Punjab

Sangrur

CC/250/2018

Ramesh Jain - Complainant(s)

Versus

LIC Of India - Opp.Party(s)

Sh.Sandip Kumar Goyal

25 Jan 2019

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                            

                                                                                       Complaint no. 250  

                                                                                        Instituted on:  28.05.2018 

                                                                                        Decided on:    25.01.2019

 

Ramesh Jain son of Late Jaswant Rai Jain resident of Jain Telecom Patran Road, Near Stadium Moonak, Tehsil Moonak, District Sangrur.

                                                …. Complainant  

                                Versus

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

2.    LIC of India through its Divisional Manager, Division Office at Jeevan Prakash Sector 17B, Chandigarh-160017

                                                  ….Opposite parties.

 

FOR THE COMPLAINANT  : Shri Sandip Goyal Advocate                        

 

FOR THE OPP. PARTIES     :   Shri Amit Goyal, Advocate

 

Quorum

                            

Vinod Kumar Gulati,  Presiding Member

Mrs. Manisha, Member

 

ORDER:    Vinod Kumar Gulati, Presiding Member

 

1.             Shri Ramesh Jain, complainant has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that wife of the complainant namely Smt. Raj Jain died on 20.12.2015 due to disease carcinoma. During her life time she obtained a policy  for sum assured Rs.1,00,000/- and paid premium of Rs.70271/- on 28.10.2013. The complainant is nominee of the said policy. The complainant  deposited all the required documents of the policy with the OPs for getting the claim but the OPs had repudiated the claim on 01.07.2016 with reason that " the above policy resulted into death claim on 20.12.2015 i.e. after two year and one month nine days from the date of commencement of risk and the cause of death is carcinoma and we have sufficient proof to show that Life assured was not keeping good health since 2002 before he got insured and was suffering from paralysis since 2009." There is no nexus between carcinoma and paralysis and OPs had wrongly repudiated the claim of the complainant. Thus, alleging deficiency in service on the part of OPs, the complainant has sought following reliefs:- 

 

1. OPs be directed to pay Rs.29829/- alongwith interest  @18% per annum from the date of death till realization,
2. OPs be directed to pay to the complainant a sum of Rs.10,000/- on account mental agony and harassment and also to pay Rs.10,000/- as litigation expenses.

 

2.                  In reply filed by the OPs, in the Legal objection that the complaint is not maintainable in the present form & complainant has no cause of action & locus standi to file the present complaint. Then complaint has not come to the Hon'ble Court with clean hands & has suppressed the material facts from the Hon'ble Court, hence the complaint of the complainant is liable to be dismissed with heavy costs. The complainant has dragged the answering opposite parties in to unnecessary litigation by filing a false & frivolous complaint with an ulterior motive of extracting money from the opposite parties, hence the complaint is liable to be dismissed with costs. The complaint of the complainant is time barred as the present complaint has been filed after a lapse of more than 2 years from the date of repudiation of claim (i.e. 31-3-2016) and as per the provisions of the Consumer Protection Act, present complaint is barred by limitation and as such same deserves to be dismissed on this ground alone. The deceased Life Assured had concealed material information regarding her state of health at the time of filing the proposal form and intentionally gave wrong answers in the proposal form. The Policy in question was obtained by the life assured with a malafide intention of defrauding LIC of India, thus complaint of complainant deserves to be dismissed with heavy costs.

 

3.                  On merits, the complaint is admitted to the extent that wife of the complainant Smt. Raj Jain obtained one insurance policy bearing number 165641197 (LIC's Bima Bachat plan for a term of 9 years) from the opposite parties for the sum assured of Rs. 1,00,000/- and a single premium of Rs. 70,271/- was paid under the policy. It is further that complainant was appointed as nominee under the policy. The claim under the policy was lodged by the complainant being nominee under the policy. The claim of the complainant was repudiated by the answering OP's for the reasons i.e. Life assured provided wrong information in the proposal form and withheld material information regarding her state of health at the time of making proposal for the policy in question. In fact claim of the complainant  was repudiated vide letter dated 31-3-2016 and not 1-7-2016 as alleged by the complainant. Complainant has cancelled material information from the Hon’ble Forum and tried to misguide the Forum by stating wrong facts. In fact deceased life assured obtained the policy in question by giving false information about her health & intentionally suppressed material facts regarding her health from the policy in question. At the time of submission of proposal under the policy, life assured intentionally gave wrong answers to the questions mentioned in the policy.

