Haryana

Jind

CC/45/2014

Smt. Kitabo Devi - Complainant(s)

Versus

Vinod Jangra - Opp.Party(s)

Sh B.S Kaushal

19 Aug 2016

ORDER

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, JIND.
                            Complaint No. 45 of 2014
                            Date of institution:-5.5.2014
                            Date of decision:- 19.8.2016 
Smt. Kitabo Devi widow of late Rajender s/o Hari Ram r/o village Desh Khera, Tehsil Julana, District Jind. 
                                       ..Complainant.
Versus
Vinod Jangra son of Raghbir Singh mistri r/o ward No.6 Patel Nagar, railway road, Jind.
PNB Metlife Insurance Company Ltd. registered office bridage Seshamahal, No.5, Vani Vilas road, Basavanagudi, Banglore 560004 through its Branch Manager, Jind.
Manager, Punjab National Bank, Jind. 

                                          …Opposite parties.
Complaint under section 12 of
                Consumer Protection Act, 1986.

Before:     Sh. Dina Nath Arora, President.
            Smt. Bimla Sheokand, Member.
            Sh. Mahinder Kumar Khurana, Member.  

Present:-    Sh. B.S. Kaushal, Adv. for  complainant. 
        Sh. Satish Bhardwaj, Adv.for opposite parties No.1&2.  
            Sh. P.K. Gupta Adv. for opposite party No.3.
Order:-
         Brief facts of the complaint are that complainant’s husband namely  Late Sh. Rajender had insured his life for a sum of Rs.4,00,000/- vide policy No.21157992 with the opposite party No.1 who is agent of the remaining opposite parties. The opposite party No.2 is registered office of PNB Metlife Insurance Company which is 
            Kitabo Devi Vs. Vinod Jangra etc.
                    …2…
launched by opposite party No.3 The above mentioned policy was never lapsed and all premiums were paid by her husband till his death. It is stated that on 27.10.2013 the life assured died due to heart attack. The complainant is nominee of the above said policy in question. After death of her husband, she applied for claim and submitted all the necessary documents to the opposite parties. The complainant visited the office of opposite parties several times and requested to give the claim amount but the opposite parties did not pay any heed on the request of the complainant. The opposite parties  have wrongly repudiated the claim of the complainant on the ground that at the time of taking the policy the life assured was suffering from cancer. The complainant’s husband  was hale and healthy at the time of taking the policy and there was no any disease. Deficiency in service on the part of the opposite parties is alleged. It is prayed  that the complaint be accepted and opposite parties be directed to make the payment of Rs.4,00,000/-  as amount of claim besides other benefit along with interest @ 18% p.a. as well as to pay a sum of Rs.55,000/- as compensation on account of mental pain and agony to the complainant.   
2.  Upon notice, the opposite parties have appeared, opposite party No.1 and 2 have filed the joint written statement but opposite party No.3 has filed he separate written statement. Opposite parties No.1 and 2 have taking some preliminary objections such as  complainant has no cause of action  to file the present complaint and the complaint is not maintainable in the present forum. On merits, it is contended during the course of investigation and assessment of the claim, it was 
            Kitabo Devi Vs. Vinod Jangra etc.
                    …3…
revealed to the opposite parties that the deceased life inured (DLI) was suffering from cancer prior to applying for the said policy and it was diagnosed as on 19.11.2012 at Bhagwat Dayal Sharma PGIMS, Rohtak, which is prior to commencement of the policy. As per the card from Bhagwat Dayal Sharma, Rohtak, DLI was diagnosed cancer base of Tongue as on 4.9.2013 which was the same date of proposal for insurance. In fact deceased was suffering from cancer prior to the date of insurance.  The insurance is a contract of utmost good faith and insured is bound to disclose all information regarding his health truthfully in proposal form. The life assured had concealed the facts about his health so the opposite parties have rightly repudiated the claim of the complainant vide letters dated 22.1.2014. Therefore, there is no deficiency in service on the part of the answering opposite parties. Dismissal of complaint with cost is prayed for.
3.    Opposite party No.3 has contended that the opposite party No.2 is an independent body and he has no knowledge about the particulars of the policy purchased by the husband of complainant. The insurance amount, if any is to be paid by opposite party No.2 and question of repudiation of the claim by answering opposite party does not arise. The opposite party No.1 is not the agent of answering opposite party. Therefore there is no deficiency in service on the part of the answering opposite party. Dismissal of complaint with cost is prayed for. 
4.    In evidence, the complainant has  produced her own affidavit Ex. C-1,  copy of ration card Ex. C-2, copy of identity card Ex. C-3, copy of death certificate Ex. C-4 and copy of letter Ex. C-5 and closed the evidence.  On the other hand, the opposite party No.3 has produced the 
            Kitabo Devi Vs. Vinod Jangra etc.
                    …4…
