BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, JALANDHAR.

 Complaint No.206 of 2019

      Date of Instt. 11.06.20198                 Date of Decision: 06.10.2022

Vinod Kumar age about 55 years S/o Sh. Panna Lal R/o VPE.N 126, Rasta Mohalla, Tehsil and District Jalandhar Punjab.

..........Complainant

Versus

1.       The Incharge/Manager of Branch Office, LIC of India, BO Unit         No.III, First Floor, Pacca Bagh, Jalandhar City.

2.       The Senior Division Manager, LIC of India, Divisional Office,          Post Box No.82, Jeevan Parkash, Model Town Road, Jalandhar.

3.       The Zonal Manager, LIC of India, Zonal Office, Jeevan Bharti,          Connaught Circus, New Delhi.

4.       LIC of India Company Limited, Head Office, Jeevan Bima Marg,      Nariman Point, Mumbai, Maharashtra-400021.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before:        Dr. Harveen Bhardwaj             (President)

                   Smt. Jyotsna                            (Member)

                   Sh. Jaswant Singh Dhillon       (Member)                                

Present:       Sh. G. R. Palli, Adv. Counsel for Complainant.

                   Sh. S. C. Sood, Adv. Counsel for OPs No.1 to 4.

Order

Dr. Harveen Bhardwaj (Member)

1.                The instant complaint has been filed by the complainant, wherein it is alleged that the deceased Saurav Kumar took policy from OP No.1 and the OP No.2 refused to accept the claim. The OPs No.3 & 4 are necessary parties to the complaint. The date of birth of the deceased Saurav Kumar is 30.12.1992 and he was healthy. He was also unmarried. The complainant is father of the deceased and he is nominee of the said insurance policy. The deceased took insurance policy known as "LIC's ANMOL JEEVAN-II” bearing No.134234780, which commenced on 28/09/2017 date of maturity commencement of Risk 28/09/2042, date of 11/10/2017, assured Rs. 10,00,000/- (Ten Lac) and the installment premium was Rs.2730/-. The said insurance policy is subsists. At the time of said insurance policy, the opposite parties said that the opposite parities would pay Rs.10,00,000/- (Ten Lac) for any accidental, natural or unnatural death etc. and some other claims during said period. Then the deceased as well as complainant took the said insurance policy as per the assurance of the opposite parties. Thus under these circumstances the complainant comes in the definition of consumer and he has right to knock the door of this honorable Commission. On 02.07.2018 the deceased was suffering from pain in abdomen and shortness breathing and he had been receiving treatment from the hospital, PGIMER, Chandigarh and he remained admit from 02.07.2018 to 08.07.2018. Thereafter he was discharged when he cured. At that time he was not suffering from any kidney problem. On 01.09.2018, the deceased was also suffering from pain in abdomen, abdominal distention and shortness breathing and he admitted and died on 01.09.2018. The officers of the OPs inquired the case and recorded statements of the complainant, his family and respectable of the locality and collected the documents. They also verified the history of the deceased from the Hospital and they filled the inquiry F.No.3816, which was completed by Sr. Resident, Emergency Medical OPD, Deptt. of Int Medicine, PGIMER, Chandigarh, which was duly signed and stamped by the said hospital. In the para No.4 and 5 of the said inquiry form it is mentioned that the deceased was suffering from abdomen pain and shortness of breath which was the medical history of the deceased on 02.07.2018 to 08.07.2018. In para No.7 of the said inquiry form, it is clear that there was not any other disease illness which preceded or co-existed with the ailment at the time of the patient's admission into the hospital. As per the said document the deceased was not suffering from any kidney or any other disease. Then said officers assured that the said claim would be released very soon. But the said inquiry falsely prepared by the opposite parties to escape their liability towards the complainant under the aforementioned claim. The complainant contacted a number of times with OPs and supply all required documents but they failed to issue the said claim. In fact the OPs declined the claim vide letter dated 30.03.2019 with the false grounds. The complainant has been running the business of clothes with the name and style as "Fancy Collection" at E.N.126, Rasta Mohalla, Tehsil and District Jalandhar. The deceased was also working with him. The complainant is holder of GST Number, PAN Card etc., which proved his business. Photographs are showing that the deceased was working with complainant in his shop. The said bills of sale and purchase are showing the sufficient source of income of the complainant. The OPs did not make the enquiry secretly in the area of the complainant, which caused more harassment and humiliation to the complainant and his family. The OPs have indulged in unfair trade practice as such, the complainant suffered great mental agony, harassment and financial loss and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to make the payment of the claim Rs.10,00,000/- alongwith @ 18% from 09.01.2018 till its realization. Further, OPs be directed to pay compensation of Rs.4,00,000/- for causing mental tension and harassment to the complainant and Rs.15,000/- as litigation expenses.       

