BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KAITHAL.
Complaint no.126/14.
Date of instt.: 12.06.2014.
Date of Decision: 18.09.2015.
Sunita Rani, Widow of Dilbag Singh, resident of Village Chandana, Tehsil and Distt. Kaithal.
……….Complainant.
Versus
1. Birla Sun Life Insurance Company Ltd., Regd. Office, One Indiabulls Centre Tower, I, 15th and 16th floor, Jupiter Mill Compound, 841, Senapati Bapal Marg Elphinstone Road, Mumbai, 400 013 through its M.D.
2. Birla Sun Life Insurance Company Ltd. Amar Tara Building Khurania Complex, Kurukshetra Road, Kaithal, through its Branch Manager.
..……..Opposite Parties.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Sh. Jagmal Singh, President.
Sh. Rajbir Singh, Member.
Smt. Harisha Mehta, Member.
Present : Sh. Gurdev Singh, Advocate for complainant.
Sh. Hardeep Rana, Advocate for the opposite parties.
ORDER
(JAGMAL SINGH, PRESIDENT).
The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that the husband of complainant namely Dilbag Singh (since deceased) got his life insured with the Ops vide policy No.004731098 dt. 26.02.2011 for the sum of Rs.19,90,000/-. It is alleged that the husband of complainant died on 03.03.2013. It is further alleged that the complainant being nominee lodged the claim with the Ops and submitted all the necessary documents but the Ops repudiated the claim of complainant on 22.12.2013. The said repudiation of claim is wrong and illegal. This way, the Ops are deficient in service. Hence, this complaint is filed.
2. Upon notice, the opposite parties did not appear and opt to proceed against exparte vide order dt. 31.07.2014. Ld. Counsel for the Ops filed an application on 29.09.2014 for setting-aside the exparte order dt. 31.07.2014 and the same was dismissed vide order dt. 30.10.2014 passed by this Forum. The Ops have challenged the said orders dt. 31.07.2014 and 30.10.2014 of this Forum before Hon’ble State Commission, Haryana vide revision petition No.134 of 2014. The Hon’ble State Commission vide order dt. 19.12.2014 accepted the said revision petition and set-aside the orders dt. 31.07.2014 and 30.10.2014, subject to the conditional cost of Rs.5,000/- which was to be paid by the petitioners to the respondent-complainant and the petitioners were directed to appear before this Forum on the date fixed i.e. 22.12.2014.
3. In pursuance of order of Hon’ble State Commission, the costs of Rs.5,000/- was paid by the Ops to the ld. Counsel for the complainant and statement of ld. Counsel for the complainant was also recorded in this regard on 22.12.2014. Reply of main complaint was filed by the Ops raising preliminary objections with regard to maintainability; cause of action; locus-standi; that the present complaint is liable to be dismissed on the ground of lack of pecuniary jurisdiction of this Forum. It is submitted that the complainant in her complaint has claimed insured amount of Rs.19,90,000/- along with all benefits and interest @ 18% p.a. from the date of death till its realization to the complainant, she has also claimed compensation to the tune of Rs.5,000/- and litigation expenses upto Rs.1100/-. It is submitted that a mere calculation of interest @ 18% p.a. from the date of death till its realization to the complainant on the amount of Rs.19,90,000/- would be about Rs.7,00,000/- till the filing of written statement. Hence, the total amount is much more than the pecuniary jurisdiction of this Forum; that the policy under question bearing No.004731098 was issued by the respondent company on 26.02.2011 on the basis of information provided by the life assured in the proposal form. Since the information provided by the life assured in the proposal form was established to be incorrect by the respondent company, hence, the respondent company was well within its rights to repudiate the said claim of the complainant; that the repudiation of claim under the subject-policy was on the grounds of mis-statement of information, suppression of material information and furnishing of false information in the proposal form. The life assured, at the time of filling up the proposal form, did not disclose the correct information about his health and he deliberately failed to disclose that he was diagnosed of Metastitis Mucinous Cyst, Adenocarcinoma (Cancer) and had undergone treatment for the same prior to his application for insurance. There is no deficiency in service on the part of answering Ops. On merits, the contents of complaint are denied and so, prayed for dismissal of complaint.
4. In support of his case, the complainant tendered in evidence affidavit Ex.CW1/A and documents Ex.C1 to Ex.C11 and closed evidence on 04.09.2014. On the other hand, the Ops tendered in evidence affidavit Ex.RW1/A and documents Ex.R1 to Ex.R5 and closed evidence on 24.04.2015.
5. We have heard ld. counsel for both the parties and perused the case file carefully and minutely and have also gone through the evidence led by the parties.
6. It is argued by ld. Counsel for the complainant that Dilbagh Singh (since deceased) the husband of complainant had got his life insured with the Ops vide policy No.004731098 dt. 26.02.2011, Ex.C7 for a sum of Rs.19,90,000/-. The deceased had paid all the instalments of the premium vide receipts Ex.C1 to C3. The complainant was appointed as nominee of the deceased Dilbagh Singh in the said policy. The husband of complainant died on 03.03.2013. He further argued that the complainant has duly intimated the Ops regarding the death of her husband and submitted all the required documents in the office of Ops but the Ops have knowingly and intentionally repudiated the claim of complainant on the false grounds on 22.12.2013 vide letter Ex.C11. He also argued that the complainant being the nominee of her husband namely Dilbagh Singh is entitled to the insured amount. In support of his versions, ld. Counsel for the complainant submitted a catena of authorities titled as The Shahbad Co-operative Sugar Mills Ltd., Shahbad Vs. NIC, 2003(2) CPC page 68 (NC); LIC Vs. Anand Kumar, 2006(2) CPC page 363 (State Commission, Haryana) and LIC Vs. Charanjit Kaur, 2001(1) CPC page 44 (State Commission, Punjab).
