NCDRC

NCDRC

RP/3803/2009

LIC OF INDIA - Complainant(s)

Versus

KANCHAN DEVI & ORS. - Opp.Party(s)

MR. NIKHIL JAIN

27 Aug 2013

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 3803 OF 2009
 
(Against the Order dated 01/07/2009 in Appeal No. 1313/2004 of the State Commission Rajasthan)
1. LIC OF INDIA
Through Its Divisioal Manager
Ajmer
...........Petitioner(s)
Versus 
1. KANCHAN DEVI & ORS.
All Meja Tehsil Mandal . Distt. Bhilwara
Rajasthan
2. SANJA
S/o. Kishnlal Meja TEhsil Mandal Distt. Bhilwara
Rajasthan
3. GOPAL
S/o. Kishanlal S/o. Kishnlal Meja TEhsil Mandal Distt. Bhilwara
Rajasthan
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE V.B. GUPTA, PRESIDING MEMBER
 HON'BLE MRS. REKHA GUPTA, MEMBER

For the Petitioner :
Mr J P Sharma, Advocate
For the Respondent :
NEMO

Dated : 27 Aug 2013
ORDER

REKHA GUPTA Revision petition no. 3803 of 2009 has been filed under section 21 of the Consumer Protection Act, 1986 against the order dated 01.07.2009 passed by the Rajasthan State Consumer Disputes Redressal Commisson, Jaipur (he State Commission in appeal no. 1313 of 2004. The brief facts of the case as per the respondents/ complainants are that Shri Kishan Lal son of Mohan Lal Blacksmith, the husband of respondent no. 1 and father of respondent nos. 2 and 3 resident of Maiza had acquired the Life Insurance Policy for a sum of Rs.50,000/- being the policy no. 184671402 from the Branch Office II, situated at Bhilwara from the petitioner/ opposite party. During the period of insurance, the insured Kishan Lal died on 25.06.2002. The insured Kishan Lal had nominated his wife - respondent no. 1 - Smt Kanchan Devi as his nominee in the above said insurance policy, the endorsement of the same is on the insurance policy. Because of the death of Kishan Lal occurred during the period of insurance policy, respondent no. 1 submitted her insurance claim with the petitioner by sending the insurance policy and other documents, she also completed all the required formalities. Petitioner did not make the payment of the insurance claim of the respondent and by sending a repudiation letter bearing no. OIC/ C 1/D Repudiation dated 06.11.2002 the said insurance claim was rejected. On the ground that prior to two and a half years of acquiring the insurance policy, the insured person Kishan Lal had been suffering from the disease of Cancer, and the insurance policy was acquired by him concealing this fact and false information was furnished in the required self insurance proposal proforma. Prior to issuance of the insurance policy, the petitioner had got a thorough medical check-up carried out of the insured person by its own doctor and the other required information was furnished true and correct by the insured person to the insurance agent of the petitioner. No false information was furnished by him. At the time of acquiring the insurance policy, the insured person was absolutely enjoying sound and good health and he had not got the said insurance policy with any malafide intention. The petitioner/ opposite party in their written statement before the District Forum admitted that the insurance policy which was issued in the name of the insured persons on 13.05.2002, wherein the date of commencement of the risk of the policy was started from 28.02.2002. The proposer died within two months and 27 days of the filling up the life proposal proforma. As the death of the respondent occurred at very early stage, therefore, the case falls under the very early claim category and hence, it was necessary to conduct an investigation into the reasons of death. On having conducted the above said investigation and procuring the documentary evidence, it came to light that the insured person for acquiring the self insurance policy, in his self insurance proposal proforma dated 15.03.2002 had concealed the material fact of his previous disease and he deliberately and intentionally gave the false information regarding his state of health, therefore, the competent officer rejected the insurance claim of the respondent no. 1 and the information to this effect was sent to the respondent no. 1 vide registered post letter dated 06.11.2002. In this regard the detail facts have been enumerated in the special reply hereinunder. The medical examination which was conducted after filling up the self insurance proposal proforma, was itself the basis on which the doctor conducted the medical examination i.e., on the basis of answers given the insured person regarding his condition of health. The insured person neither disclosed the true and correct facts of his previous disease to the doctor nor to the insurance agent of the petitioner. The proposer/ insured person intentionally and deliberately tendered the incorrect answers to the question Q. 11 (ka) (d) and (cha) of his self insurance proposal proforma and in these replies he concealed the material fact of his previous disease. At the time of filling up his self insurance proposal proforma before he was not keeping good health, rather he was at the verge of death and at that time he had malafide intention knowing he would not be live for a long period, therefore, his