Jhajjar
Distt.Consumer Court Jhajjar
consumer case(CC) No. CC/09/177
Joginder Singh
………..Appellant(s)
Vs.
Branch Manager, Life Insurance Corporation of India
L.I.C. of India
………..Respondent(s)
BEFORE:
1. Sh. A.N.Manocha
2. Smt.Krishna Yadav
Complainant(s)/Appellant(s):
1. Joginder Singh
OppositeParty/Respondent(s):
1. L.I.C. of India
2. Branch Manager, Life Insurance Corporation of India
OppositeParty/Respondent(s):
1. Sh.Surender Dhankar Adv.,
OppositeParty/Respondent(s):
ORDER
Before the President, District Consumer Disputes Redressal Forum, Jhajjar. Complaint No.177 of 2009. Date of Instt. 14.07.2009. Date of Decision :-29.04.2010. Joginder Singh son of Jage Ram and husband of late Ishwanti, resident of village Kaloi, tehsil and District Jhajjar. …Complainant. Versus 1.Life Insurance Corporation of India through its Branch Manager LIC of India, Second Floor, Ashok Plaza, Opp. Maiyana Tourist Complex, Rohtak-124001. 2.Branch Manager, LIC, Delhi Rohtak road, Bahadurgarh, District Jhajjar. …Respondents. Complaint under the Consumer Protection Act. _________ Before:- Shri Amar Nath Manocha……………..President. Smt. Krishna Yadav……………………Member. Argued by:- Shri Surender Dhankar , Advocate for the complainant. Shri J.S.Kadian , Advocate for the respondents. ORDER 1. The present complaint has been filed by the complainant with the averments that the wife of the complainant had taken insurance policy from the respondents on 3.10.2007 vide policy no.175058797 for a sum of Rs.50,000/- and the complainant is nominee of the life assured and legally entitled to receive the benefits as such. It is averred that the life assured expired on 5.3.2008 due to natural death. It is also averred that the benefits have not been paid by the respondents despite completion of all the formalities and finally a legal notice dated 12.05.2009 also. It is averred that the life assured was having a good health 177-09 Joginder Vs. LIC of India at the time of filling proposal form and there was no concealment of fact on the part of the life assured regarding her state of health. Accordingly, the complainant has sought a sum of Rs.50,000/- on account of benefits of the policy along with interest, compensation and litigation expenses. 2. On notice, the respondents appeared and filed written statement. It is averred that the life assured has concealed the material facts at the time of purchase of policy and has not disclosed her disease. It is also averred that the deceased life assured was suffering with tuberculosis and has received treatment from PGIMS, Rohtak for the last 2½ years before getting the insurance policy. It is averred that the deceased life assured was not having a good health at the time of taking the insurance policy and the claim has been repudiated on the valid grounds as per the terms and conditions of the policy. Therefore, the dismissal of the present complaint has been sought as there is no deficiency in service on the part of the respondents. 3. We have heard both the learned counsel for the parties and have also gone through the entire relevant material available on record. 4. It is not disputed that the complainant’s wife had got insured with the respondents on 3.10.2007 for a sum of Rs.50,000/- with the respondent company. It is also not disputed that the wife of the complainant Smt. Ishwanti, the life assured had expired on 5.3.2008. As per the ld. Counsel for the complainant, the claim has been wrongly repudiated as the complainant was in a fit state of health at the time of 177-09 Joginder Vs. LIC of India taking policy on 3.10.2007 and there is no concealment of fact on the part of the life assured in any manner. On the other hand, the ld. Counsel for the respondents has submitted that the deceased life assured Smt. Ishwanti had concealed her true state of health at the time of taking the policy and she was suffering with tuberculosis for the last 2½ years and was getting the treatment from PGIMS, Rohtak. In order to prove their case, the respondents have placed on record Ex.R1, affidavit of the Manager, Ex.R2 repudiation letter whereby the claim of the complainant has been repudiated, Ex.R3 claim enquiry report whereby it has been reported that the deceased life assured was suffering from lungs tuberculosis for the last 1½ years before death and she was taken to PGIMS, Rohtak where after treatment for 12-13 days, had died after 07 days at her residence. Ex.R4 is the photo copy of case summary of treatment of the complainant at PGIMS, Rohtak