Punjab

StateCommission

A/11/1669

Deepak Kumar Garg - Complainant(s)

Versus

LIC of India - Opp.Party(s)

Vishal Garg

23 Feb 2015

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,   PUNJAB      DAKSHIN MARG, SECTOR 37-A, CHANDIGARH.

 

  First Appeal No.1669 of 2011                                                  

             Date of institution  :    17.11.2011

Date of decision     :    23.02.2015

 

Deepak Kumar Garg S/o Pawan Kumar C/o Hanuman Trading Company, Anaj Mandi, Tapa, District Barnala.

…….Appellant/Complainant

Versus

1.      Life Insurance Corporation of India, 22 Acre, Barnala, through          its Branch Manager.

2.      Life Insurance Corporation of India, Divisional Office, Sector-  17, Chandigarh, through its Divisional Manager.

                                                          …Respondents/Opposite Parties 

First Appeal against the order dated 21.07.2011 of the District Consumer Disputes Redressal Forum, Barnala.

Quorum:- 

 

          Hon’ble Mr. Justice Gurdev Singh, President.

                        Shri Baldev Singh Sekhon, Member.

                        Mrs. Surinder Pal Kaur, Member.

 

Present:-

 

          For the appellant        :       None.

          For the respondents           :        Shri B.J. Singh, Advocate.

 

 

JUSTICE GURDEV SINGH,  PRESIDENT :

 

                    Deepak Kumar Garg, appellant/complainant, feeling aggrieved by the order dated 21.07.2011 passed by District Consumer Disputes Redressal Forum, Barnala (in short, “District Forum”), vide which the complaint filed by him, under Section 12 of the Consumer Protection Act, 1986 was dismissed, has come up in the present appeal for setting aside that order and for issuing the directions, as mentioned in the complaint, to the opposite parties. He alleged in his complaint that Seema Rani was his wife, who purchased one life insurance policy bearing No.164341143 for Rs.3,75,000/- from the opposite parties and paid first premium of Rs.9,097/- on 23.06.2009. She appointed him as nominee under the policy. Her signatures were obtained on the proposal form by the officials of the opposite parties, by stating that it was only an official formality. She was not so qualified, so as to understand the language of that proposal form. Even the agent of the opposite parties, from whom the contents of the proposal form were asked for by her before putting her signatures, told that it was just an official formality and the contents thereof were not required to be explained to her.  The contents of the proposal form were filled up by the agent of his own. The approved and qualified doctors of the opposite parties medically examined her and declared that she was fit for insurance purposes. On 24.12.2009, she died as a result of Cardiac Arrest in Deep Nursing Home, Barnala, at the time of delivery of the child. The information of her death was given to the opposite parties immediately, who supplied the claim form to him (complainant) and after filling up the same, he duly deposited it with them, along with the requisite documents.  However, the claim was repudiated by the opposite parties, vide letter dated 31.12.2010, alleging that the insured had withheld the material information regarding her pregnancy at the time of obtaining the policy. At the time of filling up the propel form, she was only 28 years old and she was kept in dark by the officials of the opposite parties and otherwise, she must have filled up the date of last menstruation and the date of last delivery in that form. The cause of death had no nexus with the pregnancy/ delivery. Thus, the opposite parties committed deficiency in service and adopted unfair trade practice, by repudiating his claim; as a result of which, he suffered mental agony and harassment. He prayed for the issuance of following directions to them:-

 

i)        to pay the sum assured of Rs.3,75,000/-, along with interest @        18% per annum from the date of death of the insured till      realization;

ii)       to pay Rs.1,00,000/-, as compensation for mental agony         and   harassment; and

iii)      to pay Rs.11,000/-, as litigation expenses.

 

2.                The opposite parties filed joint written reply before the District Forum, in which they admitted that the policy, in question, was purchased by Seema Rani, insured, after the payment of the first premium; in which she nominated the complainant, as her nominee. They also admitted that the policy was taken by the deceased/insured through their agent. They also admitted that the claim under the policy was made by the complainant; which was repudiated, vide    letter dated 31.12.2010. While denying the other allegations made in the complaint, they pleaded that the name of the agent was Sanjiv Kumar Mittal. The proposal form was signed by the insured in English and she was well aware of that language along with Hindi and the same was used in the proposal form. The contents of the proposal form were in her knowledge and she mentioned in column No.13 (A) thereof that she was not pregnant and the date of last delivery was shown as “September-2005”, whereas the date of last menstruation was left blank. The insured was not presented for her medical examination by the said agent, as is apparent from her signatures on the medical report, which do not resemble with the signatures on the proposal form. In fact, the claim was made by the complainant under two policies. The other claim of Rs.2,00,000/- was made under policy bearing No.163653391, which was duly sanctioned and settled by the Corporation. The claim under the present policy was an early claim, which required investigation before settlement. The same was repudiated after it was found that material information regarding pregnancy was withheld/concealed in the proposal form. At the foot of the proposal form, the insured made declaration that all the contents disclosed therein were correct and true to the best of her knowledge and if any information was found to be wrong, the contract shall be null and void and all the moneys shall be forfeited. She herself gave wrong information in the proposal form, as she was pregnant from the last 14 weeks before putting her signatures thereon.  As per the rules of the Corporation, she was not insurable, had the material information regarding pregnancy been disclosed in the proposal form for insurance. In these circumstances, the ground regarding the absence of any nexus between the cause of death and pregnancy cannot be taken up in the complaint. The complainant has no cause of action, nor any locus standi to file the complaint and the same is not maintainable in the present form. He is estopped by his act and conduct from filing the complaint. They prayed for the dismissal thereof with compensatory costs; being false and frivolous and having been filed to harass them.

