State Consumer Disputes Redressal Commission
L.I.C. vs Foolvati on 17 April, 2009
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miHkksDrk fookn izfrrks"k vk;ksx] t;iqj] jktLFkku vihy la[;k%761@2004 1- egkizcU/kd ¼nkok½] Hkkjrh; thou chek fuxe] thou izdk'k] Hkokuh flag jksM+ iks-uEcj 65] t;iqj&302005 2- ofj"B e.My izcU/kd] e.My dk;kZy;] Hkkjrh; thou chek fuxe] thou izdk'k ] jkukMs ekxZ] vtesjA 3- {ks=h;
izcU/kd] Hkkjrh; thou chek fuxe] thou Hkkjrh; fcfYMax] ubZ fnYyh tfj;s izcU/kd] ¼fof/k ,oa vkokl½] e.My dk;kZy;] Hkkjrh; thou chek fuxe] thou izdk'k ] Hkokuh flag jksM] t;iqjA vihykaV~l&foi{khx.k cuke Jherh Qwyorh nsoh iRuh Lo- Jh x.ks'kjke]prqFkZ Js.kh deZpkjh] tu vfHk;ksx fujkdj.k foHkkx] 'kklu lfpoky;] t;iqj ¼jkt-½ jsLiksMsaV&ifjokfn;k fnukad%17@4@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&foi{khx.k dh vksj ls Jh iz'kkUr ea=h] vf/koDrkA jsLiksMsaV&ifjokfn;k dh vksj ls Jh Mh-,e-ekFkqj] vf/koDrkA jkT;
vk;ksx }kjk%& 1- ;g vihy vihykaV~l&L.I.C. tks fd ewy ifjokn esa foi{khx.k Fks] us ftyk eap] t;iqj f}rh;] t;iqj ds vkns'k fnukad 10-03-2004 tks mUgksaus ifjokn la[;k 645@2003 esa fuEu :i esa vihykaV~l&L.I.C. ds fo:) ikfjr fd;k%& ^^vr% ifjokfnuh dk ifjokn Lohdkj dj foi{khx.k dks funsZ'k fn;k tkrk gS fd os bl vkns'k dh rkjh[k ls nks ekg esa ifjokfnuh dks 50]000@&: dh chek jkf'k vnk djsa A foi{khx.k }kjk ifjokfnuh dks bl vkns'k dh rkjh[k ls nks ekg esa 50]000@&:- dh jkf'k vnk u fd, tkus ij ifjokfnuh bl jkf'k ij olwyh rd uks izfr'kr izfro"kZ dh nj ls C;kt izkIr djus dh vf/kdkfj.kh gksxhA bl vkns'k dh rkjh[k ls nks ekg esa foi{khx.k ifjokfnuh dks ekufld larki dh {kfriwfrZ Lo:i 2000@&:-
,oa ifjokn O;; ds 1000@&: dqy 3000@&:-¼v{kjs rhu gtkj :i;s ½ Hkh vnk djsaA** 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&L.I.C. ds fo:) ftyk eap] t;iqj f}rh;] t;iqj esa fnukad 27-6-2003 dks ;g dgdj is'k fd;k fd mlds Lo- ifr x.ks'kjke ftldks Hkfo"; esa e`rd ds uke ls lEcksf/kr fd;k tk;sxk] us vius thoudky esa 50]000@&:i;s dh L.I.C. Policy fnukad 19-11-1993 dks ftldk uEcj 192213426 Fkk] vihykaV~l&L.I.C. ls yh FkhA mldk ;g Hkh dguk gS fd fnukad 11-4-1996 dks e`rd dh vlkef;d e`R;q gks xbZ vkSj fQj cgSfl;r iRuh vkSj uksfeuh jsLiksMsaV&ifjokfn;k us viuk Dyse vihykaV~l&L.I.C. ds ;gkaW is'k fd;k] ftldks vihykaV~l&L.I.C. us vius jsiwfM;s'ku i= fnukafdr 31-3-1999 ,usDlj vkj&9 ds }kjk ;g dgdj jn~n dj fn;k fd%& ^^e`rd us fnukad 19-11-1993 dks vius LokLF; ijh{k.k ds le; ;g dgk Fkk fd mlds dksbZ chekjh ugha gS ysfdu vihykaV~l&L.I.C ds ikl bl ckr ds iq[rk lcwr gS fd e`rd blls 3 o"kZ 7 ekg iwoZ ls Vertigo, Colitis vkfn chekfj;ksa ls xzLr Fkk pwafd mlus bu chekfj;ksa dks Nqik;k Fkk blfy;s ;g ekeyk chekjh Nqikus dk jgk gSA** fQj ;g ifjokn jsLiksMsaV&ifjokn;k dh vksj ls vihykaV~l&L.I.C ds fo:) is'k fd;k x;kA 3- vihykaV~~l&L.I.C. us viuk tokc fnukad 16-8-2003 dks fn;k vkSj mUgksaus vius tokc esa eq[; :i ls ogh Pleas yh tks vius jsiwfM;s'ku i= fnukafdr 31-3-1999 esa yh FkhA mudk ;g Hkh dguk gS fd pwafd ifjokfnuh dk Dyse fnukad 31-3-1999 dks gh jn~n dj fn;k x;k Fkk vkSj