DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANSA. Complaint No.56/02.05.2008 Decided on : 31.12.2008 Gurmail Kaur Wd/o Sh.Sukhdev Singh S/o Sh.Gurdial Singh, Village Mal Singh Wala, Post Office Boha, Tehsil Budhlada, District Mansa. ..... Complainant. VERSUS 1.Life Insurance Corporation of India, Branch Mansa, through its Branch Manager. 2.Life Insurance Corporation of India, Ludhiana, through Sh.Jeewan Parkash, Divisional Officer, Urban Estate, Phase-1, Dugri, Ludhiana. ..... Opposite Parties. Complaint under Section 12 of the Consumer Protection Act, 1986. ..... Present: Sh.P.S.Behniwal, Advocate counsel for the complainant. Sh.P.K.Arora, Advocate counsel for the Opposite Parties. Quorum: Sh.Pritam Singh Dhanoa, President. Sh.Sarat Chander, Member. Smt.Neena Rani Gupta, Member. ORDER:- Sh.Pritam Singh Dhanoa, President. This complaint has been filed by Smt.Gurmail Kaur, widow of Sh.Sukhdev Singh Son of Sh.Gurdial Singh, Village Mal Singh Wala, Post Office Boha, Tehsil Budhlada, District Mansa, under Section 12 of the Consumer Protection Act, 1986 (in short called the 'Act'), on the averments, which may briefly be described as under: 2. That Sh.Sukhdev Singh, deceased husband of the complainant Contd........2 : 2 : secured insurance policy No.300198503 on 28.6.2005 on his life from the opposite parties. In the said policy, he has nominated the complainant, as his nominee, to receive the amount, of insurance claim, in case of his death, as such, the complainant, is the consumer, under the opposite parties. The life insured, named above, expired, on 17.01.2007. The complainant conveyed the factum of his death, to the opposite parties, and completed all the formalities, required for payment, of amount of insurance claim. Since then she, had been regularly visiting the office, of the opposite parties, but they had been prolonging the matter, of settlement of her claim, on one pretext or the other, and ultimately vide letter No. claims/16/D dated 9.4.2008, they have repudiated, her claim, in illegal manner, and against the terms and conditions, of the policy. The complainant, has been subjected, to mental and physical agony, due to non settlement of her claim, by the opposite parties, as such, she is entitled, to payment of compensation, from them, in the sum of Rs.50,000/-, along with the amount of insurance claim, in the sum of Rs.1,00,000/- and interest @ 18% per annum. She is also further entitled, to payment of costs, on account of expenses incurred by her, in filing the complaint. Hence this complaint. 3. On being put to notice, OP No.2 filed written version, resisting the complaint, by taking preliminary objections; that the complainant, is estopped from her own act and conduct, from filing the complaint; that no cause of action, has accrued, in favour of the complainant, to file the present complaint; that claim, has been rightly repudiated, because, life insured, intentionally and malafidely, got the policy secured by him, revived, by filing wrong declaration, and concealing the factum of hypertension and CVA ailments, suffered by him. He also suppressed factum of his admission, in the hospital and pathological and MRI tests, got conducted by him, prior to his death; that since the parties need to lead voluminous evidence, and complicated questions, of law and medical Contd........3 : 3 : science, are involved, as such, controversy can be resolved, in just and proper manner, by the Civil Court, and not, in summary manner, by this Forum; that there is no negligence or deficiency, in service, on the part of the opposite parties; that complaint, is not the 'consumer', under the opposite parties and complaint, being false and vexatious, is liable, to be dismissed with costs. On merits, it is admitted, that husband, of the complainant, secured insurance policy, in question, from the opposite parties, on his life, but it is submitted, that said policy, has lapsed, due to non payment of premium, and was got revived, by the insured, on 10.01.2007, by concealing the factum of his sickness, treatment and pathological tests etc. and that he remained admitted, in the hospital, from 25.11.2006 to 05.12.2006, for treatment, of hypertension and CVA. He also concealed that he was even treated, by Dr.Mohinder Singh at Bathinda, and remained semi-conscious. It is also admitted, that death, of the husband of the complainant, took place, on 17.1.2007, due to hypertension and CVA, just 7, days after he got revived, the insurance policy, secured by him, by misstating and concealing the true facts, affecting his health. It is also contended, that the complainant, has also failed, to supply the documents, to the opposite parties, as such, claim lodged by her, has been rightly and legally repudiated, after proper enquiry conducted, by the opposite parties. Rest of the averments, made in the complaint, have been denied, and a prayer, has been made, for dismissal, of the same with costs. 