Haryana

StateCommission

A/579/2019

LIC OF INDIA - Complainant(s)

Versus

USHA RANI - Opp.Party(s)

PIYUSH SHARMA

06 Jul 2022

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

 

                                                      First Appeal No.579 of 2019

                                                 Date of Institution: 19.06.2019

                                                               Date of Decision: 06.07.2022

 

1.      Divisional Manager, Life Insurance Corporation of India, Divisional Manager, P.O. Box No. 106, Jeevvan Prakash, 489, Model Town, Karnal.

2.      Branch Manager, Life Insurance Corporation of India, Branch Office, Jeevan Sewa PB No. 6, New Municipal Shopping Complex Ambala City.

…..Appellants/Opposite Party

Versus

Usha Rani w/o Late Sh. Ashwani Kumar, R/o 31C, B-Block, Dayal Bagh Chowk, P.O. Babyal, Ambala Cantt.

 

…..Respondent/Complainant

CORAM:    S.P.Sood, Judicial  Member

                    Suresh Chander Kaushik, Member

                   

Present:-    Mr. Piyush Sharma, Advocate for the appellants.

                   Ms. Sapna Khurana Narang, Advocate for respondent.

 

                                                 ORDER

S P SOOD, JUDICIAL MEMBER:

          The present appeal No.579 of 2019 has been filed against the order dated 23.04.2019 of the District Consumer Disputes Redressal Forum, Ambala (In short Now “District Commission”) in complaint case No.139 of 2018, which was allowed.

2.       The brief facts of the case are that on 01.06.2011 complainant’s husband-Late Sh. Ashwani Kumar (deceased) purchased health insurance policy from the opposite parties (OPs) providing fixed benefits for hospitalization and almost all types of surgical procedures irrespective of actual cost incurred and the benefit was in addition to any other health insurance cover. The complainant’s husband had chosen initial daily cash benefit of Rs.1,000/-, Term Insurance Rider worth Rs.1,00,000/- and Accident Benefit Rider worth Rs.1,00,000/-. The complainant paid subscription amount of Rs.3,077/- from June, 2011 onwards regularly. However as the ill luck would have it her husband expired on 15.05.2015 and after his death complainant visited office of OP No. 2 for release of Rs.1,00,000/-. She even wrote a letter dated 06.05.2016 to OP No. 2 and thereafter letter dated 01.08.2016 to OP No. 1 for release of the claim amount. She filed RTI application dated 02.09.2016 seeking information regarding not release of claim amount from OP No. 1. In response of which, OP No. 1 informed that under Policy No. 177557511 the proposer at the time of proposal demanded for term rider and accidental benefit rider as per proposal form, but, while underwriting the proposal both the riders were not given and also premium for the riders were not charged. She filed an appeal to Chief Public Information Officer, New Delhi against the order of First Appeal and Chief Public Information Officer vide order dated 18.09.2017 directed OP No. 1 to provide complete self contained response to the complainant within the period of 15 days from the date of receipt of order. Complainant received letter dated 21.09.2017 from OP No. 1 wherein it was stated that the life assured was not hospitalized and no surgery was performed where any benefit could become payable. It was further submitted that the policy did not cover life risk, hence no amount was payable. Thus there was gross deficiency in service on the part of the O.Ps.

3.      In its written version, OPs submitted that premium of Rs.3,077/- was charged only for HCB/MSB cover under the plan No.903 and no premium for term rider as well as accident rider was charged. The claim was settled in terms and conditions of the policy. Since term assurance was not given by LIC, so the claim was not paid by the branch rightly and requested to dismiss the complaint.

4.      After hearing both the parties, the learned District Commission, Ambala has allowed the complaint vide order dated 23.04.2019, which is as under:-

“In view of the aforesaid discussion we hereby allow the present complaint and direct the Ops in following manner:-

1. To pay Rs.1,00,000/- (Rupees One Lakh only) to the complainant after deducting the premium amount for the Term Assurance Rider, alongwith interest @7% per annum w.e.f. 07.11.2016 i.e. the date of repudiation of the claim till its realization.
2. To pay Rs. 5,000/- (Rupees Five thousand) as compensation.
3.  To pay Rs.3,000/- (Rupees Three thousand) litigation  expenses.”

5.      Feeling aggrieved therefrom, O.Ps-appellants has preferred this appeal.

6.      This arguments have been advanced by Sh. Piyush Sharma, learned counsel for the appellants and Ms. Sapna Khurana Narang, learned counsel for the respondent. With their kind assistance the entire record of appeal as well as the original record of the District Commission including whatever the evidence has been led on behalf of  both the parties had also been properly perused and examined.

7.      Learned counsel for the appellants argued that complainant’s husband applied for Term Rider & Accident Benefit Rider, but, while underwriting the proposal, these riders were not given and premium of Rs.3,077/- was charged only for HCB/MSB cover under the Plan No. 903. Since the deceased was not hospitalized, so as per terms and conditions of the policy, Hospital Cash Benefit & Major Surgical Benefit was not payable. Thus, the complainant was not entitled for the claim amount as prayed for. So the impugned order cannot sustain and deserves to be set aside.

8.       Learned counsel for the respondent argued that complainant’s had taken Term Rider & Accident Benefit Rider and also paid premium of Rs.3,077/- to LIC.  The appellant has wrongly repudiated the claim.  Learned District Commission has very rightly allowed the complaint of the complainant Therefore, present appeal being devoid of any merit deserves to be dismissed.

9.      It is admitted fact that during the subsistence of the insurance policy, complainant’s husband had expired. Proposal Form (Annexure R-1) clearly shows that complainant’s husband at the time of purchasing the policy opted for Term Assurance Rider of Rs.1,00,000/- & Accident Benefit  Rider of Rs.1,00,000/-. Why the appellant has accepted the proposal form from him if both of the said desired options could not be permitted to him. The appellant company should have informed the complainant’s husband with regard to the error in the proposal form. The appellant company should have checked all the documents before issuing the health insurance policy.  The Hon’ble Supreme Court in such cases hs held that the technicalities cannot be allowed to stand in the way of natural justice. The learned District Commission rightly allowed the complaint.  The learned District forum rightly allowed the claim of the complainant. The learned District Forum had committed no illegality while passing the order dated 23.04.2019.  The appeal is also devoid of merits and stands dismissed.

10.    The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant-respondent No.1 against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

06th  July, 2022       Suresh Chander Kaushik                        S. P. Sood                                                    Member                                                         Judicial Member    

S.K

(Pvt. Secy.)