National Consumer Disputes Redressal
Life Insurance Corporation Of India vs Sunita & 2 Ors. on 12 March, 2020
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 54 OF 2018 (Against the Order dated 27/07/2017 in Appeal No. 122/2016 of the State Commission Haryana) 1. LIFE INSURANCE CORPORATION OF INDIA (A BODY CORPORATE CONSTITUTED UNDER THE LIFE INSURANCE CORPORATION ATC)H-39, CONNAUGHT PLACE, NEW DELHI-110001 ...........Petitioner(s) Versus 1. SUNITA & 2 ORS. W/O. LT. SH. MAHIPAL S/O. RAMESHWAR R/O. VILLAGE BHADANI, TEHSIL AND DISTRICT-JHAJJAR HARYANA 2. AMIT W/O. LT. SH. MAHIPAL R/O. VILLAGE BHADANI, TEHSIL AND DISTRICT-JHAJJAR HARYANA 3. MANJEET W/O. LT. SH. MAHIPAL R/O. VILLAGE BHADANI, TEHSIL AND DISTRICT-JHAJJAR HARYANA ...........Respondent(s)
BEFORE: HON'BLE DR. S.M. KANTIKAR,PRESIDING MEMBER HON'BLE MR. DINESH SINGH,MEMBER
For the Petitioner : For the Respondent :
Dated : 12 Mar 2020 ORDER
APPEARED AT THE TIME OF ARGUMENTS
For the Petitioner
:
Mr. Neeraj Gupta, Advocate
For the Respondents
:
Mr. Rajesh Kumar Gautam, Advocate
PRONOUNCED ON: 12th March 2020
ORDER
PER DR. S. M. KANTIKAR, PRESIDING MEMBER
1. This Revision Petition has been filed against the order dated 27.07.2017 of the Haryana State Consumer Disputes Redressal Commission, Panchkula (hereinafter "State Commission") in First Appeal No. 122/2016, where the appeal was dismissed and the order of the District Forum in Complaint No. 230 of 2014 was affirmed .
2. Briefly stated the facts that the deceased insured (husband of the complainant no.1) took an insurance policy on 28.03.2013 from the OP covering all diseases and injuries. The assured got admitted in the hospital on 03.05.2014. He was admitted in the hospital for severe abdominal pain and vomiting. He was suddenly declared dead on 01.06.2014 due to cardiac arrest. The wife of deceased Smt. Sunita - complainant no. 1 lodged an insurance claim with the OP. The claim was repudiated by OP vide letter dated 26.09.2014 on the ground that the assured died due to self-afflicted injuries or conditions (attempted suicide), and/or the use or misuse of drugs or alcohol. Being aggrieved, the complainants filed a complaint in the District Forum, Jhajjar.
3. The complaint was resisted by the OP 2 (LIC) by filing a written statement. The LIC agent was made an unnecessary party, same was deleted from the array of parties. The LIC contended that the repudiation was justified. It was done on the basis of reason in the prescription slip of the doctor at Siwach Hospital who mentioned about a history of chronic alcohol intake by the deceased insured. It was one of the self-afflicted injuries or conditions or use or misuse of any drugs or alcohol. Therefore, there was no deficiency in service on the part of the OP 2 (LIC).
4. The District Forum, after hearing the parties and perusal of the documents, partly allowed the compliant. It observed:
4. ... It has been observed that the death of Mahipal insured on 1.6.2014 is proved from death certificate Ex. P-8 placed on file. The learned counsel for complainants has placed on record the medical expenditure treatment record of Mahipal insured. As per Ex. P-9 detailed bill , the complainant has paid a sum of Rs. 4,47,956/- to Sir Ganga Ram Hospital Delhi towards hospitalization expenditures through cash vide various receipts and as per documents Ex:- P-10 to P-35 , the complainant has incurred a sum of Rs. 73,694/- on account of medicines expenditures i.e. total sum of Rs. 5,21,650/- has been spent on the treatment of insured Mahipal by the complainants, We are of the considered view that as Mahipal had purchased a health policy, after his death, the complainants are legally entitled for the reimbursement of expenditure on medical treatment. However, the complainant has claimed a sum of Rs. 6,50,000/- but we have observed that the complainant has produced on record the proof of expenditure of only: Rs. 5,21,650/- and could not produce on record any other bill. Hence, we are of the considered view that respondent No. 2 has been negligent and failed to make the payment of aforesaid amount to the complainants on some technical / baseless grounds. Thus it is hold that there has been deficiency in service on the part of the respondent No. 2 and the complainants are now entitled for the, aforementioned amount from the respondent No. 2 along with interest and a suitable compensation.
