National Consumer Disputes Redressal
Hansraj Juneja (Since Dead) Through Lrs vs M/S. Royal Sundaram Alliance Insurance ... on 26 August, 2015
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 3625 OF 2012 (Against the Order dated 16/07/2012 in Appeal No. 545/2008 of the State Commission Haryana) 1. HANSRAJ JUNEJA (SINCE DEAD) THROUGH LRS W/o Late Shri Hansraj Juneja R/o A-1/209 G.F Paschim Vihar Delhi 2. Jagdish Chander, S/o Late Shri Hansraj Juneja A-1B/95-A LIG Flats,Paschim Vihar Delhi 3. Harish Juneha, S/o Late Shri Hansraj Juneja C/o Shiv General Store,Model Town D Park Rohtak Haryana 4. Deepak Juneja, S/o Late Shri Hansraj Juneja C/o A-1/209 GF,Paschim Vihar Delhi 5. Ms Neelam Madan,D/o Late Shri Hansraj Juneja C/o A-1/209 GF,Paschim Vihar Delhi 6. Ms Shashi Ahuja, D/o Late Shri Hansraj Juneja C/o A-1/209 GF,Paschim Vihar Delhi 7. Ms Ranjana Malhotra, D/o Late Shri Hansraj Juneja C/o A-1/209 G.F,Paschum Vihar Delhi ...........Petitioner(s) Versus 1. M/S. ROYAL SUNDARAM ALLIANCE INSURANCE CO. LTD. & 2 ORS. Gurgoan Through Sh Srinivasan Deputy General Manager-Legal Of M/s Royal Sundaram Alliance Insurence Co Ltd, Sundaram Towers 45&46 Whites Road Duly Constituted Attorney Chennai - 600014 2. Pawan Juneja, S/o late Shri Hansraj Juneja B-725 Clifton Way 203 Baverly Hills, CA 90211 USA 3. Rakesh Kumar Juneja, S/o Late Shri Hansraj Juneja APT 914155 Hillcrest Avenu Mississauga On Post, CODE L5B3Z2 Canada ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER
For the Petitioner : Mr. Jagdish Chandra
LR of deceased Hansraj Juneja (insured) For the Respondent : For the Respondent No.1 : Mr. S.M. Tripathi, Advocate
For the Resp. Nos.2 & 3 : NEMO
Dated : 26 Aug 2015 ORDER
Despite of a pass-over given counsel for the petitioner has not turned up. Therefore, I am left with no alternative but to go through the file. Heard arguments of respondent No.1 and decide the matter.
2. This revision is directed against the order of the Haryana State Consumer Disputes Redressal Commission, Panchkula (in short, "the State Commission") dated 16.7.2012 in first appeal No.545/2008 whereby the State Commission reversed the order of the District Forum granting compensation to the petitioner and dismissed the complaint. Basis of the order is that late insured had obtained the insurance policy by concealment of material fact.
3. It is undisputed that late Shri Hansraj Juneja purchased a travel insurance policy, which included the reimbursement of medical expenses incurred during travel, from respondent No.1 insurance company on payment of premium. Insurance policy was issued for the period 15.4.2002 to 13.7.2002 and it was further extended upto 13th September, 2002 on payment of additional premium of Rs.10,452/-. Case set up by the complainant is that on 8.7.2002 complainant developed symptoms of slurred speech and decreased left extremity movement. He was, therefore, taken to Gundersen Lutheran Medical Centre LA Crossee, Wisconsin 54601 for treatment where he was treated till he was discharged on 10.7.2002. The complainant allegedly spent a sum of US Dollars 15,000/- on his treatment. Late Shri Hansraj Juneja submitted an insurance claim for reimbursement of hospital charges amounting to USD 10079.17. The insurance claim was, however, repudiated on the ground that the complainant at the time of obtaining insurance policy was suffering from hyper tension which fact was concealed by the complainant.
4. The District Forum on consideration of pleadings and the evidence allowed the complaint and directed the respondent/opposite party to pay the insurance claim upto the extent of insurance limit with interest @ 9% p.a. Besides compensation, litigation cost of Rs.5,000/ was imposed on respondent No.1.
