State Consumer Disputes Redressal Commission
Smt. Vimla Devi vs Lic on 23 September, 2009
vihy la[;k% 644@98 jkT;
miHkksDrk fookn izfrrks"k vk;ksx] jktLFkku] t;iqjA vihy la[;k%2091@2006 Jherh foeyk nsoh iRuh Jh ckcwyky tSu] tkfr&egktu] mez&50 o"kZ] fuoklhⓈj gkml] tVokMk [kqnZ] ekuVkmu] lokbZek/kksiqjA vihykaV&ifjokfn;k cuke 1- Hkkjrh;
thou chek fuxe] tfj;s 'kk[kk izcU/kd] 'kk[kk dk;kZy;&ekuVkmu] lokbZek/kksijqA 2- Hkkjrh;
thou chek fuxe] e.My dk;kZy;] thou izdk'k] Hkokuh flag jksM] t;iqj tfj;s eaMy izcU/kdA jsLiksMsaVl&foi{khx.k fnukad%23@9@2009 le{k ekuuh;
U;k;kf/kifr Jh lquhy dqekj xxZ] v/;{k ekuuh;
Jh fldanj iatkch] lnL;A mifLFkr%& vihykaV&ifjokfn;k dh vksj ls Jh lw;Zukjk;.k lwjoky] vf/koDrkA jsLiksMsaVl&L.I.C. dh vksj ls Jh ch-ch-ekFkqj]vf/koDrkA jkT;
vk;ksx }kjk%& 1- ;g vihy vihykaV tks fd ewy ifjokn esa ifjokfn;k Fkh] us ftyk eap] lokbZek/kksiqj ds vkns'k fnukad 26-9-2006 tks mUgksaus ifjokn la[;k 03@05 esa fuEu :i esa vihykaV&ifjokfn;k ds fo:) vkns'k ikfjr fd;k%& ^^vr% ifjokfn;k }kjk izLrqr ;g ifjokn fujLr fd;k tkrk gSA i{kdkjku [kpkZ ifjokn Lo;a viuk&viuk ogu djsaxsA** ds fo:) is'k dh gSaA 2- ;g bu ifjfLFkfr;ksa esa lkeus vk;k gS fd vihykaV&ifjokfn;k us ,d ifjokn jsLiksMsaVl~&L.I.C. ds fo:) ftyk eap] lokbZek/kksiqj esa fnukad 18-12-2004 dks ;g dgdj is'k fd;k fd mlds ifr ckcwyky tSu ftldks Hkfo"; esa e`rd ds uke ls lEcksf/kr fd;k tk;sxk] us vius thoudky esa 100]000@&:i;s dh L.I.C. Policy fnukad 7-3-2004 dks cSad MsV esa ftldk ikWfylh uEcj 194475263 Fkk] jsLiksMsaVl&L.I.C. ls yh Fkh tks fd fnukad 15-2-2004 ls izHkkoh FkhA mldk ;g Hkh dguk gS fd fnukad 17-3-2004 dks e`rd dh e`R;q gks xbZ vkSj fQj cgSfl;r iRuh ,oa uksfeuh vihykaV&ifjokfn;k us viuk Dyse jsLiksMsaVl~&L.I.C. ds ;gkaW is'k fd;k] ftldks jsLiksMsaVl&L.I.C. us vius jsiwfM;s'ku i=k fnukafdr 28-9-2004 ds }kjk ;g dgdj jn~n dj fn;k fd %& ^^pwafd e`rd us izLrko i=k Hkjrs le; fnukad 8-3-2004 dks viuk LokLF; ijh{k.k fn;k Fkk ftlesa mlus dgk Fkk fd mlds dksbZ chekjh ugha gS uk gh mlus fdlh chekjh dk dksbZ bZykt fdlh vLirky esa HkrhZ jgdj djok;k gS ysfdu jsLiksMsaVl&L.I.C. ds ikl bl ckr ds iq[rk lcwr gS fd We may, however, state that all these answers were false as we hold disputable proof to show that before he proposed for the above policy he had suffered from chronic obstructive pulmonary disease & Congestive Heart failure for which he had consulted a medical man and had taken the treatment in a Hospital. He did not howeve,disclose these facts in his proposal/personal statement. Instead he gave false anseers therein as stated above."
