Sh.Anoop Sharma, Presiding Member.

1.       The complainants have brought the instant complaint under section 11, 12 & 13 of the Consumer Protection Act, 1986 on the allegations that husband of complainant No.1 and father of complainants No.2 to 4 namely Jasbir Singh son of Arjan Singh  was insured with Opposite Party for a sum of Rs.25 lacs under policy No.500-9142703 on 18.10.2012. Before taking the life insurance policy, the Opposite Party got him medically examined and only after that insurance policy was released to him. After the death of said Jasbir Singh, the complainants preferred death claim with Opposite Party, but the same has been repudiated on the flimsy grounds which are not tenable  and the death claim of the husband of complainant No.1 has been illegally turned down when Jasbir Singh was got medically examined by the Opposite Party itself then thee remain nothing to be concealed from it.  All the people suffer from some or other problem now-a-days, which is minor in nature and which are all curable. Similarly, husband of the complainant No.1 also got a intestine problem and she got him admitted in Sri guru Ram Dass Charitable, Vallah, Amritsar. As such, nothing was concealed in obtaining the life insurance policy of Jasbir Singh by him. It is further submitted that no false and misleading information was supplied to the op4 and all the questions were truthfully and correctly replied when Opposite Party issued the policy to Jasbir Singh. It is specifically denied that the Opposite Party had been led to issue the policy by suppressing any material facts regarding his past medical history. The hospitalization of insured in the year 2012 was that of minor in nature which does not go to the root for repudiation death claim of the  insured. Opposite Party was requested many a times to admit death claim of releasing the insurance amount, but the complainants were not heard. The complainants restrict their claim to the tune of Rs.20 lakh only, though they are entitled to the full life insurance policy of Rs.25 lacs.  Vide instant complaint, the complainant has sought the following reliefs.

a)       Opposite Party may kindly be directed to release the whole death claim amount to the tune of Rs.20 lacs on account of death of insured Jasbir Singh alongwith interest at the rate of 18% per annum and Rs.1 lac as compensation on account of mental and physical harassment caused to the complainant and litigation charges to the tune of Rs.25000/-. 

Hence, this complaint.

2.       Upon notice, Opposite Party appeared and contested the complaint by filing  written statement taking preliminary objections therein inter alia that after understanding the key features of the policy the insured had signed and submitted the proposal form for insurance and based on the information provided by the insured in the documents furnished at the proposal stage including proposal form, benefit illustrations and others, the Opposite Party had issued the policy on the life  of the insured and the detail of the policy in question was duly mentioned in para No.4 of the Preliminary Submissions of the written reply filed by Opposite Party. In the proposal form in column No.7 the information was sought in respect of past medical history, consultation with doctor, medication, medical advice, disease etc. and hospitalisation within the preceding five years of the life insured and he answered in the negative to all the said questions and based on the said response, the Opposite Party was persuaded to issue the policy. The policy was issued on 31.10.2012 and the life insured left for heavenly abode on 3.11.2012 i.e. within 3 days of issuance of the policy. The death claim was received by the Opposite Party on 23.4.2014 and the matter was investigated. The intent of the complainants is very clear. They deliberately delayed the filing of the claim in order to deceive the company so that the matter could not be promptly investigated and the records get old. During investigation, it was found that the life insured was hospitalised at Sri Guru Ram Dass Hospital from 6.9.2012 to 7.9.2012 complaining of abdominal pain for the past one and half months. During the said hospitalisation the life insured  underwent diagnostic laparscopy biopsy taken from intestinal mass. It is also noted mild ascites with jejunal mass at 3 places.  He had also got done histopathology done through SRL diagnostics and histopath report dated 15.9.2012  mentioning necrotising acute on chronic inflammatory pathology and also suggested further tests under the said report. This medical history, hospitalisation and tests were just prior to the life insured filing the proposal form for the policy and the answers furnished by him were thus false and the insured had given false and misleading information to the Opposite Party. The Opposite Party was thus misled into issuing the policy by non-disclosure/ suppression of material facts. The Opposite Party had accordingly repudiated the claim lodged by the complainants for non-disclosure/ suppression of material information by way of claim repudiation letter dated 16.7.2014. On merits, the Opposite Party had taken almost same and similar pleas as taken up by them in the preliminary submissions.  Remaining facts mentioned in the complaint are also denied and a prayer for dismissal of the complaint with cost was made.

3.       In his bid  to prove the case, complainant tendered into evidence  affidavit Ex.C-1 in support of the allegations made in the complaint and also produced copies of documents Ex.C2   to Ex.C3  and closed his evidence.