ifjokfn;k }kjk ifjokn fnukad 27-6-2003 dks nks lky ckn ftyk eap esa is'k fd;k x;k] tks fd Time Bard gSA blfy;s vihykaV~l&L.I.C. }kjk vius jsiwfM;s'ku i= fnukafdr 31-3-1999 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] t;iqj f}rh;] t;iqj us vius vkns'k fnukad 10-3-2004 ds }kjk jsLiksMsaV&ifjokfn;k dk ifjokn ;g ekurs gq, Lohdkj fd;k fd%& 1- ^^ifjokfn;k ds e`rd ifr Jh x.sk'kkjke us chek ikWfylh izn'kZ vkj@1 ysrs le; vius LokLFk ds laca/k esa tkucw>dj fdlh lkjHkwr rF; dks ugha fNik;k vkSj ifjokfnuh dk chek Dyse izn'kZ vkj@9 ds ek/;e ls voS/k dkj.kksa ls o voS/k vk/kkjksa ij foi{khx.k }kjk fujLr fd;k x;kA 2- ifjokfn;k dk Dyse vafre rkSj ij fof/kd izfdz;k viuk;s tkus ds mijkUr fnukad 12-1-2002 dks fujLr fd;k x;k gS vkSj fnukad 12-1-2002 ds i'pkr~ nks lky dh vof/k ds Hkhrj gh ifjokfn;k }kjk fnukad 4-7-2003 dks ifjokn ftyk eap esa izLrqr dj fn;k x;kA** 5- mDr vkns'k fnukad 10-3-2004 ls vlarq"V gksdj vihykaV~l&L.I.C. dh vksj ls ;g vihy is'k dh xbZ gSA 6- nkSjkus cgl fo}ku odhy vihykaV~l&L.I.C. dk eq[; eqn~nk ;g jgk gS fd ftyk eap dh QkbZfMax xyr gS D;ksafd e`rd us fnukad 19-11-1993 dks vius LokLF; ijh{k.k ds le; ;g dgk Fkk fd mlds dksbZ chekjh ugha gS ysfdu vihykaV~l&L.I.C ds ikl bl ckr ds iq[rk lcwr gS fd e`rd vius LokLF; ijh{k.k dh fnukad 19-11-1993 ls 3 o"kZ 7 ekg iwoZ ls Vertigo, Colitis vkfn chekfj;ksa ls xzLr Fkk pwafd mlus bu chekfj;ksa dks Nqik;k Fkk blfy;s ;g ekeyk chekjh Nqikus dk jgk gS blds vykok ifjokfn;k dk Dyse fnukad 31-3-1999 dks jn~n dj fn;k x;k Fkk tcfd ifjokfn;k }kjk ftyk eap esa ifjokn fnukad 27-6-2003 dks izLrqr fd;k x;k gS blfy;s ifjokfn;k dk Dyse Time Bard gksus ls Hkh fujLr gksus ;ksX; gSA blfy;s ftyk eap dk vkns'k fnukafdr 10-3-2004 xyr gS rFkk vihykaV~l&L.I.C. dh vihy Lohdkj fd;s tkus dk fuosnu fd;k A 7- blds foifjr fo}ku vf/koDrk jsLiksMsaV&ifjokfn;k us ftyk eap ds vkns'k fnukad 10-3-2004 dks lgh crk;k vkSj vihykaV~l&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 19-11-1993 dks 50]000@&:i;s dh ikWfylh vihykaV~l&L.I.C. ls yh FkhA 2- blesa Hkh fookn ugha gS fd e`rd dh e`R;q ikWfylh ysus ds nks o"kZ ds ckn gks xbZA 3- blesa Hkh dksbZ fookn ugha gS fd jsLiksMsaV&ifjokfn;k dk Dyse vihykaV~l&L.I.C. us vius jsiwfM;s'ku i= fnukafdr 31-3-1999 esa of.kZr dkj.kksa ds vk/kkj ij jn~n dj fn;k FkkA 4- i=koyh esa fnukad 24-3-1992 dk fpfdRlk izek.k i= yxk gqvk gS tks fd Mka- vkj- ,e-O;kl }kjk tkjh fd;k x;k gS tks fd ;g n'kkZrk gS fd e`rd us Backache, Vertigo chekfj;ksa ds dkj.k fnukad 30-3-1992 ls 23-4-1992 rd dqy 25 fnu dk esfMdy vodk'k vius dk;ZLFky ls fy;k FkkA 5- i=koyh esa fnukad 13-12-1992 dk fpfdRlk izek.k i= tks fd Mka- okbZ-ih-pkoyk }kjk tkjh fd;k x;k gS tks fd ;g n'kkZrk gS fd e`rd us Vertigo, Colitis chekfj;ksa ds dkj.k fnukad 23-10-1992 ls 29-11-1992 rd dk dqy 38 fnu dk vodk'k vius dk;ZLFky ls esfMdy vk/kkj ij fy;k FkkA 6- blh izdkj i=koyh esa fnukad 2-5-1993 dk fpfdRlk izek.k i= tks fd Mka-okbZ-ih-pkoyk }kjk tkjh fd;k x;k gS tks fd ;g n'kkZrk gS fd e`rd us A.C.Colitis & UTI chekfj;ksa ds dkj.k fnukad 2-3-1993 ls 25-4-1993 