Haryana

StateCommission

A/317/2022

LIFE INSURANCE CORPORATION OF INDIA - Complainant(s)

Versus

YUVRAJ - Opp.Party(s)

ROHIT GOSWAMI

27 Jul 2022

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

 

                                                First Appeal No. 317 of 2022

                                                                 Date of Institution: 14.07.2022

Date of decision: 27.07.2022

 

1. The Branch Manager, Life Insurance Corporation of India, Branch office Bay Shop 1-2, Sector-12, Urban Estate, Karnal.
2. The Divisional Manager, Life Insurance Corporation of India, Divisional Office P.O. box No.106, Jeevan Parkash, Model Town, Karnal.
3. The Zone Manager, Life Insurance Corporation of India, Jeevan Bharti Town-II, 124, Canaught Circus, P.B. No.630, New Delhi-110001.

                                                                             .….Appellants

 

Versus

 

Yuvraj (minor) son of Late Shri Manoj Kumar R/o VPO Gonder, District, Karnal, through his mother Reeta Devi being his natural guardian.

…..Respondent

CORAM:    Mrs. Manjula, Member.

 

Present:-    Mr. Rohit Goswami, Advocate for the appellant.

                  

O R D E R

Manjula, Member:

 

1.      As per order dated 04.03.2022 contained in letter No.594, I am conducting these proceedings singly.

2.      The brief facts of the present case are that complainant’s father, namely, Shri Manoj Kumar (now deceased), had purchased a Life Insurance Policy with date of commencement as 28.10.2017 for a sum assured of Rs.2,50,000/- with half yearly premium of Rs.5908/- from the opposite parties (Ops). Deceased-life assured had deposited all premium installments regularly. The father of complainant died on 07.05.2020. Being a nominee of the aforesaid policy, complainant approached OP No.1 for disbursement of claim amount. The official of OP No.1 had taken signature of mother of the complainant on some printed and blank papers and also received copies of relevant documents of the policy and OPs had assured him that the claim in respect of aforesaid policy would be disbursed in his favour. After waiting sufficiently, when complainant neither received the claim amount nor received any satisfactory response from OP No.1, he again approached to OP No.1, but OP No.1 did not give any satisfactory reply. Despite several requests made by complainant, OPs illegally repudiated the claim vide letter dated 01.10.2020 on the ground that the aforesaid policy had not completed three years from the date of commencement of risk and the deceased-life assured was suffering from Tuberculosis prior to taking the insurance policy. Deceased-life assured did not disclose these facts in the proposal form. It was further averred that at the time of obtaining the policy, the agent of Ops had insisted the deceased-life assured to take the said policy. Deceased-life assured did not conceal any fact regarding his health status. The agent of OPs had also stated that the risk of the said policy would start from the first day of commencement of said policy. Thereafter, another letter was sent by OP No.2 to the complainant mentioning therein that the decision of the committee was final and it would not be possible for any of our office to review the claim in future.

3.      The complaint was resisted by the OPs by filing their written reply before the District Commission. It was submitted that the father of the complainant Shri Manoj Kumar had purchased a Life Insurance Policy with date of commencement as 28.10.2017 for a sum assured of Rs.2,50,000/- with half yearly premium of Rs.5908/- from OPs and had nominated his minor son Shri Yuvraj as nominee and his mother Smt. Reeta Devi was appointed as his appointee. It was further pleaded that the death intimation and the other claim forms and necessary papers had been submitted by Smt. Reeta Devi and as per the death certificate submitted by the complainant, the life assured Manoj Kumar had died on 07.05.2020. It was denied that OPs had taken signatures of the mother of complainant on blank papers, rather she had not provided any information regarding treatment taken by deceased-life assured. It was further submitted that the date of commencement of risk was 28.10.2017 and life assured expired on 07.05.2020, hence the duration of policy was 2 years 6 months and 10 days. Since the aforesaid policy had not completed three years from the date of commencement of risk i.e. 28.10.2017, the competent authority had examined the claim and it was revealed that the deceased-life assured was not having good health prior to taking the policy and was suffering from Tuberculosis. He did not disclose these facts in his proposal form. Hence, the claim of complainant was repudiated with forfeiture of all the money received. Rest of allegations made in the complaint were denied and prayer made for dismissal of the complaint.

4.      After hearing both the parties, learned District Consumer Disputes Redressal Commission, Karnal accepted the complaint against the OPs vide its order dated 26.05.2022.

5.      Feeling aggrieved by the order of learned District Commission, Karnal, OPs-appellants have preferred this appeal before the State Commission.

6.      The arguments have been advanced by Mr. Rohit Goswami, Advocate for the appellants. With his kind assistance the entire appeal has been properly perused and examined.

7.       It is not disputed that the deceased-life assured had obtained life insurance policy from OPs for a sum assured of Rs.2,50,000/- and the date of commencement was 28.10.2017. It is also not disputed  that life assured had died on 07.05.2020 during the subsistence of insurance policy. Being nominee, complainant lodged the claim but the OPs repudiated the same on the ground that deceased-life assured had intentionally not disclosed about the ailment that he was suffering from Tuberculosis prior to submission of the proposal form and the policy in question had not completed three years from the date of commencement of risk i.e. 28.10.2017, which was earlier to the date of death of life assured.  

8.      Keeping in view the above discussion that the case of the Ops is based upon the document i.e. Tuberculosis Register and on perusal of the said document, the same was found doubtful as the name and place of the hospital and name of the doctor who treated the life assured, were not mentioned in that register. Another plea taken by the OPs was that the duration of the policy in question was two years six months and ten days only and it had not completed three years from the date of commencement of the risk. But the OPs have failed to prove on record that the deceased-life assured was suffering from any disease as alleged by them and thus, exclusion clause is not applicable here. Hence, the deficiency in service against the opposite parties is clearly proved. Often the insurance companies through their agents are in haste to sell the insurance policies, but are either non thorough or are casual in fulfilling the required formalities. T.B. is otherwise also a curable disease. Learned counsel for the appellant during the course of arguments referred to T.B. Register Ext. OP-3 to OP-5. Learned District Commission has already considered and observed that the said register does not find mention the name and place of the Hospital, name of doctor, who treated the patient and issued the documents. Merely making the documents as exhibit does not absolve the appellant of its responsibility and dispensing the proof of the documents and linking the same with certainty to the life assured. Learned counsel for the appellant has also referred the judgment of Hon’ble Supreme Court of India in case titled as “P.C. Chacko and another Vs. Chairman, Life Insurance Co. of India” in Appeal (Civil) No.5322 of 2007, decided on 20.11.2007. The said judgment has no applicability to the facts and circumstances of the case in hand and is distinguishable. In said case, the policy was taken on 21.02.1987 and the life assured died on 06.07.1987 and the life assured died on account of “Polyneuritis” disease which was concealed.

9.      The learned District Commission has rightly accepted the complaint of the complainant. The State Commission finds no reason or ground to interfere with the order of learned District Commission. Hence, the appeal being devoid of merits, stands dismissed in liminie.

 

27^th July, 2022                                                                                             (Manjula)                                                                                                                                Member                                                                                           

 

M.S.