NIRMALA DEVI Vs. RELIANCE LIFE INSURANCE COM

JUDGEMENT

(1.) This Consumer Complaint under Sec. 21 (a) (i) of the Consumer Protection Act, 1986 (in short, 'the Act') alleges deficiency in service in denying a claim under the life insurance policy issued by the Opposite Party in respect of the deceased son of the Complainant, who is the mother and nominee of the Policy Holder.

(2.) Briefly stated, the facts are that the Deceased Life Assured (DLA), Vijay Kumar S/o. Mr. Babulal Verma, held a Life Insurance Policy No. 52392026 dtd. 14/10/2015 issued by the Opposite Party for a sum of Rs.1,00,00,000.00. The benefit payable was Rs.1,00,00,000.00 or 10 times the annualised premium or 105% of the premium paid as on date of death excluding extra premium, if any, in case of death. The Policy was issued after a medical fitness examination conducted by the Opposite Party. The DLA who was an employee of the Oriental Bank of Commerce met with a road accident on 27/10/2015, while driving a two wheeler, when he was found lying injured on the road in an unconscious state due to head injuries. He was taken to Government Hospital and was provided first aid at Government Hospital, Karnal followed by admission to Arvinda Hospital, Karnal and subsequently, shifted to Medanta Hospital, Gurgaon where he expired on 9/11/2015.

(3.) The Insurance Company was informed on 15/12/2015 and a claim of insurance was submitted by the Complainant, as the nominee of the DLA. Following investigations, since the claim was filed within the two year period from the date of issue of the policy, opposite party vide letter dtd. 7/5/2016 informed that the claim could not be considered on the ground that the DLA had not disclosed the fact that he had met with an accident one year prior to obtaining the policy in the proposal form and had suffered a concussion injury to the head and had, therefore, misled the Opposite Party to grant insurance cover in the said policy. The Complaint was repudiated in terms of Sec. 45 of the Insurance Act, 1938.