BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR.

Consumer Complaint No.166 of 14

Date of Institution: 26-03-2014

Date of Decision: 15-05-2015 

Jagir Kaur wife of Mohinder Singh, aged 42 years, resident of 485, Dashmesh Avenue, Majitha Road, District Amritsar.

Complainant

Versus

1. Life Insurance Corporation of India, 2^nd Floor, R S Tower, Hall Bazar, Amritsar through its Branch Manager.
2. Life Insurance Corporation of India, 4-5, District Shopping Complex, Ranjit Avenue, Amritsar through its Senior Divisional Manager.
3. Manjit Singh, Agent Code No. 5097-146, LIC of India, 2^nd Floor, R S Tower, Hall Bazar, Amritsar.
4. Satnam Singh, Agent Code No. 4898-146, LIC of India, 2^nd Floor, R S Tower, Hall Bazar, Amritsar.

Opposite Parties

Complaint under section 11 and 12 of the Consumer Protection Act, 1986 as amended upto date.

Present: For the Complainant: None for the complainant.

              For  Opposite Parties No.1 and 2: Sh.M.S.Bhatia, Advocate

              For Opposite Parties No.3 and 4: Given Up.

Quorum:

Sh.Bhupinder Singh, President

Ms.Kulwant Kaur Bajwa, Member

Mr.Anoop Sharma, Member  

Order dictated by:

Sh.Bhupinder Singh, President.

