Punjab

StateCommission

A/11/401

Kulwinder Kaur - Complainant(s)

Versus

LIC of India - Opp.Party(s)

Vivek Suri

24 Mar 2015

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,                                               PUNJAB

          SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.

                                     

                             First Appeal No.401 of 2011

 

                                                          Date of Institution:03.03.2011  

                                                          Date of Decision : 24.03.2015

 

Kulwinder Kaur wife of late Basant Singh son of Jagdev Singh, resident of Village Balahar Mehma, PO Mehma Sawal, Tehsil and District Bathinda.

 

                                                          …..Appellant/Complainant

         

                                      Versus

 

1.       Life Insurance Corporation of India, Jeevan Parkash, Divisional Office, Urban Estate, Phase-I, Dugri, Ludhiana 141002, through its           Divisional Manager.

 

2.       Life Insurance Corporation of India, through its Senior Branch    Manager, Bibi Wala Road, Bathinda.

 

                                                          ….Respondents/Opposite parties

         

First Appeal against order dated 03.01.2011 passed by the District Consumer Disputes Redressal Forum, Bathinda

Quorum:-

 

          Shri J. S. Klar, Presiding Judicial Member.

          Shri Vinod Kumar Gupta, Member.  

Present:-

 

          For the appellant              :         Sh.Vivek Suri, Advocate

          For the respondents        :         Sh.Pawan Kumar Longia,, Advocate

 

          . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                            

J. S. KLAR, PRESIDING JUDICIAL MEMBER:-

                  

           The appellant Kulwinder Kaur (the complainant in the complaint) has directed this appeal against the respondents of this appeal (the opposite parties in the complaint), challenging order dated 03.01.2011 of District Consumer Disputes Redressal Forum Bathinda, dismissing the complaint of the complainant. The instant appeal has been preferred by the complainant now appellant

2.      The complainant has filed this complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs on the averments that the husband of the complainant purchased policy bearing No.300817514 for Rs.2,10,000/- with date of commencement 28.05.2008 and the maturity date May 2024. The husband of the complainant had been paying the premium of the said policy. The life assured Basant Singh, the husband of the complainant, expired on 09.10.2008, while undergoing treatment from P.G.I Chandigarh. The complainant lodged the insurance claim with the OPs for the settlement of the insurance claim of the above policy with all documents. The OPs failed to settle the insurance claim of the complainant within the scheduled period of 60 days. Vide letter dated 06.02.2010, the OPs repudiated the insurance claim of the complainant. That the repudiation of the insurance claim of the complainant by the OPs is unreasonable and unsustainable on the ground that there has been unreasonable delay in the settlement of the claim. That the Ops have invented false excuse to repudiate the insurance claim on the ground of concealment of the fact regarding previous health of the life assured Basant Singh on the basis that the life assured concealed the material fact with regard to his suffering from pre-existing disease, when he took the insurance policy. That the repudiation of insurance claim on the part of the OPs is deficient in service and unfair trade practice on the part of the OPs as well. The complainant has filed the complaint against the OPs directing them to pay the amount of Rs.2,10,000/- as insurance claim to the complainant along with  interest 18% per annum thereupon, besides compensation of Rs.50,000/- for her mental harassment  being widow of life assured Basant Singh.

3.      Upon notice, OPs appeared and filed written reply raising preliminary objections that the complainant has no cause of action to file the complaint. The present complaint is false, frivolous and merits dismissal. On merits, the OPs contested the complaint of the complainant vehemently. It was averred in the written reply by the OPs that the contract of insurance is based on the utmost good faith, expected from the parties before entering into the contract of insurance. That the life assured died due to pre-existing disease for which he was taking treatment from P.G.I Chandigarh. That the life assured Basant Singh concealed the material fact of pre-existing disease with regard to his health, when he took the insurance policy in this case from the OPs, which materially impinged on the discretion of the OPs whether to accept the proposal of the life assured or not. He has not disclosed in the proposal form with regard to his suffering from previous pre-existing disease and thereby it rendered contract of the insurance as invalid. The OPs further averred that the contract of insurance has been rightly repudiated by the OPs.