fQj ;g ifjokn is'k fd;k x;kA 3- jsLiksMsaVl&L.I.C. us viuk tokc fnukad 3-2-2005 dks fn;k vkSj mUgksaus tokc esa eq[; :i ls ogh Pleas yh tks vius jsiwfM;s'ku i=k fnukafdr 28-9-2004 esa yh FkhA mudk ;g Hkh dguk gS e`rd ikWfylh ysus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 ls iwoZ ls COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) ds jksxksa ls ihfMr Fkk ftldk mlus vLirky esa HkrhZ jgdj bZykt djok;k Fkk vkSj pwafd e`rd ,d ljdkjh deZpkjh Fkk blfy;s e`rd us vius dk;ZLFky ls esfMdy ds vk/kkj ij vodk'k Hkh fy;s Fks vkSj viuh chekjh ds mDr rF;ksa dks e`rd }kjk izLrko i=k Hkjus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 dks Nqik;k x;k FkkA blfy;s gj lwjr esa ekeyk chekjh Nqikus dk gS blfy;s jsLiksMsaV~l&L.I.C. }kjk vius jsiwfM;s'ku i=k fnukafdr 28-9-2004 ds }kjk tks Dyse vihykaV&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] lokbZek/kksiqj us vius vkns'k fnukad 26-9-2006 ds }kjk vihykaV&ifjokfn;k dk ifjokn ;g ekurs gq, [kkfjt dj fn;k fd%& 1- i=kkoyh ij miyC/k fjdkMZ ds vuqlkj e`rd ikWfylh ysus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 ls iwoZ COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure(C.H.F.) ds jksxksa ls xzLr Fkk A 2- Lo;a ifjokfn;k us ifjokn ds iSjk ua-4 esa fpfdRld nsosUnz ekFkqj ls iwoZ esa mipkj ysuk Lohdkj fd;k gSA 3- fpfdRld nsosUnz ekFkqj us izi=k ua-51] 52 esa Li"V :i ls e`rd ds COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) chekfj;ksa ls ihfMr gksus dk mYys[k fd;k gSA 5- mDr vkns'k fnukad 26-9-2006 ls vlarq"V gksdj vihykaV&ifjokfn;k dh vksj ls ;g vihy is'k dh xbZ gSA 6- nkSjkus cgl fo}ku odhy vihykaV~&ifjokfn;k dk eq[; eqn~nk ;g jgk gS fd ftyk eap dh QkbZfMax xyr gS D;ksafd e``rd }kjk fnukad 8-3-2004 dks izLrko i=k Hkjdj ,oa viuk LokLF; ijh{k.k nsdj mDr ikWfylh yh xbZ Fkh vkSj ;fn mlds dksbZ chekjh gksrh rks og LokLF; ijh{k.k dh tkap ds le; lkeus vk tkrh ysfdu ikWfylh ysrs le; fnukad 8-3-2004 dks fd;s x;s LokLF; ijh{k.k esa mlds dksbZ chekjh ugha vkbZ Fkh] blfy;s ;g dguk fd e`rd ikWfylh ysus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 ls iwoZ COPD (Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) chekfj;ksa ls xzLr Fkk] xyr gS blfy;s ftyk eap lokbZek/kksiqj ds vkns'k fnukad 26-9-2006 dks vikLr fd;k tkdj vihykaV~&ifjokfn;k dh vihy Lohdkj fd;s tkus dk fuosnu fd;k A 7- blds foifjr fo}ku vf/koDrk jsLiksMsaVl&L.I.C us ftyk eap ds vkns'k fnukad 26-9-2006 dks lgh crk;k vkSj vihykaV~&ifjokfn;k dh vihy [kkfjt fd;s tkus dk fuosnu fd;kA 8- bl lUnHkZ esa fopkj fd;k x;kA 1- bl dsl esa blesa dksbZ fookn ugha gS fd e`rd us fnukad 8-3-2004 dks csd MsV