Punjab

Sangrur

CC/25/2015

Jasbir Kaur - Complainant(s)

Versus

LIC of India - Opp.Party(s)

Shri Jagtar Singh Kaler

01 Jul 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

 

                                                               

                                                Complaint No.    25

                                                Instituted on:      12.01.2015

                                                Decided on:       01.07.2015

 

Jasbir Kaur wife of Late Sukhwinder Singh son of Jangir Singh, R/o Quarter No.110, Housing Board Colony, Nabha Gate, Sangrur.

                                                        …Complainant

                                Versus

1.     LIC of India, Branch Railway Road, Sangrur through its Branch Manager.

2.     LIC of India, Jeewan Prakash Building, Sector 17-B, Chandigarh through Sr. Divisional Manager.

                                                        ..Opposite parties

 

For the complainant    :       Shri Jagtar Singh, Adv.

For OPs                    :       Shri Amit Goyal, Adv.

 

Quorum:    Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

 

Order by : Sukhpal Singh Gill, President.

 

1.             Smt. Jasbir Kaur, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that husband of the complainant Shri Sukhvinder Singh (referred to as DLA in short) obtained one life insurance policy bearing number 164599682 from OP number 1 under Salary Saving Scheme through his department (Ranbir College, Sangrur), where he was an employee.  It is further averred that the date of commencement of the policy was 14.8.2012 and the date of maturity as 09/2032 with the sum assured of Rs.4,00,000/-. It is further averred that the complainant is the nominee under the policy.  It is further averred that the DLA died on 15.8.2013 due to sudden heart attack and after performing the last rights of the DLA, the complainant lodged the claim with the Ops and submitted all the documents for settlement of the claim of the complainant.  Thereafter the complainant visited the office of OP number 1 a number of times to enquire about the claim, but the OPs told that the same will be intimated to the complainant as soon as the same is settled, but nothing happened. Thus, alleging deficiency in service on the part of the Ops the complainant has prayed that the Ops be directed to pay to the complainant an amount of Rs.4,00,000/- along with all other benefits payable under the policy along with interest @ 18% per annum from the date of death i.e. 15.8.2013 till realisation and further claimed compensation and litigation expenses.

 

2.             In reply, preliminary objections are taken up on the grounds that the complaint is not maintainable, that the complainant has not come to the Forum with clean hands and that the complainant has dragged the Ops into unwanted litigation and the complaint is said to be false and frivolous one.  It is stated that the DLA had concealed the material information regarding his state of health at the time of filling the proposal form and intentionally gave wrong answers regarding his health in the proposal form.  On merits, it has been admitted that the DLA Sukhwinder Singh had obtained the insurance policy in question from the Ops for the sum of Rs.4,00,000/- under salary saving scheme and the complainant was the nominee under the policy.  It is also admitted that the DLA died on 15.8.2013 as per the death certificate submitted by the complainant. It is stated further stated that the required documents for settlement of the claim were not submitted at once by the complainant rather the same were submitted on 14.5.2014 and 26.8.2014. It is further stated that form number 3787 (issued by the employer of the DLA) was submitted by the complainant. It is further stated that the copies of other documents such as leave application, medical certificate submitted for availing medical leave and medical reimbursement record etc. were not submitted by the complainant to the Ops despite reminders to the complainant. It is further stated that since the claim under the policy in question was an early claim i.e. death of the life assured took place within one year one day, so investigation was conducted regarding the genuineness of the claim of the complainant.  The investigation was conducted by S.L. Chaudhary, Chief Manager, LIC of India, Sangrur and during investigation it came to the knowledge of the OPs that the DLA was not having good health for the last 4-5 years before the commencement of the policy and the DLA was suffering from multiple diseases and he was taking treatment for the same.  It is further stated that the DLA was suffering from hypertension, diabetes, depression, anorexia nervosa, G. debility etc., whereas the DLA suppressed all these material facts at the time of taking the insurance policy.  As such, it is stated that the claim of the complainant has been rightly repudiated by the Ops vide letter dated 16.3.2015.  Any deficiency in service on the part of the OPs has been denied.

