At, Rajasthan State Consumer Disputes Redressal Commission Jaipur
By, THE HONOURABLE MR. ASHOK PARIHAR
By, THE HONOURABLE MR. SHASHI KUMAR PAREEK
By, MEMBER & THE HONOURABLE MR. VINAY KUMAR CHAWLA
For the Appellant: Vizzy Agarwal, Advocate. For the Respondent: Akhalesh Jain, Advocate.
1. The complainant took a policy for his sister Kumari Anupama Bai for a sum of Rs. 5 lakh on 28.3.2006. The complainant was also nominee in the policy. The above insured however, died on 29.1.2009 due to heart failure. A claim was duly submitted before the appellants. However, the same was repudiated only on the ground of concealment of physical disability/disorder.
2. It has been submitted on behalf of the appellants that the insured was suffering from Kyphoscoliosis, in common, known as Kubar which led to cardio respiratory failure. There is no denial that even if the same is treated as disorder or disability the insured was having the same from her childhood and such physical disorder is also apparently visible on the body. There cannot be any dispute that before issuing the insurance policy proper medical check-up is done and even facts mentioned in the proposal form are duly verified. The learned Counsel for the appellants with all vehemence try to shift the burden on the insured to prove that he or she was not suffering from any disability or disorder. However, until and unless the insured is fully explained all the terms and conditions of the policy, he or she is not expected to know that the disorder if any suffered by the insured from the childhood can be a disqualification for insurance claim. The appellants is well established Insurance Company in the country. However, it appears that they also functions in a very mechanical way without any human sympathetic considerations.
3. Even otherwise with the fast growing business competition among the Insurance Companies unhealthy practices develop to get maximum benefits and profits. The banks are also becoming part of the same trend where insurance policies are automatically attached to the bank accounts as an incentive to the customer. It is not a case of a businessman, trader or an educated employed person but that of a common poor man. He puts in hard earned small savings in such schemes with a hope and aspiration that in case of accident or death he or his family shall get some immediate financial assistance but in most of the cases he is left cheated when his claim is rejected with just a stroke of pen that he concealed some material facts at the time of signing proposal form or the claim was not properly submitted before the Insurance Company. That apart the agent of the company is required to explain all the details and conditions of the insurance policy sought to the customer. A common man is not supposed to know all the niceties and technicalities of law. Once accepting the premium and having entered into an agreement without verifying the facts, the Insurance Company cannot riggle out of the liability merely by saying that the contract was made by misrepresentation and concealment. The insurance policies should not be issued and repudiated in such a casual mechanical manner. The policy entails the liability on both sides. It is rather exploitation of the customer and more or less fraud on the public. Such practice should be strongly depricated.
4. Having considered all the facts and circumstances of the present case, we find no error or illegality in the impugned order dated 13.6.2011 passed by the District Forum, Alwar by which the appellants have
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been directed to pay a sum of Rs. 5,03,000 with interest towards insurance claim and mental agony. 5. Accordingly, the appeal is dismissed as having no merits. The amount deposited by the appellants before the District Forum may now be paid to respondent and remaining compliance be made by the appellants within 30 days. Appeal dismissed.