Haryana

StateCommission

A/1115/2014

ICICI Prudential Life Insurance Co. Ltd - Complainant(s)

Versus

Vijay Kumar - Opp.Party(s)

13 Dec 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                            First Appeal No.1115 of 2014

Date of Institution: 02.12.2014

                                                             Date of Decision: 13.12.2016

 

1.      ICICI Prudential Life Insurance Co. Ltd ICICI Prulife Towers, 1089 Appasaheb Marathe Marg, Prabhadevi, Mumbai 400025

2.      ICICI Prudential Life Insurance Co. Ltd. Shop NOI.972/11, 2^nd Floor, Ambala road, Opp. RKSD College, Kaithal & above UTI Bank, Kaithal, Tehsil & District Kaithal, Haryana.

…..Appellants

Versus

Vijay Kumar, S/o Sh.Prem Chand aged about 44 years, R/o 459/14, Sargodha Colony, Jind road, Kaithal Tehsil & District Kaithal, Haryana.

                                      …..Respondent

CORAM:             Mr. R.K.Bishnoi, Judicial Member.

                             Mrs. Urvashi Agnihotri, Member.                                                                                                                                        

Present:     Mr. Ramneek Gupta, Advocate counsel for appellants.

Mr.Hitender Kansal proxy for Mr.P.M.Goyal, Advocate  counsel for the respondent.

 

                                                   O R D E R

R.K.BISHNOI, JUDICIAL MEMBER:

          It was alleged by the complainant that his wife Sarla Rani  (since deceased) was insured for a sum of Rs.Three lacs  with the opposite parties (O.Ps.)-appellants. She died on  28.03.2010. Being nominee of deceased, he lodged claim, but, O.Ps. neither accepted nor rejected his claim. They be directed to pay the insured value alongwith other compensation as mentioned in the complaint.

2.      O.Ps. filed reply controverting his averments and alleged that he was not entitled for compensation as prayed for. The complaint was barred by time because the cause of action accrued in the year 2010, whereas complaint was filed in the year 2013 i.e. after expiry of two years. At the time of obtaining insurance policy life assured concealed the fact of previous ailment in the year 2007.  She was diagnosed a case of “Osteosarcoma left knee” and received three cycles of Chemotherapy in October.  Due to concealment of this fact he was not entitled for any compensation.

4.      After hearing leanred counsel for the parties, learned District Consumer Disputes Redressal Forum,  Kaithal (In short “District Forum”) allowed the complaint vide impugned order dated 01.10.2014 and ordered as under:-

“Thus, in view of above discussion, we allow the complaint and direct the OPs to pay Rs.3,00,000/- to the complainant and further to pay Rs.2,000/- as lump sum compensation on account of harassment, mental agony and cost of litigation charges.  Both the OPs  are jointly and severally liable.”

5.      Feeling aggrieved therefrom, opposite parties-appellants have preferred this appeal.

6.      Arguments heard. File perused.

7.      Learned counsel for the complainant vehemently argued that   O.Ps. have miserably failed to show that the claim was repudiated on 29.09.2010. They have not produced any receipt etc. vide which the repudiation letter dated 29.09.2010 was sent to him. So, it cannot be alleged that cause of action accrued on that date and complaint is time barred.  O.Ps. have also failed to show that she was suffering from cancer at the time of obtaining insurance policy or DLA ever received treatment at All India Institute of Medical Sciences (AIIMS). They have not produced any witness or record to prove this fact, so learned District Forum rightly came to conclusion that he was entitled for compensation.

8.      This argument is devoid of any force. Our Hon’ble  Supreme Court has clearly opined in Kandimalla Raghavaiah and Co. Vs. National Insurance Co. and Anr (2009) 7 SCC 768 (case law cited by appellants counsel) that limitation for filing complaint will start from the date when cause of action accrued. It cannot continue till the denial of claim. It is specifically mentioned therein that when cause of action has accrued, the party is supposed to file complaint within two years thereof. Relevant portion of above-said judgement is reproduced as under:-

“(i) Consumer Protection Act, 1986-Sections 2 (1) (g) 23, 24 A-Limitation-time barred-Insurance Claim-Fire in tobacco godown took place on 22/23 March, 1988- Intimation to Bank, in whose favour stock hypothecated, given on 23 March itself-Insurance company informed in November 1992- Period of limitation expired-Section 24 A, consumer Protection Act bars Consumer For a from admitting complaint after two years from the date of cause of action-complaint before consumer for a filed in October 1997, dismissed as time barred-Civil appeal filed-contention, denial of insurance company in honouring claim received in March-Limitation period will commence from that date-Contention not acceptable-Cause of action not  continues till denial of claim-Filing of claim by Bank in 1988 in no way helped complainant-Insurance company’s reply to legal notice in March 1996, declining to issue claim forms, not resulted in extending limitation period-complaint filed in 1997, without application of condonation of delay manifestly bared by limitation-Dismissal of complaint justified-No interference required in appeal.”

In the present case wife of complainant died on 28.03.2010 and he submitted claim form Ex.R-3 on 01.09.2010.  As per O.Ps. the same was repudiated on 29.09.2010. Why he waited for such a long time is no-where explained by him. So, it is clear that complaint was hopelessly time barred.

9.      Further more from the perusal of discharge summary issued by hospital, it is clear that she had already received chemotherapy before obtaining insurance policy.  Relevant portion of Serial No.1 of Ex.R-4 is mentioned as under:-

                   “C/o: Admitted for chemotherapy.

          Diagnosis

.         Osteosarcoma Ltd. Lower and Femur and Lt. tibia with post amputation with B/L Lung metastasis.

.         Cisplatin + Adriamycin given 3 cycles in AIIMS-Jst in 10/07

.         Above knee amputation done on 04/08.”

10.    She did not disclose this fact and obtained insurance policy which is clear from the proposal form Ex.R-1. It is no-where alleged by complainant that this record was not pertaining to her. More so, it was mentioned by complainant in claim form Ex.R-3 that she died due to cancer which was diagnosed at IVY Hospital, Mohali.  In this way record of Ex.R-4 is clearly connected with her (DLA).  When she has concealed the previous ailment, complainant is not entitled for any compensation as opined by Hon’ble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. (2009) 8 SCC 316.  (case law cited by the counsel for the appellant).  Learned District Forum failed to take into consideration all these aspects, so impugned order cannot be sustained, the same is hereby set aside, appeal is allowed and complaint is dismissed.

11.    The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification in accordance with rules.

December 13th, 2015      Urvashi Agnihotri                      R.K.Bishnoi,                                                Member                                    Judicial Member                                           Addl. Bench                              Addl.Bench           

S.K.

 

F.A. No.1115 of 2014

Present:     Mr. Ramneek Gupta, Advocate counsel for appellants.

Mr.Hitender Kansal proxy for Mr.P.M.Goyal, Advocate counsel for the respondent.

                    File taken up today as on 12.12.2016 was declared as holiday on account of Eid-E-Milad.

                             Delay of 26 days in filing the appeal is condoned for the reasons mentioned in the application filed for condonation of delay.

December 13th, 2016      Urvashi Agnihotri                      R.K.Bishnoi,                                                Member                                    Judicial Member                                           Addl. Bench                              Addl.Bench           

S.K.