LIC of India, Branch Mandi Dabwali, model Town Karnal (Haryana)
This is a discussion on LIC of India, Branch Mandi Dabwali, model Town Karnal (Haryana) within the Judgments forums, part of the General Discussions category; Before the District Consumer Disputes Redressal Forum, Kangra at Dharamshala, District Kangra (HP) Consumer complaint No 336/06 Date of presentation: ...
- 09-02-2009, 10:47 PM #1
LIC of India, Branch Mandi Dabwali, model Town Karnal (Haryana)
Before the District Consumer Disputes Redressal Forum, Kangra at Dharamshala, District Kangra (HP)
Consumer complaint No 336/06
Date of presentation: 18.11.2006
Date of decision: 25.3.2009
Sudesh Kumari wife of late Shri Kashmir Singh resident of village Bhaglar, PO Jaunta Ratial, Tehsil Jawali, District Kangra (HP)
1. Zonal Manager Life Insurance Corporation of India, Cannaught Circus New Delhi
2. LIC of India, Dharamshala through its Branch Manager, Branch Office Dharamshala
3. LIC of India, Branch Mandi Dabwali, model Town Karnal (Haryana) through its Divisional Manager
Complaint under section 12 of the Consumer
Protection Act, 1986
MEMBERS: PABNA SHARMA & PARDEEP DOGRA
For the complainant: Sh. Manish Awasthi, Advocate.
For O.Ps: Sh.Rajeshwar Sapeya, Advocate.
A.S.JASWAL, PRESIDENT (ORAL)
In nut-shell, the case of the complainant is that she is the widow of late Shri Kashmir Singh, who, during his life time, had taken an Endowment Insurance Policy bearing No.173352468 on dated 13.3.2003 from the opposite parties. The date of maturity was 15.3.2019. It is asserted that during the subsistence of the Policy, her husband expired and that she, being his nominee, had filed her claim before the opposite parties, but they repudiated the same in illegal manner and thus committed deficiency in service.
2. The claim of the complainant has been resisted and contested by the opposite parties by taking various preliminary objections, including that the deceased, while filling in the proposal form, had suppressed material facts regarding her health. On merits, it is asserted that the claim of the complainant was duly investigated and that during investigation, it was revealed that the deceased, had died within a period of two years from the date of proposal due to “Esophagus carcinoma’ and thus concealed material facts regarding his pre medical history. It has been denied that the deceased, life assured, had died due to heart attack. Rather he had died due to cancer as is apparent from the leave record maintained by the employer. It is asserted that the life assured had remained on medical leave prior to obtaining the Policy and thus had suppressed material facts regarding his health. Therefore, the opposite parties are not liable to indemnify the complainant.
3. Both the parties adduced evidence by way of affidavits and annexures in support of their contentions. This Forum on 3.3.2008 framed the following points for determination:-
1. Whether O.Ps committed deficiency in service, as alleged? OPC
2. Whether the complaint is not maintainable, as alleged? OPOPs
4. For the reasons to be recorded hereinafter while discussing points for determination, our findings on the aforesaid points are as under:-
Point no.1: Yes
Point no.2: No
Relief: The complaint is partly allowed as per
operative part of the order
REASONS FOR FINDINGS
POINTS No.1 & 2
5. Both these points are inter connected and inter linked, hence are taken up together for determination, in order to avoid repetition in discussion. The learned counsel for the complainant has argued that the action of the opposite parties in not paying the insured amount to the complainant is nothing but deficiency in service.
6. On the other hand, the learned counsel for the opposite parties has argued that the deceased, life assured, had suppressed material facts regarding her ailment prior to obtaining the Policy and the claim of the complainant has been rightly repudiated by the opposite parties and that there is no deficiency in service on their part.
7. To appreciate the arguments of the learned counsel for the parties, the entire record available on the file was gone into in detail. From the record it stands proved that the deceased/life assured had obtained Endowment insurance Policy from the opposite parties and that he had also paid the premium amount to them. There is no dispute regarding these facts. The death of the deceased has also been admitted.
8. The only basis for the rejection of the claim of the complainant is that the deceased, life assured, had suppressed material facts regarding his ailment as he was suffering from “Esophagus carcinoma (Cancer) and had availed medical leave before and after obtaining the insurance Policy. This plea of the opposite parties has no force and is rejected being devoid of any force because the opposite parties have failed to prove that the deceased was suffering from cancer prior to issuance of policy in his favour and that he had died due to the said disease. The complainant has placed on record copy of death certificate of the deceased-life assured and its perusal goes to show that the deceased-life assured had died due to heart attack. No evidence has been produced by the opposite parties, on record, to prove that the deceased/life assured had died due cancer. No doubt, the opposite parties have placed on record, the leave record of the deceased life assured, but the said record, no where speaks that the deceased was suffering from cancer prior to issuance of policy in his favour. Further, the opposite parties have also placed on record, the affidavit of Dr. Parkash Chand Sharma, Registered Medical Practitioner in support of their defence, but the said Doctor in his affidavit, Ex.OPW1, has no where stated the name of disease with which the deceased-life assured was suffering from, prior to obtaining the insurance Policy. Moreover, we would also like to observe that no doubt, policy holder was legally bound to disclose about his illness or ailment at the time of taking of the policy, but, the opposite parties were also equally bound to cross check the information furnished by the insured, whether he was medically fit to be insured by them. It is, thus a gross negligence, on their part, while issuing the Policy of the insured before subjecting him to through medical examination. As such the grounds taken by OPs-LIC to repudiate the insurance claim of the complainant do not appear to be legally tenable. Definitely, it amounts to deficiency in service.
09. In view of the discussion made hereinabove, we hold that the opposite parties have not applied their mind to the facts of the present case, and illegally and arbitrarily repudiated the genuine claim of the complainant.
10. Now, how this deficiency can be cured. We are of the view that the ends of justice will be met in case the opposite parties are directed to pay the insured amount alongwith all accrued policy benefits to the complainant. Due to deficiency in service, the complainant has suffered mental pain, agony and inconvenience and the ends of justice will be met in case the opposite parties are directed to pay compensation, which is quantified at Rs.5000/-. Hence, point No.1 is answered in affirmative and point no.2 in negative.
11. No other point argued or urge before us.
12. In view of our findings on points No.1 and 2 above, the complaint is partly allowed and we order the opposite parties jointly and severalty to pay the insured amount alongwith all accrued policy benefits to the complainant within 30 days after the receipt of copy of this order, failing which it will carry interest @ 9% per annum from the date of complaint, till its realization. The opposite parties are also directed to pay compensation to the complainants to the tune of Rs.5000/-. The complaint is allowed alongwith litigation costs of Rs.2000/-. The copy of this order be sent to the parties, free of costs and the file after due completion be consigned to the record-room.
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