State Consumer Disputes Redressal Commission
Ramveer vs Sri Ram Life Insurance Co. Ltd on 11 October, 2023
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 First Appeal No. A/1114/2018 ( Date of Filing : 12 Jun 2018 ) (Arisen out of Order Dated 18/05/2018 in Case No. C/16/2017 of District Jyotiba Phule Nagar) 1. Ramveer Amroha ...........Appellant(s) Versus 1. Sri Ram Life Insurance Co. Ltd Haidrabad ...........Respondent(s) BEFORE: HON'BLE MR. Rajendra Singh PRESIDING MEMBER HON'BLE MR. Vikas Saxena JUDICIAL MEMBER PRESENT: Dated : 11 Oct 2023 Final Order / Judgement Reserved State Consumer Disputes Redressal Commission U.P. Lucknow. Appeal No. 1114 of 2018 Ramveer s/o Mahipal, R/o Gram, Adampur Dr. Adampur, Tehsil, Hasanpur, Janpad, Amroha. ...Appellant. Versus Shriram Life Insurance Co. Ltd. through Manager, Shriram Life Insurance Co. Ltd., Plot no.31 and 32, 5th and 6th Floor, Ramky Selenium, beside Andhra Bank Training Centre, Financial District, Gochibowli, Hyderabad-500032 ....Respondents. Present:- 1- Hon'ble Mr. Rajendra Singh, Presiding Member. 2- Hon'ble Mr.Vikas Saxena, Member. Sri R.D. Kranti, Ld. counsel for appellant. None for respondent. Date 20.10.2023 JUDGMENT
Per Sri Rajendra Singh, Member- This appeal has been filed against the judgment and order dated 18.5.2018 passed by the Ld. District Commission, Amroha in complaint case no.16 of 2017, Ramveer vs. Shriram Life Insurance Co. Ltd.
The brief facts of the appeal are that, that the wife of the appellant/complainant got insured for 15 years having a annual premium of Rs.13,476/-. The first premium was paid on 21 August 2015. Unfortunately the wife of the appellant died on 30.12.2015 due to vomiting and diarrhoea and the insurance company was informed immediately. The complainant filed a claim which was repudiated and thereafter complaint was filed before the Learned District Consumer Commission. The impugned judgment and order of the learned District Consumer Commission, Amroha is against the law and facts. The proposal form was filled after completing enquiry and the appellant wife was healthy at that time. When the claim was filed before the insurance company, the matter was investigated and the officials of the insurance company did not take evidence of the neighbours. The insurance company sent a letter to the complainant saying that at the time of taking policy the insured had five months pregnancy therefore the claim is repudiated. It is wrong to say that she was pregnant and the time of taking policy. She was died due to vomiting and diarrhoea. No document has been filed by the insurance company regarding her pregnancy or her delivery. The learned District commission did not consider all the matters and dismissed the claim of the appellant. The said judgment and order is not according to the facts of the case hence it is most humbly prayed that the present appeal be allowed and the judgment of the Learned District Commission be set aside.
We heard the learned counsel for the appellants Sri R.D. Kranti. None is present from the side of the respondent and as per office report dated 31.07.2018 the notice has not been returned unserved till date, hence the service on the respondent is held sufficient.
The appellant has stated that the death was during the course of delivery. The fact that at the time of taking policy, the insured was pregnant, has been concealed therefore on the ground of concealment of a vital fact the claim has been repudiated which was correct. The learned District Consumer Commission has discussed about the statement of the Asha worker and also the worker of the Sadhna Saini Anganbadi that the insured Munesh was pregnant of nine months and on 30.12.2015 pregnant lady and her child expired. Here one question arises, both the child and mother expired during delivery, it should have been known to the police station or the hospital concerned. The insurance company has not produced any eyewitness who can say that they have seen the dead body of the insured and her child. Who attended the insured person during her delivery? There was no need to conceal the fact of pregnancy.
Further if any person dies and his/her last ritual is performed at any Ghat, the concerned person issues a death certificate. No such certificate had been filed by the insurance company. Only the photocopy of the statement has been filed as discussed in the judgment of the learned District Consumer Commission. Some doctor must have attended the insured person during her pregnancy because so many complications arises during pregnancy and it is necessary to be checked by a physician or by a gynaecologist. No such evidence has been filed by the insurance company.
In such circumstances we are not convinced with the argument of the appellant that the insured was pregnant at the time of issuance of proposal and she expired during delivery with a child. Therefore the learned District Commission should have inquired about it but he did not performed his duty properly. Hence the impugned judgment is liable to set aside and the appeal is liable to be allowed.
ORDER The appeal is allowed with cost. The impugned judgment and order passed by the learned District Consumer Commission, Amroha in complaint case no.16/2017 is set aside. The opposite party is directed to pay the insured amount of Rs.8,40,000/- to the complainant within 30 days from the date of judgment of this appeal otherwise the opposite party shall pay interest at a rate of 12% per annum from 30.12.2015 till the date of actual payment. The opposite party is also directed to pay to the complainant Rs.50,000.00 towards mental agony and Rs.20,000.00 towards cost of the case within 30 days from the date of judgment of this appeal otherwise the opposite party shall pay interest at a rate of 12% per annum from 30.12.2015 till the date of actual payment.
The stenographer is requested to upload this order on the Website of this Commission today itself.
Certified copy of this judgment be provided to the parties as per rules.
(Vikas Saxena) (Rajendra Singh) Member Presiding Member Judgment dated/typed signed by us and pronounced in the open court. Consign to record. (Vikas Saxena) (Rajendra Singh) Member Presiding Member Dated 20.10.2023 Jafri, PA I (H) Court 2 [HON'BLE MR. Rajendra Singh] PRESIDING MEMBER [HON'BLE MR. Vikas Saxena] JUDICIAL MEMBER