5. Being aggrieved of the order the respondent insurance company preferred an appeal and the State Commission, Haryana vide impugned order took the view that late Shri Hansraj Juneja had obtained insurance policy by concealment of material fact. Therefore, the insurance contract was void. The State Commission accordingly allowed the appeal and dismissed the complaint. The petitioners, who are the legal heirs of late Shri Hansraj Juneja (insured) have preferred the revision petition. As per the grounds of revision the stand of the petitioners is that the State Commission has committed a grave error in holding that the insurance policy was obtained by misrepresentation and concealment of fact whereas there is no evidence to substantiate the aforesaid finding.
6. Learned Shri S.M. Tripathi, Advocate for respondent No.1 has argued in support of the impugned order and drawn my attention to the proposal form submitted by late Shri Hansraj Juneja for obtaining the insurance policy wherein in response to the question, "whether the insured had suffered from any illness/disease or had an accident or ever been admitted in hospital/nursing home/clinic for treatment or observation in 24 months preceding the date to proposing for insurance", late Shri Hansraj Juneja had replied in the negative. Learned counsel for respondent No.1/insurance company has also taken me through the discharge summary of late Shri Hansraj Juneja pertaining to his treatment abroad wherein in the column of past medical history it is recorded as under: -
"Hypertension, constipation, hemorrhoids with some bleeding one month ago, no recent surgeries, no history of aneurysm or aneurysm or arteriovenous malformation, and no true gastrointestinal bleed other than the hemorrhoidal bleeding."
7. Learned counsel has also referred to a letter dated 26th September, 2002 addressed by the Doctor of the concerned hospital to Satish Dhawan, Business Manager, Resolve consultants (Inspector) which reads as under: -
"I am thankful we were able to resolve the difficulty with the signed release. In answer to your questions, Mr. Juneja had slurred speech with the right middle cerebral artery distribution infarct, not because of an aphasia, i.e. a language problem which you are correct would be located in the left hemisphere, but more because of weakness in the musculature involved in the production of speech and his consequential facial weakness on the left side. Mr. Juneja did have history of hypertension, which is a known risk factor for stroke, but certainly would not tell him that he was definitely going to suffer a stroke because of its. I hope this answers your questions appropriately. Please contact me if you have any further questions.
8. Learned counsel has contended that on reading of the history recorded in the discharge summary and the letter of the concerned Doctor, it is clear that late Shri Hansraj Juneja did have a history of hyper tension which is known risk factor for stroke. This fact was concealed by late Shri Hansraj Juneja in his response given to the question about his physical condition in the proposal form and as such in the view of the judgment of the Hon'ble Supreme Court in the matter of Satwant Kaur Sandhu Versus New India Assurance Company Limited (2009) 8 SCC 316, the respondent No.1/insurance company was justified in repudiating the claim. Thus, the order of the State Commission cannot be faulted.
9. I do not find merit in the contention of learned counsel for respondent No.1/insurance company. In order to succeed in its defence, the onus of proving that the insured had concealed the material facts in the proposal form was on the insurance company. Respondent No.1/insurance company has placed heavy reliance upon the medical record pertaining to the treatment of the insured late Shri Hansraj Juneja and the letter of the concerned Doctor dated 26.9.2002. In both these documents it is recorded that Shri Hansraj Juneja did have history of hyper tension but it is not specified since when Shri Hansraj Juneja was suffering from hyper tension. In absence of any evidence in this regard, one cannot conclude that late Shri Hansraj Juneja was suffering from hyper tension on the date of filling the proposal from i.e. 8.4.2002 or for that matter he was aware at that time that he was suffering from hyper tension. In absence of any cogent evidence in this regard, the State Commission, in my view has committed a grave error in holding that late Shri Hansraj Juneja obtained the insurance policy by concealment of material fact. Therefore, the impugned order cannot be sustained.
10. In view of the discussion above, revision petition is allowed, impugned order is set aside and the order of the District forum is restored.
......................J AJIT BHARIHOKE PRESIDING MEMBER