| ORDER | BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR. Consumer Complaint No.279 of 2015 Date of Institution: 04.05.2015 Date of Decision: 18.02.2016 Mrs.Joginder Kaur (aged 65 years) widow of Sh.Pritam Singh, resident of L-2416, Gali No.1, Krishana Nagar, Tarn Taran Road, Amritsar. Complainant Versus Life Insurance Corporation of India Limited, through its Chairman/ Managing Director/ Principle Officer, service through its Branch Office at Ranjit Avenue, Near M.K.Hotel, Amritsar through is Branch Manager. Opposite Party Complaint under section 12 & 13 of the Consumer Protection Act, 1986 as amended upto date. Present: For the Complainant: Sh.Deepinder Singh, Advocate. For the Opposite Party: Sh.M.S.Bhatia, Advocate Quorum: Sh.Bhupinder Singh, President Ms.Kulwant Kaur Bajwa, Member Mr.Anoop Sharma, Member Order dictated by: Sh.Bhupinder Singh, President. - Present complaint has been filed by Smt.Joginder Kaur under the provisions of the Consumer Protection Act alleging therein that Sukhpal Singh son of the complainant got insurance policy bearing No. 472234845 from the Opposite Party covering an assured amount of Rs.5,50,000/- and the complainant is the nominee under that policy. Complainant alleges that unfortunate son of the complainant expired on 13.6.2012 while on his service of Punjab Police. The complainant lodged the claim with Opposite Party for payment of sum assured, but the Opposite Party disallowed the genuine claim of the complainant vide letter dated 16.2.2015 on the frivolous grounds that of suppression of fact and the deceased son of the complainant has not disclosed the disease he was suffering from and the deceased committed suicide. Alleging the same to be deficiency in service, complaint was filed seeking directions to the Opposite Party to pay the insured amount of Rs.5,50,000/- alongwith interest @ 12% per annum from the date of death till its realization. Compensation and litigation expenses were also demanded.
- On notice, Opposite Party appeared and filed written version in which it was submitted that the present complaint is not maintainable as Sukhpal Singh, deceased life assured ( herein-after called as ‘DLA’) had willfully and fraudulently withheld the correct information regarding his health at the time of taking the policy in question and gave wrong answers in the proposal form signed by him on 1.3.2012 knowing fully well that these are incorrect. DLA Sukhpal Singh was serving as Constable with IVth Indian Reserve Battalion, Kapurthala and took various leave i.e. 30.7.2009 to 9.8.2009, 11.5.2011 to 9.6.2011, 23.6.2011 to 25.6.2011 and 19.9.2011 to 21.9.2011 because of Hepatitis-C related illness and he was constantly taking medical assistance for the same. After his death on 13.6.2012, just 3 months & 13 days of taking of the policy, the chemical analysis was conducted by Chemical Examiner of Punjab Government and as per his report, Chlorocompound group of insecticide was detected in the contents of viscera, so death was due to taking Celphos. It indicated that DLA Sukhpal Singh had committed suicide as he was found lying on the floor of his room by his colleagues and was declared dead on taking to the hospital. It proves that DLA Sukhpal Singh was not keeping good health prior to the date of proposal and as per medical and service records. Moreover, the DLA Sukhpal Singh did not disclose correct information about his health and taking treatment from hospitals for Hepatitis-C, in the proposal form and tried to play fraud with Opposite Party to grab the public money. Hence the repudiation of the claim by the Opposite Party is legal. While denying and controverting other allegations, dismissal of complaint was prayed.
- Complainant tendered into evidence her affidavit Ex.C1 alongwith documents Ex.C2 to Ex.C4 and closed the evidence on behalf of the complainant.
- Opposite Party tendered into evidence affidavit of Sh.Yogender Singh Sisodia, Manager Ex.OP1 alongwith documents Ex.OP2 to Ex.OP9 and closed the evidence on behalf of Opposite Party.
- We have carefully gone through the pleadings of the parties; arguments advanced by the ld.counsel for the parties and have appreciated the evidence produced on record by both the parties with the valuable assistance of the ld.counsel for the parties.
- From the record i.e. pleadings of the parties and the evidence produced on record by the parties, it is clear that Sukhpal Singh son of the complainant got insurance policy bearing No. 472234845 with sum assured of Rs.5,50,000/- from the Opposite Party and the complainant is the nominee under that policy. Insured Sukhpal Singh expired on 13.6.2012 while on his service of Punjab Police. The claim was lodged by the complainant with Opposite Party, but the Opposite Party repudiated the genuine claim regarding the death of insured Sukhpal Singh vide letter dated 16.2.2015 Ex.OP9 on the grounds of suppression of facts by DLA Sukhpal Singh at the time of taking insurance policy. Ld.counsel for the complainant submitted that DLA Sukhpal Singh did not suppress any fact from the Opposite Party nor there is any nexus of death of DLA Sukhpal Singh with the alleged ground of repudiation and all this amounts to deficiency of service on the part of the Opposite Party.