 

3.             The learned counsel for the complainant has produced Ex.C-1 copy of death certificate, Ex.C-2 copy of insurance policy, Ex.C-3 affidavit, Ex.C-5 copy of bank statement, Ex.C-5 to Ex.C-7 affidavits and closed evidence. On the other hand, the learned counsel for the OPs has produced Ex.OP-1 copy of proposal form, Ex.OP-2 copy of agent report, Ex.OP-3 copy of policy, Ex.OP-4 copy of intimation letter, Ex.OP-5 copy of claimant statement, Ex.OP-6 and Ex.OP-7 copies of certificates, Ex.OP-8 copy of confidential report, Ex.OP-9 copy of certificate, Ex.OP-10 to Ex.OP-19 copies of leave record along with treatment record, Ex.OP-20 copy of letter, Ex.OP-21 to Ex.OP-23 copies of treatment record, Ex.OP-24 to Ex.OP-27 copies of certificates, Ex.OP-28 copy of status report, Ex.OP-29 copy of claim inquiry report, Ex.OP-30 copy of repudiation letter and Ex.OP-31 an affidavit and closed evidence.

 

4.             We have carefully perused the complaint, version of the opposite parties, evidence produced on the file and written submissions and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.

 

5.             It is an admitted fact that the DLA took an insurance policy bearing number 164599682 from the OP number 1 under salary saving scheme through his employer i.e. Ranbir College Sangrur on 14.8.2012 and the date of maturity of the policy as 08/2032. It is also an admitted fact that the DLA died on 15.08.2013 due to sudden heart attack.  It is also an admitted fact that the Ops have repudiated the claim of the complainant.

 

6.             After hearing the arguments of the learned counsel for the parties and on perusal of the documents produced on the record, we find that it is an admitted fact that the DLA Sukhwinder Singh had obtained the policy in question from the Ops.  In the present case, the main point of controversy is with regard to the suppression of existing disease by the DLA at the time of obtaining the insurance policy in question.  The Ops have placed on record the medical certificate, which was submitted by the DLA in order to avail the leave from the employer and there are only two documents i.e. Ex.OP-18 and Ex.OP-23, which are the hospital record and in these two also the disease mentioned on discharge slip shows that the DLA was suffering from high Blood Pressure and diabetes.  Except these two documents, there is no other document submitted by the OPs with regard to the admission of the DLA in the hospital and neither medical certificate has been obtained from the hospital nor any doctor who treated the DLA has been produced in evidence. The documents with regard to the disease submitted by the Ops are only procured from the employer i.e. Govt. Ranbir College, Sangrur, which the DLA had submitted for obtaining the leave.  Whereas the version of the complainant is that the DLA was not suffering from any such disease nor at the time of death he was under the treatment of any doctor nor he was taking any medicine for any such disease as alleged by the OPs.  More over, the documents placed by the OPs with regard to the suppression of the disease by the DLA have neither been attested by the concerned doctor nor supported by any affidavit, so the same are not admissible in the evidence of the OPs.

 

7.             We have gone through the documents placed on record and find that the Ops have got the matter investigated and they themselves have placed on record the document Ex.OP-8, which is confidential report of the agent and this document clearly states that there is no suspicion or fraud and the claim is bonafide one.  So, it seems that when the Ops have got the claim investigated and are relying on the report, which is Ex.OP-8, then why the question of suppression of material fact at the later stage has occurred.  We have also gone through the document Ex.OP-7, which is the certificate of hospital treatment and in this document also, the doctor concerned has submitted that the patient was brought dead at 9.55 AM on 15.08.2013.  This also supports the version of the complainant that the DLA had died due to heart attack and in support of her version the complainant has placed on record the affidavits of the colleagues of the DLA, namely, Shri Karamjit Singh, Shri Roshan Lal and Shri Arvinder Singh, Ex.C-5, Ex.C-6 and Ex.C-7, respectively.  The learned counsel for the complainant has also brought to the notice of this Forum that the Ops have made the payment of another policy to the complainant on 30.09.2013 of the same DLA and this fact goes to prove from the document Ex.C-4, which is a copy of the passbook issued by State Bank of Patiala, Sangrur.  It seems that in one policy, the Ops have made the payment to the complainant without any hesitation, whereas in the present policy bearing number 164599682, the OPs have taken the ground of suppression of disease at the time of taking the insurance policy by the DLA.  The learned counsel for the Ops has cited the judgment of the Hon’ble National Commission delivered in Mrs. Shnyni Valsan Pombally versus State Bank of India and others 2014(1) CLT 356, wherein it has been held that it is a well settled proposition of law that a contract of insurance is based on the principle of utmost good faith – uberrimae fidei, applicable to both the parties.  The rule of non disclosure of material facts vitiating a policy still holds the field. The bargaining position of the parties in a contract of insurance is unequal. It is held that a contract of insurance, therefore, can be repudiated for non disclosure of ‘material facts’. The same view has also been taken by the Hon’ble National Commission in Life Insurance Corporation of India versus Santosh Devi 2014(4) CLT 89.  As such, the learned counsel for the OPs has contended vehemently that the claim has been rightly repudiated by the OPs as the DLA suppressed the material information at the time of taking the insurance policy in question.