whereby the date of admission has been shown as 25.02.2008 and date of discharge as 03.03.2008. Ex.R4, Ex.R5 and Ex.R6 all are the photo copies and have not been attested by any of the competent person from the relevant institution. The documents Ex.R4, Ex.R5 and Ex.R6 simply bears the name Ishwanti. There is o other identity such as name of the husband, name of father, residence etc. of the patient. Therefore, the documents Ex.R4, Ex.R5 and Ex.R6 which are merely a photo copies and also does not disclose the identity of the patient cannot be relied upon by this Forum for the adjudication of the present case. Even the name of the authority who have issued the said photo copies and the source thereof has also not been brought on record by the respondents. No any cogent evidence in the form of any certificate 177-09 Joginder Vs. LIC of India or affidavit of the treating doctors or any other authorized person has been placed on record by the respondents. Therefore, simple the treatment chart and case history without any particulars of the patient cannot be taken into consideration to give a decision that the life assured was suffering with tuberculosis for the last 2½ years before getting the insurance policy. There is also contradictory stand of the respondents regarding tenure of disease of the complainant. In the written statement, the respondents have pleaded that the life assured was taking treatment for tuberculosis for the last 2½ years before taking the policy, whereas vide claim enquiry report, Ex.R3, it has been mentioned at Column 8 that the life assured was having tuberculosis for lungs for 1½ years before death. Therefore, there is no any cogent and acceptable evidence that the deceased life assured was suffering from tuberculosis at the time of taking the policy. As such, the repudiation of claim by the respondents is not legally justified and is invalid. 5. In view of the aforesaid discussion and findings, it is observed that the respondents shall pay all the benefits to the complainant on account of policy no.175058797 on account of death of life assured Smt. Ishwanti along with interest at the rate of 09% per annum from the date of filing of this complaint i.e. 14.07.2009 till its actual realization. The present complaint stands allowed. File be consigned after due compliance. Announced. 29.04.2010. Member President, DCDRF, Jhajjar. DCDRF, Jhajjar. Each and every page has been signed by me. President, DCDRF, Jhajjar
Before the President, District Consumer Disputes Redressal Forum, Jhajjar. Complaint No.177 of 2009. Date of Instt. 14.07.2009. Date of Decision :-29.04.2010. Joginder Singh son of Jage Ram and husband of late Ishwanti, resident of village Kaloi, tehsil and District Jhajjar. …Complainant. Versus 1.Life Insurance Corporation of India through its Branch Manager LIC of India, Second Floor, Ashok Plaza, Opp. Maiyana Tourist Complex, Rohtak-124001. 2.Branch Manager, LIC, Delhi Rohtak road, Bahadurgarh, District Jhajjar. …Respondents. Complaint under the Consumer Protection Act. _________ Before:- Shri Amar Nath Manocha……………..President. Smt. Krishna Yadav……………………Member. Argued by:- Shri Surender Dhankar , Advocate for the complainant. Shri J.S.Kadian , Advocate for the respondents. ORDER 1. The present complaint has been filed by the complainant with the averments that the wife of the complainant had taken insurance policy from the respondents on 3.10.2007 vide policy no.175058797 for a sum of Rs.50,000/- and the complainant is nominee of the life assured and legally entitled to receive the benefits as such. It is averred that the life assured expired on 5.3.2008 due to natural death. It is also averred that the benefits have not been paid by the respondents despite completion of all the formalities and finally a legal notice dated 12.05.2009 also. It is averred that the life assured was having a good health 177-09 Joginder Vs. LIC of India at the time of filling proposal form and there was no concealment of fact on the part of the life assured regarding her state of health. Accordingly, the complainant has sought a sum of Rs.50,000/- on account of benefits of the policy along with interest, compensation and litigation expenses. 