3.                Both the sides produced evidence in support of their respective averments before the District Forum, which after going through the same and hearing learned counsel on their behalf, dismissed the complaint, vide aforesaid order.

4.                We have heard the learned counsel for the respondents/opposite parties, as no one appeared on behalf of the appellant. We have also carefully gone through the records of the case.

5.                The impugned order has been challenged in the appeal, mainly on the following two grounds:-

 

i)        All the documents were in custody of the opposite parties since       the inception of the policy and it was for them to check all those documents at the time of issuing the policy. Once the           policy has been issued, a valid contract comes into existence.           If there was any discrepancy in the documents, it should have         been brought to the notice of the insured in the beginning itself.

 

ii)       It was the duty of the officials of the opposite parties to get the         insured medically examined from their empanelled doctors and if they have failed to do so, they are to suffer for the same.

 

6.                It was submitted by the learned counsel for the opposite parties that the findings were recorded by the District Forum against the complainant, after thoroughly going through the evidence produced on the record and by taking into consideration the law; which has been well settled in the judgments, so cited in the order. There is no ground for upsetting the well reasoned findings, on the grounds taken up in the appeal.

7.                The repudiation letter dated 31.12.2010 was proved on the record as Ex.C-3. A perusal thereof shows that the claim made by the complainant, after the death of the insured, was repudiated on the ground that she made deliberate misstatement and withheld material information regarding her health/pregnancy at the time of effecting the insurance, by stating that she was not pregnant at that time and the date of last delivery was shown as “Sept. 2005”.  It is the case of the complainant himself that the insured had died at the time of delivery of the child, though the cause of death was Cardiac Arrest. The first question to be determined is, whether the finding recorded by the District Forum that there was concealment of material information by the insured at the time of obtaining the policy, is correct?

8.                The proposal form was proved by the opposite parties as Ex.R-2. There is column No.13A in this proposal form, containing the question “Are you pregnant now?” and “Date of last delivery”. In that column, “No” was written under the first query and “Sept.05” was written under the second query. The complainant has tried to take up the plea in the complaint that the contents of those columns were not brought to the notice of the insured and were filled up by the agent of the opposite parties itself. In support of those averments, he proved on record his affidavit Ex.C-1. In the verification of the affidavit, he verified the contents to be true and correct to the best of his knowledge and belief. He could have deposed about such facts, if he himself was present at the time of filling up the proposal form. It was never his case at any stage. Then how he can depose about those facts from his knowledge? Once the signatures of the insured were proved on the proposal form, the onus shifts upon the complainant to prove that it was not so stated by her. It is now well settled that the agent, at the stage of filling up the proposal form, was the agent of the insured and not that of the insurer. Thus, the insured was bound by the answers given in the proposal form. Had those facts been not disclosed by her to the agent, it was not possible for him to state the same, as he could not have come to know about the date of her last delivery.  

9.                The opposite parties proved on record the Certificate of Hospital Treatment, Ex.R-4. A perusal thereof shows that the insured was admitted in Deep Nursing Home, Barnala on 24.12.2009 for the delivery of the child and at the time of delivery, died of Cardiac Arrest. The fact that she delivered the child on 24.12.2009 itself proves that she was pregnant on the day, she filled up the proposal form. Thus, she concealed material information from the opposite parties.

10.              It is now well settled that the contracts of insurance are based upon the doctrine of Uberrima-fides, i.e. of utmost good faith. The concealment of the material facts, which the insured is liable to disclose, makes a contract of insurance void. In that regard, reference can be made to the following judgments:-

i)        Usha Rani & Others Vs. Life Insurance Corporation of        India & Others (2013) (1) CLT 573;

ii)       Life Insurance Corporation of India Vs. Smt. Minu Kalita     (III) (2002) CPJ 10 (NC); and

iii)      Life Insurance Corporation of India & Another Vs.      Kantaben (1) (1996) CPJ 115 (NC).

 

11.              Thus, the claim of the complainant was validly repudiated by the opposite parties and correct findings to that effect were recorded by the District Forum. We do not find any ground to reverse those well reasoned findings. This appeal, which is without any merit, is hereby dismissed.

12.              The arguments in this case were heard on 20.02.2015 and the order was reserved.  Now, the order be communicated to the parties.

13.              The appeal could not be decided within the statutory period due to heavy pendency of court cases.

 

 

 

                                                        (JUSTICE GURDEV SINGH)

                                                                       PRESIDENT  

                                                         

 

 

                                                        (BALDEV SINGH SEKHON)

                                                                         MEMBER

                                                         

 

 

                                                      (MRS. SURINDER PAL KAUR)

February 23, 2015                                       MEMBER

(Gurmeet S)