the contention of the Ops that deceased policy holder was suffering from pre-existing disease.
7. On going through various documents relied upon by the complainant, we find that the claim of the complainant was wrongly declined vide letter Annexure C-16 by the Ops because as per Annexure C-5 to C-13 it is revealed that at the time of revival of the policy on 17.08.2017 the policy holder had been medically examined. We have gone through these documents and find that the policy holder Satyawan husband of complainant was found medically fit. Even otherwise also, it is very important to mention here that since his health was found fit, therefore, the policy was revived.
8. The contention of the Ops that the disease on account of which the policy holder suffered was pre-existing. We have not been able to lay our hands even on a single document which may show that the disease regarding which he remained admitted in the hospital in the month of April 2018 was pre-existing. Although there is a mention of chronic smoker and chronic alcoholic regarding the complainant’s husband yet it is not clear whether he became victim of this chronic vices and further whether he developed these vices even before the revival of the policy or before the filling up of the proposal form.
9. So far as OP-10 is concerned, we are not inclined to attach any credence to this document because it came into existence after demise of the complainant’s husband on 10.11.2018. The doctor concerned who authored Annexure OP-10 has not been examined by the Ops nor his affidavit was filed. Similarly, the affidavit of doctor who prepared Annexure OP-8 & OP-9 has not been filed. For want of these affidavits and non-examination of the doctors before this Commission, we are not inclined to attach any credence worth its salt. During the course of arguments, learned counsel Sh. Lather referred to one enquiry report purported to have been conducted by the Ops which is placed on record as Annexure OP-7. We have gone through this enquiry report. This enquiry appears to have been conducted by Sh. K.S. Bhalla. The OP failed to file affidavit of this Investigating Officer concerned. In column 12 & 13 of this report, it is mentioned that family members had not cooperated. Apart from this, in column no.9 it is also mentioned that the health of the policy holder was not good reported by the neighbor and also that he was cancer patient. There is no mention of the name of the neighbor, it is quite strange as to how I.O. came to know regarding process of cancer since there is no reference of this disease in other documents relied upon by the Ops. Name of the neighbor have not been recorded. This enquiry appears to be sham and in our opinion has been prepared falsely to make abortive attempt to support the repudiation letter Annexure OP-1.
10. To sum up here, we do not find any merit in the repudiation letter Annexure OP-1. In other words, the Ops wrongly rejected or repudiated the claim of the complainant.
11. As discussed at length (supra), no cogent evidence has been placed on record by the Ops nor to show that Satyawan policy holder was suffering from any ailment before obtaining the insurance policy. On this point, we place reliance on First Appeal No.528 of 2016 case titled Life Insurance Corporation of India Vs. Sarojini and another decided on 17.08.2016 by Hon’ble State Consumer Disputes Redressal Commission Haryana, Panchkula.
12. As discussed above that at the time of revival of the policy, the policy holder Satyawan was medically examined as per Annexure C-5 to C-13 whereby he was not found suffering from any disease. On this point, we place reliance on Revision Petition No.1782 of 2018 case titled Life Insurance Corporation of India Vs. Reena Nanda decided on 20.07.2018 by Hon’ble National Consumer Disputes Redressal Commission, New Delhi.
13. In support of our reasoning, we also rely upon 2011(4) CPJ-6 case titled P.Vankat Naidu Vs. Life Insurance Corporation of India and Anr. decided by Hon’ble Supreme Court of India. Since it has not been proved on record by the Ops that the policy holder had pre-existing disease, therefore, the repudiation of the claim by the Ops is altogether wrong and illegal.
14. In view of our discussion in the aforesaid background, we have no hesitation in allowing the present complaint and award a sum of Rs.15.00 lac to the complainant.
15. As per the facts on record, the complainant’s husband expired on 10.11.2018 and the claim of complainant was declined vide repudiation letter Annexure C-16 dated 19.08.2019. This complaint was filed before this Commission on 24.10.2019. Despite lapse of almost four years, the complainant is still endlessly waiting for the claim on account of unfortunate death of her husband upon which she became widow and lost consortium. It can be well presumed that the complainant’s husband chose to purchase policy from Ops in the fond hope to cover risk of his life adequately as it will help the family in the adverse times. Instead of getting any help they were compelled to face wrath at the callous and negligent attitude of the Ops for no rhyme or reason. We have no hesitation to conclude that the Ops were quite insensitive to the death of complainant’s husband and in a very clumsy manner chose to decline her genuine and rightful claim by issuing one repudiation letter Annexure C-16. Therefore, the Ops by their act chose to pour salt on the wounds of complainant. The complainant consequently was made to run from pillar to post for all these almost four years despite entering into widowhood. Instead of putting balm on her wounds. Ops altogether caused mental agony. Keeping in view entire gamut of the circumstances and in the interest of justice, we are inclined to award compensation of Rs.5.00 lac to the complainant. Accordingly, the complaint is allowed and Ops jointly and severally are directed to comply with the following directions within 45 days from the date of this order:-
(i) To pay Rs.15,00,000/- (Rs. Fifteen lacs) to the complainant alongwith interest @ 9% per annum from the date of death of complainant’s husband Satyawan i.e. 10.11.2018 till the date of actual realization. In case of default, the amount shall carry interest @ 12% per annum till the actual realization.
(ii) To pay a sum of Rs.5,00,000/- (Rs. Five lac) as compensation on account of mental and physical harassment.
(iii) Also to pay a sum of Rs.11,000/- (Rs. Eleven thousand) as litigation expenses.
Certified copies of the order be sent to parties concerned, free of costs, as per rules. File be consigned to the record room, after due compliance.
Announced on:12.09.2022. (Mukesh Bansal) President
(Gopal Singh)
Stenographer
(Neeru Agarwal) (G.D. Goyal)
Member Member