1. Present complaint has been filed by Smt.Jagir Kaur under the provisions of the Consumer Protection Act alleging therein that Kuldeep Singh son of the complainant had obtained two life insurance policies, one namely LIC’s Jeevan Saral (with Profit) under policy No.473132788 for a sum assured of Rs.1,25,000/- on 13.9.2011 and second namely LIC’s Bima Gold under Policy No. 472904000 for a sum assured of Rs.75,000/- on 14.5.2009 from the Opposite Parties No.1 and 2 through Opposite Parties No.3 and 4 respectively. Complainant alleges that Kuldeep Singh son of the complainant died on 27.4.2012 and the complainant being the mother and nominee in the aforesaid policies approached the Opposite Party No.1 for the payment of the death claim in the aforesaid policies, but the Opposite Parties No.1 and 2  repudiated the claim of the complainant vide letter dated 28.5.2013 on the false and flimsy grounds that DLA (deceased life assured) has not disclosed about his disease i.e.cancer at the time of taking and reviving of policies. Alleging the same to be deficiency in service, complaint was filed seeking directions to the Opposite Parties No.1 and 2 to pay the death claim amounting to Rs.2 lac to the complainant alongwith interest @ 18% per annum. Compensation and litigation expenses were also demanded.
2. On notice, Opposite Parties No.1 and 2 appeared and filed written version in which it was submitted that the DLA (deceased life assured) Kuldeep Singh had willfully and fraudulently withheld the correct information regarding his health condition at the time of revival of policy bearing No. 472904000 on 23.12.2011 and taking of second policy bearing No. 473132788 on 13.9.2011. The first policy was revived and the second new policy issue to DLA on non-medical basis and no medical examination was conducted by the Opposite Parties. In fact, the DLA was not keeping good health and had been admitted in Shri Guru Ram Dass Charitable Hospital, Vallah, Amritsar and Guru Nanak Dev Hospital, Amritsar  as he was suffering from ‘Carcicoma Post Cricoids Region and underwent Radiotherapy and Chemotherapy’ for the same. He remained admitted in Shri Guru Ram Dass Charitable Hospital, Vallah, Amritsar between 5.12.2010 and 21.12.2010. He did not disclose these material facts about his health at the time of revival and taking of second policy, which were in his exclusive knowledge and the DLA (deceased life assured)  had deliberately suppressed these facts from the Opposite Parties and tried to play fraud with the Opposite Parties No.1 and 2 to grab the public money for his legal heirs. The DLA (deceased life assured)  had expired on 24.7.2012, within one year of revival/ taking of second policy. Hence, the repudiation of the claim by the Opposite Parties No.1 and 2 is legal, valid and in accordance with rules.  While denying and controverting other allegations, dismissal of complaint was prayed.
3. Opposite Parties No.3 and 4 were given up vide order dated 9.7.2014 of this Forum on the statement of ld.couunsel for the complainant recorded before this Forum separately on 9.7.2014. 
4. Complainant tendered into evidence his affidavit Ex.C1 alongwith documents Ex.C2 to Ex.C6, affidavit of Inderjit Singh Ex.C7, affidavit of Bhupinder Singh Ex.C8 and closed the evidence on behalf of the complainant.
5. Opposite Parties No.1 and 2 tendered into evidence affidavit of Sh.Yogender Singh Sidodia, Manager (Legal) Ex.OP1,2/1 alongwith documents Ex.OP1,2/1 to Ex.OP1,2/11, affidavit of Dr.Meena Sudan Ex.OP1,2/12 alaongwith treatment file of Kuldeep Singh, DLA, patient file of Kuldeep Singh Ex.OP1,2/13 and closed the closed the evidence on behalf of the Opposite Parties No.1 and 2.
6. We have carefully gone through the pleadings of the parties; arguments advanced by the ld.counsel for the Opposite Parties No.1 and 2 and have appreciated the evidence produced on record by both the parties with the valuable assistance of the ld.counsel for the Opposite Parties No.1 and 2.
7. From the record i.e. pleadings of the parties and the evidence produced on record by the parties, it is clear that  son of the complainant namely Kuldeep Singh had obtained two life insurance policies, i.e. one policy  namely LIC’s Jeevan Saral (with Profit) bearing No.473132788 (Ex.OP1,2/4)  for a sum assured of Rs.1,25,000/- on 13.9.2011 and second policy namely LIC’s Bima Gold bearing No. 472904000 (Ex.OP1,2/2)  for a sum assured of Rs.75,000/- on 14.5.2009 from the Opposite Parties No.1 and 2.  The complainant submitted that her son Kuldeep Singh, deceased Life assured (herein-after referred to as ‘DLA’) died on 27.4.2012.  The complainant being the mother and nominee of Kuldeep Singh, DLA  in the aforesaid policies approached the Opposite Party No.1 for the payment of the death claim in the aforesaid policies. However, the complainant received letter dated 28.5.2013 Ex.OP1,2/10 from the Opposite Parties No.1 and 2 vide which the Opposite Parties No.1 and 2 rejected the death claim of Kuldeep Singh under the policy 472904000 on 23.12.2011 on the ground that deceased Kuldeep Singh had not disclosed his health condition at the time of revival of the policy whereas he was a patient of cancer since November, 2010 as per the hospital record of Shri Guru Ram Dass Charitable Hospital, Vallah, Amritsar. Complainant further received another letter dated 28.5.2013 whereby Opposite Party No.2 has repudiated the death claim of Kuldeep Singh by stating that deceased had made mis-statement at the time of making the proposal for assurance dated 13.9.2011 regarding his health condition. The complainant submitted that the complainant has not concealed anything, but the  Opposite Parties No.1 and 2 have wrongly repudiated the death claim of Kuldeep Singh, DLA and all this amounts to deficiency of service on the part of the Opposite Parties No.1 and 2.