family would get the benefit of his insurance policy. The District Consumer Disputes Redressal Forum, Bhilwara, Rajasthan vide order dated 03.06.2004 after hearing the counsels and perusing the records observed that e have perused the case and respectfully have gone through the submitted judgment citation. From the written submission, documents submitted by the petitioner/ opposite party and the principles laid down in the judgment citations submitted on behalf of the petitioner/ opposite party, in this case, it is clear that the husband of the applicant no. 1 had been suffering from the disease of cancer prior to the time of filling up of the self life insurance proposal proforma and the above mentioned facts were not mentioned in the said self life insurance proposal proforma by him. But the questions asked for the insured person while filling up the self life insurance proposal proforma regarding his status of health, there were oodand oword were mentioned in reply of those questions, which have not been filled n the handwriting of the deceased insured person, rather it is written in the handwritten of the insurance agent,. On perusal of the written submission and documentary evidence submitted on behalf of the petitioner, it is clear that the right leg of the deceased insured person Shri Kishan Lal had already been amputated prior to filling of the self life insurance proposal proforma. When the right leg of the deceased insured person had already been amputated prior to filling up the self life insurance proposal proforma and the deceased insured person Kishan Lal could not have been concealed the fact of amputation of his leg even if he desired to do so, and the insurance agent who did his insurance and the doctor who conducted medical examination of the insured person, at the first sight would have known this fact that the right leg of the insured person is amputated and this fact would have been mentioned by the insurance agent and the doctor in the self life insurance proposal proforma but neither the insurance agent mentioned the fact of amputation of the right leg of the insured person Kishan Lal nor the concerned doctor has mentioned anything regarding this fact, whereas merely seeing the insured person, amputation of his right leg is visible. At this stage we would also deem it necessary and appropriate to mention the conclusion report submitted by Shri R P Morya, Enquiry Officer appointed by the petitioner Life Insurance Corporation wherein Shri Morya has clearly mentioned this fact that the insurance agent is a resident of the same village where the insured person resides and he has not mentioned the fact of his physical infirmities and the insurance agent has deliberately and intentionally concealed the physical infirmities/ disability of the insured person. He has concealed the fact of amputation of leg. The insurance agent has not given the complete and correct information. The above mentioned enquiry officer has recommended the appropriate action against the insurance agent and has mentioned the comments of not making his payment. Therefore on the basis of the above mentioned facts and from the conclusion of the enquiry report, it is abundantly clear that in the present case whatever facts have been concealed, they were concealed by the insurance agent of the life insurance corporation, and by the doctor and the deceased insured person Kishan Lal was not in a position to conceal this fact even if he desired so that his right leg has not been amputated. The insurance agent and the authorised doctor of the Life Insurance Corporation, first of all for their personal gain and also for the benefit of the opposite party, on the basis of filling the self life insurance proposal proforma, on the basis of the medical examination, they issued the insurance policies and after death of the insured person in the early stage, they refuse to make the payment of insurance claim of the insured person. Therefore, on the basis of all the above mentioned analysis/ discussion, we came to the conclusion that at the time of filling up the self life insurance proposal proforma, whatever facts have been concealed regarding the health and physical condition of the insured person, they have been concealed deliberately and intentionally by the insurance agent and the authorised doctor of the life insurance corporation and in our opinion it is not appropriate and just to punish the insured person and after his death to the heirs of the deceased for the misdeeds of concealing the facts by the insurance agent and the doctor of the petitioner life insurance corporation and in our opinion, due to misdeeds committed by the insurance agent and the doctor of the petitioner life insurance corporation, at least the insurance amount of Rs.50,000/- should be made to the complainants so that in future the insurance agent and the doctor of the petitioner be cautioned. In this case the petitioner LIC may recover the above mentioned insurance amount of Rs.50,000/- from its agent and doctor. The District Forum then ordered and irected that the petitioner/ opposite party shall make