 2.               Notice of the complaint was given to the OPs, who filed joint written reply and contested the complaint by taking preliminary objections that there is no valid contract between the life assured Saurav Kumar and the OP. The policy was obtained by committing a fraud by way of concealment by the life assured and as such, no claim is to be payable to the complainant. It is further averred that the life assured was suffering from Abdominal distression and Pain X 1 week b shortness of breath X 1 day and was diagnosed CKD and MHD as per case summary- K/C/O CKD- ESRO and dialysis acute on CKD and severe acidosis with cardiac Arrhythmia, as per Form 3816 provided by the PGI, Chandigarh, wherein the disease of the life assured was explained. The life assured taken the policy bearing No.134234780 in question on 11.10.2017 and date of commencement was 28.09.2017 for Rs.10,00,000/-. Yearly premium was Rs.2730/-. The premium was due on 28.09.2018, whereas the life assured was fully conscious about his ailment, stated above, when he took the policy and this falls in an early claim. The life assured took another policy on 31.03.2018, date of commencement was 15.01.2018 for an amount of Rs.3,10,000/- and premium was half-yearly i.e. he was to pay Rs.5874/- half yearly. After taking the policy the life assured did not pay any amount as due and policy No.102148791 was lapsed due to non-payment of premium. It is further averred that the complainant has not disclosed about the lapse policy which was showing that the life assured had no source of income. The life assured had shown his income Rs.3,00,000/- in both the proposal forms and shown his business, but in fact the life assured was not doing any business and have no income. At the time of taking the policy he has suppressed the material facts about his ailment, income, about his business, as such, this Commission is a summary court and the evidence by both the parties are required to be led as fraud was committed on the OP. On merits, the factum with regard to taking insurance policy by deceased son of the complainant is admitted and it is also admitted that the OP repudiated the claim and the same has been conveyed to the complainant, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.

3.                Rejoinder not filed by the complainant.

4.                In order to prove their respective versions, both the parties have produced on the file their respective evidence.

5.                We have heard the learned counsel for the respective parties and have also gone through the case file as well as written arguments submitted by counsel for both the parties very minutely.

6.                The complainant has proved on record that his deceased son purchased the policy known as ‘LIC’s Anmol Jeevan-II’ on 28.09.2017 and the date of commencement of the risk was 11.10.2017. The policy was for the sum assured Rs.10,00,000/- and the installment premium was Rs.2730/- per year. The policy has been proved by the complainant as Ex.C-1. The issuance of the policy has been admitted by the OP also. The date of maturity as per Ex.C-1 was 28.09.2042. As per the case of the complainant, the deceased suffered pain in abdomen on 02.07.2018 and remained admitted in PGI, Chandigarh from 02.07.2018 to 08.07.2018 and was discharged. At that time, he was not suffering from any kidney problem, but again he was admitted in PGI, Chandigarh on the complaint of pain in abdomen and was again admitted on 01.09.2018 and he died on 01.09.2018 in the PGI, Chandigarh. Ex.C-2 is the Out Patient Card of deceased Saurav Kumar, which is dated 01.09.2019. He was admitted at 03:20 and he died on the same date. The death certificate has been proved as Ex.C-3. The claim was submitted before the OPs, but the same was rejected on the ground that the complainant has given false replies to the questions put to him at the time of the issuance of insurance policy and the detail has been given stating the reasons for refusal in Ex.C-5. The complainant has further stated that the complainant was not suffering from any problem and no false replies were ever given by the complainant. The record was collected by the OPs, but they have rejected the claim of the complainant on false grounds.

7.                The case of the OPs on the other hand is that the complainant is not entitled to any relief and any claim as he has concealed the material facts from the OPs. He was not having any source of income at the time of purchasing the insurance, whereas he had informed the OPs that he is earning Rs.3,00,000/- which is wrong. He was not able to pay the premium as he was not doing any job. This is proved that he also purchased another policy which was annulled because of non-payment of the premium. He has relied upon 2008 (1) PLR 257, titled as “P. C. Chacko and another Vs. Chairman, Life Insurance Corporation of India and others” and submitted that a deliberate wrong answer leads to the vitiation of the policy in the eyes of law. He has also referred 2006 Legal Digest, titled as “LIC of India & Ors. Vs. Roshal Lal Gupta”. He has further relied upon 2018 Vol-III, titled as “Allaudin @ Ajauddin Vs. Kotak Mahindra Old Life Insurance Ltd. and Legal Digest April 2011, titled as “Senior Divisional Manager, LIC of India Vs. Smt. Satwant Kaur Sandhu” and submitted that the case of the OPs is very much covered with the facts and the law laid down by the Hon'ble National Commission and Hon’ble Supreme Court, therefore the claim of the complainant was rightly rejected as the deceased was suffering from the kidney problem since long and was on dialysis.

