Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 348.
Instituted on : 29.06.2007.
Decided on : 31.12.2009.
Smt. Harmeet Kaur wife of Late Sh. Manohar Singh resident of House no.911/18 Mohalla Ghani Pura Rohtak.
………..Complainant.
Vs.
1. LIC of India Subhash Road Rohtak through its Branch Manager.
2. Divisional Manager LIC of India Divisional Office, Jivan Prakash 489 Model Town, Karnal.
……….Opposite parties.
COMPLAITN U/S 12 OF CONCUMER PROTECTION ACT,1986.
BEFORE: SH. JOGINDER SINGH JAKHAR, PRESIDENT.
SMT. MEENA KUMARI, MEMBER.
SH. VIRENDRA KUMAR JAIN, MEMBER.
Present: Sh.Ajay Dua, Advocate for the complainant.
Sh.Vijay Groha Advocate for the opposite parties.
ORDER
JOGINDER SINGH JAKHAR, PRESIDENT:
According to the complainant her husband had obtained a policy bearing no.173709513 for a sum of Rs.2 lacs and P & T was 90-15, dated 28.12.2003 and the premium was payable yearly. The husband of the complainant had paid the premium well within time and regularly. The husband o complainant expired on 2.8.05 and as such the complainant had lodged the death claim before the opposite party and completed all the required formalities. But the opposite party had repudiated the claim of the complainant on the ground that the husband of complainant had given wrong answers to the questions given in proposal form. The husband of complainant was medically examined by the doctor of opposite parties and was found fit. Moreover, the husband of complainant had died a natural death and not due to suffering from any alleged ailment. Complainant requested the opposite parties many times to pay the claim amount but to no effect. Hence this complaint with prayer to direct the opposite parties to pay the claim amounting to Rs.2 lacs, bonus and other benefits alongwith interest @ 18% p.a. from the date of death of husband of complainant till payment to complainant and also to pay another amount of Rs.20000/- on account of unnecessary harassment and litigation expenses to the complainant.
After notice opposite parties appeared and filed its written reply submitting therein that it is not disputed that the life assured had taken the policy for sum assured of 2 lacs with T.T. 90-15 whereunder, the claim, if payable would have been paid at the time of maturity only. Since the claim under the policy stands repudiated, nothing is payable not now neither at maturity. It is further submitted that the deceased L.A. died on 2.8.05 as he was suffering from pleural effusion(Tubercular) with UTI & remained admitted in the hospital from 25.3.03 to 19.4.03 and also availed leaves on medical ground on different dates prior to the date of proposal. These facts were not disclosed by him, rather he gave false answers. It is very much clear from F.No.3816 received from Railway Central Hospital, New Delhi that the deceased L.A. suffered from various ailments and he died due to diseases. It is not a natural death. There is no deficiency on the part of answering opposite party. It is also came to the notice of opposite parties that deceased L.A. had undergone operation in July/August 2004 there exist ample evidence to prove that deceased L.A. suffered from various ailments prior to proposing for insurance. All the other contents of the complaint were stated to be wrong and denied. Opposite parties prayed for dismissal of the complaint with costs.
Both the parties led evidence in support of their case.
Ld. Counsel for the complainant in his evidence tendered affidavit Ex.P1, documents Ex.P2 to Ex.P8 and closed his evidence.
Ld. Counsel for the opposite party in his evidence tendered affidavit Ex.R1, documents Ex.R2 to Ex.R8 and closed his evidence.
We have heard learned counsel for the parties and have gone through the evidence and other material aspect of the case very carefully.
After going through the file and hearing the parties we have observed that in the present complaint insurance and death of the life assured is not disputed. After the death of life assured, complainant filed the claim with the opposite parties but the same was repudiated by the opposite parties on the ground that the life assured was suffering from various diseases prior to making proposal for the policy and he had concealed these facts from the opposite party. To prove the fact, opposite party has placed on file Claim Enquiry Report Ex.R3, Certificate of Hospital Treatment Ex.R4 & Leave record Ex.R5. As per claim Enquiry report Ex.R3, the cause of death is Heart Attack and he was suffering from Liver problem and was operated for liver in Railway Hospital in July August 2004.