the payment of insurance amount of Rs.50,000/- in respect of insurance policy no. 184671402 for the death insurance claim of the insured person within one month from the date of this judgment. The petitioner may recover the above mentioned amount paid to the respondent from the delinquent insurance agent and the doctor Aggrieved by the order of the District Forum, the petitioner filed an appeal before the State Commission. The State Commission after hearing the counsels for the appellants as well as for the respondents and having gone through the material available on record has observed as under: here is no dispute on the point that the deceased had taken a life insurance policy for a sum of Rs.50,000/- from the appellants bearing policy no. 184671402 on 15.03.2002 and the policy was issued on 13.05.2002. There is also no dispute on the point that at the time of taking insurance policy a declaration was made by the deceased and in that declaration on 15.03.2002 he had not mentioned that he was suffering from any kind of disease or had taken any treatment from any hospital. There is also no dispute on the point that the deceased had died on 25.06.2002 meaning thereby, within one year of issuance of the policy. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the appellants through letter dated 06.11.2002 on the grounds mentioned therein. From the record of medical leave that had been produced, it is vey much clear that the deceased had taken the treatment for cancer prior to filling in up the declaration form regarding his health on 15.03.2002 and his right leg was amputed. In our considered opinion when the fact that the deceased was patient of Cancer prior to taking the policy in question and when this fact was known to him and it was his duty to disclose that fact in the declaration from especially when the questions were put to him in respect of that disease and thus if the deceased had not mentioned the fact that he was a patient of Cancer, it would amount to suppression of material facts regarding health on the part of the deceased and the responsibility could not be thrown on the shoulders of the agent. For the reasons stated above, it is held that repudiation of claim of complainants respondents by the appellants through letter dated 06.11.2002 on the ground of suppression of material facts regarding health by the deceased was justified and no illegality or irregularity has been committed by the appellants in repudiating the claim of complainant respondent and in view of this, the findings of the District Forum decreeing the claim of the complainant respondent could not be sustained and the same are liable to be quashed and set aside as they are wholly illegal, erroneous and perverse one and the appeal deserves to be allowed. However, looking to the entire facts and circumstances of the case and on humanitarian consideration, this Commission thinks it just and proper to award ex-gratia amount of Rs.20,000/- in lumpsum to the complainant respondent no. 1. It is further made clear that ex-gratia payment to the tune of Rs.20,000/- in lumpsum is being given to the complainant respondent no. 1 who is a widow, not as a matter of right but taken into consideration the facts and circumstances that the condition of a widow in India is not good and in the present case the complainant respondent no. 1 is a widow lady. In view of the discussions made above, this appeal filed by the appellants is allowed and the impugned order dated 03.06.2004 passed by the District Forum, Bhilwara is quashed and set aside and the complaint of the complainant respondent is dismissed. However, the appellants LIC would pay a sum of Rs.20,000/- in lumpsum as ex-gratia payment to the complainant respondent no. 1 Hence, the present revision petition. The main grounds for the revision petition are that: The Honle State Commission failed to appreciate that when the complaint was dismissed, then there was no question of awarding ex-gratia as lumpsum to the tune of Rs.20,000/- to respondent no. 1. The Honle State Commission failed to appreciate that payment on humanitarian ground was not justified when the complaint was dismissed as the deceased had suppressed material facts in the declaration form. The Honle State Commission failed to appreciate that the deceased was a patient of cancer prior to taking of the policy and this fact was not disclosed in the declaration form and was guilty of suppressing material facts. We have heard the counsel for the petitioner and have gone through the records of the case carefully. It is an undisputed fact that Shri Kishan Lal son of Mohan Lal, Blacksmith- complainant no.1 and father of complainant nos. 2 and 3 had been suffering from cancer and did not disclose this fact while taking the insurance policy. Both the Fora below had also come to the conclusion that there was no deficiency of service by the petitioner. However, the District Forum held that the insurance agent and the concerned doctor who had conducted the medical examination were guilty of having the complete and correct information were guilty of concealment of the correct status of health. The