7. On the other hand, Ld. counsel for the Ops has argued that this Forum has no pecuniary jurisdiction to entertain and try the present complaint because the insured claim amount is Rs.19,90,000/- along with all the benefits and interest @ 18% p.a. which will exceed Rs.20,00,000/-. He further argued that the policy in question bearing No.004731098 was issued by the Ops on 26.02.2011 on the basis of information provided by the husband of complainant namely Dilbagh Singh (since deceased) vide proposal form. Since the information provided by the life assured in the proposal form was established to be incorrect and false by the Ops and so, the Ops are well within its right to repudiate the claim of complainant. He further argued that the life assured Dilbagh Singh at the time of filling-up the proposal form did not disclose the correct information about his health and he deliberately concealed the true facts that he was diagnosed vide Ex.R4 of Metastitis Mucinous Cyst, Adenocarcinoma (Cancer) by the Rajiv Gandhi Cancer Institute and Research Centre on 21.01.2011 i.e. before the issuance of the policy in question. Hence, the life assured had given wrong information and suppressed the material facts from the Ops in order to wrongfully obtain the policy from the Ops. So, the Ops have rightly repudiated the claim of complainant. He further argued that from the record of Rajiv Gandhi Cancer Institute and Research Centre, it is very much clear that Dilbagh Singh (since deceased) had got the treatment with regard to the cancer and from Ex.R4, it is very much clear that the same was at stage-IV. He also argued that from the record of Rajiv Gandhi Cancer Institute and Research Centre, it is clear that the husband of complainant had taken treatment from there many times before the issuance of policy in question but inspite of that the life assured (Dilbagh Singh) has concealed these facts which are very much material. He further argued that the proposal form is to be filled in by the proposer for insurance, for furnishing of material information required by the insurer to decide whether to accept or decline, to undertake the risk and observed that in a contract of insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not to accept the risk is a material fact. The insurance policy is a contract which was issued after believing that the proposer has furnished all the true facts and if lateron, it is found that the proposer has furnished false information, then the Ops have right to render the contract as void and so, the Ops have rightly repudiated the claim of complainant. Ld. Counsel for the Ops has produced the authorities titled as Mrs. Shnyni Valsan Pombally Vs. S.B.I. & others, 2014(1) CLT page 356 (NC) and Satwant Kaur Sandhu Vs. NIA, 2009(4) RCR (Civil) page 692 (SC).
7. From the facts and circumstances of the case, we are of the considered view that as per citation of Hon’ble National Commission produced by the complainant cited in 2003(2) CPC page 68 titled as The Shahbad Co-operative Sugar Mills Ltd., Shahbad Vs. National Insurance Company Ltd. and others, wherein it has been held “Consumer Protection Act, 1986-Setion 11-Pecuniary jurisdiction-Complainant claimed a sum of Rs.18,33,000/- with 18% interest-State Commission was of the view that if interest was added, the limit of amount would exceed pecuniary jurisdiction of Rs.20 lacs-Order of State Commission held to be erroneous because award of interest was in the discretion of State Commission-Order set-aside. So, this Forum has the pecuniary jurisdiction to entertain and try the present complaint. So far as the claim of complainant is concerned, it is very much material to see whether the life assured has furnished correct information in the proposal form or not. It is very much clear from the proposal form Ex.R1 that the proposer has filled in the proposal form on 24.02.2011 and on the basis of this proposal form, the policy in question was issued on 26.02.2011. From the record of Rajiv Gandhi Cancer Institute and Research Centre, Ex.R4 produced by the Ops, it is clear that on 21.01.2011 the life assured i.e. Dilbagh Singh (since deceased) was diagnosed as suffering from Metastitis Mucinous Cyst, Adenocarcinoma and Germ Cell Tumer (Matastitis Stage-IV). This disease is a cancer. Dilbagh Singh (since deceased) had taken treatment from Rajiv Gandhi Cancer Institute and Research Centre many times before filling-up the proposal form i.e. on 24.02.2011 and before the issuance of policy on 26.02.2011. The relevant column of the proposal form i.e. 14((ii)(f) is as under:-
“14(ii) Have you ever sought advice or suffered from any of the following?
(f) Cancer, tumour, abnormal growth, thyroid disorder, enlarged glands or enlarged lymph nodes? No”
From these facts, it is crystal clear that the life assured (Dilbagh Singh) had not furnished correct facts in the proposal form rather furnished the wrong information and concealed the true and material facts. The life assured had got issued the policy in question by furnishing the false information and so, the Ops are entitled to render the contract of insurance in question as void and repudiate the claim of complainant on this ground. Hence, the Ops have rightly repudiated the claim of complainant vide their letter E.C11, which is well reasoned. The authorities produced by the Ops are fully applicable to the facts of present case. So, we found no deficiency in service on the part of Ops.
8. Therefore, as a sequel of above discussion, we find no merit in the present complaint and hereby dismiss the same. No order as to costs. A copy of this order be sent to both the parties free of cost. File be consigned to the record room after due compliance.
Announced.
Dt.18.09.2015.
(Jagmal Singh),
President.
(Harisha Mehta), (Rajbir Singh),
Member. Member.