After going through the file and hearing the parties we are of the considered view that the allegation of the opposite party is that the life assured was suffering from pleural effusion(Tubercular) with UTI & remained admitted in the hospital from 25.3.03 to 19.4.03 and he was suffering from various ailments and had died due to diseases but no record of alleged disease has been placed on file and the cause of death in the present case is heart attack. Secondly the life assured had taken the policy in the year 2003 and as per claim enquiry report Ex.R3, he was operated for liver in July/August 2004 i.e. after making proposal for the policy. Moreover, the treatment record is not supported by any affidavit of doctor. In this regard as per the authority reported I(2009) CPJ 402 titled LIC Vs. Kastura Ram, Hon’ble Rajasthan State Commission, Jaipur has held that: “Suppression of material facts-Claim repudiated-Contention, deceased suffering from cancer, took medical treatment, not disclosed at the time of taking of policy-Contention not acceptable- Health declaration made in 2000-Deceased admitted in hospital first time in 2002-Cancer diagnosed after expiry of two years, from the date of policy-Deceased aware of cancer at the time of taking of policy not proved-Deceased died after two years of policy-Heavy burden lies on insurer to prove fraudulent concealment of material facts-Repudiation of claim unjustified”, IV(2007) CPJ 319 titled LIC of India Vs. Darshna Devi, Hon’ble U.T. Commission, Chandigarh has held that: “No nexus between cause of death and diabetes-Insured suffering from diabetes/hypertension prior to having of policy, intentionally/fraudulently suppressed it, not proved-Repudiation of claim unjustified-Insurance Company liable under policy”, as per II(2008) CPJ 300(NC) titled Life Insurance Corporation, of India Vs. Chandra Kanta Lohande(Smt.), Hon’ble National Commission has held that: “Life insurance- Suppression of pre-existing disease-Claim repudiated-Contention, assured chronic patient of ‘Dyspepsia’, under regular treatment as outpatient, not disclosed-Contention not acceptable-Dyspepsia not disease in itself- In today’s world, people face problems like acidity, indigestion, back pain, headache-Symptoms may occur time-to-time with different levels of intensity-They cannot enumerated in proposal form-Repudiation unjust, improper- Insurer liable to pay sum assured with interest”, as per II(2007)CPJ 242 (NC) titled LIC of India Vs. Patel Ganesh bhai Ramji bhai , Hon’ble National Commission has held that “Suppression of material fact that life assured suffering from pre-existing disease TB prior to taking policy-Complaint-Compensation awarded with 12% interest-Hence appeal-Life assured medically examined before issuance of policy-Presence of TB not found at that point of time-No suppression of material fact as alleged-Claim wrongly repudiated-Order of State Commission upheld-Cost awarded” and as per 2007(3)CLT 535 titled LIC Vs . Sajida Begum, Hon’ble National Commission has held that: “No affidavit of the doctor and no other evidence produced by petitioner in order to reaffirm the contention-Rightly held to be unreliable evidence”.
Keeping in view the above referred case laws, which are applicable on the facts and circumstances of the case, we have come to the conclusion that complaint is tenable. Accordingly we hereby allow the complaint with direction to the opposite parties to pay the insured amount of Rs.200000/-(Rupees two lacs only) with all benefits alongwith interest @ 9% p.a. from the date of filing the present complaint till its realization and Rs.2500/-(Rupees two thousand five hundred only) as litigation expenses to the complainant maximum within one month from the date of decision failing which the amount of award shall carry interest @ 12% p.a. from dated 31.01.2010 onwards till its realization to the complainant.
Copy of this order be supplied to both the parties free of costs.
File be consigned to the record room.
Announced in open court:
31.12.2009.
………………………….
Joginder Singh Jakhar, President.
…………………………
Meena Kumari, Member.
…………………………
Virendra Kumar Jain, Member.
vs