Chandigarh

StateCommission

A/257/2019

Aarti - Complainant(s)

Versus

AGM LIC of India - Opp.Party(s)

Sajjal Sharma Adv.

23 Feb 2022

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

UNION TERRITORY, CHANDIGARH

 

Appeal No.	257 of 2019
Date of Institution	25.10.2019
Date of Decision	23.02.2022

 

 

Aarti aged 36 years wife of Late Sh. Chanchal Kumar R/o House No.1127, Phase 10, Mohali.

     …..Appellant/Complainant

 

Versus

1. Assistant General Manager, life Insurance Corporation, Jeevan Paraksh Building, Sector 17-B, Chandigarh.

 

2. General Manager LIC of India, Zonal Office “Jeevan Bharti” Connaught Circus, New Delhi-110001

                             …..Respondents/Opposite Parties

BEFORE:   MRS. PADMA PANDEY, PRESIDING MEMBER

                 MR. RAJESH K. ARYA, MEMBER

 

Argued by:  Sh. D.S. Soundh, Advocate proxy for Sh. Sajjal Sharma, Advocate for the appellant.

                   Sh. Rajneesh Malhotra, Advocate for the respondents.

                           

PER PADMA PANDEY, PRESIDING MEMBER

              This appeal is directed against an order dated 28.08.2019, rendered by District Consumer Disputes Redressal Forum-II, UT, Chandigarh, now District Consumer Disputes Redressal Commission-II (hereinafter to be called as the District Commission only), vide which, it partly allowed the complaint, filed by the complainant (now appellant) and directed the Opposite Parties (now respondent) as under:-

“In view of the above position, the complainant is held entitled for refund of premiums amount paid against the policy No.165523582 (Ann.R-2).  Therefore, the present complaint is partly allowed with direction to the Opposite Parties to refund the total premium paid amount of Rs.20,718/- (6906X3) to the complainant, within a period of 30 days from the date of receipt of copy of this order.”  

  

2. In brief, the facts of the case are that Late
   Sh. Chanchal Kumar, deceased husband of complainant Aarti, had availed Policy No.165523582 from Opposite Parties on 09.05.2013 for sum assured of Rs.5.00 lacs and complainant was nominee in the said policy (Annexure C-2 colly.). It was stated that the policyholder Chanchal Kumar died on 29.12.2013 due to heart-attack at PGI, Chandigarh, during currency of the policy period (Annexure C-1). It was further stated that the complainant, being nominee under said policy, filed claim with Opposite Parties, but the same was rejected vide letter dated 20.06.2015 (Annexure C-3) on the ground of concealment of material information about health by the policyholder at the time of availing policy. The complainant again represented the Opposite Parties, but to no avail.  It was further stated that the aforesaid act of the Opposite Parties, amounted to deficiency in service and unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint was filed.
3. The Opposite Parties filed their reply and admitted the factual matrix of the case. It was stated that the Chanchal Kumar (deceased Life Assured) was admitted on 08.05.2012 under CR No.201214159 in Govt. Medical College & Hospital, Sector 32, Chandigarh as c/o pain abdomen since 20.04.2012 and was diagnosed to be suffering from GSD and Choledocholithiasis, ERCP was done, stone was removed, managed and was discharged on 17.05.2012.  It was further stated that the OPD Card of PGI, Chandigarh dated 06.04.2013 – CR No.201302031153 also mentioned that Chanchal Kumar was diagnosed to be suffering from Chronic Liver Disease (CLD) with stones in bile duct, obstructive jaundice and Ascites since January, 2013.  It was further stated that Chanchal Kumar remained under treatment in PGI Chandigarh even in the month of April, 2013 i.e. just one month prior to the date of submitting proposal for insurance.  It was further stated that the material fact regarding his adverse health which was known to the insured has been intentionally concealed while taking policy in question, so the claim was righty repudiated as per terms & conditions of the policy on the basis of deliberate concealment of material information by Chanchal Kumar regarding his health (Annexure R-9). It was further stated that there is no deficiency in service on their part, and the Opposite Parties had prayed for dismissal of the complaint.
4. In the rejoinder, filed by the complainant, she reiterated all the averments, contained in the complaint.
5. The Parties led evidence, in support of their case.
6. After hearing the Counsel for the Parties, and, on going through the evidence, and record of the case, the District Commission, partly allowed the complaint, as stated above. 
7. Feeling aggrieved, the instant appeal, has been filed by the appellant/complainant, against the order dated 28.08.2019.
8. We have heard the Counsel for the Parties, and have gone through the evidence, and record of the case, carefully.
9. After giving our thoughtful consideration and the evidence, on record, we are of the considered opinion, that the appeal is liable to be dismissed for the reasons to be recorded hereinafter.
10. We observe from the record that Late
    Sh. Chanchal Kumar, deceased husband of appellant, took Insurance Policy No.165523582 from Life Insurance Corporation of India i.e. respondents on 09.05.2013 by filling up the proposal form. Clause 11 of the form clearly showed that he denied that any ailment, hospitalisation or presence of any serious disease which is a major concealment of the fact for obtaining the required insurance policy. The respondents on investigation came to know that the deceased (Late Sh. Chanchal Kumar) was admitted in Government Medical College and Hospital, Sector-32, Chandigarh on 08.05.2012 with the following physical ailment:-