5. In view of aforesaid discussion and findings, we direct the respondent No. 2 to make the payment of a sum of Rs. 5,21,650/- as actual expenditure on medical treatment of Mahipal, insured along with an interest 9 % p.a. from the date of death of life assured i.e. 1.6.2014 till realization of final payment to the complainants. The complainants are also entitled for a sum of Rs. 20,000 on account of mental agony, harassment and other misc expenses and also for as sum of Rs. 5500/- on account of litigation expenses for the present unwanted and unwarranted litigation only due to the deficiency in service on the part of the respondent No. 2.
(paras 4 and 5 of the District Forum's Order)
5. Being aggrieved by the order of the District Forum, the OP 2 (LIC) appealed in the State Commission. The State Commission dismissed the appeal and upheld the order of the District Forum. It observed:
7. However , there is no dispute as far as opinion expressed in cited case laws is concerned, but the appellant cannot derive any benefit from them because it is miserably failed to show that these terms and conditions were brought to the notice of DLA. Only proposal form is got filled initially and thereafter policy, alongwith terms and conditions, is sent. In the present case it is neither pleaded nor proved that on which date insurance policy alongwith terms and conditions were sent to DLA. When the terms and conditions were not brought to the notice of DLA it cannot be alleged that he is not entitled for the relief as mentioned above. However, as per certificate Ex. R-3 it cannot be presumed that complainant was having previous ailment. This certificate is dated 02.05.2014, whereas the insurance policy was obtained o 28.03.2013 one year before certificate. So, on the basis of this certificate it cannot be presumed that he was suffering from very serious ailment at the time of obtaining insurance policy. Had it been existing before obtaining insurance policy then it could have been different matter. So there is no ground to deny the claim. In these circumstances, impugned order dated 09.12.2015, passed by learned District Forum, Jhajjar cannot be disturbed, appeal fails and the same is hereby dismissed.
(para 7 of the State Commission's Order )
6. Against the order of the State Commission, the OP 2(LIC) filed the present Revision Petition.
7. We have heard the learned counsel of both the parties and perused the material on record.
8. As per the death summary, the death was due to a sudden cardiac arrest and inspite of best resuscitative measures, the patient could not be revived. We note both the fora have arrived at concurrent findings and allowed the complainant.
9. In the present case, the deceased assured was suffering from diabetes mellitus and chronic liver disease when bought to the hospital. But, the death was due to cardiac arrest. In our view the cause of death is nowhere connected to his pre - existing disease. Our view dovetails from the decision of Hon'ble Supreme Court in the Civil Appeal No. 8245 of 2015 titled Sulbha Prakash Motegaoneker and Ors. v. Life Insurance Corporation of India, decided on 05.10.2015, wherein it was observed that suppression of information regarding any pre-existing disease , if it has not resulted in death or has no connection to cause of death , would not disentitle the claimant for the claim.
10. We find the Orders of the District Forum and the State Commission to be well-appraised and well-reasoned. The State Commission concurred with the findings of the District Forum. We note in particular the extracts of the respective observations made by the two fora, quoted in paras 4 and 5 above. Within the meaning and scope of section 21(b), we find no grave error in appreciating the evidence by the two fora below, as may necessitate re-appreciation of the evidence in revision. We find the award made by the District Forum (quoted in para 4 above), and as affirmed by the State Commission, to be just and appropriate. We find no jurisdictional error, or a legal principle ignored, or miscarriage of justice, as may necessitate interference in the exercise of the revisional jurisdiction of this Commission.
11. The revision petition, being misconceived and devoid of merit, is dismissed.
12. Needless to add that the District Forum shall undertake execution as per the law.
13. A copy each of this Order be sent to the District Forum and to the complainant by the Registry within ten days.
...................... DR. S.M. KANTIKAR PRESIDING MEMBER ...................... DINESH SINGH MEMBER