State Consumer Disputes Redressal Commission
Ravishanker Madan vs Lic on 28 August, 2009
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thou chek fuxe] e.My dk;kZy;& thou izdk'k] Hkokuh flag jksM] t;iqjA tfj;s& e.My izca/kd jsLiksMsaV&foi{kh 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%& Jh Mh-,e-ekFkqj],MoksdsV]vihykaV&ifjoknh dh vksj ls Jh iz'kkar ea=kh],MoksdsV]jsLiksMsaV&LIC dh vksj ls jkT;
vk;ksx }kjk%& 1- ;g vihy ifjoknh&vihykaV us ftyk eap] t;iqj f}rh;] t;iqj ds vkns'k fnukad 13-1-2005 tks ifjokn la[;k 98@2004 esa ikfjr djrs gq;s ifjoknh&vihykaV dk ifjokn [kkfjt dj fn;k] ds fo:) is'k dh gSA 2- ;g bu ifjfLFkfr;ksa esa lkeus vk;k gS fd ifjoknh&vihykaV us ,d ifjokn jsLiksMsaV&LIC ds fo:) ftyk eap]t;iqj f}rh;] t;iqj esa fnukad 20-2-2004 dks ;g dgdj is'k fd;k fd jsLiksMsaV&LIC ds ,tsUV }kjk mls Asha Deep Policy ysus gsrq izksRlkfgr djus ij ifjoknh us Asha Deep Policy 25 o"kZ dh e; ,DlhMsaaV nqxquk chek doj ikfylh la- 191267035 :i;s 3]00]000@&¼v{kjs rhu yk[k :i;s ek=k½ dh yh Fkh ftldh 'krsZ fuEukuqlkj Fkh& ¼d½& chek vof/k ds nkSjku ifjoknh ;fn pkj izeq[k chekfj;ksa ;Fkk dSalj] i{kk?kkr] nksuksa xqnksZa dh fuf"Ø;rk rFkk g`n; /keuh jksx ftlesa ckbZikl ltZjh lfEefyr gS] esa ls fdlh ls jksxzLr gks tkosa rks chek/kkjh fuEu ykHkksa dk gdnkj gksxk& ¼i½ 50 izfr'kr chek jkf'k dk rqjUr Hkqxrku ¼ii½ lHkh ns; fd'rsa Hkfo"; ds fy, ekQ ¼iii½iw.kZ chek /ku dh 10 izfr'kr jkf'k jksx gksus dh frfFk ls ikWfylh dh ifjiDo gksus dh frfFk rd izfro"kZ chek/kkjh dks ns; gksxhA ¼iv½chek/ku dh 'ks"k 50 izfr'kr jkf'k dk Hkqxrku iwjs chek/ku ij cksul ds lkFk ifjiDo frfFk vFkok e`R;q tks Hkh igys gks dks ns; gksxhA ¼[k½bl ;kstuk ds rgr mDr ikWfylh ij chek vkjEHk gksus dh frfFk ls 1 o"kZ dk fy;u gksxk ftlesa mijksDr ykHk chek/kkjh dks ugha fey ldsaxsA ifjoknh&vihykaV dk vkxs ;g dguk gS fd mlds lhus esa ,d fnu vpkud xEHkhj ihMk eglwl gbZ ftl ij mls t;iqj esa Tongia Heart & General Hospital esa HkrhZ djk;k x;k vkSj ogka ij mls ckbZikl ltZjh dh lykg nh] ftl ij mlus fnukad 23-6-2000 dks Indraprastha Apollo Hospital] ubZ fnYyh esa ckbZikl ltZjh djkbZA blds ckn mlus jsLiksMsaV&LIC ds ;gka vDVwcj 2000 esa nkok izLrqrq dj 50 izfr'kr vFkkZr 1]50]000@&:i;s¼v{kjs ,d yk[k ipkl gtkj :i;s ek=k½chek jkf'k fnyk;s tkus gsrq fuosnu fd;k] ysfdu mls 2 lky yVdk;sa j[kk vkSj vUr esa vius i=k fnuakd 23-3-2002 }kjk ifjoknh&vihykaV dk ifjokn ;g dgrs gq;s [kkfjt dj fn;k fd& "We are in receipt of your letter of 22-10-2001 and note what you write but the explanation given by you is not at all satisfactory."
