BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 141 of 2017
Date of Institution : 16.6.2017
Date of Decision : 20.12.2017.
- Balbir Kaur, widow aged 48 years, 2. Atinder Pal Singh son, aged 27 years, 3. Parvinder Singh son aged 23 years of late Shri Joginder Singh son of Shri Jaimal Singh, resident of C/o Dashmesh Tyre Company, Sirsa Road, Ellenabad, District Sirsa.
……Complainants.
Versus.
- Life Insurance Corporation of India, Sirsa, through its Branch Manager.
- The Senior Divisional Manager, Life Insurance Corporation of India, Divisional Manager, Rohtak.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SH. MOHINDER PAUL RATHEE …… MEMBER.
Present: Sh. JBL Garg, Advocate for the complainant.
Sh. K.K. Relan, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that Shri Joginder Singh since deceased son of Sh. Jaimal Singh husband of the complainant no.1 and father of complainants no.2 and 3 had purchased two insurance policies bearing No.172109602 for sum assured of Rs.one lac and 179902916 for sum assured of Rs.five lacs. Joginder Singh continued making payment of the premium to the ops. It is further averred that Joginder Singh died on 25.7.2016. After his death, the complainants being his legal heirs lodged the claim with op no.1 in respect of above policies and supplied all the required documents and information to op no.1 as required. The ops settled the claim of the complainants in respect of policy No.172109602 whereas the ops have repudiated the claim in respect of policy No.179902916 vide their letter dated 31.1.2017 on the grounds that the policy had not completed three years from the date of FPR i.e. 26.3.2015 and that he gave false answers to few questions in the proposal form and that as per report No. 3816 received from DMC, Ludhiana, the deceased was admitted to the hospital on 17.7.2016 with complaint of acute pancreatitis with acute kidney injury with hypertension since three years and that DLA had not disclosed this adverse history in the proposal form. The said ground taken by the Corporation for repudiation of the claim of the complainant is totally false and baseless and it appears that a false excuse has been generated to repudiate the genuine claim of the complainant. The deceased Joginder Singh had developed the acute pain in abdomen all of a sudden and he had no previous history of such disease. Moreover, the ops had settled the claim of complainants in respect of other policy No.172109602. So, it is quite obvious that a false ground has been taken for repudiating the claim in respect of policy No.179902916. That the complainants are legally as well as factually entitled to get the sum assured and the ops are under legal obligation to pay the same to the complainants. It is further averred that the ops by their such act and conduct have been indulged in unfair trade practice and have committed gross deficiency in service towards the complainants due to which they have suffered harassment and mental tension and as such they are entitled to a compensation of Rs.50,000/- from the ops. That the complainants approached the ops and requested them to make payment of the sum assured of the policy in question alongwith all other insurance benefits but the ops did not pay any heed to the same. Ultimately, the complainants got served a legal notice upon the ops on 12.5.2017 but of no use. Hence, this complaint.
