BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PATIALA. Complaint No.CC/10/870 of 1.10.2010 Decided on: 7.9.2011 Bhura Singh son of Sh.Jagga Singh resident of House No.177, village Gagarpur, Tehsil & District Sangrur. -----------Complainant Versus 1. Birla Sun Life Insurance Co.Ltd. Branch Patiala through its Branch Manager SCF 33, First Floor, Leela Bhawan, above SBOP branch Patiala. 2. Birla Sun Life Insurance Co.Ltd., G-Corporation, Tech Park, 6th Floor, Kasar Vadavali,Ghodb7under Road, Thane West Mumbai(MH) through its G.M. ----------Opposite parties. Complaint under Section 12 of the Consumer Protection Act. QUORUM Sh.D.R.Arora, President Sh.Amarjit Singh Dhindsa, Member Smt.Neelam Gupta, Member Present: For the complainant: Sh.R.K.Singla, Advocate For opposite parties: Sh.B.S.Chehal, Advocate ORDER D.R.ARORA, PRESIDENT Late Ms. Labh Kaur had purchased the insurance policy No.003904726 on 26.2.2010 from the ops and the complainant was appointed as the nominee in the policy. The policy was issued after the medical examination of the deceased on 2.4.2010. 2. Ms Labh Kaur died on 14.5.2010. The complainant being the nominee under the policy asked for the reimbursement of the claim under the policy but the ops refused to reimburse the claim and rather sent letter dated 30.6.2010 having repudiated the claim of the complainant. Accordingly, the complainant has approached this Forum through the present complaint brought under Section 12 of the Consumer Protection Act, 1986(for short the Act) for a direction to the ops to pay the claim of Rs.2,10,000/- under the policy with interest @18% per annum and to further pay him Rs.11000/- by way of compensation for the harassment and the mental agony experienced by him at the hands of the ops. 3. On notice, the ops appeared and filed their written version having taken up certain legal objections, interalia, that the complainant had no cause of action to file the complaint; that the complainant has suppressed the material facts from the Forum; that the complaint involves intricate questions of facts and law, which can not be determined in the summary procedure under the Act; that the complainant is not an aggrieved person and therefore, the Forum lacks jurisdiction to entertain and try the complaint and that the complaint being false, frivolous and vexatious the same is liable to be dismissed. As regards the facts of the complaint, it is admitted that the Insured Ms Lab Kaur had purchased the insurance policy No.00390426 in which the complainant was declared as the nominee of the life assured. It is also admitted that Labh Kaur died on 14.5.2010. 4. It is further averred that at the time of purchasing the policy, the life assured had to reply questionnaire with regard to the medical and personal history in the application and in reply to questions No.1(2),a,b,c and (3)f, she replied the answers in the negative as under:- 1. Are you on a diet or any other medicine of any kind prescribed by Doctor………………No. 2. Within the past give years have you: a) Consulted any doctor or any health practitioner except for common cold, influenza lasting less than 4 days? No. b) Submitted to ECG, X-rays, blood test or other tests? No. c) Attended or been admitted/advised to be admitted to any hospital or other medical facility----------No. 3. Have you ever had or sought advice for the following: f) Cancer, Tumor, thyroid disorder, enlarged glands or enlarged lymph nodes…….No. 5. It is denied by the ops, if life assured was got medically examined and rather the life assured appeared before Dr.Harbans Lal Bansal, M.D.Patiala and the doctor put the above questionnaire to the life assured and who gave the answers to the questions in the negative. 6. It is also the plea taken up by the ops that the complainant applied for the claim under the policy and submitted the claimant statement. On receipt of the claimant’s statement and other documents, the ops deputed M/s Guru Associates Ludhiana vide letter dated 3.6.2010 to investigate the matter. The Investigator approached the complainant and the neighbours including Kartar Singh who disclosed that the life assured suffered from cancer and was getting the treatment from the hospital at Patiala and PGI, Chandigarh during the period December 2009 to January 2010. The investigator approached the Govt. Rajindra Hospital, Patiala and collected the bed head ticket and other relevant documents, which disclosed that the life assured had been suffering from cirrhosis cancer of gallbladder and secondaries in liver, the diagnosis having been done by Dr.P.P.Singh and that the life assured got the treatment from the aforesaid hospital as in door patient and then as out door patient. The Investigator also approached Patiala Surgical Centre,Patiala from where it was transpired that the doctors had examined the life assured during the period 14.12.2009 to 19.12.2009 as out door patient and on 19.12.2009 the doctors had referred the life assured to Rajindra Hospital, Patiala.It also appeared that the life assured was on medicine prescribed by the doctors and within past five years had consulted the doctors and health practitioners except for common cold and further submitted herself to ECG, X-rays, blood tests and other tests and also remained admitted in Govt.Rajindra Hospital, Patiala from 19.12.2009 to 20.12.2009.It is further clear that the life assured got advice for cancer from different doctors but at the time of purchasing the police the life assured had concealed the material facts from the ops and also from Dr.Harbans Lal Bansal MD Patiala. 7. It is further averred that after considering the documents and the report of the Investigator, the underwriters of the ops observed that the life assured committed breach of fundamental principles of “Uberrima fides” i.e. the life assured at the time of filing the application mis stated the material facts regarding the past medical history, which were well within her knowledge and therefore, the ops had a right to dislodge the claim of the complainant After denouncing the other averments of the complaint going against the ops, it was prayed to dismiss the complaint. 8. In support of his claim, the complainant produced in evidence his sworn affidavit,Ex.C1, Ex.C2 the sworn affidavit of Jagtar Singh alongwith the documents,Exs.C3 and C4, and his learned counsel closed the evidence. 9. On the other hand, on behalf of the ops, their learned counsel produced in evidence,Ex.R1, the sworn affidavit of Puneet Bansal, the authorized signatory of the ops alongwith the documents,Exs.R2 to R48 and closed their evidence. 