We have, therefore, to inform you that in view of your failure to disclose to us material information as per details mentioned in our previous letter to you of 4-10-2001 in terms of the declaration made by you at the foot of the Proposal for Assurance and the Policy contract the Policy has become null and void and all moneys paid thereunder belon to us.
blds ckn ifjoknh&vihykaV us ifjokn is'k fd;kA 3- jsLiksMsaV&LIC us ftyk eap esa viuk tokc fnukad 12-4-2004 dks fn;k ftlesa mudk ;gh dguk gS fd ifjoknh&vihykaV us fnuakd 28-6-1998 dks ns; fd'r le; ij tek ugha djkbZ Fkh ftl ij Policy dkykrhr gks xbZ o ifjoknh&vihykaV us fnukad 9-4-1999 dks vnRr izhfe;e dh jkf'k nsdj Declaration of good health (izn'kZ& vkj&3½ nsdj Policy dks fjokbZo djk;k FkkA mudk ;g Hkh dguk gS fd Indraprastha Apollo Hospital] ubZ fnYyh ds fMLpktZ fVfdV o Tongia Heart & General Hospital, Jaipur dh Discharge Summary ¼izn'kZ& vkj4 o izn'kZ& vkj5½ ds vuqlkj History ds vkxs ifjoknh dk 20 lky ls Chronic Smoker o Heavy drinker gksuk vafdr gS o ifjoknh dks Hypercholesterolemia dk gksuk vafdr gS vr% ifjoknh&vihykaV us Lothou chek izLrko o DGH es egRoiw.kZ rF;ksa dks fNikdj ikWfylh izkIr dh gS blfy, muds }kjk i=k fnukad 23-3-2002 ¼izn'kZ vkj&6½ ls ifjoknh&vihykaV dk Dyse lgh jn~n fd;k gS ftlesa dksbZ xyrh ugha gksus ls ifjoknh&vihykaV dk ifjokn [kkfjt fd;k tk,sA 4- ftyk eap us nksuks i{kksa dks lquus ds ckn ifjoknh&vihykaV dk ifjokn [kkfjt dj fn;k ;g ekurs gq;s fd& ^^ifjoknh us Lothou chek izLrko i=k ifjf'k"V vkj@1 esa Øksfud Leksdj o gSoh fMªadj rFkk gkbZijdksysLVªksysfe;k dh chekjh ls xzflr gksrs gq, Hkh] vius LokLF; ds lEcU/k esa] bu rF;ksa dks tkucw>dj fNikdj] chek ikWfylh ifjf'k"V vkj@2 izkIr dh rFkk 9-4-99 dks Mh-th-,p-¼fMD;yjs'ku vkWQ xqM gSYFk½ ifjf'k"V vkj@3 esa] bu rF;ksa dks fNikdj] chek ikfylh dk iquZpyu djok;kA bl izdkj foi{kh Hkkjrh; thou chek fuxe }kjk ifjoknh dk chek Dyse ifjf'k"V&1 fnukafdr 23-3-2002 ds }kjk fujLr dj] dksbZ lsoknks"k dkfjr ugha fd;k x;k gSA** 5- ml vkns'k ls vlarq"V gksdj ifjoknh&vihykaV us ;g vihy is'k dh gSA 6- fo}ku odhy ifjoknh&vihykaV dk nkSjkus cgl vihy eq[; :i ls fuEu eqn~ns jgs gSa& 1- ;g fd tc ifjoknh&vihykaV }kjk Policy fnukad 28-6-1997 dks yh xbZ Fkh vkSj LokLF; ijh{k.k ds fnu mls dksbZ chekjh ugha FkhA 2- ;g fd Policy fjokbZo ds le; ifjoknh&vihykaV dks