Haryana

Charkhi Dadri

65

Salesh Kumari - Complainant(s)

Versus

Lic of India - Opp.Party(s)

Manjeet Chahar

08 Jul 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, CHARKHI DADRI.      

         

                                                                   Complaint No.: 65 of 2021.

                                                                    Date of Institution: 15.03.2021.

                                                                   Date of Decision: 08.07.2024.

Salesh Kumari wife of late Shri Suresh Kumar, permanent resident of village and post office Chhapar, Tehsil and District Charkhi Dadri.

                                                                             ….Complainant.

                                                                                       

                                      Versus

1.       Life Insurance Corporation of India, through its Senior Division Manager, Divisional Officer, Sector-1, Rohtak.

2.       Manager, Life Insurance Corporation of India, Branch office Loharu Road, Charkhi Dadri.

                                                                              …...Opposite Parties.

 

                             COMPLAINT UNDER THE

     CONSUMER PROTECTION ACT.

 

Before: -      Hon’ble Mr. Manjit Singh Naryal, President.

                   Hon’ble Dharampal Rauhilla, Member.

 

Present:       Shri Manjeet Sheoran, Advocate for the complainant.

Shri Satish Jatrana, Advocate for the OPs.

 

ORDER:-

 

                    Brief facts of the case are that the complainant’s husband Shri Suresh Kumar had purchased two insurance policies from OPs, bearing No. 101237191 for Rs. 8,00,000/- on 28.5.2017 with date of maturity 28.5.2023 and No. 101432622 for Rs. 12,00,000/- on 28.10.2017 with date of maturity 28.10.2033.  It is alleged that the OPs have issued the insurance policies after through check up of health and habits of life assured in person and conducting various medical tests like ECG/TMT/BST etc. and after that the policies were issued.  It is further alleged that the OPs have assured that under terms and conditions of the insurance policies basic sum assured plus attached benefits will be paid in case of death of insured during the currency of the policy and double the sum assured will be paid if death is accidental death.  It is further alleged that the husband of the complainant paid all the premium to reap the benefits of the policies and for future provision for family in case of any miss-happening during currency of policies.  It is further alleged that in the month of September, 2018, husband of complainant developed some health problem and through various medical tests/checkup, it was found that he has liver problems and was admitted at Institute of Liver and Biliary Sciences, New Delhi on 14.9.2018 and died due to above disease on 4.11.2018.  It is further alleged that the complainant being legally wedded with and nominee under above insurance policies had completed all the requirements for the payment of insurance death claim, but the OPs have repudiated the claim of policy No.101432622 for Rs. 12 lacs vide their letter dated 23.9.2020, which was received to the complainant in the month of February, 2021.  It is further alleged that OPs have wrongly repudiated the claim of the complainants merely saying that insured was suffering some disease earlier to insurance done by the OPs.  Hence, it amounts to deficiency in service on the part of OPs, hence, this complaint.

2.                On appearance, the OPs filed written statement alleging therein that the OPs issued policies No.101432622 on the life of Shri Suresh Kumar son of Shri Amir Singh under Plant & Term 815/16/16, S.A.- 1200000/-, FPR- 24.11.2017, Nominee: Salesh Kumari (W) and 504837191 under Plan & Term 815/16/16, S.A.- 800000/-, FPR- 16.8.2017, Nominee Salesh Kumari (W).  It is further alleged that above claim were an early death claim and were examined in view of Provisions u/s 45 of Insurance Act, 1938.  It is further alleged that above policies were completed on the basis of questions answered in proposal form by life assured and contract of insurance is based on the principle of “utmost good faith”.  It is further alleged that death claim had been paid u/p- 504837191, as the policy had fallen in purview of provision u/s 45 of the Insurance Act, 1938, but policy No.101432622 was examined in view of provision u/s 45 of Insurance Act and competent authority had repudiated the liability under the said policy on genuine ground.  It is further alleged that as per discharge summary of Institute of Liver & biliary Science, DLA was admitted on 7.10.2017 and discharged on 13.10.2017 and diagnosed as Portal Hypertension (Bleeder, antral Gave+Mild PHG, Esophageal, Chronic liver disease Ethanol related) (L-1-10 months back).  It is further alleged that in February, 2017 he developed jaundice and diagnosed to have CLD and April, 2017, he noted abdominal ditension diuretic responsive.  It is further alleged that DLA had not disclosed this adverse history of illness, which is prior to date of FPR.  It is further alleged that the policy in question had not completed three years from the date of FPR i.e. 24.11.2017, which is prior to date of death of the LA.  It is further alleged that at the time of proposal for the life insurance the deceased Suresh Kumar had concealed the material facts with regard to his health.  It is further alleged that Suresh Kumar (DLA) was taking treatment from Institute of Liver & biliary Science w.e.f. 7.10.2017 to 13.10.2017 i.e. prior to date of proposal, as per treatment record/discharge summery.  It is further alleged that in terms of declaration signed by Suresh Kumar at the said personal statement, was declared void and all moneys paid towards policy and subsequent thereto belongs to OPs.  It is further alleged that the competent authority rightly repudiated the liability under the policy in question and same has been informed to complainant vide letter dated 23.9.2020.  Hence, there is no deficiency in service on the part of OPs and complaint is liable to be dismissed with costs.

3.                The complainant in his evidence has tendered affidavit Ex. CW1/A and documents Ex. C1 to Ex. C5 and closed his evidence on 25.4.2022.

4.                Ld. Counsel for the OPs has tendered affidavit Ex. RW1/A, documents Ex. R1 to Ex.R5 and closed his evidence on dated 5.1.2023.