10. The parties filed the written arguments. We have examined the same, heard the learned counsel for the parties and gone through the evidence on record. 11. Ex.R44 is the copy of letter dated 30.6.2010 written by op no.2 to the complainant having informed him that his claim dated 1.6.2010 for the benefits under policy No.003904726 on the life of late Mrs.Labh Kaur was repudiated on the ground that the life assured in the application for insurance had replied in the negative, the question nos. (XII) (D), 1, 2 (a), (b) & (c) and 3(f). Similarly in her replies to part 1 of the medical examiner’s report on 2nd April,2010as a part of her application for insurance, the life assured had replied in negative to question nos.2,3(a),(b) & ( c) and 4(f) and that their investigations established that the life assured was under going treatment for cancer of gallbladder for secondaries in liver prior to her application for insurance and that the aforesaid replies in the application for insurance and in the medical examiner’s report were false. Had the life assured reply the aforesaid questions in application for insurance and in the medical examiner’s report truthfully and correctly the company would not have issued the policy on existing terms. The complainant was also informed that in case he felt that his case desired further consideration, he may register his dissatisfaction regarding the same justifying the grounds for reconsideration with the “Claims Redressal Machinery” at the address given in the letter Ex.R44, itself. 12. Ex.R8, is the copy of the letter dated 10.4.2010 written by the ops to Mrs.Labh Kaur having sent the policy No.003904726.The policy is produced alongwith said letter. In the validity and non disclosure it is provided,” this policy is issued in utmost good faith based on the declaration and statements made by you and we can not be held responsible in any manner for any action taken by us based on these declarations and statements. You and the life assured under this policy have an obligation to disclose every fact material to our assessment of the risk of issuing this policy. Failure to disclose or mis representation on a material fact will allow us to terminate the contract or deny the claim, subject to the provisions of Section 45 of the Insurance Act,1938”. 13. Now it is to be seen whether the declarations and statements made by the life assured in the application,Ex.R2, regarding the aforesaid questions were an attempt on the part of the life assured to conceal the material facts covering the risk of life having replied the same in the negative. Ex.R33, is the copy of the OPD slip dated 14.12.2009 issued by Patiala Surgical Center in respect of Labh Kaur in which the diagnose has been noted low backache pain hyper gastric . Ex.R34 is the copy of the bed head ticket of Labh Kaur w/o Jaggar Singh of village Ghagarpur got from the CR Rahindra Hospital, Patiala showing the date of admission as 19.12.2009 and date of discharge as 22.12.2009.Diagnosis have been recorded k/c/o ( known case of ) secondaries liver with Haemetemesis /Malena. Ex.R35 is also a part of the bed head ticket Ex.R34 in which the case summary has been noted as patient admitted in emergency with a complaint of blood in vomiting and stool , patient examined and diagnosed as k/c/o secondaries and malena. Patient examined and put on RX & left against medical advice on 22.12.2009. Ex.R37 is also a part of the aforesaid bed head ticket,Ex.C34 in which Dr.P.P.Singh has written to the another doctor with a request to, “please come and examine the patient who is patient of CA( cancer) with gallbladder with secondaries liver. Please do the needful”. 14. It was submitted by Sh.B.S.Chehal, the learned counsel for the ops that the life assured having suffered from the disease of CA gall bladder with secondary liver only in the month of December 2009, she was not supposed to reply question no.2 a,b & C touching the material information in the negative and in that way it was an intentional suppression of the material information on the part of the life assured. Question No.2a was, whether during the past 5 years had the life assured consulted any doctor or health practitioner except for common cold and further submitted herself to ECF, X-rays, blood tests and other tests. A perusal of Ex.R33, the OPD slip of Patiala Surgical Centre dated 14.12.2009 and the copy of the bed head ticket issued by the Rajindra Hospital, Patiala in respect of the life assured would go to show that she had under gone CT scan and ECG tests but all this was concealed by the life assured in the application,Ex.R2. 15. In the case of the citation Life Insurance Corporation of India Versus Akhtarbi Sayyed Imam Ali & Ors 2010 Legal Digest 21, the Hon’ble National Consumer Disputes Redressal Commission, New Delhi made a reference to P.C.Chacko & Anr. Vs. Chairman, Life Insurance Corporation of India & Ors. (2008) 1 SCO 321 as under:- “The purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bona fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose.A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law.” 16. Similarly in the case of the citation Smt.Budhiben Pababhai V. LIC of India through its Sr.Divisional Manager 2010(1)LAW Herald(Acc.)488 , Hon’ble National Consumer Disputes Redressal Commission, placed reliance upon the citation Life Insurance Corporation of India & Others Vs.Asha Goel(Smt.) & Anr[(2001)SCC 160] for the following observations: “ The contracts of insurance including the contract of life assurance are contracts uberrima fids and every fact of material(sic material fact) must be disclosed, otherwise, there is good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract and also implies any material alteration in the character of the risk which may take place between the proposal and its acceptance. If there are any misstatements or suppression of material facts, the policy can be called into question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person.” 17. In the light of our aforesaid discussion, we find that the ops were justified in having repudiated the claim of the complainant because of the life assured having given replies to the material questions in negative falsely and consequently we do not find any substance in the complaint and the same is hereby dismissed. Pronounced. Dated:7.9.2011 Neelam Gupta Amarjit Singh Dhindsa D.R.Arora Member Member President
| | Smt. Neelam Gupta, Member | HONABLE MR. D.R.Arora, PRESIDENT | , | | 