 

8.             On the other hand, the learned counsel for the complainant has cited the judgment of the Hon’ble Andhra Pradesh State Commission pronounced in The Branch Manager, LIC Of India  and others versus Pasupleti Bhagya Laxmi and others 2014(4) CLT 116, wherein it has been clearly held that the insurance companies are issuing policies basing on the statements made by the proposer in utmost good faith but when it comes to settlement of claims, they start examining the matter under the microscope.  In a majority of policies issued by the insurance companies they are routed through their agents.  The agents in their anxiety to get their commission and the insurance companies in order to do more and more business see that the policies are issued the moment they receive the premium amount.  Even the insurances companies are not aware as to who is the proposer, what is his/her status or health condition etc.  Here, the intention is very clear that first they induce the people to purchase policies and later thy start litigation.  It is further held that the agents are playing fraud on LIC as well as gullible consumers with false assurances. When the policy was issued by the insurance company with utmost good faith, the same yardstick had to be applied while settling the claim.  The LIC ought to have made thorough enquiry, investigation or necessary medical health check ups before issuance of police irrespective of the amount involved.  Without doing so, when they have issued the policy, now they cannot turn round and contend that they need not pay any amount as there was suppression of material information with regard to his health.  The learned counsel for the complainant has further cited M/s. ICICI Prudential Life Insurance Company Limited versus Veena Sharma and others 2014(4) CLT 507 (NC), wherein in para 9 it has been held and the same is reproduced below:-

“The onus to prove that the deceased had obtained policy by suppressing facts relating to his illness was on the Corporation, but no tangible evidence was produced on its behalf to prove that the deceased was suffering from serious liver ailment at the time of taking policy and he deliberately suppressed this fact.  Undisputedly, the policy was issued on 29.3.1998. The deceased must have filled the proforma some time prior to that date. Therefore, the Corporation ought to have produced evidence to prove that on the date of filling the proforma, the deceased was suffering from any identified ailment and he intentionally written ‘no’ against items Nos.(a) to (d) of clause 11. This the corporation had failed to do.”   

 

The learned counsel for the complainant has further cited ICICI Lombard General Insurance Company Ltd. versus Jasbir Singh 2014(1) CLT 220 (HP State Commission),  wherein it has been held that the hypertension is a life style disease and easily controllable with conservative medicines and has dismissed the appeal of the insurance company. 

 

9.             In view of the above discussion, we find that in the present case the Ops have miserably failed to produce any cogent, reliable and trustworthy evidence to show that the DLA was suffering from any pre existing disease and he took the policy by suppressing any material disease or he took any treatment from any hospital for any particular disease.  Further, we find it to be a clear cut case of deficiency in service on the part of the OPs.

 

10.            The insurance companies are in the habit to take these type of projections to save themselves from paying the insurance claim. The insurance companies are only interested in earning the premiums and find ways and means to decline claims. The above said view was taken by the Hon’ble Justice Ranjit Singh of Punjab and Haryana High Court in case titled as New India Assurance Company Limited versus Smt. Usha Yadav and others 2008(3) R.C.R. 9 Civil) 111.

11.            In view of our above discussion, we allow the complaint and direct the OPs to pay to the complainant an amount of Rs.4,00,000/- along with interest @ 9% per annum from the date of filing of the present complaint i.e. 12.01.2015 till its realisation.  The OPs are further directed to pay to the complainant an amount of Rs.10,000/- in lieu of compensation for mental tension and harassment and litigation expenses.

12.            This order of ours be complied with within a period of thirty days of its communication. A  copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                July 1, 2015.

                                                        (Sukhpal Singh Gill)

                                                           President

 

 

                                                              (K.C.Sharma)

                                                                Member

 

 

                                                                (Sarita Garg)

                                                                    Member