2. On notice, opposite parties appeared and filed written statement taking certain preliminary objections regarding maintainability; cause of action; suppression of material facts; no deficiency in service; complaint is based on false and frivolous claim and that complainant did not avail the departmental remedy of filing representation against the repudiation of the claim before the Zonal office, New Delhi before filing this complaint and that complaint is not within the period of limitation. On merits, it is submitted that ops have issued a policy no.172109602 on the life of Sh. Joginder Singh son of Jaimal Singh and another insurance policy No.179902916 with date of commencement 19.3.2015 for sum assured of Rs.5,00,000/- and as per the record of the ops, the name of nominee in the policy is Balvir Kaur i.e. complainant no.1. It is a matter of record that Joginder Singh continued making payment of the premium to the Corporation. It is further submitted that an amount of Rs.3,57,700/- has been paid as a death claim under the policy no.172109602. It is wrong to say that a false ground has been taken for repudiating the claim of policy no.179902916. The competent authority has repudiated the liability under the policy on genuine grounds. The aforesaid policy has not completed three years from the date of FPR i.e. 26.3.2015 to the date of death of life assured. As such the corporation has examined the claim keeping in view of provisions of Section 45 of the Insurance Act, 1938. While examining the claim, the ops noted from the proposal assurance dated 19.3.2015 that the deceased life assured had given wrong answers in respect of his health and all these answers were false as the ops hold undisputable proof. As per report no.3816 received from DMC Ludhiana, the deceased was admitted to the hospital on 17.7.2016 with complaint of acute pancreatitis with acute kidney injury with hypertension since three years. LA was not in good health at the time of taking insurance. DLA had not disclosed this adverse history in the proposal form. He did not disclose these facts in his proposal instead he gave wrong answers. It seems that LA had taken policy to defraud the corporation. It is further submitted that life assured had not mentioned material facts regarding his health. The suppression of material facts which have a bearing on the granting of risk was clearly done with intent to mislead the corporation. In this way the competent authority has repudiated the liability under the above policy on genuine ground. With these averments, dismissal of complaint has been prayed for.
3. The parties then led their respective evidence by way of affidavits and documents.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. Learned counsel for the complainants has contended that it is proved on record that the deceased life assured Joginder Singh had purchased two policies bearing No.172109602 for sum assured of Rs.one lac and another policy bearing No.179902916 for sum assured of Rs.five lacs. The complainants have proved that claim was lodged by the complainants qua the death claim of the deceased LA Joginder Singh, but however, the ops paid the claim against policy no.172109602 but however, the claim of the complainants qua the policy No.179902916 was repudiated arbitrarily and illegally. The second policy was purchased by the life assured after duly medical examination of the deceased LA by doctor approved by ops. No doubt deceased was admitted to the hospital on 17.7.2016 but there is nothing on record that deceased Joginder Singh was suffering from any disease from the last three years. The ops have not led any evidence in order to prove their defence plea nor the ops have summoned any doctor in order to prove the medical record against the complainants qua the disease of the deceased Joginder Singh. Learned counsel for complainants has relied upon judgment of the Hon’ble Supreme Court in case titled as Mithoolal Nayak vs. LIC of India, AIR 1962 Supreme Court 814, judgment of the Hon’ble National Commission in cases titled as Surinder Kaur & ors. Vs. LIC of India & ors. II(2005) CPJ 32 (NC), judgment of the Hon’ble Madhya Pradesh State Commission, Bhopal in case titled as Sunita Agarwal Vs. LIC of India & ors. III (2005) CPJ 446 and judgment of the Hon’ble Punjab State Commission, Chandigarh in case titled as Bajaj Allianz Life Insurance company Ltd. Vs. Major Singh and others, 20173) CLT 384.
6. On the other hand, learned counsel for the ops has strongly contended that though the deceased LA had purchased two policies out of which claim against first policy was settled and paid to the complainants but however, claim qua the second policy which was purchased by the deceased life assured on 26.3.2015 was repudiated on the ground that he gave false answers to the questions in the proposal form and that as per report no.3816 received from DMC Hospital, Ludhiana, the deceased was admitted to the hospital on 17.7.2016 with complaint of acute pancreatitis with acute kidney injury with hypertension since three years. DLA had not disclosed the adverse history in the proposal form. The policy had not completed period of three years as such the inquiry was got conducted as a result of which it was revealed that the deceased LA was not in good health at the time of taking of second insurance policy. It seems that LA had taken the policy to defraud the corporation. The ops have proved on record that LA was suffering from disease of kidney since long, as such he got the policy by misrepresenting the facts while making declaration at the time of filling the proposal form.
7. We have considered the rival contentions of the parties and have gone through the file as well as judgments relied by learned counsel for complainant.
