Delhi

StateCommission

FA/12/1042

LIC OF INDIA - Complainant(s)

Versus

CHAMAN LAL JINDAL - Opp.Party(s)

08 Oct 2015

ORDER

IN THE STATE COMMISSION : DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

 

Date of Decision:04.03.2016

 

First Appeal- 1042/2012

 

(Arising out of the order dated 03.10.2012 passed in Complainant Case No. 07/2009 by the District Consumer Disputes Redressal Forum (VI), M-Block, Vikas Bhawan, New Delhi)

Life Insurance Corporation of India,

Divisional Office-I,

Jeevan Prakash Building,

25, K.G. Marg,

New Delhi-110001.

Through Ms Nandita, Manager(L&HPF)

•  

Versus

Shri Chaman Lal Jindal,

S/o Shri Gopi Ram,

R/o C-31, Nehru Enclave,

Behind Jain Hardware,

Narela Road, Alipur,

Delhi.

                                              ….Respondent

CORAM

Justice Veena Birbal, President

Salma Noor, Member

OP Gupta, Member (Judicial)

1.     Whether reporters of local newspaper be allowed to see the judgment?

2.      To be referred to the reporter or not?

 

 

 

 

 

 

Justice Veena Birbal, President

 

1. This is an appeal under Section 15 of the Consumer Protection Act, 1986 (in short, “the Act”) challenging order dated 3.10.12 passed by the Consumer Disputes Redressal Forum (VI), M-Block, Vikas Bhawan, New Delhi (in short, “the District Forum”) whereby the CC No.07/2009 has been allowed and appellant/OP has been directed to pay Rs.12 lacs with interest @ 9% p.a. from date of claim till payment to respondent/complainant.  Rs. 2 lacs has been awarded towards harassment inclusive of litigation expenses.
2. The relevant facts for the disposal of present appeal are as under:

A complaint under Section 12 of the Act was filed by the respondent herein i.e. complainant before the District Forum stating therein that his son, Shri Rajeev Jindal had obtained a LIC policy No.175154922 for a sum of Rs. 11,40,000/- from Kurukshetra (Haryana), branch of appellant/OP.  For taking the policy, the deceased filled a Proposal Form on 9.10.06 and was medically examined on that day by the concerned doctor.  The said policy was back dated at the request of proposer, Shri Rajiv Jindal as is mentioned in clause 3 of Proposal Form and the date of commencing of policy was 28.6.06.  The policy was to mature on 28.6.31.  The respondent/complainant was the nominee in the said policy.  It was alleged that at the time of taking policy, his son was hale and hearty.  Unfortunately, his son, Shri Rajeev Jindal had died on 5.4.07 due to sudden heart attack.  At that time, his age was 31 years.  In June 2007, the respondent/complainant had filed a claim in respect of death of his son with appellant/OP.  However, no action was taken. Thereupon the respondent/complainant had approached Insurance Ombudsman, Chandigarh.  The Insurance Ombudsman referred the matter to Sr. Divisional Manager of appellant/OP at Karnal.  Thereafter requisite claim documents were sent to the respondent/complainant and after completing the formalities, the same were sent to appellant/OP.  Before the Insurance Ombudsman, the stand of the appellant/OP was that the signatures on proposal form and on medical form were different and the same were being verified.  It was also alleged that the deceased was resident of Delhi but he got himself insured from Kurukshetra.  It was also alleged that the matter was being investigated. The appellant/OP also alleged that the signatures were being verified from Forensic Science Laboratory. The Insurance Ombudsman obsserved that the case was inordinately delayed and directed appellant/OP to settle the claim on merits by 20.11.08.  On 18.11.2008 respondent/complainant received a letter from appellant/OP whereby the claim was repudiated on the ground that in order to conceal ill health, the deceased did not present himself before the Medical Examiner at the time of medical examination on 9.10.06 and someone else had appeared on his behalf.  It was also alleged that signature of the person who was medically examined did not tally with the signatures of deceased.  Thereafter many letters were written to the appellant/OP but no response was given.  Ultimately the aforesaid complaint was filed by respondent/complainant praying for the payment of Rs.11,40,000/- towards sum assured by the appellant/OP on the death of policy holder and also to pay interest on the aforesaid amount @ 18% p.a. from the date of claim till realization.  Besides aforesaid amount, respondent/complainant also prayed for compensation for causing mental pain and agony as well as towards litigation cost.

