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STATE CONSUMER DISPUTES REDRESSAL COMMISSION, MAHARASHTRA, MUMBAI Appeal No.A/12/64 (Arisen out of order dated 15/11/2011 in Complaint No.217 of 2009 of District South Mumbai) Life Insurance Corporation of India, Central Office, 3rd Floor, Jeevan Bima Marg, Mumbai 400 021. Through The Zonal Manager, LIC of India, Yogakshema, Jeevan Bima Marg, Mumbai 400 021.

…..Appellant(s)

Versus 1. Smt. Manju Sharma, 301, Vrindavan Vrajbhoomi Complex, Dahanukar Wadi, Kandivali (West), Mumbai 400 067. 2. Deepak J. Raichuri, 13, Jay Vishambhari Society Ltd., 1st Floor, Opp. Turakhai Park, M.G. Road, Kandivali (West), Mumbai 400 067.

........Respondent

Appeal No.A/12/171 (Arisen out of order dated 15/11/2011 in Complaint No.217 of 2009 of District South Mumbai) 1. Smt. Manju Sharma, 301, Vrindavan Vrajbhoomi Complex, Dahanukar Wadi, Kandivali (West), Mumbai 400 067. Versus 1. Life Insurance Corporation of India, Central Office, 3rd Floor, Yogakshema, Jeevan Bima Marg, Mumbai 400 021.

…..Appellant(s)

........Respondent

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2. Deepak J. Raichuri, 13, Jai Vishambhari CHS Ltd.,., 1st Floor, Opp. Turakhai Park, M.G. Road, Kandivali (West), Mumbai 400 067. BEFORE: Mrs.Usha S. Thakare – Presiding Judicial Member Mr.D.R.Shirasao, Judicial Member PRESENT: Advocate Mr.A.S. Vidyarthi for Life Insurance Corporation of India, original opponent no.1. Advocate Ms.Rashimi Manne for Smt.Manju Sharma/original complainant. Advocate Mr.Ajay Pawar for Deepak J. Raichuri/original opponent no.2. COMMON ORDER Per Hon’ble Mr.D.R. Shirasao – Judicial Member: (1)

Ld.South Mumbai District Consumer Disputes Redressal Forum by passing

order

dated

15/11/2011

in

Consumer

Complaint

No.217/2009 directed opponent Life Insurance Co. Ltd. to pay amount of Rs.2,50,000/- to complainant – Manju Sharma, to pay compensation of Rs.10,000/- and costs of Rs.5,000/- to her. Being aggrieved by the same opponent no.1 – Life Insurance Corporation of India has filed First Appeal No.A/12/64 and Complainant Manju Sharma has filed Appeal No.A/12/171. Hence, both the appeals are decided by this common order. (2)

Complainant – Manju Sharma filed complaint for getting amount of Rs.2,50,000/- from the opponent Life Insurance Corporation along with interest on that amount, costs and compensation.

She

submitted that her deceased husband Vishwajeet Sharma had filed proposal for getting Jeevan Mitra Tripple Cover Policy to the

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opponent Life Insurance Corporation.

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Before issuing insurance

policy in favour of Vishwajeet Sharma he was required to undergo medical examination under the supervision of panel doctors of opponent Life Insurance Corporation. Accordingly Vishwajeet Sharma had undergone various medical tests and investigation as directed by the panel doctors of opponent. Complainant submitted that after considering medical report of Vishwajeet Sharma opponent no.1 issued life insurance policy bearing No.891591365 in favour of her husband Vishwajeet Sharma which was styled as “Jeevan Mitra Tripple Cover Policy”. The same was for the period from 28/04/2004 to 28/04/2034.

