STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
UNION TERRITORY, CHANDIGARH.


Appeal case No.335/2009

Date of institution:11.6.2009

Date of decision :2.7.2009

M/s Aviva Life Insurance Company India Ltd., Aviva Tower, Sector Road, Opp. Golf Course, DLF Phase V, Sector-43, Gurgaon-122003. …Appellant
Versus
Mrs. Sween Goyal wife of late Sh.Arun Kumar Goyal, resident of House NO.57, Sector-7, Panchkula.
...Respondent



Appeal U/s 15 of Consumer Protection Act,1986 against

order dated 6.5.2009 passed by Consumer Disputes

Redressal Forum-I, U.T.Chandigarh.



Argued by: Sh.Arun Dogra,,advocate for appellant.





BEFORE : Hon’ble Mr.Justice Pritam Pal, President

Maj.Gen.S.P.Kapoor (Retd.),Member





JUDGMENT

2.7.2009



Justice Pritam Pal, President





1. This appeal by one of the opposite parties namely M/s Aviva Life Insurance Company India Ltd., Aviva Tower Sector Road, opp. Golf Course, Sector-43 Gurgaon (hereinafter to be referred as LIC) is directed against order dated 6.5.2009 passed by Consumer Disputes Redressal Forum-I, U.T.Chandigarh (hereinafter to be referred as District Consumer Forum) whereby complaint No.1212 of 2008 filed by complainant (respondent) namely Mrs.Sween Goyal was allowed with costs of Rs.10,000/- and opposite parties were directed to pay to the complainant the sum assured of Rs.4,95,000/- plus Rs.2,85,000/- as the expenses incurred on the treatment of the life assured in Silver Oaks Hospital and Rs.2,31,364/- as the expenses incurred on the medicines purchased within the said hospital, as per the receipts Annexure C-8/1 to C-8/11 and Annexure C-9/1 to C-9/28. The aforesaid entire amount was directed to be paid to the complainant within thirty days from the date of receipt of copy of the order, failing which Ops were held liable to pay the same alongwith interest at the rate of 9% per annum since 2.3.2008(one month after the submission of death claim) till payment.

2.. In nutshell the facts culminating to the commencement of this appeal may be recapitulated thus ;

Sh.Arun Goyal, husband of the complainant was insured by LIC vide insurance policy bearing No.LPG1461754 effective from 26.2.2007 having date of maturity as 26.2.2012 and the sum insured was Rs.4,95,000/- for which a single one time premium of Rs.99,000/- was received by the LIC in lump sum. It was on 8.11.2007 the husband of complainant suffered pain in abdomen, vomiting etc. whereupon he was immediately shifted to Silver Oaks Hospital, Mohali where he went in coma and inspite of best treatment given to him he expired on 30.11.2007. This untimely death of the husband of complainant caused shock and trauma as the deceased had left behind three marriageable daughters whose education had to be cut short. Complainant lodged her claim after completing all the formalities with the LIC but the same was rejected on 9.4.2008.

3. On the other hand, case of LIC before the District Forum was that deceased husband of the complainant was infact suffering from diabetes and he was also an alcoholic and all these material facts were concealed at the time of taking the insurance policy, so, complainant was not entitled to claim any benefit from it. It had also been averred in the reply that there was a direct relation between the diabetes/chronic alcoholism and cardiac arrest. Ultimately LIC in its reply also submitted that there was no deficiency in service or unfair trade practice on its part.

4. The District Forum after obtaining the evidence and hearing the parties allowed the complaint and granted relief as indicated in the earlier part of the judgment.

5. This is how feeling aggrieved, OP NO.2 has come up in this appeal. The only noticeable point of argument raised on behalf of LIC is that since deceased husband of the complainant had concealed the factum of disease at the time of taking policy from LIC, therefore, no relief could have been granted by the District Forum. At the same time it was also argued that from the papers placed on file nexus between diabetes and cardiac arrest/heart attack due to which the insured had died was also established. To our mind, the only point at this stage is to be seen as to whether there was any cogent and convincing evidence led by LIC which could show that there was a direct relation/nexus between diabetes/alcoholism and cardiac arrest/heart attack. Admittedly there is neither any affidavit nor any certificate of any competent doctor which could prove the aforesaid assertion raised on behalf of LIC, rather in the questionnaire submitted by LIC it itself says “that the death may not be due to alcoholism per se”. In the case in hand the life assured had died due to heart attack and no material worth the name had been made available to point out that the heart attack was having any sort of link with the consumption of alcoholic beverages. In this view of the matter, we are of the considered opinion that the claim of the complainant could not be repudiated on the ground that the insured had concealed the factum of his disease or consuming liquor.

6. Thus, apparently no case is made out for admitting the appeal, hence, same is dismissed in limine.

7. Copies of this order be communicated to the parties, free of charge.





Announced ( Justice Pritam Pal)(Retd.)

2nd July.,2009 President



(Maj.Gen.S.P.Kapoor )(Retd.)

Member