dksbZ chekjh ugha Fkh vkSj ifjoknh dks gkVZ esa ijs'kkuh vpkud gqbZ Fkh tks fd Policy fjokbZo djkus dh fnukad 9-4-1999 ds ckn twu 2000 esa gqbZ gS blfy, ;g ekeyk chekjh fNikus dk ugha gSA 3- ;g fd dsoy ek=k vLirky ds cSM gSM fVfdV esa fy[k nsus ek=k ls ;g ugha ekuk tk ldrk fd ifjoknh&vihykaV 20 lky ls Chronic Smoker o Heavy drinker gS o ifjoknh dks Hypercholesterolemoia gks vr% ;g ekeyk fdlh Hkh lwjr esa chekjh fNikus dk ugha gS vr% blds foijhr ftyk eap us tks vkns'k ikfjr fd;k gS og xyr gksus ls fujLr fd;k tkdj ifjoknh&vihykaV dh vihy Lohdkj dh tk,sA 7- blds foijhr fo}ku odhy jsLiksMsaV&LIC dk dguk gS fd ftyk eap dh QkbZfMax rF;ksa ij vk/kkfjr gS ftlesa fdlh izdkj dh dksbZ xyrh ugha gS vr% ifjoknh&vihykaV dh vihy [kkfjt dh tk,sA 8- bl lanHkZ esa fopkj fd;k x;kA 9- bl dsl esa blesa dksbZ fookn ugha gS fd ifjoknh&vihykaV us jsLiksMsaV~& ls Asha Deep Policy with Profits(With accident benefit) ¼izn'kZ vkj&2½ 25 o"kZ gsrq fnukad 28-6-1997 dks 3]00]000@&:i;s¼v{kjs rhu yk[k :i;s ek=k½ dh yh Fkh ftlds ikWfylh la- 191267035 gSA 10- blesaa Hkh dksbZ fookn ugha gS fd mDr Policy ysrs le; ifjoknh us Lothou chek izLrko&i=k¼izn'kZ vkj&1½ Hkjk Fkk ftlesa vius dksbZ chekjh gksuk ugha crk;k gSA 11- blesa Hkh dksbZ fookn ugha gS fd ifjoknh us viuh Policy fnuakd 9-4-1999 dks vnRr izhfe;e vnk dj fjokbZo djkbZ Fkh o Declaration of good health ¼izn'kZ vkj&3½ Hkjk Fkk ftlesa Hkh mls dksbZ chekjh ugha gksuk dgk gSA 12- blesa Hkh dksbZ fookn ugha gS fd i=kkoyh esa Tongia Heart & General Hospital, Jaipur dk Discharge Summary ¼izn'kZ&vkj 5½ yxh gqbZ gS ftlds vuqlkj ifjoknh&vihykaV mDr vLirky esa fnukad 3-6-2000 ls 6-6-2000 rd HkrhZ jgk Fkk tgka ij mlds gkVZ dh chekjh ikbZ xbZ ftlesa ifjoknh&vihykaV dks Chronic Smoker o Heavy drinker gksuk crk;k gSA 13- blesa Hkh dksbZ nkSjk; ugha gS fd i=kkoyh esa Tongia Heart & General Hospital, Jaipur dk Coronary Angiography Report fnukad 5-6-2000 ¼ist ua-53½ yxh gqbZ gS ftlds vuqlkj Indication esa Chest pain dk Investigation gksuk o mlds uhps Risk Factors esa Smoker/Obese/Hypertension/Hyperchol gksuk vafdr fd;k gSA 14- blesa Hkh dksbZ nkSjk; ugha gS fd i=kkoyh esa Indraprastha Apollo Hospital dh Discharge Summary ¼izn'kZ&vkj4½ yxh gqbZ gS ftlds vuqlkj ifjoknh&vihykaV ogka ij fnukad 21-6-2000 ls 30-6-2003 rd HkrhZ jgk gS rFkk ogka ij mldk fnukad 