The amount insured was

Rs.2,50,000/-. Complainant submitted that her husband Vishwajeet Sharma had deposited annual premium of Rs.12,833/- with the opponent Life Insurance Corporation. She submitted that in the month of September, 2004 her husband suffered from dengue fever. Subsequently, he suffered from renal failure and ultimately her husband died on 21/04/2007 due to cardio respiratory arrest. She submitted that she had made claim for getting amount of this insurance policy with the opponent life insurance corporation. However, the opponent by issuing letter dated 28/02/2008 repudiated her claim. Hence, complainant filed this complaint for getting amount of Rs.2,50,000/- as the amount of insurance from opponent Life Insurance Corporation along with interest on that amount along with costs and compensation. (3)

Opponent Life Insurance Corporation contested claim by filing their written version on record. They submitted that in respect of getting insurance policy deceased had given proposal form on 23/05/2004. In that proposal form he had given declaration that before accepting first premium amount if there is any change in his health or in the

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health of his family he will inform about the same to opponent. They submitted that first premium of deceased Vishwajeet Sharma was accepted by opponent no.1 Insurance Company on 28/05/2004. Deceased Vishwajeet Sharma had undergone pathological tests and in those pathological tests it was revealed that creatinine level of complainant was increased. However, he had not informed this fact to opponent before accepting his premium amount. Hence, they submitted that deceased husband of complainant had suppressed material facts in respect of his health from opponent.

Hence,

opponent Insurance Company had rightly repudiated the claim of complainant.

Hence, they submitted that complaint filed by

complainant is to be dismissed. (4)

Considering rival contentions of parties, evidence adduced by them on record and documents filed by them on record, the Ld.District Forum partly allowed the claim of complainant directing opponent no.1 Life Insurance Corporation to pay amount of Rs.2,50,000/- to complainant along with interest on that amount. The Ld.District Forum had also directed opponent no.1 Life Insurance Corporation to pay amount of Rs.10,000/- as compensation to the complainant and amount of Rs.5,000/- as costs of litigation to her.

Being

aggrieved by the same opponent no.1 Life Insurance Corporation has filed Appeal No.A/12/64 and Complainant has filed appeal No.A/12/171. (5)

Heard Ld.Advocate appearing for complainant - Manju Shama. She submitted that Life Insurance policy taken by deceased husband of complainant was Tripple Cover policy. She submitted that, hence, complainant was entitled to get amount of Rs.7,50,000/- from Life Insurance Corporation along with costs and compensation. She

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submitted that, however, Ld.District Forum had given amount of Rs.2,50,000/- only to complainant from Insurance Corporation. Hence, she submitted that the order passed by the Ld.District Forum be modified and complainant be given amount of Rs.7,50,000/from Life Insurance Corporation along with costs and compensation along with interest on that amount. (6)

Heard Ld.Advocate appearing for Insurance company.

He

submitted that the deceased husband of Complainant Vishwajeet Sharma had submitted his proposal form for getting this policy on 23/05/2004. At that time by giving proposal Forum Vishwajeet Sharma had given declaration that if there will be any change in his health he will inform about the same to opponent before acceptance of his first premium for the policy. He submitted that thereafter on 25/04/2004 the deceased husband of complainant had undergone several pathological tests. During those pathological tests it was revealed that creatinine level of complainant has been increased. He submitted that in view of declaration given by Vishwajeet Sharma he was required to inform this fact to opponent Life Insurance corporation. If he would have informed this fact to opponent, either opponent would not have given policy to him or had taken more amount of premium from him.

He submitted that as deceased

husband of complainant had suppressed material fact in respect of his health from opponent, opponent had rightly repudiated the claim of complainant. He submitted that, moreover, as per this policy the insured will get triple amount of insurance only if he dies accidentally. The deceased husband of complainant had not died in accident and hence, complainant is not entitled to claim triple benefit of sum insured. He submitted that the Ld.District Forum had not considered this fact and partly allowed the claim of

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complainant and directed them to pay amount of Rs.2,50,000/- to complainant.

Hence, he submitted that the order passed by the

Ld.District Forum is to be set aside by allowing this appeal and complaint filed by complainant is to be dismissed. (7)

Perused record of the case, evidence adduced on record by the parties and documents filed by parties on record. On perusal of the same it has become clear that deceased husband of complainant by name Vishwajeet Sharma had given proposal form for Jeevan Mitra Tripple Cover Policy to Opponent on 23/04/2004. At that time various medical tests and investigations were conducted in respect of Vishwajeet Sharma by the panel doctors of opponent who checked up his health. Thereafter the opponent had issued the said policy in favour of deceased husband of complainant. Said policy is bearing No. 891591365 and it was for the period from 28/04/2004 to 28/04/2034.