4.      The complainant tendered in evidence  the affidavit of Kulwinder Kaur complainant Ex.C-1, copy of letter dated 06.02.2010 Ex.C-2, copy of death certificate of Basant Singh husband of the complainant Ex.C-3, copies of payment receipts Ex.C-4 to C-6, copy of policy document Ex.C-7, affidavit of Smt. Kulwinder Kaur wife of the deceased Basant Singh. As against it, OP tendered in evidence affidavit of Sh. Param Veer , Manager Legal & HPF LIC, copy of leter dated 06.02.2010 Ex.R-2, copy of certificate issued by Dr.R.K Gupta, copies of medical record Ex.R-4 to Ex.R-7, copy of medical certificate of cause of death Ex.R-8, copy of Form No. 3816 Ex.R-9 , copy of certificate of employee Ex.R-10, copy of leave application Ex.R-11, copy of death certificate Ex.R-12, copy of proposal form Ex.R-13 and copy of policy document Ex.R-14  . On conclusion of evidence and arguments, the District Forum, Bathinda dismissed the  complaint of the complainant. Dissatisfied with the order of the District Forum dated  03.01.2011, the complainant now appellant has preferred this appeal against the same.

5.      We have heard learned counsel for the parties and also examined the record of the case. The submission of the counsel for the complainant  now appellant in this case is that the OPs have repudiated the contract of insurance without any valid reason and that too at a later stage only.  The         OPs have repudiated the insurance claim of the complainant  on the ground that the deceased was suffering from Hepatitis B at the time of taking the policy and it aggravated to Hepatitis C and life assured concealed this material fact when he took the insurance policy. The submission of the counsel for the complainant now appellant is that there is no material concealment of any material fact by the life assured from the OPs and hence the order of the District Forum is wrong and erroneous.

6.      We have to refer to evidence on the record to determine the controversy in this case between the parties. The ground of the OPs to repudiate the contract of insurance is that the life assured, when he took the policy has not disclosed the material fact with regard to his any pre existing disease therein. On the other hand, the counsel for the complainant now appellant countered it on the ground  the matter can be adjudicated on the basis of the evidence on the record only. The affidavit of the complainant Kulwidner Kaur is Ex.C-1. She has challenged the repudiation of the contract of the insurance by the OPs. It is undisputed fact that the life assured Basant Singh, who was husband of the complainant, took the insurance policy wherein he has not said anything regarding his health conditions. Ex.C-2 is registered letter sent to the complainant by the OPs on 06.02.2010 regarding repudiation of the contract of the insurance on the ground that life assured suffered from HCV related liver disease for which he had consulted a medical man and took treatment from him for this disease. He has not disclosed these facts in the proposal form, when he took the insurance policy and hence the contract of insurance was repudiated by virtue of this letter Ex.C-2 dated 06.02.2010 by the OPs. Ex.C-3 is death certificate of Basant Singh life assured proving his death on 09.10.2008 at PGI Chandigarh. Ex.C-4 is letter addressed to complainant by the OPs on 12.2.2009 with regard to deduction of premium. Ex.C-5 is letter dated 12.2.09 issued to the complainant for the loan interest deducted due from 18.3.2008 to 9.10.2008 and premium deducted from 11/2008 to 02/2009. Ex.C-6 is letter dated 12.2.09  to complainant for income tax purposes. Ex.C-7 is copy of insurance document placed on record by the complainant. Ex.C-8 is supplementary affidavit of complainant.

