State Consumer Disputes Redressal Commission
L.I.C. vs Smt. Sampati Devi on 28 August, 2009
vihy la[;k% 644@98 jktLFkku jkT; miHkksDrk fookn izfrrks"k vk;ksx]jktLFkku] t;iqj vihy la[;k%1950@2006 ofj"B e.My izcU/kd] Hkkjrh; thou chek fuxe] e.My dk;kZy;] vyoj xsV] vtesj tfj;s izcU/kd ¼fof/k ,oa vkokl½] thou izdk'k Hkokuh flag jksM] t;iqjA vihykaV&foi{kh cuke Jherh lEifRr nsoh iRuh Lo- Vsukey] tkfr&jsxj] fuoklh&gkml uEcj 227@19] lsUVLVhQu Ldwy ds ikl] jktkjsMh] enuxat] fd'kux<A jsLiksMsaV&ifjokfn;k fnukad%28@8@2009 le{k ekuuh;
U;k;kf/kifr Jh lquhy dqekj xxZ] v/;{k ekuuh;k Jherh foeyk lsfB;k] lnL;k mifLFkr%& vihykaV~&L.I.C. dh vksj ls Jh iz'kkar ea=kh] vf/koDrkA jsLiksMsaV&ifjokfn;k dh vksj ls Jh vt; VkafV;k] vf/koDrkA jkT;
vk;ksx }kjk%& 1- ;g vihy vihykaV~ tks fd ewy ifjokn esa foi{kh Fks] us ftyk eap] vtesj ds vkns'k fnukad 27-9-2006 tks mUgksaus ifjokn la[;k 126@2006 esa fuEu :i esa vihykaV&L.I.C. ds fo:) vkns'k ikfjr fd;k%& ^^ifj.kkeLo:i izkFkhZ;k dk ifjokn vizkFkhZ chek fuxe ds fo:) Lohdkj fd;k tkdj vizkFkhZ chek fuxe dks ;g vkns'k fn;k tkrk gS fd vizkFkhZ chek fuxe izkFkhZ;k dks chek ikWfylh la[;k 185261105 ds isVs chek Dyse dh jkf'k :- 1]00]000@&leLr ifjykHkksa lfgr chek Dyse is'k fd, tkus dh fnukad ls 2 ekg dh vof/k mijkUr rknk;xh 9 izfr'kr okf"kZd C;kt lfgr e; :-1000@&okn O;; ds vkns'k ls nks ekg dh vof/k esa vnk djsa vFkok vknsf'kr jkf'k eap esa tek djkosA vknsf'kr jkf'k ;fn vizkFkhZ chek fuxe eap esa tek djuk pkgs rks vknsf'kr jkf'k dk pSd fMek.M MªkQ~V tks izkFkhZ;k ds uke gks] izkFkhZ;k dks lwfpr djrs gq, tek djkosaA ** ds fo:) is'k dh gSaA 2- ;g bu ifjfLFkfr;ksa esa lkeus vk;k gS fd jsLiksMsaV&ifjokfn;k us ,d ifjokn vihykaV&L.I.C. ds fo:) ftyk eap] vtesj esa fnukad 4-5-2006 dks ;g dgdj is'k fd;k fd jsLiksMsaV&ifjokfn;k ds e`rd ifr Lo-Jh Vsukey ftldks Hkfo"; esa e`rd ds uke ls lEcksf/kr fd;k tk;sxk] us vius thoudky esa ,d Policy vihykaV&L.I.C. ls fnukad 21-2-2005 dks 1]00]000@&:i;s dh yh Fkh ftldk uEcj 185261105 Fkk mldk ;g Hkh dguk gS fd fnukad 8-8-2005 dks e`rd dh e`R;q gks xbZ vkSj fQj jsLiksMsaV&ifjokfn;k us crkSj iRuh ,oa ukWfeuh viuk Dyse vihykaV&L.I.C. ds ;gkaW is'k fd;k] ftls vihykaV&L.I.C. us vius jsiwfM;s'ku i=k fnukafdr 9-3-2006 ds }kjk ;g dgdj jn~n dj fn;k fd%& ^^pwafd e`rd us vius LokLF; ijh{k.k dh fnukad 21-2-2005 dks dgk Fkk fd mlds dksbZ chekjh ugha gS vkSj uk gh mlus fdlh vLirky esa HkrhZ jgdj fdlh chekjh dk bZykt djok;k gS ysfdu vihykaV&L.I.C ds ikl bl ckr ds iq[rk lcwr gS fd that all these answers were false as we hold indisputable proof to show that for about one month before he proposed for above policy he had suffering from cancer for which he had consulted a medical man and had taken treatment from him/in a hospital and was also on medical leave from 14-7-04 to 16-7-2004 (3 days) & 13-12-2004 to 20-12-2004 (8 days) .He did not however, disclose these facts in his proposal . Instead he have false answers therein as stated above.