3. The appellant/OP had filed written statement wherein it was admitted that the deceased, Shri Rajiv Jindal i.e. son of the respondent/complainant had taken a LIC Policy No.175154922 w.e.f. 28.6.06 for a sum of Rs.11,40,000/-. The claim was denied on the ground that being an early death claim, the appellant/OP had initiated an enquiry as required under Part-I of Section 45 of the Insurance Act, 1938.  The enquiry had revealed that the policy holder had concealed material information in the proposal form and had also obtained medical fitness certificate by presenting some other healthy person (impersonator) to conceal his ill health. It was alleged that the signature on the medical sheet and proposal form were of two different persons.  It was alleged that even the report of Handwriting Expert from Forensic Science Laboratory, Karnal was also taken.  It was alleged that as per the said report, the signatures of the person examined by Medical Examiner and endorsed by the doctor and those on Proposal Form were found not matching.  The signatures on the medical examiner report and the proposal form were of two different persons.  It was alleged that since the Insurance Policy was taken fraudulently by concealing ill health, as such the contract of insurance was void.  It was alleged that there was no deficiency on the part of the appellant/OP.  It was, therefore, prayed that the consumer complaint was liable to be rejected.
4. The respondent/complainant had filed rejoinder denying the allegation made in the written statement and reiterated the averments of consumser complaint. Parties had also led evidence by way of affidavits.
5. After hearing the parties, Ld. District Forum decided the consumer complaint in favour of the respondent/complainant and directed the appellant/OP to make payment to respondent/complainant as has been stated above.
6. Aggrieved with the aforesaid order, present appeal is filed.
7. Ld. Counsel for the appellant/OP has contended that Ld. District Forum has passed the order in an arbitrary manner without considering the evidence on record.  It is contended that the Ld. District Forum has failed to consider that the insured Rajeev Jindal had concealed the material information in the proposal form stating himself having healthy status.  It is contended that he had produced some other healthy person to impersonate him at the time of medical examination and obtained the policy fraudulently.  It is contended that there is report of Forensic Science Laboratory, Haryana dated 23.10.2008, Ex.A-5 which shows that signature of the person examined by Medical Examiner and endorsed by doctor and that on proposal form were not found matching.  It is contended that no objection was filed to the said report by the respondent/complainant before the Ld. District Forum.  It is contended that even the findings given are wrong.  Ld. District Forum has wrongly held that the medical examination was done after 4 months of filling up of Proposal Form whereas the medical examination was done on the same day.  It is contended that even the response to the interrogatories have also not been considered by the appellant/OP wherein it has come that the concerned doctor had been suspended and action was also taken against the agent through whom the policy was taken. It is contended that contract of insurance is a contract of ‘Utmost Good Faith’.  It is contended that deceased was not a healthy person.  A false declaration was given by him in the Proposal Form about his state of health.  It is contended that the claim was rightly repudiated.  It is further contended that even the compensation awarded is more than what was claimed by the respondent/complainant which is not legally permissible. 
8. We may mention that no one has appeared on behalf of the respondent/complainant to assist the Commission. The matter was listed for arguments on 7.10.15.  On the said date, a proxy had appeared for Counsel for the respondent/complainant. On his request, the matter was adjourned to 8.10.15 for arguments.  Even on the said date, Counsel for respondent/complainant did not appear.   
9. Accordingly, we have considered the submissions made on behalf of appellant/OP and perused the material on record. 
10. It is admitted position that the Policy No.175154922 was in the name of Shri Rajeev Jindal i.e. son of the respondent/complainant who had taken the same during his life time.  It is also admitted position that the son of the respondent/complainant had died on 5.4.07 i.e. within 6 months of the policy.  According to the appellant/OP, the Proposal Form i.e. Ex-OP-1/B for taking the policy was signed by the deceased.  However, the medical examination report, Ex-OP-1/C which was given on the medical examination did not bear the signatures of deceased.  It is contended that deceased presented some other person for medical examination and did not present himself.  To substantiate the same, the appellant/OP has relied upon Forensic Science Laboratory report, Ex.A-5 which is as under:
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3911647396117. :    Red enclosed admitted signatures marked A1 to A4 stated to be of Sh. Rajeev Jindal.