“Patient presented c Pain Abdomen in Rt. hypochondrium since 20.4.2012. Yellowish discoloration of body X 7 days along with vomiting X Pain Abdomen. ERCP was done – Stone was removed. Managed constantly and was discharged.”

Therefore, Chanchal Kumar was later on discharged after treatment on 17.05.2012.

11. Further to this, Late Sh. Chanchal Kumar (deceased) was diagnosed to be suffering from Chronic Liver Disease (CLD) with stones in bile duct, obstructive Jaundice and Ascites since January, 2013. This shows that the deceased was under continuous treatment earlier with Government Medical College and Hospital, Sector-32, Chandigarh and later in PGI, Chandigarh where he expired on 29.12.2013. The deceased had taken the Insurance Policy on 09.05.2013, exactly after one month of diagnosis of Chronic Liver Disease (CLD) by PGI, Chandigarh (diagnosed on 06.04.2013) by concealing the said fact in proposal form.
12. The Insurance Company had relied upon Section 45 of the Insurance Act, 1938, which read as under:-

“In case the premium shall not be duly paid or in case any conditions herein contained or endorsed hereon shall be contravened or in case it is found that any untrue or incorrect statement is contained in the proposal, personal statement, declaration and connected documents or any material information is withheld, then and in every such case but subject to the provisions of Section 45 of the Insurance Act,1938, as amended upto date, wherever applicable, this policy shall be void and all claims to any benefit in virtue hereof shall cease and determine and all moneys that have been paid in consequence hereof shall belong to the corporation excepting always in so far as relief is provided in terms of the Privilege herein contained may be lawfully granted by the Corporation.”

13. The learned District Commission has relied upon various judgments of National Consumer Disputes Redressal Commission and the Hon’ble Supreme Court of India on the subject, which speaks about repudiation of contract of insurance on the ground of non-disclosure of misstatement in the proposal form and accordingly, the learned District Commission partly allowed the complaint with the direction to the Opposite Parties/Respondents to refund the total premium paid amount of Rs.20,718/-. Therefore, this Commission is inclined to fall in line with the decision of the District Commission and hence, the appeal is dismissed.
14. For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, with no order as to costs. The order of the District Commission is upheld.
15. Certified copies of this order, be sent to the parties, free of charge.
16. The file be consigned to Record Room, after completion.

 

Pronounced.

23.02.2022

                    

                                                                            Sd/-

[PADMA PANDEY]

PRESIDING MEMBER

 

                                                                             Sd/-

                                                                     [RAJESH K. ARYA]

 MEMBER

Gp