8. Whereas the case of the Opposite Parties No.1 and 2 is that DLA Kuldeep Singh had willfully and fraudulently withheld the correct information regarding his health condition at the time of revival of policy bearing No. 472904000 on 23.12.2011 as well as  taking of second policy bearing No. 473132788 on 13.9.2011. The first policy was revived and the second new policy issue to DLA on non-medical basis. DLA was not keeping good health and had been admitted in Shri Guru Ram Dass Charitable Hospital, Vallah, Amritsar and Guru Nanak Dev Hospital, Amritsar  as he was suffering from ‘Carcicoma Post Cricoids Region and underwent Radiotherapy and Chemotherapy’ for the same. He remained admitted in Shri Guru Ram Dass Charitable Hospital, Vallah, Amritsar between 5.12.2010 and 21.12.2010, but he did not disclose these material facts about his health at the time of revival and taking of second policy. DLA had deliberately suppressed these facts from the Opposite Parties thereby he tried to play fraud with the Opposite Parties No.1 and 2.  The DLA had expired on 24.7.2012, within one year of revival/ taking of second policy. Ld.counsel for the Opposite Parties No.1 and 2 submitted that the Opposite Parties No.1 and 2 have rightly repudiated the claims of the complainant vide letter dated 28.5.2013 Ex.OP1,2/10 and Ex.OP1,2/11. The Opposite Parties No.1 and 2 have also produced the record of Shri Guru Ram Dass Charitable Hospital, Vallah, Amritsar Ex.OP1,2/13 which has been duly proved by Dr.Meena Sudan MBBS, MD, Prof and Head Shri Guru Ram Dass Rotary Cancer Hospital, Mehta Road, Vallah, Amritsar, Punjab as well as record of Guru Nanak Dev Hospital, Amritsar  Ex.OP1,2/13A. The complainant has concealed all these material facts at the time of revival of the first policy as well as at the time of taking second policy. Opposite Parties No.1 and 2 have therefore, rightly repudiated the death claim of DLA Kuldeep Singh. It is therefore, submitted that there is no deficiency of service on the part of the Opposite Parties No.1 and 2.  
9. From the entire above discussion, we have come to the conclusion that DLA Kuldeep Singh got two life insurance policies, i.e. one policy  namely LIC’s Jeevan Saral (with Profit) bearing No.473132788 (Ex.OP1,2/4)  for a sum assured of Rs.1,25,000/- on 13.9.2011 by filling in and signing the proposal form Ex.OP1,2/3  and second policy namely LIC’s Bima Gold bearing No. 472904000 (Ex.OP1,2/2)  for a sum assured of Rs.75,000/- on 14.5.2009 by filling in and signing the proposal form Ex.OP1,2/1  from the Opposite Parties No.1 and 2.  DLA Kuldeep Singh, died on 27.4.2012.  The complainant mother of DLA is nominee in the  aforesaid policies. She lodged the death claim of DLA Kuldeep Singh with Opposite Parties No.1 and 2. During investigation, it was found that the policy obtained by DLA Kuldeep Singh bearing No.472904000 had expired and the DLA got the same revived on 23.12.2011. At that time, the DLA Kuldeep Singh did not disclose the true facts about his health condition. He has categorically stated that he has not been suffering from any disease. Further, the DLA Kuldeep Singh got second policy 473132788 on 13.9.2011 Ex.OP1,2/4 by filling in and signing the proposal form on 13.9.2011 Ex.OP1,2/3 in which the DLA Kuldeep Singh has mentioned that he has already existing L.I.C. insurance policy whereas his earlier policy bearing 472904000 had already expired and at the time of taking of second policy 473132788 on 13.9.2011  Ex.OP1,2/4, the earlier policy of the complainant was not existing. The DLA Kuldeep Sigh in the proposal form Ex.OP1,2/3 for the second policy, has not mentioned the true facts regarding his health condition and he has stated that he has not been suffering from any disease whereas as per record of Shri Guru Ram Dass Institute of Meidcal Sciences & Research (S.G.R.D. Rotary Cancer Hospital), Mehta Road, Sri Amritsar, Ex.OP1,2/13 which has been duly proved by   Dr.Meena Sudan MBBS, MD, Prof. and Head Shri Guru Ram Dass Rotary Cancer Hospital, Mehta Road, Vallah, Amritsar, Punjab through her affidavit Ex.OP1,2/12, fully proves that Kuldeep Singh, DLA remained in their hospital from 18.12.2010 to 21.12.2010 and he was diagnosed case of ‘Carcicoma Post Cricoids Region (Throat Food Pipe)’ and had received  Radiotherapy and Chemotherapy in their hospital. Further record of Guru Nanak Dev Hospital, Amritsar Ex.OP1,2/13A also proves these facts regarding DLA. So, the DLA Kuldeep Singh while filling in and signing both the proposal forms Exc.OP1,2/1 and Ex.OP1,2/3 concealed the material facts regarding his health that he had been suffering from cancer and had undergone  Radiotherapy and Chemotherapy at Shri Guru Ram Dass Rotary Cancer Hospital, Mehta Road, Vallah, Amritsar, Punjab as well as Guru Nanak Dev Hospital, Amritsar attached with Government Medical College, Amritsar. It has been held by Hon'ble National Commission in case Life Insurance Corporation of India Vs. Mansa Devi 2003(1) Judicial Reports Consumer 501 that where the insured has suppressed the material facts of existence of any pre-existing disease and had undergone treatment for that, the suppression of such a material fact renders the contract of insurance illegal, invalid, void abinitio and unenforceable. Hon'ble National Commission further held that the contract of insurance is of utmost good faith i.e. Ubremma Fidei and the life assured is bound to disclose honestly, truthfully and correctly all the answers in the proposal form concerning the state of his health. The same view has been taken by the Hon'ble National Commission in case Sr. Divisional Manger, LIC of India Vs. Smt. Satwant Kaur Sandhu Legal Digest April 2011 page 85 as well as in case Panchal Ramabhai Motibhai Vs. LIC of India Legal Digest April 2011 page 83. So the concealment of this material fact by the complainant while obtaining the present policy from the opposite party renders this contract of insurance illegal and void. Hon'ble Supreme Court of India in case Satwant Kaur Sandhu Vs. New India Assurance Company Ltd IV (2009) CPJ 8 (SC) has held that in case of mediclaim policy where the policy holder suffering from chronic diabetes and renal failure not disclosed while obtaining the medi claim insurance policy, this suppression of material fact has been fully proved by the opposite party. Apart from this Hon'ble Supreme Court of India observed in case Satwant Kaur Sandhu Vs. New India Assurance Company Limited (supra) that :-

“A medi claim policy is a non-life insurance policy meant to assure the policy-holder in respect of certain expenses pertaining to injury, accidents or hospitalizations. Nonetheless, it is a contract of insurance falling in the category of contract ubremma fidei, meaning a contract of utmost good faith on the part of the assured. Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. It is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not. Of course, the obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known. The obligation to disclose necessarily depends upon the knowledge one possesses. His opinion of the materiality of that knowledge is of no moment.”

10. From the above discussion, we are of the opinion that the Opposite Parties No.1 and 2 have rightly repudiated the death claim of DLA Kuldeep Singh in both the aforesaid policies.
11. Resultantly, we hold that the complaint is without merit and the same is hereby dismissed with no order as to costs. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

Dated: 15-05-2015.                                                   (Bhupinder Singh)                                                                                               President

hrg                                                 (Kulwant Kaur Bajwa)    (Anoop Sharma)

              Member                         Member