 

4.                  During the investigations, it came to the knowledge of Ops that life assured had undergone surgery(hysterectomy) in the year 2002 and she was paraplegic since 2009, but she did not disclosed these facts at the time of making proposal for the policy in questions. Thus it is quite clear that the DLA had intentionally concealed material information i.e. She was not having good health and was taking treatment and had intentionally given wrong answers regarding her health in the proposal form. It clearly shows that the DLA had obtained the policy in questions from the answering Ops with a malafide intention of defrauding LIC of India and had intentionally concealed material information regarding her state of health at the time of proposal. Had the DLA disclosed the true facts regarding her health, answering opposite parties would not have accepted the proposal and policy would not have been issued. It is pertinent to mention here that the contract of Insurance is based on the principles of "ubberrimafides" i.e. of utmost good faith and is governed by the terms and conditions of the policy contract, however the life assured violated the same by intentionally concealing her actual state of health at the time of proposal and deliberately gave wrong answers to the questions asked in the proposal form/personal statement. Thus the DLA obtained the policy I question by concealment of actual facts and deliberately gave wrong information, with a malafide intention  of obtaining the policy by defrauding the LIC of India, which is the custodian of public moneys and holds the same with utmost trust, custodian of public moneys and holds the same with utmost trust, faith and this money could not be used for giving unlawful gains to any persons, hence keeping in view of the above said facts, and after carefully examining the hospital record and other documentary evidence, claim of the complainant has been rightly repudiated by the answering opposite parties vide letter dated 31-03-2016. Though Deceased life assured died of carcinoma, but still she intentionally concealed material facts regarding her health at the time of making proposal under the policy & obtained the policy in question by providing wrong information/answers to the questions mentioned in the proposal form. As far as nexus between carcinoma and paralysis is concealed, it is submitted that nexus between cause of death and ailments suffered by the life assured in the past are irrelevant so far as the claim of complainant is concerned, as the claim has been repudiated on the ground of obtaining the policy by misrepresentation of facts regarding health of life assured at the time of making proposal for the policy in question. Hence claim of the complainant has been rightly repudiated by the answering Ops vide letter dated 31-03-2016 in view of the above mentioned facts. Thus neither the answering Ops defamed the complainant, nor he suffered any mental agony or harassment or financial loss as alleged by him. Thus complaint of the complainant deserves to be dismissed with heavy costs being totally false and frivolous. That para no.7 of complaint is totally wrong hence denied. The claim of the complainant has already been repudiated by the answering opposite parties, hence the complainant is not entitled for any relief as claimed in this para of complaint. Complaint of the complainant deserves to be dismissed with costs. It is therefore respectfully prayed that complaint of the complainant may kindly be dismissed with heavy costs.

 

5.                  The complainant has tendered documents Ex.C-1 to Ex.C-11and closed evidence. The learned counsel for Ops has produced Ex.OP-1 to Ex.OP-14 and closed evidence.

 

6.                  It is admitted fact that wife of the complainant Smt. Raj Jain obtained the policy in question from the OPs. It has been stated that the claim of the complainant was repudiated by the Ops on 31-03-2016 for the reason that life assured provided wrong information in the proposal form and withheld material information regarding her state of health at the time of making proposal for the policy in question. But the complainant has submitted that the claim was repudiated on 01-07-2016. From the perusal of the letter dated 01-07-2016 from LIC of India addressed to the complainant that it has been observed that, it is not a repudiation letter but  a communication between the complainant and Ops vide which  the Ops have demanded explanation from the complainant being the agent of the Ops. As per the record, the repudiation of  the claim was done on 31-03-2016 and the complaint was filed on 28-05-2018 . As such the complaint has been filed after a lapse of more than 2 years and as per the provision of the Consumer Protection Act, the complaint is barred by limitation and the same is deserved to be dismissed on this ground.

 

7.                  As a sequel of the above discussion, complaint is dismissed without any order as to costs. Copies of order be supplied to parties free of costs as per rules.

 

8.               File be indexed and consigned to record room. 

 

                Announced.

                                                   January 25, 2019.

 

 

                                                                                        ( Manisha )                (Vinod Kumar Gulati)     

                                                                                           Member                      Presiding Member