Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. : 05.
Instituted on : 02.01.2018.
Decided on : 18.11.2020.
Shiva Devi, Age 55 years wd/o Late Sh. Bhakti Ram R/o H.No.1571, Sugar Mill Colony, Rohtak.
………..Complainant.
Vs.
- P.N.B. Metlife India Insurance Company Limited, Sonepat Road, Rohtak through its Branch Manager.
- P.N.B Metlife India Insurance Company Limited, SCO 223, Second floor, Sector-12, Karnal through its Manager.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.NAGENDER SINGH KADIAN, PRESIDENT.
DR. RENU CHAUDHARY, MEMBER.
MS.TRIPTI PANNU, MEMBER.
Present: Sh.Naresh Kumar, Advocate for complainant.
Sh. O.P.Mittal, Advocate for opposite parties.
ORDER
NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the case are that husband of the complainant late Sh. Bhakti Ram had got his life insured with the respondent/opposite parties by taking a policy from the respondents. During the currency of Insurance policy, the husband of the complainant has expired. As such complainant being the nominee in the policy has filed the present complaint. At the time of death of the husband of complainant, the policy was active and had not lapsed. The husband of the complainant had expired on 10.01.2017 and the complainant had duly informed the respondent and lodged a claim with the respondents to pay her the assured amount to the tune of Rs.6 lakhs. Complainant received a letter dated 14.03.2017 for producing some documents, which were submitted by the complainant. Thereafter the complainant approached the office of opposite party so many times and requested them to pay the assured amount but any heed was not paid to her requests. Hence this complaint and it is prayed that opposite parties may kindly be directed to pay the sum assured on the policy/amount of coverage of Rs.600000/- alongwith interest, compensation and litigation expenses as explained in relief clause.
2. After registration of complaint, notice was issued to the opposite parties. Opposite parties in their reply has submitted that in the present case, the deceased Life Assured(DLA) suppressed material fact that he was suffering from Hypertension for 2 years, Diabetes Mellitus Type 2 for 20-25 years, Chronic Kidney disease with Maintenance Hemodialysis from 1.5 years, which is prior to issuance of subject policy and was under treatment for the same making it evident that he was well aware of the said fact, which amounts to material suppression of fact. However, it is submitted that respondents have not done any deficiency in service. The non-payment of claim amount under subject policy is only due to malafide act of deceased life assured in suppression of material medical history of his chronic ailments which were found during claim investigation. It is submitted that there is no deficiency in service on the part of opposite parties and as such, dismissal of complaint has been sought.
3. Ld. counsel for the complainant in his evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C4 and has closed his evidence on dated 21.01.2019. On the other hand, Ld. counsel for the opposite parties has tendered affidavit Ex.RW1/A and documents Ex.R1 to Ex.R7 and closed his evidence on dated 01.07.2019.
4. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
5. In the present case, the claim of the complainant has been repudiated by the opposite parties vide letter Ex.R7 on the ground that as per the claim records it indicate that Late Mr. Bhakti Ram was suffering from Diabetes Mellitus type-2 and chronic Kidney Disease prior to policy issuance. However the concerned question in the application form dated 9.01.2015 seeking insurance cover under this policy was answered as “No” by Late Mr. Bhakti Ram. To prove this fact, opposite party has placed on record copy of investigation report Ex.R4 as per which, in the column of facts & finding, it is submitted that: “Insured was suffering from kidney problem and was also suffering from diabetes problem past many years for which he was taking treatment from PGI, Rohtak. Investigator has obtained medical file of Oxygen Hospital Rothak of 06.01.2014(which is prior to the issuance of policy) in which diagnosis mentioned is ECHO, Investigator has obtained discharge summary of Pt. BDS PGIMS, Rohtak in which it is mentioned that insured got admitted in the hospital on 17.04.2015 & 19.06.2015 with the diagnosis of T2DM with AKI with CKD with ESRD with Hypoglycemia, Maintenance Hemodialysis and the past history mention is KCO T2DM on irregular Rx and was discharged from the hospital on 01.05.2015 & 05.07.2015. Insured again got admitted in the hospital on 30.08.2016 with the diagnosis of T2DM with HTN with CKD and got discharged on 21.09.2016 and in the medical document history mentioned is that he was suffering from DM past 30 years, HTM past 10 years and CKD past around 1.5 years. Opposite party has also placed on record copy of medical record of insured of PGIMS, Rohtak Ex.R5(pg. 1 to pg.25), Ex.R6 of Oxygen Hospital, Rohtak. Opposite party has placed reliance upon the order dated 12.05.2016 of Hon’ble National Consumer Disputes Redressal Commission, New Delhi in Revision Petition titled as Subinoy Majumdar Vs. Life Insurance Corporation of India.
6. In view of the aforesaid law which is fully applicable on the facts and circumstances of the case and after going through the documents, it is observed that from the medical record of the insured Bhakti Ram as well as investigation report placed on file by the opposite parties, it is proved that the insured has suppressed the material fact regarding his illness in the proposal form. As such the opposite parties have rightly repudiated the claim of the complainant. Hence the present complaint stands dismissed with no order as to costs.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
18.11.2020.
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Nagender Singh Kadian, President
………………………………..
Renu Chaudhary, Member.
…………………………………..
Tripti Pannu, Member.