8. It is undisputed fact that deceased LA had purchased a policy insurance coverage of Rs.1,00,000/- vide policy no.172109602 and he also filled proposal form on 19.3.2015 and policy No.179902916 was issued for the sum assured of Rs.5,00,000/-. Said Joginder Singh had died on 25.7.2016 and the present complainants being legal heirs of the deceased have filed present complaint qua the death claim of the deceased Joginder Singh. It is further undisputed fact between the parties that claim qua first policy was processed, settled and paid by ops to the complainants. However, the claim qua second policy was repudiated by the ops on the ground that deceased was already suffering from hypertension and kidney disease from the last three years and this fact had been concealed by LA in order to defraud the ops.
9. The complainants in order to prove their claim have furnished affidavit of Atinder Pal Singh complainant as Ex.C1 in which he has deposed in terms of the contents of the complaint. The complainants have also furnished copy of policy Ex.C2, copy of death certificate of Joginder Singh Ex.C3, copy of application of Balbir Kaur Ex.C4, copy of repudiation letter dated 31.1.2017 Ex.C5, medical record as Ex.C6 to Ex.C10, documents regarding claim Ex.C11 to Ex.C14, treatment record dated 18.7.2016 Ex.C15, copy of policy Ex.C16, copy of application Ex.C17, copy of legal notice Ex.C18 and postal receipts Ex.C19 and Ex.C20. On the other hand, ops in order to prove their defence plea have furnished affidavit of Sh. Rajendra Singh, Manager as Ex.R1, copy of repudiation letter dated 31.1.2017 Ex.R2 , policy documents, claim form and copy of medical examiner’s confidential report as Ex.R3 to Ex.R23.
10. As per the defence plea of ops, the deceased LA had concealed the fact qua his disease from which he was suffering from the last three years. The ops have relied upon the form of LIC mentioning report of DMC No.3816 Ex.R23, but however, the ops have not placed on record any corroborative evidence from DMC Ludhiana in order to prove their defence plea that deceased LA was suffering from the kidney disease from the last three years. Further, the ops have not placed on record any affidavit of the attending doctor who was allegedly treating the LA from the last three years. The perusal of the evidence of the ops further reveal that ops have placed on record certain reports of the different hospitals including SPS Hospital, Ludhiana but ops have not furnished the affidavit of any of the treating doctors in order to prove the medical record that the deceased LA was suffering from hypertension and kidney problem from the last more than three years. The perusal of Ex.R22 medical examiner’s confidential report which was obtained by the ops from the approved panel Dr. Vijay Kumar reveals that he examined the deceased LA on 19.3.2015 at 1.00 p.m. but he did not report that deceased LA was suffering from any kidney disease or any other disease or he was alcoholic from the last so many years. Further more, on the basis of this report Ex.R22, the ops had issued the second policy to the deceased LA and once it is proved on record that the deceased LA was not suffering from any disease on the day i.e. 19.3.2015 when he was medically examined by the doctor who was on panel of the ops and issued the medical examiner’s confidential report as Ex.R22 which clearly indicates that the ops have failed to prove their defence plea that deceased LA was suffering from hypertension and kidney disease from the last three years prior to his death. So, it appears that ops have failed to lead any cogent and convincing evidence from which it could be presumed that the deceased LA was suffering from aforesaid disease three years prior to the inception of the policy. The repudiation of the claim and non payment of the claim amount by the ops amounts to deficiency in service on the part of ops.
11. In view of the above, we allow this complaint and direct the opposite party to pay the sum assured amount of Rs.5,00,000/- alongwith other benefits to Balbir Kaur who was appointed as nominee as per plea of the ops as per terms and conditions of the policy within a period of one month from the date of receipt of copy of this order, failing which they shall be liable to pay interest @9% per annum from the date of order till actual payment. We also direct the ops to further pay a sum of Rs.10,000/- as compensation to all the three complainants for their harassment and Rs.2000/- as litigation expenses. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:20.12.2017. Member District Consumer Disputes
Redressal Forum, Sirsa.