It is therefore evident that he had made incorrect statements and with held correct information from us regarding his health at the time of effecting the assurance and hence in terms of the policy contract and the declarations contained in the form of proposal for asssuance, We hereby repudiate the claim and accordingly we are not liable for any payment under the above policy and all moneys that have been paid in consequence thereof belong to us."
mlds ckn ifjokn i=k is'k fd;k x;kA 3- vihykaV&L.I.C. us viuk tokc fnukad 6-7-2006 dks fn;k vkSj mUgksaus tokc esa eq[; :i ls ogh Pleas yh tks vius jsiwfM;s'ku i=k fnukafdr 9-3-2006 esa yh FkhA blds vykok mudk ;g Hkh dguk gS fd pwafd e`rd ,d ljdkjh deZpkjh Fkk blfy;s e`rd us fnukad 14-7-2004 ls 16-7-2004 rd rhu fnu o 13-12-2004 ls 20-12-2004 rd 8 fnu dk esfMdy vodk'k fy;k Fkk vkSj e`rd fnukad 14-3-2005 ls 16-3-2005 rd dh vof/k esa jktdh; ;K ukjk;.k vLirky] fd'kux< esa HkrhZ jgk Fkk tgka ij e`rd dk fnukad 15-3-2005 dks vkWijs'ku Hkh gqvk vkSj e`rd dks ¼Axillary Gland) mlds cxy esa tks xkaB gks xbZ Fkh mldh ck;ksIlh djokus dh lykg nh xbZ Fkh mlds i'pkr~ e`rd fnukad 12-4-2005 ls 13-4-2005 rd jsYos fpfdRlky;] t;iqj esa HkrhZ jgk tgka ls mls txthou jke fpfdRlky;] eqEcbZ esa jsQj fd;k x;k vkSj e`rd fnukad 15-4-2005 ls 4-5-2005 rd txthoujke vLirky] eqEcbZ esa HkrhZ jgk tgka e`rd ds Non-Hodgking Lymphoma dh chekjh ;kfu dSalj ls ihfMr crk;kA blfy;s ekeyk chekjh Nqikus dk gSA blfy;s vihykaV&L.I.C. }kjk viusa jsiwfM;s'ku i=k fnukafdr 9-3-2006 ds }kjk tks Dyse jsLiksMsaV&ifjokfn;k dk jn~n fd;k x;k Fkk] og lgh jn~n fd;k x;k FkkA ifjokn [kkfjt fd;s tkus dk fuosnu fd;kA 4- ftyk eap] us vius vkns'k fnukad 27-9-2006 ds }kjk jsLiksMsaV&ifjokfn;k dk ifjokn ;g ekurs gq, Lohdkj dj fy;k fd%& 1- pwafd e`rd ,d ljdkjh deZpkjh Fkk blfy;s mlds }kjk esfMdy ds vk/kkj ij fy;s x;s vodk'kksa ls ;g vo/kkfjr ugha fd;k tk ldrk fd e`rd dks dSalj dk jksx gks] ftldks Nqikdj e`rd }kjk ikWfylh yh xbZ gksA 2- ekeyk chekjh Nqikus dk ugha gSA 3- e`rd }kjk ck;ksIlh ikWfylh ysus ds ckn djokbZ xbZ gS ftlesa dSalj ik;k x;k Fkk A 