The sum assured was Rs.2,50,000/- and deceased

husband of complainant had paid amount of premium of Rs.12,833/to opponent. (8)

In this case it is admitted fact that in the month of September, 2004 deceased husband of complainant by name Vishwajeet Sharma suffered from dengue fever. Subsequently he suffered from renal failure and ultimately he died on 21/04/2007 due to cardio respiratory arrest. After death of Vishwajeet Sharma, Complainant had made claim in respect of this policy with opponent life insurance corporation. However, it appears that the Life Insurance Corporation had repudiated the claim of complainant by issuing letter dated 28/02/2008.

(9)

The opponent Life Insurance Corporation has mainly contested the case on the ground that deceased husband of complainant had not

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informed about changes in his health condition to opponent after filing his proposal form and before opponent had accepted his first premium. From documents filed on record, it has become clear that the deceased husband of complainant had given proposal form for getting this insurance policy on 23/05/2004 and the amount of first premium was accepted by opponent from deceased husband of complainant on 28/05/2004. On perusal of proposal form it appears that while giving that proposal deceased husband of complainant had given undertaking that if there will be any change in his general health or health of his family members then he will inform about the same to opponent before his premium amount is accepted by opponent. In this case, it is admitted fact that deceased husband of complainant

had

undergone

certain

pathological

tests

on

25/05/2004. The report of pathological tests is on record. It appears that these pathological tests were conducted as per the advice given by panel doctors of opponent. 10)

On perusal of these pathological reports it appears that some of the reports are on higher levels and the same were found while examination of blood, urine, lipid profile etc. However, there was nothing abnormal found while conducting those tests.

Hence,

deceased husband of complainant had not informed about the same to opponent. Although those pathological tests were done as per advice of panel doctors of opponent, the opponent doctors had also not informed about the same to opponent. It appears that as there was nothing serious, deceased husband of complainant had not informed about those pathological reports to opponent. In this case it is admitted fact that death of deceased husband of complainant has taken place as he suffered from dengue fever and because of which there was renal failure to him and subsequently he died of

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cardio respiratory arrest. Hence, it has become clear that after the proposal form was given by deceased husband of complainant, after carrying out pathological tests by panel doctors of the Life Insurance Corporation the policy was given to the deceased husband of complainant. Although after submitting proposal form deceased husband of complainant had undergone pathological tests. Nothing serious was found in those tests and hence, deceased husband of complainant had not informed about the same to opponent. We are of the opinion that, under such circumstances only, on this ground opponent Life Insurance Corporation was not required to repudiate the claim of complainant.

The Ld.District Forum had rightly

observed the same and directed opponent Life Insurance Corporation to pay amount of Rs.2,50,000/- which was the sum assured in Insurance Policy to complainant along with interest on that amount along with costs and compensation. Hence, we are of the opinion that appeal filed by Life Insurance Corporation against the order passed by the Ld.District Forum is to be dismissed. 11)

The Ld.Avocate appearing for the complainant has submitted that as it was a triple cover policy complainant is entitled to get amount of Rs.7,50,000/- from opponent. In this case it is admitted fact that neither complainant nor insurance company has filed original insurance policy on record.

However, it is the contention of

Ld.Advocate of Insurance Company that complainant is entitled to get triple amount of insurance policy only if death is accidental. In this case, admittedly, deceased husband of complainant died as he suffered from dengue fever and he had not died due to accident. Moreover, on perusal of complaint filed by complainant it appears that she had claimed only amount of Rs.2,50,000/- from opponent insurance company along with costs and compensation along with

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interest on that amount. Hence, we are of the opinion that the Ld.District Forum had rightly considered that complainant is entitled to get amount of Rs.2,50,000/- only from opponent insurance company.

Under such circumstances, we are of the

opinion that appeal filed by complainant is also to be dismissed. Hence, we proceed to pass the following orders: ORDER (i)

Appeal Nos.A/12/64 and A/12/171 are hereby dismissed.

(ii)

Order passed by the Ld.District Forum is hereby confirmed.

(iii)

Parties to bear their won costs.

Pronounced on 27th September, 2017. [USHA S. THAKARE] PRESIDING JUDICIAL MEMBER

[D.R.SHIRASAO] JUDICIAL MEMBER ep