8.                Ex.C-1 is the insurance policy, the date of commencement is 28.09.2017 and the date of commencement of risk 11.10.2017 with date of maturity 28.09.2042. The OPs have produced the form of the complainant while purchasing the policy Ex.OP-3. Perusal of this document shows that in the column of ‘present occupation’, it has been mentioned that he is doing business of cloth shop and having Rs.3,00,000/- annual income. In the column of the ‘pre-existing diseases’ or ‘having diagnosed with any disease’, against all the columns the word ‘No’ has been mentioned. The OP has relied upon these columns and submitted that wrong answers have been given by the complainant, whereas he was suffering from kidney problem since long. Another arguments of OPs is that the deceasedHe HHhhhkkkdkdkdkddk

 was not having any source of income. For this, they have relied upon Ex.OP-2, the insurance policy form got filled in by the deceased on 31.03.2018, which was allegedly cancelled due to non-payment of premium, but this nowhere proves that the deceased was having any problem at the time of getting the insurance in the year 2017. The onus was upon the OP to prove that there is a nexus between the cause of death and the disease and it was the incumbent duty of the OPs to prove that the deceased has concealed anything and violated the terms and conditions of the policy terms. The OPs have proved on record Ex.OP-6, the questionnaire completed by the medical practitioner on the questions asked by the OPs. This document Ex.OP-6 shows that the deceased contacted the doctor a month before his death with a pain in abdomen and no previous history was given by the deceased or by the doctors in this document. The OPs have also proved on record Ex.OP-7, which is the certificate of the hospital treatment of PGI, Chandigarh. Perusal of this document shows that he was admitted in the hospital on 01.09.2018 and in the column of history, there is no mention of the fact that he was having any previous history of any kidney problem or pain in abdomen as alleged by the OPs. He was admitted on 01.09.2018 and he died on the same day. Though, in column No.11, it has been mentioned that history of K/C/O CKD-ESRO on dialysis acute on CKD and severe acidosis with cardiac arrhuythmia. This document nowhere shows that since when he was on dialysis or he was on dialysis prior to the purchasing the policy in question. The insurance policies have also been proved by the OPs, which are Ex.OP-8 and Ex.OP-9, which have also been exhibited and proved by complainant. In the written arguments, the OPs themselves have admitted that as per the documents Ex.OP-5, Ex.OP-6 and Ex.OP-7 the life assured was suffering from abdominal distression and Pain X 1 week b shortness of breath X 1 day and was diagnosed CKD and MHD. This itself shows that he suffered the problem in the year 2018 only and not prior to that. There is no document on the record to show that prior to 2018, he was having any kind of problem and the OP has failed to prove that there is a nexus between the cause of death and the pre-existing disease.

9.                The next contention of the OP is that the incorrect answers were given as he was not having any source of income and wrong income has been alleged by the complainant. This contention is also not tenable. Though, the complainant has got mentioned in the proposal form that he is having Rs.3,00,000/- income per year, but at the same time, it has been mentioned by the complainant that he is doing the business of cloth shop. At the time of the insurance, it was the duty of the LIC employees to verify as to whether the insured fulfills all the requisite conditions necessary for the insurance. The OP cannot repudiate the claim on the ground that incorrect answers were given by the insured at the time of purchasing insurance policy specially when they had received the premium. It has been held by the Hon'ble National Commission, in 2017 (2) CLT 376, case titled as “J. R. Banik Vs. National Insurance Co. Ltd.” that it is the duty of the OP that the terms and conditions should be supplied by the insurance company. It has further been held that the agents of insurance companies to achieve a target of number of insurance policies act in haste and collect premium and the consumers are supplied either cover note only or the insurance certificate without any policy clauses or terms and conditions. In the present case also the complainant has proved on record the photographs showing that his father is sitting in a shop and in photographs Ex.C-6 & Ex.C-7, the son of the complainant i.e. the deceased is also sitting in a shop. Even if, the deceased is not shown in the shop sitting with his father or doing the business of cloth, this does not prove that he was not doing any business. There is a shop of clothes which is being run by his father. This shows that this is family business. Doing family business alongwith father or siblings is covered under the condition/definition of source of income. Thus, this means that the deceased was a young man capable of doing business with his father. Therefore, it cannot be said that he was not having any source of income or any incorrect answers were given by the deceased regarding his income or source of income. In order to save the skin of their employees/agents, the claim of the complainant is wrongly repudiated. Thus, no material fact has been concealed by the complainant or the deceased son. Therefore, the complainant is entitled for the relief.

10.               In the light of above detailed discussion, the complaint of the complainant is partly allowed and OPs are directed to make the payment of the claim Rs.10,00,000/- alongwith interest @ 18% per annum from 09.01.2018 till its realization. Further, OPs are directed to pay a compensation of Rs.10,000/- to the complainant for causing mental tension and harassment and Rs.5000/- as litigation expenses within 45 days from the date of receipt of the copy of order. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.

11.               Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated          Jaswant Singh Dhillon    Jyotsna               Dr. Harveen Bhardwaj     

06.10.2022         Member                          Member           President