7.      The OPs relied upon affidavit of Sh. Param Veer Manager Legal & HPF Life Insurance Corporation of India. He has stated in his affidavit that the contract of insurance is based on utmost good faith (Uberrima Fides). The life assured Basant Singh was suffering from illness before taking the insurance policy and he has concealed the material fact of his previous illness when he took the insurance policy in this case. The  contract of insurance is liable to be invalidated on that ground. Ex.R-3 is letter of repudiation of the insurance claim of the complainant regarding incorrect statement and withholding correct information by the life assured to OP. Ex.R-3 is certificate of Dr. R.K.Gupta to the effect that life assured was admitted in PGI Chandigarh with cirrhosis of liver. It is recorded in it that the life assured suffered from above liver disorder even before taking the policy on 28.5.08. This certificate is issued by Dr. R.K. Gupta MD Medicines Ludhiana in connection with this policy. Ex.R-4 is treatment and investigation report by Government Medical College & Hospital Chandigarh of Basant Singh life assured. It is recorded in it that the life assured was suffering from chronic liver disease and he received the treatment for Hepatitis problem from Government Medical College and Hospital Chandigarh by virtue of this OPD Card. Ex.R-5 is in continuation of the same. Ex.R-6 of Hepatitis B Envelope Antigen  and report dated 25.10.2007 of the life assured Bansant Singh. Ex.R-7 is the certificate by Dr. Rajesh M Korde M.D (Pathology) of Basant Singh life assured. Ex.R-8 is medical certificate of cause of death of Basant Singh life assured by PGI Chandigarh. This is authentic document on the record and we can safely rely upon this document Ex.R-8. There is little scope of falsity of this document, which has been issued by topmost Research Medical Institute of Government of India. It has been recorded in the observation by the doctor that chronic liver disease -HCV Related Cirrhosis-Child -C (Child Score) Decompensated with Ascites Encehald Pathy as the condition attributed to the death of the deceased. The manner of death is recorded and postmortem was not willed to be conducted by Jagroop Singh, the brother of the deceased. Ex.R-9 is the nature of ailment as decompensated  HCV related Cirrhosis. The cause of death is Hepatic Encephacopathy Grade IV. Ex.C-11 is application of life assured Basant Singh Head Constable regarding taking leave from 12.6.07 to 11.7.07 on medical grounds. Ex.R-12 is death certificate of Basant Singh. Ex.R-13 is proposal form filled in by the life assured, wherein he replied in negative to the questionnaire, if he suffered from any liver disease. This proposal form was filled up by Basant Singh life assured on 28.4.08. It is evident from the proposal form Ex.R-13 by the life assured that he replied in negative to the question regarding suffering from any liver disorder, as asked from him by the OPs.