23-6-2002 dks CABG dk vkWijs'ku fd;k x;k gS o History esa ifjoknh dk 20 lky ls Chronic Smoker o Heavy drinker gS o ifjoknh dks Hypercholesterolemoia gksuk fy[kk gqvk gSSA 15- blesa Hkh dksbZ nkSjk; ugha gS fd Tongia Heart & General Hospital, Jaipur ds Dr. Sanjiv Gupta us ifjoknh dks ckbZikl ltZjh ds ckn esa fnukad 2-11-2002 dks Low Cholesterol Diet ysus] Regular Exercise djus o Weight Reduction djus o Smoking ugha djus dh lykg¼ist ua-56½ nh gSA 16- ,slh fLFkfr esa vc ;g ns[kuk gS fd ftyk eap dh QkbZfMax ftlds }kjk ifjoknh&vihykaV dk ifjokn [kkfjt fd;k x;k] dkfcys iqf"V gS ;k ugha rFkk jsLiksMsaV&LIC }kjk ifjoknh&vihykaV dk Dyse lgh jn~n fd;k x;k ;k ughaA 17- bl dsl esa ;g rF; fufoZokn gS fd ifjoknh&vihykaV }kjk Policy fnukad 28-6-1997 dsk yh vkSj mls fnukad 9-4-1999 dks fjokbZo djk;k o ifjoknh&vihykaV dk Policy ysus o fjoksbZo djkus ls iwoZ bl ckr dk dksbZ fjdkMZ ugha gS fd ifjoknh&vihykaV us gkVZ dh chekjh dk bZykt djk;k gksA 18- bl dsl esa ifjoknh&vihykaV dh Policy fnukad 9-4-1999 dks fjokbZo gqbZ gS vkSj ifjoknh dks gkVZ esa rdyhQ loZizFke twu 2000 esa gqbZ gS o ifjoknh&vihykaV igys Tongia Heart & General Hospital, Jaipur esa fnukad 3-6-2000 ls 6-6-2000¼izn'kZ&vkj 5½ rd HkrhZ jgk gS o HkrhZ jgus ds nkSjku ifjoknh us ogka Angiography djkbZ gS ftldh fjiksVZ fnukad 5-6-2000¼ist 53½ ij gS o mlds ckn og Indraprastha Apollo Hospital esa fnukad 21-6-2000 ls fnukad 30-6-2000 ¼izn'kZ&vkj4½ rd HkrhZ jgk gS ,oa mldk ogka fnukad 23-6-2000 dks vkWijs'ku fd;k x;k gSA 19- egt Tongia Heart & General Hospital o Indraprastha Apollo Hospital dh Discharge Summary esaa ifjoknh&vihykaV dk Chronic Smoker o Heavy drinker gksuk o ifjoknh dks Hypercholesterolemoia gksuk fy[kus ek=k ls ;g fu"d"kZ ugha fudkyk tk ldrk dh ifjoknh&vihykaV us bu rF;ksa dks Policy ysrs ls le; o fjokbZo djkrs le; fNik;k gksA 20- ;gka dguk mfpr gksxk fd ekuuh; jk"Vªh; vk;ksx us National Insurance Co.Ltd. V/s Bipul Kundu II(2005)CPJ12(NC) = 2005CTJ 377(CP)(NCDRC) esa ;g fl)kUr izfrikfnr fd;k gS fd& "May be referred to where it was held that for repudiating a claim of an insured, it is for the insurer to show that a statement on a fact, which was material for the policy, had been suppressed by the insured and that statement was fraudulently made by him/her with the knowledge of the falsity of that statement."