2. On notice, the respondents appeared and filed written statement. It is averred that the life assured has concealed the material facts at the time of purchase of policy and has not disclosed her disease. It is also averred that the deceased life assured was suffering with tuberculosis and has received treatment from PGIMS, Rohtak for the last 2½ years before getting the insurance policy. It is averred that the deceased life assured was not having a good health at the time of taking the insurance policy and the claim has been repudiated on the valid grounds as per the terms and conditions of the policy. Therefore, the dismissal of the present complaint has been sought as there is no deficiency in service on the part of the respondents. 3. We have heard both the learned counsel for the parties and have also gone through the entire relevant material available on record. 4. It is not disputed that the complainant’s wife had got insured with the respondents on 3.10.2007 for a sum of Rs.50,000/- with the respondent company. It is also not disputed that the wife of the complainant Smt. Ishwanti, the life assured had expired on 5.3.2008. As per the ld. Counsel for the complainant, the claim has been wrongly repudiated as the complainant was in a fit state of health at the time of 177-09 Joginder Vs. LIC of India taking policy on 3.10.2007 and there is no concealment of fact on the part of the life assured in any manner. On the other hand, the ld. Counsel for the respondents has submitted that the deceased life assured Smt. Ishwanti had concealed her true state of health at the time of taking the policy and she was suffering with tuberculosis for the last 2½ years and was getting the treatment from PGIMS, Rohtak. In order to prove their case, the respondents have placed on record Ex.R1, affidavit of the Manager, Ex.R2 repudiation letter whereby the claim of the complainant has been repudiated, Ex.R3 claim enquiry report whereby it has been reported that the deceased life assured was suffering from lungs tuberculosis for the last 1½ years before death and she was taken to PGIMS, Rohtak where after treatment for 12-13 days, had died after 07 days at her residence. Ex.R4 is the photo copy of case summary of treatment of the complainant at PGIMS, Rohtak whereby the date of admission has been shown as 25.02.2008 and date of discharge as 03.03.2008. Ex.R4, Ex.R5 and Ex.R6 all are the photo copies and have not been attested by any of the competent person from the relevant institution. The documents Ex.R4, Ex.R5 and Ex.R6 simply bears the name Ishwanti. There is o other identity such as name of the husband, name of father, residence etc. of the patient. Therefore, the documents Ex.R4, Ex.R5 and Ex.R6 which are merely a photo copies and also does not disclose the identity of the patient cannot be relied upon by this Forum for the adjudication of the present case. Even the name of the authority who have issued the said photo copies and the source thereof has also not been brought on record by the respondents. No any cogent evidence in the form of any certificate 177-09 Joginder Vs. LIC of India or affidavit of the treating doctors or any other authorized person has been placed on record by the respondents. Therefore, simple the treatment chart and case history without any particulars of the patient cannot be taken into consideration to give a decision that the life assured was suffering with tuberculosis for the last 2½ years before getting the insurance policy. There is also contradictory stand of the respondents regarding tenure of disease of the complainant. In the written statement, the respondents have pleaded that the life assured was taking treatment for tuberculosis for the last 2½ years before taking the policy, whereas vide claim enquiry report, Ex.R3, it has been mentioned at Column 8 that the life assured was having tuberculosis for lungs for 1½ years before death. Therefore, there is no any cogent and acceptable evidence that the deceased life assured was suffering from tuberculosis at the time of taking the policy. As such, the repudiation of claim by the respondents is not legally justified and is invalid. 5. In view of the aforesaid discussion and findings, it is observed that the respondents shall pay all the benefits to the complainant on account of policy no.175058797 on account of death of life assured Smt. Ishwanti along with interest at the rate of 09% per annum from the date of filing of this complaint i.e. 14.07.2009 till its actual realization. The present complaint stands allowed. File be consigned after due compliance. Announced. 29.04.2010. Member President, DCDRF, Jhajjar. DCDRF, Jhajjar. Each and every page has been signed by me. President, DCDRF, Jhajjar
………………….
Sh. A.N.Manocha
………………….
Smt.Krishna Yadav