4.       On the other hand, to rebut the evidence of the complainants, the Opposite Party tendered into evidence the affidavit of Sh.Sunita Yadav, Ex.Op1 alongwith copies of documents Ex. Op2 to Ex.OP6 and closed the evidence on behalf of the Opposite Party.

5.       We have heard the ld.counsel for the parties and have carefully gone through the evidence on record.

6.       From the record i.e. pleadings of the parties and the evidence produced on record by the parties, it is clear that the husband of complainant No.1 and father of complainants No.2 to 4 namely Jasbir Singh son of Arjan Singh  was insured with Opposite Party for a sum of Rs.25 lacs under policy No.500-9142703 on 18.10.2012. Before taking the life insurance policy, the Opposite Party got him medically examined and only after that insurance policy was released to him. After the death of said Jasbir Singh, the complainants preferred death claim with Opposite Party, but the same has been repudiated on the flimsy grounds which are not tenable  and the death claim of the husband of complainant No.1 has been illegally turned down when Jasbir Singh was got medically examined by the Opposite Party itself then thee remain nothing to be concealed from it.  All the people suffer from some or other problem now-a-days, which is minor in nature and which are all curable. Similarly, husband of the complainant No.1 also got a intestine problem and she got him admitted in Sri guru Ram Dass Charitable, Vallah, Amritsar. As such, nothing was concealed in obtaining the life insurance policy of Jasbir Singh by him. It is further submitted that no false and misleading information was supplied to the op4 and all the questions were truthfully and correctly replied when Opposite Party issued the policy to Jasbir Singh. It is specifically denied that the Opposite Party had been led to issue the policy by suppressing any material facts regarding his past medical history. The hospitalization of insured in the year 2012 was that of minor in nature which does not go to the root for repudiation death claim of the  insured. Opposite Party was requested many a times to admit death claim of releasing the insurance amount, but the complainants were not heard. Ld.counsel for the   complainants  submitted that all this amounts to deficiency of service on the part of the Opposite Party.

7.       Whereas the case of the Opposite Party is that the after understanding the key features of the policy the insured had signed and submitted the proposal form for insurance and based on the information provided by the insured in the documents furnished at the proposal stage including proposal form, benefit illustrations and others, the Opposite Party had issued the policy on the life  of the insured and the detail of the policy in question was duly mentioned in para No.4 of the Preliminary Submissions of the written reply filed by Opposite Party. In the proposal form in column No.7 the information was sought in respect of past medical history, consultation with doctor, medication, medical advice, disease etc. and hospitalisation within the preceding five years of the life insured and he answered in the negative to all the said questions and based on the said response, the Opposite Party was persuaded to issue the policy. The policy was issued on 31.10.2012 and the life insured left for heavenly abode on 3.11.2012 i.e. within 3 days of issuance of the policy. The death claim was received by the Opposite Party on 23.4.2014 and the matter was investigated. The intent of the complainants is very clear. They deliberately delayed the filing of the claim in order to deceive the company so that the matter could not be promptly investigated and the records get old. During investigation, it was found that the life insured was hospitalised at Sri Guru Ram Dass Hospital from 6.9.2012 to 7.9.2012 complaining of abdominal pain for the past one and half months. During the said hospitalisation the life insured  underwent diagnostic laparscopy biopsy taken from intestinal mass. It is also noted mild ascites with jejunal mass at 3 places.  He had also got done histopathology done through SRL diagnostics and histopath report dated 15.9.2012  mentioning necrotising acute on chronic inflammatory pathology and also suggested further tests under the said report. This medical history, hospitalisation and tests were just prior to the life insured filing the proposal form for the policy and the answers furnished by him were thus false and the insured had given false and misleading information to the Opposite Party. The Opposite Party was thus misled into issuing the policy by non-disclosure/ suppression of material facts. The Opposite Party had accordingly repudiated the claim lodged by the complainants for non-disclosure/ suppression of material information by way of claim repudiation letter dated 16.7.2014. Ld.counsel for the opposite party submitted that there is no deficiency of service on the part of the Opposite Party.