21- bl fl)kUr dks /;ku esa j[krs gq;s vxj dksbZ O;fDr Smoke o drink djus dk vkfn gks vkSj bl ckr dks mlds }kjk LokLF; ijh{k.k esa ugha crk;k gS rks blls ;g fu"d"kZ fudkyuk dh chek/kkjh us mls Fraudulently ;k /kks[kk nsus dh fu;r ls fNik;k gks] ugha ekuk tk ldrkA 22- tgka rd 'kjkc ihus dk lEcU/k gS vkt ds ;qx esa fdrus gh yksx 'kjkc ihrs gS vkSj cM+s yksx rks T;knk gh 'kjkc ihrs gSA vxj ifjoknh&vihykaV }kjk 'kjkc ds rF;ksa dks fNik;k tkuk ekuk tkos rks fQj gj dsl esa Policy ds rF;ksa dks fNik;k tkuk ekuk tkosxk 23- bl dsl esa blesa Hkh dksbZ fookn ugha gS fd ifjoknh&vihykaV }kjk Policy ysus dh fnukad 28-6-1997 o Policy fjokbZo djkus dh fnukad 9-4-1999 ls igys dk gkVZ dk bZykt djkus ds lEcU/k esa i=kkoyh ij dks fjdkMZ ugha gS ,oa Tongia Heart & General Hospital o Indraprastha Apollo Hospital dh Discharge Summary ¼izn'kZ&vkj 5 o vkj&4½ twu 2000 ds gSA ;gka Li"V fd;k tkrk gS fd gkVZ ,d ,slh chekjh gS tks vpkud gks ldrh gS ftldk irk izR;sd O;fDr dks igys ls gks] ekuus okyh ckr ugha gS D;ksafd gkVZ vVsd ,d ,slh chekjh gS tks ftlesa vVsd vpkud iMrk gS vkSj 40 izfr'kr ejht rks vLirky igqapus ls igys gh ej tkrs gSA uksV& ;gka Li"V fd;k tkrk gS fd bl dsl esa ifjoknh&vihykaV us Lo;a ds uke ikWfylh yh Fkh vkSj mlds gkVZ dk vkWijs'ku gqvk Fkk ,oa mlh dh jkf'k ds lanHkZ esa ifjoknh&vihykaV }kjk Dyse jsLiksMsaV&LIC ds ;gka is'k fd;k gSA 24- blds vykok Mere incorrect or wrong answer to questions which ultimately do not have any bearing or connection with the Death of the deceased would not absolve the LIC from its liability under the policy and thus from that point of view also repudiation of the claim of the complainant by the Respondent could not be justified.
25- blfy, vxj ifjoknh&vihykaV us Smoke o drink djus ds rF; dks viuh chek Policy djkrs o fjokbZo ds le; ugha crk;k rks ;g Suppression of concealment of material facts ugha dgyk,sxkA ;g blfy, Hkh ugha dgyk,sxk D;ksafd tks rF; Tongia Heart & General Hospital o Indraprastha Apollo Hospital }kjk History esa fy[ks x;s gS og Authentic piece of evidence ugha gksrh gS vkSj d;kl ek=k gksrk gSA 26- vxj ifjoknh&vihykaV ds lEcU/k esa Policy ysus ls iwoZ ;k fjokbZo ls iwoZ gkVZ dh chekjh ds lEcU/k esa dksbZ lcwr gksrs ;k /kweziku djus o 'kjkc ihus ls lacaf/kr vU; dksbZ chekjh Policy ysus ;k fjokbZo djkus