5- mDr vkns'k fnukad 27-9-2006 ls vlarq"V gksdj vihykaV~&L.I.C. dh vksj ls ;g vihy is'k dh xbZ gSA 6- nkSjkus cgl fo}ku odhy vihykaV~&L.I.C. dk eq[; eqn~nk ;g jgk gS fd ftyk eap dh QkbZfMax xyr gS D;ksafd pwafd e`rd ,d ljdkjh deZpkjh Fkk blfy;s e`rd us fnukad 14-7-2004 ls 16-7-2004 rd rhu fnu o 13-12-2004 ls 20-12-2004 rd 8 fnu dk esfMdy vodk'k fy;k Fkk vkSj e`rd fnukad 14-3-2005 ls 16-3-2005 rd dh vof/k esa jktdh; ;K ukjk;.k vLirky] fd'kux<] vtesj esa HkrhZ jgk Fkk tgka ij e`rd dk fnukad 15-3-2005 dks vkWijs'ku Hkh gqvk vkSj e`rd dks ¼Axillary Gland) mlds cxy esa tks xkaB gks xbZ Fkh mldh ck;ksIlh djokus dh lykg nh xbZ Fkh mlds i'pkr~ e`rd fnukad 12-4-2005 ls 13-4-2005 rd jsYos fpfdRlky;] t;iqj esa HkrhZ jgk tgka ls mls txthou jke fpfdRlky;] eqEcbZ esa jsQj fd;k x;k vkSj e`rd fnukad 15-4-2005 ls 4-5-2005 rd txthoujke vLirky] eqEcbZ esa HkrhZ jgk tgka e`rd ds Non-Hodgking Lymphoma dh chekjh ;kfu dSalj ls ihfMr crk;k x;kA blfy;s ekeyk chekjh Nqikus dk gSA blfy;s ftyk eap ds vkns'k fnukad 27-9-2006 dks vikLr fd;k tkdj vihykaV&L.I.C. dh vihy Lohdkj fd;s tkus dk fuosnu fd;kA 7- blds foifjr fo}ku vf/koDrk jsLiksMsaV&ifjokfn;k us ftyk eap ds vkns'k fnukad 27-9-2006 dks lgh crk;k vkSj vihykaV&L.I.C. dh vihy [kkfjt fd;s tkus dk fuosnu fd;kA 8- bl lUnHkZ esa fopkj fd;k x;kA 1- bl dsl esa blesa fookn ugha gS fd e`rd us fnukad 21-2-2005 dks ,d Policy rknknh 1]00]000@&:i;s dh vihykaV&L.I.C. ls yh Fkh A 2- bl dsl esa blesa Hkh dksbZ fookn ugha gS fd fnukad 21-2-2005 dks vius LokLF; ijh{k.k ds le; e`rd us dgk Fkk fd mlds dksbZ chekjh ugha gS uk gh mlus fdlh chekjh dk dksbZ bZykt fdlh vLirky esa HkrhZ jgdj djok;k gSA 3- bl dsl esa blesa Hkh fookn ugha gS fd e`rd dh e`R;q mDr ikWfylh ysus ds ,d o"kZ ds vUnj fnukad 8-8-2005 dks gqbZ gS A 4- blesa Hkh dksbZ fookn ugha gS fd jsLiksMsaV&ifjokfn;k dk Dyse vihykaV&L.I.C. us vius jsiwfM;s'ku i=k fnukafdr 9-3-2006 esa of.kZr dkj.kksa ds vk/kkj ij jn~n dj fn;k FkkA 5- i=kkoyh esa layXu fjdkMZ ds vuqlkj e`rd loZizFke Y.N. Hospital, Kishangarh (Ajmer) esa fnukad 14-3-2005 ls fnukad 16-3-2005 rd HkrhZ jgk FkkA 