8.       From the entire above discussion, we have come to the conclusion that the the husband of complainant No.1 and father of complainants No.2 to 4 namely Jasbir Singh son of Arjan Singh  was insured with Opposite Party for a sum of Rs.25 lacs under policy No.500-9142703 on 18.10.2012. The death of Jasbir Singh, insured on 3.11.2012 is not denied by the parties. It is not denied that during the policy period, the life insured died. The claim was lodged by the complainants with Opposite Party, but the Opposite Party  repudiated the claim of the complainant vide letter Ex.C3 on the ground that during investigation, it was found that the life insured was hospitalised at Sri Guru Ram Dass Hospital from 6.9.2012 to 7.9.2012 complaining of abdominal pain for the past one and half months. During the said hospitalisation the life insured  underwent diagnostic laparscopy biopsy taken from intestinal mass. It is also noted mild ascites with jejunal mass at 3 places.  He had also got done histopathology done through SRL diagnostics and histopath report dated 15.9.2012  mentioning necrotising acute on chronic inflammatory pathology and also suggested further tests under the said report. This medical history, hospitalisation and tests were just prior to the life insured filing the proposal form for the policy and the answers furnished by him were thus false and the insured had given false and misleading information to the Opposite Party. The Opposite Party was thus misled into issuing the policy by non-disclosure/ suppression of material facts. The Opposite Party had accordingly repudiated the claim lodged by the complainants for non-disclosure/ suppression of material information by way of claim repudiation letter dated 16.7.2014.On the other hand, though  Opposite Party has produced on record the discharge summary of life insured Ex.OP5 regarding his admission in the hospital, but they   could examine any medical practitioner/ doctor who has treated the complainant for the said disease nor the Opposite Partu has filed any affidavit of any doctor who has medically treated the insured for the disease prior to taking of the policy. It has been held by the Hon'ble National Commission in case New India Assurance Co.Ltd & Anr Vs. Murari Lal Bhusri 2011(III) CPJ 198 (NC) that where the Insurance company failed to produce any evidence to show that respondent was aware of any pre-existing disease at the time when insurance policy was taken, opposite party was not justified in repudiating the claim of the complainant on the ground of pre-existing disease. It has been held by the Hon'ble Supreme Court of India in case P.Vankat Naidu Vs. Life Insurance Corporation of India & Anr 2011(3) CPC 350 that where no cogent evidence was produced by the respondent to prove that insured/deceased had concealed any fact about his illness or hospitalization, it was held that no material fact was suppressed by the deceased in this respect. It has been held by the Hon'ble State Commission of Punjab in case  Life Insurance Corporation of India Vs. Miss Veenu Babbar and another 2000(1) CLT 619 that repudiation on the basis of history recorded in the hospital records is illegal and arbitrary and the same could not be treated as substantive material to base any decision. Same view has been taken by the Hon'ble National Commission in case Life Insurance Corporation of India & Ors. Vs. Kunari Devi IV(2008) CPJ 89 (NC) that where no document has been produced in support of allegation of suppression of disease at the time of taking policy or revival of policy, history recorded in hospital's bed ticket, not to be treated as evidence as doctor, recording history not examined, suppression of disease not proved, insurer was held liable under the policy. It has further been held by the Hon'ble National Commission in case Sahara India Life Insurance Co. Ltd. & Anr Vs. Hansaben Deeepak Kumar Pandya IV(2012) CPJ 13(NC) that where the opposite party insurance company has failed to produce on record any evidence to show that deceased insured ever consulted doctor for taking treatment of heart disease, the repudiation of the claim on the ground of suppression of material fact is totally illegal. It has been  held by Hon’ble State Consumer Disputes Redressal Commission, Chandigarh in case titled as Ashwani Gupta & Ors. Vs. United India Insurance Company Limited 2009(1) CPC page 561 that where the claim of the complainant has been repudiated on the ground that the assured had pre-existing disease of diabetes mellitus which was not disclosed- apparently, burden to prove lies  upon the insurer- If assured was suffering from pre-existing disease why insurer  had not checked it at the time when proposal form was accepted by its  staff-Respondent has failed to fulfill this requirement before repudiating the claim and the appellant was held entitled  to claim alongwith interest. The complainants restrict their claim to the tune of Rs.20 lakh only, though they are entitled to the full life insurance policy of Rs.25 lacs. 

9.       In view of the above discussion, we are of the opinion that the Opposite Party  has wrongly repudiated the claim of the complainants. Consequently, we allow the complaint with costs and the Opposite Party  is directed to pay the claim amount of Rs.20 lacs (twenty lacs) to the complainants in equal shares, within one month from the date of receipt of copy of this order failing which the complainants shall be entitled to interest @ 6% per annum on this amount from the date of filing of the complaint till the payment is made to the complainants. Opposite Party is also directed to pay litigation expenses to the complainant  to the tune of Rs. 2000/-.  Copies of the order be furnished to the parties free of cost. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

Announced in open Forum.