- Whereas the case of the Opposite Party is that DLA Sukhpal Singh had willfully and fraudulently withheld the correct information regarding his health at the time of taking the policy in question with commence date 1.3.2012. He had given wrong answers in the proposal form Ex.OP10 signed by him on 1.3.2012. DLA Sukhpal Singh was serving as Constable with Fourth Indian Reserve Battalion, Kapurthala and took various leave i.e. 30.7.2009 to 9.8.2009, 11.5.2011 to 9.6.2011, 23.6.2011 to 25.6.2011 and 19.9.2011 to 21.9.2011 because of Hepatitis-C related illness and he was constantly taking medical assistance for the same. After his death on 13.6.2012, just 3 months & 13 days of taking of the policy, the chemical analysis was conducted by Chemical Examiner of Punjab Government and as per his report, Chlorocompound group of insecticide was detected in the contents of viscera, so death was due to taking Celphos which indicated that DLA Sukhpal Singh had committed suicide and he was found lying on the floor of his room by his colleagues and was declared dead when taken to hospital. DLA Sukhpal Singh was not keeping good health, but he had given wrong answers in the proposal form on 1.3.2012 to the affect that he did not consult any medical practitioner for any ailment during the last 5 years. He was never admitted in any hospital, nor he remained absent from place of his work on the grounds of health during last 5 years nor he suffered any ailment pertaining to liver, stomach, heart, lungs, brain or nervous system and that his state of health is good, whereas he was taking treatment from the hospital for Hepatitis-C. As such, he obtained the aforesaid insurance policy from the Opposite Party by misrepresentation of facts and concealment of true facts, thereby tried to play fraud with the Opposite Party to get public money. Opposite Party was, therefore, rightly repudiated the claim of the complainant. Ld.counsel for the Opposite Party submitted that there is no deficiency of service on the part of the Opposite Party.
- From the entire above discussion, we have come to the conclusion that DLA Sukhpal Singh obtained insurance policy in question bearing No. 472234845 with sum assured Rs.5,50,000/- from the Opposite Party and in order to obtain this policy, DLA Sukhpal Singh filled in proposal form Ex.OP10 on 1.3.2012 in which he has mentioned that he did not consult any medical practitioner for any ailment during the last 5 years; he was never admitted in any hospital, nor he remained absent from place of his work on the grounds of health during last 5 years nor he suffered any ailment pertaining to liver, stomach, heart, lungs, brain or nervous system and that his state of health is good; whereas his office record where he was working as Constable in IVth Indian Reserve Battalion, Kapurthala Ex.OP6 fully proves that DLA Sukhpal Singh remained on leave for treatment of Hepatitis-C for the period 30.7.2009 to 9.8.2009, 11.5.2011 to 9.6.2011, 23.6.2011 to 25.6.2011, 30.6.2011 to 2.7.2011 and 19.9.2011 to 21.9.2011 and he was constantly taking medical assistance for the same. The complainant could not rebut this documentary evidence produced by the Opposite Party that DLA Sukhpal Singh remained on leave on various occasions for treatment of Hepatitis-C related disease, but DLA Sukhpal Singh did not disclose these facts to the Opposite Party while filling in proposal form Ex.OP10, rather he stated his state of health as good. It has been held by Hon'ble National Commission in case Life Insurance Corporation of India Vs. Smt.Ayesha inRevision Petition No. 3362 of 2004, decided on 21.9.2004 cited in Legal Digest of July, 2006 that where the claim was repudiated on the ground that assured suppressed the material fact about his sickness and on being on medical leave before purchase of the policy, the cause of death had no relevant to the non disclosure of health at the time of purchase of policy and the repudiation was upheld. It has been held by Hon'ble Supreme Court of India in case Satwant Kaur Sandhu Vs. New India Assurance Company Ltd IV (2009) CPJ 8 (SC) that though section 45 of the Insurance Act is applicable to a life insurance policy which is entirely different from a mediclaim policy, still is a contract of insurance falling in the category of contract of ‘uberrimae fidei’. Policy can be repudiated if any material fact is suppressed and a material fact would mean any fact by that affects the decisions of insurer in accepting the risk. An inaccurate answer to the question in the proposal form, if any, which the life assured had knowledge thereof will entitle insurer to repudiate his liability. Same view has been taken by Hon’ble National Commission in case P.Prabha Vs. LIC of India & Ors in Revision Petition No. 2127 of 2011, decided on 12th June, 2015. As DLA Sukhpal Singh has suppressed the material fact at the time of taking the policy while filling in proposal form Ex.OP10, thereby he has obtained the insurance policy from Opposite Party by concealment of facts. As such, the Opposite Party was justified in repudiating the claim of the complainant vide letter dated 16.2.2015 Ex.OP9.
- 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: 18.02.2016. (Bhupinder Singh) President hrg (Kulwant Kaur Bajwa) (Anoop Sharma) Member Member | |