District Forum hence went to on to order that the petitioner should pay Rs.50,000/- and recover the same from the insurance agent and the doctor. The State Commission also correctly came to the conclusion that repudiation of the claim of the respondents by the petitioner on the grounds of suppression of material facts regarding health by the deceased was justified by the petitioner and in repudiating the claim of the respondents and there was no deficiency in service by them and hence, the order of the District Forum should be set aside and they should be made to pay Rs.50,000/- to the respondents. The State Commission however, erroneously went on to award an ex-gratia payment on humanitarian consideration of Rs.20,000/-. This is beyond the pleadings of the respondents. Further, in P C Chacko and Anr. Vs Chairman Life Insurance Corporation of India and Ors (2007 XAD (SC) 429), in which paragraph 20 which is relevant to us in this case reads as under: e are not unmindful of the fact that Life Insurance Corporation being a state within the meaning of Article 12 of the Constitution of India, its action must be fair, just and equitable but the same would not mean that it shall be asked to make a charity of public money, although the contract of insurance is found to be vitiated by reasons of an act of the insured. This is not a case where the contract of insurance or a clause thereof is unreasonable, unfair or irrational which could make the court carried the bargaining powers of the contracting parties. It is also not the case of the appellants that in framing the aforesaid questionnaire in the application/ proposal form, the respondents had acted unjustifiably or the conditions imposd are unconstitutional The National Commission in RP Nos. 858, 894, 995, 1435, 1446, 1503, 1504, 1505, 1553, 1554, 1679, 1680, 1722, 1723, 3631 of 2009, 1504 of 2006, 3147, 3789, 3855, 3858 to 3860, 3917, 3918, 4662, 4663, 4726, 4727, 4836, 4837, 5009, 5010, 5030 of 2008, 23, 164, 331, 359, 1909, 1926, 2945, 2946, 3094, 3097 of 2009 decided on 17.12.2009 have stated as under: e are afraid in terms of provisions of Consumer Protection Act, 1986, we are not free to do a avourto a party. As far as the moral obligation is concerned, that has to be done oluntarilyby the authority concerned. The Consumer Fora cannot pass or give direction or order to give a avourotherwise the word moral grounds are voluntarily will lose its very meaning. While going through the aim and objectives of the Consumer Protection Bill, 1986, as highlighted by the learned counsel for the respondent we are of the view that a distinction needs to be made between justice natural or otherwise and avour There is no room for favouritism while dispensing justice. The word x-gratiahas been interpreted/ understood to mean avour rendered oluntarilyand on oral grounds thus, clearly ousting the jurisdiction of quasi judicial bodies like ours to direct a party to show favour. If we do this, this will not only run counter to the letter and spirit of Consumer Protection Act but also assume/ confer powers which are not conferred upon us by Law/ mandate. Any direction by Consumer Fora to the party concerned to grant ex-gratia payment will defeat the very purpose and meaning of x-gratia i.e., favour, grace shown voluntarily on moral grounds. However, this order would not deter directing payment of x-gratiabasis by the Consumer Forums, provided, the concurrence of the sanctioning authority of insurance company, is obtained through their counsel (counsel for the insurance company) for making the payment on x-gratiabasis Learned counsel for the petitioner have also filed the judgment of this Commission in RP No. 3310 of 2009 decided on 06.01.2010, wherein it has been observed as under: tate Commission while allowing the appeal and dismissing the complaint, has awarded Rs.25,000/- by was of ex-gratia. This judgment is contrary to a subsequent judgment passed by this Commission in Life Insurance Corporation of India vs Prahlad Singh and Ors and other connected revision petitions in which we have held that the State Commission, suo moto, cannot order payment of ex-gratia amount. The point in issue is concluded in favour of the petitioner and against the respondent. Respondent is not present despite service. Ordered to be proceeded ex parte. In view of the law laid down by this Commission in Prahlad Singh case (supra), we allow the revision petition, set aside the order passed by the State Commission and dismiss the complaint. Revision petition stands disposed of in above terms In view of the aforementioned circumstances, we are of the view that Consumer Fora by the very construction of the Act, are not empowered to direct any party for grant of x-gratiapayment, in view of which we are unable to sustain the orders passed by the State Commission directing the LIC to pay ex-gratia amount of Rs.20,000/-. Hence, the revision petition is allowed and the order passed by the State Commission is set aside.

 
......................J
V.B. GUPTA
PRESIDING MEMBER
......................
REKHA GUPTA
MEMBER

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