esa ,d ikWfylh tks fd fnukad 15-2-2004 ls izHkkoh Fkh] izLrko i=k Hkjdj yh FkhA 2- bl dsl esa blesa Hkh dksbZ fookn ugha gS fd fnukad 8-3-2004 dks e`rd us viuk LokLF; ijh{k.k fn;k Fkk ftlesa e`rd us dgk Fkk fd mlds dksbZ chekjh ugha gS uk gh mlus fdlh chekjh dk dksbZ bZykt fdlh vLirky esa HkrhZ jgdj fy;k gSA 3- bl dsl esa blesa Hkh fookn ugha gS fd e`rd dh e`R;q fnukad 17-3-2004 dks ;kfu ikWfylh ysus dh fnukad 15-2-2004 ds yxHkx 32 fnu ckn gh gks xbZ FkhA 4- blesa Hkh dksbZ fookn ugha gS fd vihykaV&ifjokfn;k dk Dyse jsLiksMsaVl&L.I.C. us vius jsiwfM;s'ku i=k fnukad 28-9-2004 esa of.kZr dkj.kksa ds vk/kkj ij jn~n dj fn;k FkkA 5- i=kkoyh esa miyC/k fjdkMZ ds vuqlkj e`rd ds lEcU/k esa ,d Vh-ch-;wfuV lokbZek/kksiqj ds MkaDVj dk fnukad 8-8-2004 dk ,d izek.k i=k ,Dth-Mh&7 yxk gqvk gS ftlesa ;g dgk x;k gS fd e`rd dks COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) dh chekjh fiNys nks lkyksa ls FkhA 6- i=kkoyh esa e`rd ds lEcU/k esa ,d MEDICAL CERFIFICATE SICKNESS izn'kZ Mh&8 dk yxk gqvk gS ftlesa ;g fy[kk gS fd e`rd us 7 fnu dh NqV~Vh fnukad 4-2-2004 ls yh Fkh vkSj chekjh COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) fy[kh gqbZ gS vkSj blesa vks-ih-Mh-ua-560----fy[kk gqvk gSA uksV% ;g izek.k i=k e`rd ds LokLF; ijh{k.k dh fnukad 8-3-2004 ls iwoZ dk gSA 7- i=kkoyh esa e`rd ds lEcU/k esa ,d MEDICAL CERFIFICATE OF FITNESS TO RETURN ON DUTY dk fnukad 10-2-2004 dk yxk gqvk gS tks fd esfMdy vkWfQlj us tkjh fd;k gS ftlesa e`rd dks fnukad 11-2-2004 dks QhV ?kksf"kr fd;k x;k gSA 8- i=kkoyh esa izn'kZ&Mh&14 lgk;d vfHk;ark¼,&II) fo-fo-fu-fy]lokbZek/kksiqj dk izek.k i=k yxk gqvk gS tks fd e`rd dk ,Eiyks;j Fkk] tks ;g nf'kZr djrk gS fd e`rd }kjk fuEu NqfV~V;k yh xbZ Fkh%& fnukad 19-9-2001 ls 21-9-2001 rd 3 fnu ih-,y- vodk'k fnukad 18-6-2002 ls 21-6-2002 rd 4 fnu ih-,y- vodk'k fnukad 16-4-2003 ls 23-4-2003 rd 8 fnu ih-,y- vodk'k fnukad 10-9-2003 ls 13-9-2003 rd 4 fnu ih-,y- vodk'k fnukad 3-12-2003 ls 6-12-2003 rd 4 fnu ih-,y- vodk'k fnukad 4-12-2004 ls10-12-2004 rd 7 fnuesfMdy vodk'k 9- vc iz'u ;g mBrk gS fd D;k mijksDr ifjfLFkfr;ksa esa ftyk eap] lokbZek/kksiqj dh QkbZfMax fnukafdr 26-9-2006 lgh gS vFkok ugha ;k jsLiksMsaVl&L.I.C. us vius jsiwfM;s'ku i=k fnukafdr 28-9-2004 ds }kjk tks Dyse vihykaV&ifjokfn;k dk jn~n fd;k Fkk og lgh gS ;k ughaA 10- gekjh jk; esa ftyk eap dh QkbZfMax dkfcys iqf"V gS D;ksafd bl izdj.k esa e`rd dk LokLF; ijh{k.k fnukad 8-3-2004 dks gqvk Fkk ftlesa mlus dgk Fkk fd mlds dksbZ chekjh ugha gS uk gh mlus fdlh chekjh dk dksbZ bZykt fdlh vLirky esa HkrhZ gksdj fy;k gS tcfd i=kkoyh esa layXu fjdkMZ ds vuqlkj