ls iwoZ gksrh] rks ckr vyx gksrh] ysfdu ,slk dksbZ fjdkMZ i=kkoyh esa miyC/k ugha gSA 27- mijksDr dkj.kksa ds vk/kkj ij jsLiksMsaV&LIC }kjk ifjoknh&vihykaV dk dsl vius i=k fnukad 23-3-2002 }kjk fujLr dj lsok esa deh dh gS o ftyk eap dh QkbZfMax ftlds }kjk ifjoknh&vihykaV dk ifjokn Policy ysrs le; chekjh fNikuk ekurs gq;s [kkfjt fd;k gS] dkfcys iqf"V ugha jgrk gS o fujLr fd;s tkus ;ksX; gSA {kfriwfrZ ds lEcU/k esa& 28- pwafd bl dsl esa ifjoknh&vihykaV us jsLiksMsaV&LIC ls Asha Deep Policy with Profits(With accident benefit) ¼izn'kZ vkj&2½ 3]00]000@&:i;s chek/ku dh izkIr dh Fkh ftldh 'krkZs dks gekjs }kjk Åij dksM fd;k tk pqdk gS ftlds vuqlkj ifjoknh chek jkf'k dh 50 izfr'kr jkf'k vFkkZr 1]50]000@&:i;s¼v{kjs ,d yk[k ipkl gtkj :i;s ek=k½ o ml ij Policy dh 'krksZsa ds vuqlkj ns; ykHk izkIr djus dk vf/kdkjh gS o ifjoknh&vihykaV blds vykok mDr ns; jkf'k ij ifjokn i=k is'k djus dh fnukad 20-2-2004 ls rkvnk;xh izkIr djus dk vf/kdkjh gSA 29- ;gka Li"V fd;k tkrk gS fd jsLiksMsaV&LIC dh lsok esa deh ds dkj.k ifjoknh&vihykaV dks igys ftyk eap esa ifjokn is'k djuk iMk o ckn esa bl vk;ksx esa vihy esa Hkh vk;k gS vr% fuf'pr :i ls ifjoknh dks vuko';d :i ls ijs'kkfu;ksa dk lkeuk djuk iMk gS vr% ekeys ds leLr rF;ksa ,oa ifjfLFkfr;ksa dks ns[krs gq;s ifjoknh&vihykaV dks jsLiksMsaV&LIC ls yele esa ,d eq'r dksLV Lo:i 3]000@&:i;s¼v{kjs rhu gtkj :i;s ek=k½ fnyk;k tkuk mfpr gSA 30- mijksDr dkj.kksa ds vk/kkj ij ifjoknh&vihykaV dh vihy Lohdkj dh tkus ;ksX; gSA ifj.kker% ifjoknh&vihykaV dh vihy Lohdkj dh tkrh gS] ftyk eap]t;iqj f}rh;] t;iqj dk fookfnr vkns'k fnukad 13-1-2005 fujLr fd;k tkrk gS rFkk ifjoknh&vihykaV dk ifjokn fo:) jsLiksMsaV&LIC bl izdkj ls Lohdkj fd;k tkrk gS fd& 1- jsLiksMsaV&LIC ] ifjoknh&vihykaV dks chek ikWfylh dh 'krksZa ds vuqlkj chek /ku 3]00]000@&:i;s¼v{kjs rhu yk[k :i;s ek=k½ dh vk/kh jkf'k 1]50]000@&:i;s¼v{kjs ,d yk[k ipkl gtkj :i;s ek=k½ o ml ij ns; ykHk o bl jkf'k ij ifjoknh&vihykaV }kjk ifjokn&i=k is'k djus dh fnukad 20-2-2004 ls rkvnk;xh 09 izfr'kr izfro"kZ dh nj ls vnk djsaxsA 2- jsLiksMsaV&LIC ] ifjoknh&vihykaV dks dksLV Lo:i 3]000@&:i;s¼v{kjs rhu gtkj :i;s ek=k½ Hkh vkt ls nks ekg esa vnk djsaxsA 3- ifjoknh&vihykaV dh 'ks"k izkFkZuk fujLr dh tkrh gSA ¼Jherh foeyk lsfB;k½ ¼U;k;kf/kifr lquhy dqekj xxZ½ lnL;k v/;{k @@eukst@@