5.                We have heard learned counsels for the parties and have gone through the documents placed on record by both the parties as well as the material aspects of the case very carefully.

6.                Ld. Counsel for the complainants reiterated the contents of the complaint.  Ld. Counsel for the complainants has further contended that OPs have wrongly & illegally repudiated the claim of the complainant because no cogent and convincing evidence has been produced to prove that Suresh Kumar, husband of complainant was suffering from any disease, prior to commencement of insurance policy.  Therefore, repudiation of claim vide letter dated 23.9.2020 is illegal and liable to be set aside and the complaint is liable to be accepted with costs.  Ld. Counsel for the complainant has placed his reliance upon Oriental Insurance Company Limited Vs Mr. Romesh Suri and another, SCDRC, Delhi, FA No. 195/2010, DOD 15.11.2017 and LIC of India Vs. Smt. Sudesh, NCDRC, New Delhi, FA No.774 of 2006, DOD 27.2.2012.  But these judgments are not applicable to the facts of the present case due to peculiar facts & circumstances

7.                On the other hand, ld. counsel for OPs reiterated the contents of the written statement. Ld. Counsel for the OPs has further contended that the life assured was not honest in making the disclosure about his state of health when the proposal form was filled up by him. He further contended that in view of these circumstances the claim of the complainant was rightly repudiated vide letter dated 23.9.2020. Hence, there is no deficiency in service on the part of OPs and the complaint of the complainant is liable to be dismissed.  He placed his reliance upon Satwant Kaur Sandhu Vs. New India Assurance Company limited (2009) 8 Supreme Court Cases 316.

8.                Now question of law arises as to whether the insurance company was justified in repudiating the claim of the complainant.  The sought answer is “Yes”.  The claim of the complainant was repudiated on the allegations that the complainant had made false statement in the proposal form knowingly as he was taking treatment from Military Hospital and was taking radiotherapy prior to issuing of insurance policy.  The OPs have proved their plea by placing on record copy of proposal form as Ex. R4 and treatment papers and discharge summery as Ex. R1 as proof of treatment taken by complainant from Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi and also placed on record duly sworn affidavit of its Manager Sunita Matta as Ex. RW1/A.  From a perusal of the overwhelming evidence adduced on the file, it is evident that late Suresh Kumar before taking the policies was admitted in the hospital on 7.10.2017 and discharged on 13.10.2017.  The insurance policy in question was taken on 28.10.2017 i.e. less than 3 years prior to the death of the deceased.  In the history of illness, it is clearly mentioned that the insured was diagnosed as Portal Hypertension (Bleeder, antral Gave+Mild PHG, Esophageal, Chronic liver disease Ethanol related) (L-1-10 months back).  It is further alleged that in February, 2017 he developed jaundice and diagnosed to have CLD and April, 2017, he noted abdominal ditension diuretic responsive.

9.                It means that prior to the taking of the said two policies, the deceased was suffering from liver disease and he underwent treatment for the same.  There is no explanation from the side of the complainant about the treatment taken by the deceased. Thus, the cause of the death is the liver disease, which the deceased suppressed at the time of taking the policies. The deceased at the time of taking the insurance policies had filled the proposal form, as it is so apparent from Ex. R-4 given by the LIC company to the complainant, wherein it has been observed that proposal forms were submitted, wherein the life insured ( deceased) had answered the following questions in negative:-

“During the last five year, did you consult a medical practitioner for any ailment requiring treatment for more than a week?	No
Have you ever been admitted to any hospital or nursing home for general checkup, observation, treatment or operation?	No
Have you remained absent from place of work on grounds of health during last five years.	No
Are you suffering from or have ever suffered from ailment for pertaining to liver, stomach, heart, lungs kidney, brain or nervous system.”	No
Are you suffering from or have ever suffered from diabetes, tuberculosis, high BP, Low BP, cancer, epilepsy, hernia, leprosy or any other disease.	No
Did you ever have any bodily defect or deformity	No
Did you ever have any accident or injury?	No
What has been your usual state of Health	Good

 

10.                    It is thus apparent from the said replies by deceased that he neither suffered any liver disease nor he consulted medical practitioner for any ailment and further he was never admitted in any Hospital for general checkup or for operation and further he never remained absent from the place of work.  In all the said queries he replied in-negative.  Thus, it is evident that the deceased despite having undergone liver treatment gave incorrect and false answers to the said questions put to him by the insurer. Had the deceased stated about the true state of his health and of the factum of his having already underwent the liver treatment, probably the insurer, being a prudent insurer, would not have run the risk of issuing the said life insurance polices to the insured. Thus, it is the deceased who violated the principle of utmost good faith of ‘Uberrima Fides’.  The contract of insurance between the insured and the insurer is based upon good faith and trust. It is based upon the principle of Uberrima Fides.

11.              Hon’ble Supreme court of India in case Satwant Kaur Sandhu Vs. New India Assurance Company limited ( 2009) 8 Supreme Court Cases 316 has justified the repudiation of insurance claim by the insurer.  In the proposal form, the insured suppressed the material factum, as he was bound to give a true and full disclosure of information within his knowledge.

In that case, the insured was fully aware that he was suffering from chronic liver disease, but despite that he did not disclose the said factum in the insurance policy.  

12.              Hence, as an upshot of our above discussion, finding no merit in

this complaint, it  is dismissed with no order as to cost.  Copy of this order be sent to both the parties as per rules free of cost.  This order be uploaded on the website of this Commission promptly.   File be consigned to record room after due compliance.