ftudk mYys[k mij fd;k tk pqdk gS ls Li"V gS fd e`rd COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) chekfj;ksa ls ikWfylh ysus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 ls iwoZ ls xzLr Fkk vkSj pwafd e`rd ,d ljdkjh deZpkjh Fkk blfy;s e`rd us vius dk;ZLFky ls esfMdy ds vk/kkj ij Hkh mDr chekfj;ksa ds bZykt ds fy;s NqfV~V;k yh Fkh vkSj viuh chekjh ds mDr rF; vius Kku esa gksrs gq, Hkh e`rd }kjk ikWfylh ysus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 dks ugha crk;k x;k Fkk tcfd crk;k tkuk vko';d Fkk blfy;s ;g ekeyk Li"V :i ls chekjh Nqikus dk gSA 11- blds vykok COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) chekfj;ksa dks ekewyh [kkalh&tqdke dh chekjh ugha dgk tk ldrk gS D;ksafd COPD chekjh ,d ,slh chekjh gS tks fd ,d fnu esa fodflr ugha gksrh gS vkSj bl chekjh dks fodflr gksus esa de ls de 2 lky dk le; yxrk gSA 12- lcls egRoiw.kZ ckr ;g gS fd tc e`rd ls fnukad 8-3-2004 dks LokLF; ijh{k.k ds le; ;g iwNk x;k fd D;k mls dksbZ chekjh gS ;k mlus fdlh chekjh dk dksbZ bZykt fdlh vLirky esa HkrhZ jgdj djok;k gS rks e`rd us mldk mRrj ugha esa fn;k Fkk tcfd i=kkoyh ij miyC/k lk{; ls ;g Li"V gks tkrk gS fd e`rd ikWfylh ysus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 ls iwoZ COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) chekfj;ksa ls ihfMr Fkk ftldk mlds }kjk bZykt djok;k x;k Fkk vkSj vius dk;ZLFky ls esfMdy ds vk/kkj ij NqfV~V;k Hkh yh xbZ Fkh vkSj viuh chekjh ds mDr rF; vius Kku esa gksrs gq, Hkh e`rd }kjk LokLF; ijh{k.k dh fnukad 8-3-2004 dks viuh chekjh ds mDr rF;ksa dks Nqik;k x;k FkkA blfy;s ekeyk Li"V :i ls chekjh Nqikus dk gSA 13- mijksDr leLr rF;ksa ls ;g izekf.kr gksrk gS fd e`rd dks izLrko i=k Hkjus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 ls iwoZ bl ckr dk Kku Fkk fd mls COPD(Chronic obstructive pulmonary disease) and from congenstive Heart Failure (C.H.F.) chekfj;ka Fkh vkSj e`rd us bl ckr dk Kku gksrs gq, Hkh izLrko i=k Hkjus ,oa LokLF; ijh{k.k dh fnukad 8-3-2004 dks mDr chekjh ds rF; dks Nqikdj ikWfylh yh Fkh tcfd mls mDr chekjh dk mYys[k djuk vko';d FkkA bl izdkj Li"V :i ls ekeyk chekjh Nqikus dk jgk gSA bl dkj.k ftyk eap] lokbZek/kksiqj dk vkns'k fnukad 26-9-2006 dkfcys iqf"V gS D;ksafd og rF;ksa ij vk/kkfjr ugha gS] ,oa blh izdkj vihykaVl&L.I.C ds }kjk jsLiksMsaV&ifjokfn;k dk vius jsiwfM;s'ku i=k fnukad 28-9-2004 ds }kjk jn~n fd;k x;k Dyse lgh Fkk vkSj vihykaV&ifjokfn;k dh ;g vihy [kkfjt fd;s tkus ;ksX; gSA 14- cgl ds nkSjku fo}ku odhy vihykV&ifjokfn;k us tkfgj fd;k gS fd ;fn fdlh otg ls vihykaV&ifjokfn;k dh vihy [kkfjt dh tkrh gS rks vihykaV&ifjokfn;k tks fd e`rd dh iRuh gS mldks ex-gratia payment ds :i esa dqN jkf'k fnyok;h tkosA On ex-gratia payment