6- i=kkoyh esa layXu fjdkMZ ds vuqlkj e`rd fnukad 15-4-2005 ls 4-5-2005 rd txthoujke vLirky] eqEcbZ esa HkrhZ jgk Fkk tgka rd e`rd dkss Non-Hodgking Lymphoma dh chekjh ;kfu dSalj ls ihfMr crk;k x;kA 7- i=kkoyh esa layXu fjdkMZ ds vuqlkj e`rd fnukad 19-5-2005 ls 25-5-2005 rd crkSj Qksyks vi dsl txthoujke vLirky] eqEcbZ esa HkrhZ jgk FkkA 8- i=kkoyh esa layXu fjdkMZ ds vuqlkj e`rd Hkxoku egkohj dSalj gksLihVy ,oa fjlpZ lsUVj] t;iqj esa fnukad 26-6-2005 ls 12-7-2005 rd dSalj ds bZykt gsrq HkrhZ jgk FkkA 9- i=kkoyh esa e`rd }kjk yh xbZ NqfV~V;k dk fjdkMZ is'k fd;k x;k gS ysfdu e`rd }kjk mDr NqfV~V;k fdl vk/kkj ij vkSj fdl chekjh ds dkj.k yh xbZ gS bldk dksbZ mYys[k ugha fd;k x;k gSA 10- i=kkoyh esa Department of Pathology, J.L.N. Medical College, Ajmer dh Histopathology/cytology dh fjiksVZ yxh gqbZ gSA 11- bl dsl esa blesa dksbZ fookn ugha gS fd e`rd ds LokLF; ijh{k.k dh fnukad 21-2-2005 ls iwoZ dk e`rd ds fdlh vLirky esa HkrhZ gksus ;k viuh fdlh chekjh ;k dSalj dh chekjh dk bZykt djokus dk ;k fdlh MkaDVj ls lykg ysus dk vihykaV&L.I.C. dh vksj ls dksbZ fjdkMZ is'k ugha fd;k x;k gSA 9- vc iz'u ;g gS fd mijksDr ifjfLFkfr;ksa esa D;k ftyk eap dh QkbZfMax fnukafdr 27-9-2006 lgh gS ;k ugha ;k vihykaV&L.I.C. }kjk vius jsiwfM;s'ku i=k fnukafdr 9-3-2006 ds }kjk jsLiksMsaV&ifjokfn;k dk tks Dyse jn~n fd;k x;k Fkk oks lgh gS ;k ughaA 10- tgka rd vihykaV&L.I.C. }kjk mBk;k x;k eqn~nk fd ekeyk chekjh Nqikus dk gS bl lEcU/k esa gekjh jk; gS fd i=kkoyh esa layXu fjdkMZ ds vuqlkj e`rd loZizFke Y.N. Hospital, Kishangarh (Ajmer) esa fnukad 14-3-2005 ls fnukad 16-3-2005 rd HkrhZ jgk FkkA rFkk mlds i'pkr~ e`rd fnukad 15-4-2005 ls 4-5-2005 rd txthoujke vLirky] eqEcbZ esa HkrhZ jgk Fkk] tgka rd e`rd dkss Non-Hodgking Lymphoma dh chekjh ;kfu dSalj ls ihfMr crk;k x;k fQj e`rd fnukad 19-5-2005 ls 25-5-2005 rd crkSj Qksyks vij dsl txthoujke vLirky] eqEcbZ esa HkrhZ jgk Fkk blds ckn e`rd Hkxoku egkohj dSalj gksLihVy ,oa fjlpZ lsUVj] t;iqj esasa fnukad 26-6-2005 ls 12-7-2005 rd dSalj ds bZykt gsrq HkrhZ jgk FkkA i=kkoyh esa Department of Pathology, J.L.N. Medical