8.      From appraisal  of above referred evidence on the record, we find that life assured replied to the questionnaire in the proposal form in the negative if he suffered from any ailment pertaining to liver, stomach, heart, lungs, kidney, brain or nervous system. He described his state of health as good in the proposal form. The policy was purchased on 28.5.2008, vide Ex.C-1 by the life assured and he died on 09.10.2008 in the same year, approximately five months after purchase of the policy. Sh. Param Veer Manager Legal deposed in his affidavit Ex.R-1 on behalf of OPs that material concealment of the fact of pre-existing disease has not been disclosed by the life assured, when he took the insurance policy in this case. The life assured died due to pre-existing disease of liver, while taking the treatment from PGI Chandigarh, which fact was not disclosed by him to the OPs, when he took the insurance policy. This is a clear-cut case of suppressio vari and suggestio falsi on the part of life assured Basant Singh, when he filled up the proposal form at the time of taking the insurance policy. The OPs demanded the documents from the complainant for processing the claim and no delay has been caused  on their part in this case. The certificate of Dr. R.K. Gupta , MD Medicines, Senior Consultant Physician & Heart Specialist recorded the fact that deceased life assured was suffering from HCV related cirrhosis and was admitted in PGI Chandigarh on 09.10.2008 with fever altered sensorium UIG blood. There was h/o abdominal distension and oedema for the last six months. He was HCV Reactive and got treatment from 12.06.2007 to 11.07.2007 after getting earned leave. Dr. R.K Gupta in his certificate Ex.R-3 recorded that the life assured had suffered from HCV related lever disease before taking the policy on 28.5.2008. Even from perusal of Ex.R-1, it is indicated that the treatment, which was taken by the life assured was of Hepatitis and evaluation on 30..6.2007 from Government Medical College Hospital Chandigarh and he continued this treatment till 19.7.07. He again got treatment on 1.8.2007 from Government Medical College & Hospital Chandigarh, vide Ex.R-5 till 11.12.2007. The report of Beant Singh deceased dated 25.12.2007, vide Ex.R-6 further points that he was suffering from Hepatitis B Envelope Antigen (HBeAg) and name of the test, which was conducted on the patient was HCV RNA PCR. The report of Reliance Life Sciences Pvt. Ltd is Ex.R-7 shows that the life assured was suffering from HCV and this test is a definite pointer to individuals with chronic liver disease, cell or organ transplant  recipients, blood/blood product recipients and health care workers with occupational exposure. The District Forum recorded the findings in detail under Para No.9 of the judgment reaching the conclusion that the deceased life assured was suffering from liver disease, but he intentionally concealed this material fact when he took the insurance policy from the OPs. Even in Ex.R-8, the medical certificate issued by Dr.Venkata Siva Tez, Junior Resident, Department Hepatology,  PGI Chandigarh, the life assured Basant Singh was found to be suffering from liver disorder. The complainant took the insurance policy by disclosing his good health in the proposal form by suppressing the correct facts regarding his state of health. The proposal form filled up by him on 28.4.2008, vide Ex.R-13, vide proposal no.388. The life assured took the insurance policy on 28.5.2008 and died on 09.10.2008 just within a few months after taking the insurance policy.

9.      The medical literature on cirrhosis liver indicates that liver cirrhosis develops generally at least in 5 to 10 years period due to alcoholic abuse. The life assured died within a span of six months only after taking the insurance policy in this case. The cirrhosis of liver generally develops in 5 to 10 years period of time. We can safely infer and presume this fact that life assured also remained on treatment due to his illness even before taking the policy in this case on 28.5.2008. The life assured knew this fact that he was suffering from liver cirrhosis and it is mainly on account of heavy consumption of liquor/alcoholic. He concealed the material fact on this point from the OPs, when he took the insurance policy. He breached the good faith reposed in him by the OPs. The Apex Court has held the case law titled as "Mithu Lal Nayak Vs. Life Insurance Corporation of India" AIR 1962 SC 814  and Hon'ble National Commission also held in case law Life Insurance Corporation of India Vs. Krishan Chander Sharma" 2007(II) CPJ 61 (NC) and also law laid down by Apex Court in Civil Appeal No.5322 of 2007 titled as "Chacko and another Vs. Chairman Life Insurance Corporation of India and other" 2007(VI) CLT 2009 (SC) decided on 20.11.2007 that where material fact has been concealed fraudulently by the life assured, which was material fact to disclose, then it is a case of concealment of material fact, justifying the repudiation of the insurance claim, as the contract of insurance is Uberrima Fides.

10.    As a sequitor of our above discussion, we agree with the findings of the District Forum contained in the order, under challenge  in this case to the effect that on account of material fact of concealment of liver disorder of life assured, when he took the insurance policy by pretending to a good health and dying within six months from taking the insurance policy, the contract of insurance has rightly been repudiated by the insurer in this case on this ground. The order of the District Forum Bathinda is legal and sustainable calling for no inference in this appeal. We affirm the order of the District Forum in this appeal.

11.    As a result of our above discussion, appeal of the appellant is found without any merit and same is hereby dismissed.

12      Arguments in this appeal were heard on 19.03.2015 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.

 

                                                                          (J. S. KLAR)

                                                             PRESIDING JUDICIAL MEMBER

                       

                                                                   (VINOD KUMAR GUPTA)

                                                                          MEMBER

 

March 24  2015.                                                             

(ravi)