Delhi

StateCommission

FA/12/1083

LIC OF INDIA - Complainant(s)

Versus

MADHU - Opp.Party(s)

23 Aug 2017

ORDER

IN THE STATE COMMISSION: DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

                                                             Date of Decision: 23.08.2017

First Appeal No. 1083/2012

(Arising out of the order dated 26.10.2012 passed in Complaint Case No. 113/2010 by the District Consumer Disputes Redressal Forum VI, ‘M’ Block Vikas Bhawan I P Estate New Delhi-110001)

In the matter of:

Life Insurance Incorporation of India

Through

Senior Branch Manager

LIC of India

Unit 311, Rajender Place

DDA Shopping Complex

New Delhi-110008

 

Senior Divisional Manager

LIC of India, Delhi Division I

25, K G Marg New Delhi-110001               .........Appellant

 

Versus

 

Smt. Madhu

W/o Sh. Mukesh Kumar

R/o F-201/3 Mehrauli

New Delhi-110030                                  ..........Respondent

                                                                  

CORAM

N P KAUSHIK                         -                  Member (Judicial)

 

1.         Whether reporters of local newspaper be allowed to see the judgment?                   Yes

2.         To be referred to the reporter or not?                                                                  Yes

 

PRESENT:        Sh. Arun Aggarwal, Counsel for the Appellant.

                   None for Respondent

 

N P KAUSHIK – MEMBER (JUDICIAL)

 

JUDGEMENT

1.         Present appeal is directed against the orders dated 26.10.2012 passed by the District Forum VI Vikas Bhawan New Delhi. Vide impugned orders, the Ld. District Forum allowed the complaint and directed the appellant herein to pay to the respondent/complainant, an amount of Rs. 1 lakh each of the two policies purchased by the husband of the complainant (since deceased). Compensation to the tune of Rs. 50,000/- was also awarded.
2.         Admitted facts of the case are that the deceased Sh. Mukesh Kumar was holding two insurance policies bearing nos. 111917371 dated 24.05.2004 and 331037423 dated 01.07.2006. These policies had the assurance of Rs. 1,00,000/- each. Deceased Mukesh Kumar was admitted to Batra Hospital on 02.01.2007. He died on 03.01.2007. During the treatment, he was declared a case of brain hemorrhage.  Prior to this the deceased was hospitalized for headache followed by unconsciousness in Batra Hospital itself for 2-3 days. At that time, he was diagnosed as a case of hypertension. Claim is filed by the complainant who happens to be the wife of the deceased. Claim was repudiated by the appellant on the grounds that the deceased had disease at the time of taking the policy. Appellant has taken a plea to the effect that the material fact was concealed.
3.         Ld. District Forum observed that the appellant without any valid evidence or reasoning repudiated the claim.
4.         I have heard at length the arguments addressed by the counsel for the appellant, Sh. Arun Aggarwal Advocate. The respondent stands already proceeded against ex-parte.
5.         Ld. Counsel for the Appellant has argued that the policy bearing No. 111917371 had lapsed on 15.05.2006 whereas the deceased died on 03.01.2007.
6.         Perusal of the letter of repudiation shows that the repudiation of the claim was not done on these grounds. The plea hence now is not available to the appellant. Now coming to the policy No. 331037423, the plea raised by the appellant is that the deceased had a preexisting disease. The appellant has relied upon the discharge summary of the deceased pertaining to his earlier hospitalization for hypertension. He was discharged on 15.05.2006. The Apex Court and the Hon’ble National Commission in a catena of authorities have held that hypertension or diabetic mellitus are not the disease but only lifestyle problems. A similar view was taken by this Commission in the case of Life Insurance Corporation v. Sudha Jain, II (2007) CPJ 453. Clearly repudiation of the claim on these grounds was illegal and unjustified. Appeal is, therefore, dismissed for these reasons.
7.         Copy of the orders be made available to the parties free of costs as per rules and thereafter the file be consigned to Records.

 

 

(N P KAUSHIK)
MEMBER (JUDICIAL)