College, Ajmer Histopathology/cytology dh fjiksVZ yxh gqbZ gS ysfdu vihykaV&L.I.C. dh vksj ls e`rd ds LokLF; ijh{k.k dh fnukad 21-2-2005 ls iwoZ dk fdlh vLirky esa HkrhZ gksus vkSj fdlh chekjh ;k dSalj dh chekjh dk bZykt djokus ;k fdlh MkaDVj ls viuh chekjh ds lEcU/k esa lykg ysus dk dksbZ fjdkMZ is'k ugha fd;k x;k gS vkSj tks mDr fjdkMZ is'k fd;k x;k gS og LokLF; ijh{k.k dh fnukad 21-2-2005 ds ckn dk is'k fd;k x;k gSA ;g rks ,d ckr jghA 11- blds vykok bl dsl esa lcls egRoiw.kZ ckr ;g gS fd vihykaV&L.I.C. ;g dsl ysdj vk;s gS fd e`rd ikWfylh ysrs le; dSalj ds jksx ls xzLr Fkk ftl rF; dks e`rd }kjk ikWfylh ysrs le; ,oa LokLF; ijh{k.k dh fnukad 21-2-2005 dks Nqik;k x;k Fkk bl lEcU/k esa gekjh jk; gS fd i=kkoyh esa layXu fjdkMZ ls ;g lkfcr gks tkrk gS fd e`rd ds dSalj dh chekjh ikWfylh ysus ,oa LokLF; ijh{k.k dh fnukad 21-2-2005 ds ckn tc e`rd jktdh; ;K ukjk;.k vLirky] fd'kux<] vtesj esa fnukad 14-3-2005 ls 16-3-2005 rd HkrhZ jgk Fkk vkSj e`rd dks tks mlds cxy esa xkaB ¼Axillary Gland ) gks xbZ Fkh mldh ck;ksIlh djokus dh lykg nh xbZ Fkh vkSj mlds ckn e`rd }kjk txthoujke vLirky] eqEcbZ esa ck;ksIlh djkus ds ckn e`rd ds dSalj dh chekjh fMVsDV dh xbZ FkhA blfy;s vihykaV&L.I.C. dk ;g dguk fd e`rd dks ikWfylh ysrs le; ,oa LokLF; ijh{k.k dh fnukad 21-2-2005 dks mlds dSalj dh chekjh dk Kku Fkk mlds ckotwn dSalj dh chekjh ds rF; dks Nqikdj e`rd }kjk ikWfylh yh xbZ Fkh] xyr gSA 12- blds vykok jktdh; ;K ukjk;.k vLirky]fd'kux<] vtesj }kjk e`rd dks tks Axillary Gland dh ck;ksIlh dh lykg nh xbZ Fkh mlls ;g fu"d"kZ ugha fudkyk tk ldrk fd e`rd dks dSalj dh chekjh Fkh vkSj Axillary Gland ls e`rd dks dSalj dh chekjh dk bZYe gks x;k gks] ;g Hkh ugha ekuk tk ldrk vkSj Axillary Gland dSalj ds rF; dks lkfcr djus ds fy;s i;kZIr ugha gS tcfd e`rd ds dSalj dh chekjh txthoujke vLirky] eqEcbZ esa fnukad 12-4-2005 ls 4-5-2005 rd dh vof/k esa HkrhZ jgus vkSj mDr vof/k esa ck;ksIlh djkus ij fMVsDV dh xbZ Fkh tcfd e`rd }kjk viuk LokLF; ijh{k.k mlls iwoZ fnukad 21-2-2005 dks fn;k x;k FkkA 13- blds vykok dSalj ,d ,slh chekjh gS ftldk :fVu eSuj esa Mk;Xuksfll