rd dk 55 fnu dk vodk'k vius dk;ZLFky ls esfMdy ds vk/kkj ij fy;k Fkk 9- vc iz'u ;g gS fd mijksDr ifjfLFkfr;ksa esa D;k ftyk eap t;iqj f}rh;] t;iqj dh QkbZfMax fnukafdr 10-3-2004 lgh gS ;k ugha ;k vihykaV~l&L.I.C. }kjk vius jsiwfM;s'ku i= fnukafdr 31-3-1999 ds }kjk jsLiksMsaV&ifjokfn;k dk Dyse jn~n fd;k x;k Fkk] oks lgh gS ;k ughaA 10- tgka rd e`rd }kjk chekfj;ksa ds dkj.k NqV~Vh ysus dk iz'u gS bl dsl esa e`rd ds tks chekfj;ka A.C.Colitis, Backache, Vertigo , UTI Fkh] ,slh chekfj;ka gS ftudh rqyuk fdMuh] gkVZ] czsu vkSj ySaXl ls ugha dh tk ldrhA e`rd ds tks ;s ¼A.C.Colitis, Backache, Vertigo , UTI ) chekfj;ka Fkh og VsEijsyh chekfj;ka dgykrh gS vkSj ,slh chekfj;ksa ds lEcU/k esa LokLFk; ijh{k.k ds le; ftdz ugha fd;k tkrk gS rks ;g LokLF; ds lEcU/k esa Material Fact Nqikuk ugha dgk tk ldrk gSA 11- blds vykok bl dsl esa e`rd dh e`R;q ikWfylh ysus ds nks o"kZ ds ckn gqbZ gS dkuwu dh fLFkfr bl lUnHkZ esa Li"V gS fd%& ^^If the Policy is called in question after passing of two years of its being effected, heavy burden lies on the insurer and in such case, insurer is required to prove the following facts:-
(a) That policy holder concealed or suppressed material facts.
(b) That such suppression or concealment was fraudulently made by the policy holder.
(c)That Policy holder was aware at the time of making the statement that it was false or that it suppressed facts which its was material to disclose.
In other words, policy holder knowingly and deliberately gave incorrect information in the presonal statement ."
Ysfdu gekjh jk; esa bu rhuksa eqn~nksa dks vihykaV~l&L.I.C. lkfcr djus esa vlQy jgs gSA blfy;s ;g dguk fd e`rd us tkucw>dj vkSj /kks[kk nsus dh fu;r ls fraudulently LokLF; ijh{k.k ds le; xyr rF; fn;s gks] ugha ekuk tk ldrkA blfy;s ftl vk/kkj ij vihykaV~l&L.I.C. }kjk e`rd dk Dyse jn~n fd;k x;k gS mldh iqf"V ugha dh tk ldrhA Limitation ds lEcU/k esa%& 12- ;gka ;g dguk mfpr gksxk fd ifjokfn;k dk Dyse fnukad 31-3-1999 dks vihykaV~l&L.I.C. }kjk jn~n fd;k x;k gS ftldh vihy ifjokfn;k }kjk Review Committee ls dh xbZ Fkh ftUgksaus vius i= fnukafdr 12-1-2002 ,usDlj vkj@13 }kjk vihykaV~l&L.I.C. }kjk ifjokfn;k ds Dyse dks jn~n djus dks lgh ik;k FkkA mlds mijkUr ifjokfn;k }kjk fnukad 27-6-2003 dks ifjokn ftyk eap esa izLrqr dj fn;k x;kA bl izdkj Li"V gS fd bl dsl esa ifjokfn;k us vihy Review Committee ds le{k dh Fkh ftUgksaus 12-1-2002 ds i= ds }kjk Dyse jn~n dks lgh ik;k Fkk blfy;s bl dsl esa Limitation fnukad 12-1-2002 ls gh fn;k tk;sxkA ,slk gksus ls ekeyk Limitation ds vUrxZr vk tkrk gSA blfy;s vihykaV~l&L.I.C. dk Limitation dk eqn~nk Hkh pyus ;ksX; ugha gSA 13- mijksDr foospu Lo:i ftyk eap] t;iqj f}rh;] t;iqj dk vkns'k fnukad 10-3-2004 dkfcys iqf"V gS tks fd rF;ksa ij vk/kkfjr gksus ls mlesa gLr{ksi fd;s tkus dh dksbZ vko';drk ugha gSA 14- mijksDr dkj.kksa ds dkj.k vihykaV~l&L.I.C. dh vihy [kkfjt dh tkrh gS rFkk ftyk eap t;iqj f}rh;] t;iqj ds vkns'k fnukad 10-3-2004 dh iqf"V dh tkrh gSA ¼Jherh foeyk lsfB;k½ ¼U;k;kf/kifr lquhy dqekj xxZ½ lnL;k v/;{k @@lat;@@