 

LABORATORY EXAMINATION

 

All the documents were carefully and thoroughly examined with Scientific Instruments, such as, Stereo Micro-Scope, Video Spectral Comparator etc. under different lighting conditions and I am of the opinion that:

 

4506931586. :         Comparison of standard signatures marked A1 to A4 (dated 09.10.06) with questioned signature marked Q1 (dated 09.10.06) shows divergences in the manner of execution of characters such as: Shape of the body part character ‘ ’, extended nature of finish of character   ‘ ’; Shape of the body part of ‘ ’; Location of commencement and movement in the formation of vowel sign of ‘EEKAR’ (  ) together with its downward extended nature and finish, an additional vertical stroke is also been observed; Location of commencement and movement in the formation of character ‘ ’ with the direction of axis of its body oval; Shape of the upper body curved part of vowel sign of ‘IKAR’ (  ); Nature of the body part of ‘half-Na’; Location of impulse in the body part of ‘ ’ together with nature and direction of finish; Shape of two body curved part of ‘ ’; Nature and location of top scoring as observed in Q1 is no where observed vide A1 to A4.

 

                      Divergences are also observed in the nature and class of elements of writing, such as: Writing movement, Writing skill, Speed, Slant, Relative size and proportion of characters.

 

                      The aforesaid divergences are fundamental in nature and are beyond the range of natural variations and intended disguise and when considered collectively they lead to the opinion that the person who wrote red enclosed signatures stamped and marked A1 to A4 did not write the red enclosed signature similarly stamped and marked Q1.

 

2058049. :            Documents stamped and marked Q1 and A1 to A4 in Three (03) sheets.

 

•                 All the Documents sent to this laboratory for examination and the case report have been sealed with the seal of DD/FSL (H).”

 

11. The aforesaid report has not been taken into consideration while passing the impugned order.  The report is from the Govt. laboratory.  No objection to the aforesaid report was filed by the respondent/complainant before the Ld. District Forum.  The Ld. District Forum ought to have considered the same while passing the impugned order.  An important piece of evidence is ignored by the Ld. District Forum while passing the impugned order.  Even the factual aspect has been wrongly recorded by Ld. District Forum in the impugned order.  It is stated that the proposal form was filled on 9.10.06 and the medical examination was done after four months.  The said fact is wrongly recorded. Both are of the same date i.e. of 9.10.06.   The material on record shows that respondent/complainant had given list of interrogators before the Ld. District Forum. The appellant/OP has given specific replies to the same.  Even the same has not been considered while deciding the case.  It has been categorically stated in the reply to the interrogatories that agent and medical examiner were party to the fraud and action had been taken against them.  Ld. District Forum has not discussed the same in the impugned order.  The stand of the appellant/OP throughout has been that the insured Rajeev Jindal has committed fraud on the appellant/OP by producing some other person for medical examination.  The stand of the appellant/OP goes to the root of the matter.  It has been specifically taken in written statement.  The District Forum has not tried to examine the same. Prima facie we find that Forensic Science Laboratory report is correct. 
12. Ld. Counsel for the appellant/OP also wants to file additional documents i.e. copy of investigation report of investigation conducted by LIC Officer concerning the deceased, letter of complainant to appellant/OP dated 24.9.08 stating weight of deceased as 45 Kg. and decision of standing committee of appellant/OP in repudiating the claim. It is contended that if aforesaid documents are considered, the same will substantiate the stand of appellant/OP that some other person was produced for medical examination.
13. Considering the totality of facts and circumstances, the impugned order is not sustainable in the eyes of law.  Complete material has not been considered by the Ld. District Forum while passing the impugned order.  The order has been passed in haste.  We have also noticed that even amount awarded is more than what was claimed in the complaint.  It has also been brought to our notice that the amount awarded has already been taken by the respondent/complainant in the execution proceedings. 
14. In view of above discussion, we accept the appeal and set aside the impugned order and remand back the case to the Ld. District Forum for deciding the same afresh after considering the material on record.  The appellant/OP shall be at liberty to file additional documents before the Ld. District Forum by making an appropriate application, if any.  The respondent/complainant shall also be at liberty to file additional documents, if any.  The Ld. District Forum shall give opportunity of hearing to both the parties and thereafter shall pass fresh order in the matter.
15. The parties shall appear before the District Forum on 22.4.16.
16. It is clarified that nothing stated herein shall have any bearing on the merits of the case and the District Forum shall be free to decide on the basis of material on record.
17. The respondent/complainant shall deposit the entire amount within 4 weeks from the date of receipt of this order and the District Forum shall keep the same in the form of FDR till the matter is decided afresh.
18. A copy of this order as per the statutory requirement be forwarded to the parties free of charge and also to the concerned District Forum along with their record and thereafter the file be consigned to Record Room.

(Justice Veena Birbal)

President

 

 

(Salma Noor)

Member

 

 

(OP Gupta)

Member (Judicial)