ugha fd;k tk ldrk gS vkSj ftlds fy, dqN vko';d VsLV@ck;ksIlh djokuh iMrh gS vkSj bl dsl esa e`rd dh ck;ksIlh ikWfylh ysus ,oa LokLF; ijh{k.k dh fnukad 21-2-2005 ds ckn fnukad 15-4-2005 ls 4-5-2005 dh vof/k esa txthoujke vLirky] eqEcbZ esa HkrhZ jgus ds nkSjku gqbZ gS ftlesa e`rd dks Non-Hodgking Lymphoma dh chekjh ;kfu dSalj dh chekjh ik;h x;h FkhA 14- blds vykok e`rd dh NqfV~V;ksa dk tks fjdkMZ is'k fd;k x;k gS mlls ;g Li"V ugha gksrk gS fd e`rd }kjk mDr NqfV~V;ka fdl vk/kkj ;k fdl chekjh ds dkj.k yh xbZ Fkh vkSj ljdkjh deZpkjh NqfV~V;k ysrs jgrs gS pkgs og esfMdy ds vk/kkj ij ;k vU; fdlh vk/kkj ijA blfy;s vihykaV&L.I.C. dk ;g dguk fd e`rd }kjk tks NqfV~V;k yh xbZ Fkh og dSalj dh chekjh ds dkj.k yh xbZ Fkh] xyr gSA 15- tgka rd vihykaV&L.I.C. }kjk izLrqr ekuuh; National Consumer Disputes Redressal Commission, New Delhi ds U;kf;d n`"Vkar 2009 N.C.J. 49 (NC) Manju Bala Vs. L.I.C. dk lEcU/k gS bl lEcU/k esa gekjh jk; gS fd mijksDr ekuuh; U;kf;d n`"Vkar bl dsl ds rF;ksa ls vyx gS D;ksafd fdMuh dh chekjh vyx gksrh gS vkSj dSalj dh chekjh vyx gksrh gS vkSj dSalj ,d ,slh chekjh gksrh gS tks o"kksZ rd euq"; ds 'kjhj esa iyrh c<rh jgrh gS ftldk ckn esa vko';d VsLV djokus ds ckn irk pyrk gSA blfy, mijksDr ekuuh; U;kf;d n`"Vkar rF;ksa dh fHkUurk ds dkj.k bl dsl ij ykxw ugha gksrk gSA 16- bl izdkj vihykaV&L.I.C. bl dsl esa ;g rF; lkfcr djus esa vlQy jgs gS fd e`rd us mDr ikWfylh tkucw>dj viuh chekjh ds rF; dks Nqikdj /kks[kk nsdj yh gks vkSj LokLF; ijh{k.k dh fnukad 21-2-2005 dks tkucw>dj viuh dSalj dh chekjh ds rF; dks Nqik;k gksA 17- mijksDr foospu ds vuqlkj ftyk eap] vtesj dh QkbZfMax fnukad 27-9-2006 dkfcys iqf"V gS D;ksafd og rF;ksa ij vk/kkfjr gS rFkk vihykaV&L.I.C. }kjk vius jsiwfM;s'ku i=k fnukafdr 9-3-2006 ds }kjk jsLiksMsaV&ifjokfn;k dk jn~n fd;k x;k Dyse xyr Fkk vkSj vihykaV&L.I.C. dh vihy [kkfjt fd;s tkus ;ksX; gSA mijksDr dkj.kksa ds dkj.k vihykaV&L.I.C. dh ;g vihy [kkfjt dh tkrh gS rFkk ftyk eap] vtesj ds fookfnr vkns'k fnukad 27-9-2006 dh iqf"V dh tkrh gSA ¼Jherh foeyk lsfB;k½ ¼U;k;kf/kifr Jh lquhy dqekj xxZ½ lnL;k v/;{k lat;