15. Ex-gratia payments are made as an act of grace, if the damage caused is outside the scope of the policy terms, or the liability under the policy is doubtful. In such cases the payment is made as an act of grace on humanitarian grounds. As a matter of fact, the loss or damage is outside the terms of the policy but the insurer takes a lenient view on humanitarian grounds. In such cases, full amount to indemnify the damages is not made.Such payments do not place the insurer under an obligation to make such payments in similar circumstances in future.
16. Further ex-gratia payment of claim would arise where there was no legal liability on the life insurance corportation to make payment as in the case of repudiated claim or unconcluded contract. Such claims are paid to mitigate hardship to the claimants by way of equitable relief. The analysis, particularly of a repudiated claim for consideration of an ex-gratia payment, would be a skilful exercise on the part of the concerned officers of the opponent life insurance corporation of india. Ex-gratia payment cannot be claimed as a matter of right. For that the law laid down by the Hon'ble National Commission in the case of LIC Vs. Shashi Gupta (1994) 2CPR 622 (NC) may be referred to.
17. Further the word 'ex-gratia' payment itself means a payment which is voluntarily and charitable in nature and since the C.P.Act, 1986 is based on the principle of equity, therefore, hypertechnicalities could be ignored and equitable consideration should be kept in mind while deciding the matter.
18- bu rF;ksa dks ns[krs gq, fd pwafd vihykaV&ifjokfn;k ,d fo/kok L=kh gS vkSj fo/kok dh fLFkfr fgUnwLrku esa vPNh ugha gS blfy;s izdj.k ds rF;ksa o ifjfLFkfr;ksa o bl ckr dks /;ku esa j[krs gq, fd e`rd dh e`R;q ikWfylh ysus dh fnukad 15-2-2004 ds yxHkx 32 fnu ckn gh fnukad 17-3-2004 dks gks xbZ Fkh vkSj ikWfylh 1]00]000@&:i;s dh Fkh blfy, yele esa 10]000@&:i;s dh jkf'k ex-gratia payment ds :i esa vihykaV&ifjokfn;k dks fnyok;k tkuk mfpr izrhr gksrk gSA mijksDr dkj.kksa ds dkj.k vihykaV&ifjokfn;k dh ;g vihy [kkfjt dh tkrh gS rFkk ftyk eap] lokbZek/kksiqj ds vkns'k fnukad 26-9-2006 dh iqf"V dh tkrh gSS ysfdu lkFk gh vkns'k fn;k tkrk gS fd jsLiksMsaVl&L.I.C 10]000@&:i;s ¼ v{kjs nl gtkj :i;s ½ yele esa vihykaV&ifjokfn;k dks ex-gratia payment ds :i esa bl fu.kZ; dh fnukad ;kfu vkt ls ,d efgus esa Hkqxrku djsaxsA ¼Jh fldanj iatkch½ ¼U;k;kf/kifr lquhy dqekj xxZ½ lnL;
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