affidavit of Sh. M.K. Sharma, Chief Manager, PNB Ex. OP-1 and closed the evidence. Opposite parties No.1 and 2 have produced the copy of application form Ex. OP-2, copy of death/disability certificate Ex. OP-3, copy of claim investigation report Ex. OP-4, copy of letter Ex. OP-5 and affidavit of Urmila Mekalki, Dy. Manager Legal Ex. OP-6 and closed the evidence. 
5.    We have heard Ld. counsel of both the parties and also perused the record placed on file. The counsel for complainant argued that the complainant’s husband namely Rajender had purchased  PNB Metlife Insurance policy for a sum of Rs.4,00,000/- through agent of the company Sh. Vinod Jangra on 4.9.2013 and filled up the proposal form and paid the premium but unfortunately complainant’s husband died on 27.10.2013 due to heart attack and complainant is widow and also nominee of the above said policy. It is further argued that complainant had applied the claim under the policy and fulfilled the all formalities as required by the opposite parties but the opposite parties  have  wrongly repudiated the claim on the ground that the deceased life assured  Rajender Kumar was suffering from cancer before purchasing the policy and insured has concealed the material facts regarding his disease at the time of taking the policy. Although her husband was hale and healthy at the time of taking the policy and there was no any disease and prayed for allow the complaint. 
6.    On the other hand, counsel for opposite parties has argued that the deceased life assured had died  after one month from the date of issuing the policy and we have gone through the investigation report it 
            Kitabo Devi Vs. Vinod Jangra etc.
                    …5…
was revealed  that DLI was suffering from cancer prior to apply for the said policy it was dignosed as on 19.11.2012  at Bhagwat Dayal Sharma PGIMS, Rohtak, which is prior to date of  commencement of the policy i.e. 4.9.2013.  The insurance is a contract of utmost good faith and insured is bound to disclose all information regarding his health truthfully in proposal form and prayed for dismissal of complaint. 
7.    After hearing Ld. counsel of parties and going through on record from the perusal of the document- proposal form dated 4.9.2013 Ex. OP-2 in the proposal form DLI has given a declaration with regard about his health and medical detail question was answered which as under:-
“Have you ever had symptoms of been treated for, been advised to receive treatment or have any investigations for any of the following (the below conditions provided as example only and would request you to disclose all disorders, disease, disturbance or other condition, which are, or might be relevant. If answer for any of the question in this section is “yes” please provide the medical reports if available)
(4) Cancer, Tumor, Cyst, Leukemia, Growth, Lump or other
Malignancy?                                        No
(13) During the past five years have you:-
Consulted any doctor or health practitioner for illness lasting  No
For month than 4 days except for fever, common cold or cough?     
Undergone ECG X-rays blood test or other test?             No     
Have been admitted/advised to be admitted to any Hospital or 
            Kitabo Devi Vs. Vinod Jangra etc.
                    …6…
Any other medical facility?                             No  
We have also gone through the claim investigation report along with medical record issued by PGIMS, Rohtak dated 19.11.2012 and 4.9.2013, 9.1.2013, 8.4.2013 and 23.9.2013 it reveals that DLI was suffering from tongue cancer and availed the treatment. it is clear that the complainant was suffering from cancer disease since 19.11.2012 whereas the complainant has purchased the policy in question on 4.9.2013. Hence, it clearly shows that the complainant has purchased the policy by suppressing the true facts from the company regarding his health as he was suffering from the cancer disease before taking the policy in question.
8.       In view of the above said discussion, we are of the firm view that the complainant has concealed the true facts about his health from the insurance company and he has willfully suppressed the above said disease as the same was not disclosed by  him in the proposal form at the time of availing the above said policy. There is no deficiency in service on the part of the opposite parties. Hence the present complaint is hereby dismissed with no order as to costs. Copies of order be supplied to the parties under the rule. File be consigned to the record-room.
Announced on: 19.8.2016

                                  President,
    Member     Member                    District Consumer Disputes                                         Redressal Forum, Jind

Kitabo Devi Vs. Vinod Jangra etc.
                    
                    
Present:-    Sh. B.S. Kaushal, Adv. for  complainant. 
        Sh. Satish Bhardwaj, Adv.for opposite parties No.1&2.  
            Sh. P.K. Gupta Adv. for opposite party No.3.

                Arguments heard.  Order announced. Vide our separate order of the even date, the complaint is dismissed. File be consigned to the record room after due compliance. 
                                                                                                      President,
        Member             Member                               DCDRF/Jind
                                           19.8.2016