4. On being called upon, by this Forum, to do so, the complainant, furnished her affidavit Ext.C-1 and Balwant Singh son of Waryam Singh, examined by her, furnished his affidavit Ext.C-2. The complainant has also tendered, in evidence copies of documents Ext.C-3 to C-8 and closed her evidence. On the other hand, Sh.J.P.Arya, Manager of the opposite parties furnished his affidavit Ext.OP-1 and tendered, copies of documents, Ext.OP-2 to OP-16, before closure of their evidence. Contd........4 : 4 : 5. We have heard the learned counsel, for the parties and gone through, the oral and documentary evidence, adduced on record, by the parties, carefully, with their kind assistance. 6. At the out set, learned counsel, for the complainant, Sh.P.S.Behniwal, Advocate, has submitted, that claim, has been repudiated, by the opposite party, illegally against the terms and conditions, of the policy, because it was incumbent upon, them to subject the life insured, to medical examination, before revival of the policy. Learned counsel, has argued, that complainant, has examined independent and respectable person of her village, who has supported, her version, that her husband did not suffer, from any serious ailment, before his death, during the validity period of the policy and no reliance, can be placed, on the documents adduced by the opposite parties about concealment of admission and treatment, because, they have not examined, any doctor, who treated the deceased insured. The learned counsel, has further argued, that even if, the documents produced, on record, by the opposite parties, be treated as genuine, it cannot be inferred, on their basis, that deceased policy holder, had given false information and concealed the material facts touching his health, because, he was rural rustic person , who used to affix his thumb impressions on documents and no evidence, has been led, by the opposite parties, that contents of declaration were read over and explained to him. Learned counsel, has urged that due to repudiation, of the claim, of the complainant, who has been burdened to look after the minor children born to her from the loins of the policy holder and had undergone mental and physical agony, as such, opposite parties are bound, to pay compensation and costs, incurred by her for filing the complaint, in addition, to amount of insurance claim payable, under the policy. In support of his contentions, learned counsel, has placed reliance upon 1998 JRC 231 Smt.Tripta Rani versus Life Insurance Corporation of India wherein, it has been held, by the Hon'ble Punjab State Commission, that repudiation of claim solely, on Contd........5 : 5 : the basis of the history recorded, in the hospital record, is illegal and arbitrary and non-settlement of the claim amounts, to deficiency in service, on the part of the opposite party. Learned counsel, has also relied upon 2008 (III) CPJ 120 Life Insurance Corporation of India & Anr. Versus Sarabjit Kaur, wherein contention of the opposite party was, that material information, has been suppressed by the insured, as he had given false answers, in the proposal form. It was held by Hon'ble State Commission, U.T. Chandigarh that contention, is not acceptable, because, ultimate cause of death of life insured, was aspiration pneumonia and diabetes, which had direct nexus with ultimate cause of death, have not been mentioned in documents. It was further held diabetes and hypertension was not serious diseases, rather part of ordinary strain and stress of life, as such, repudiation of claim, by the opposite party was not justified. Learned counsel has further relied upon 1999(1)RCR (Civil) 646 Veena Sharma versus Life Insurance Corporation of India, wherein personal statement filed by the insured, no where indicated, if insured was specifically asked, to whether he was a patient of hypertension. It was held by the Hon'ble Punjab & Haryana High Court, that in the absence of any such material, respondents were not entitled to deny payment of compensation to her, on account of suppression of material facts and repudiation of her claim. Learned counsel has further relied upon 2008 (3) RCR (Civil) Punjab & Haryana 637 Birla Sun Life Insurance Co.Ltd. Versus Keshav Lal & others wherein insurance policy was sold after subjecting the life insured, to thorough medical examination and death of policy holder took after a period of about 10 months and Insurance Company repudiated the claim on the ground, that policy holder, was suffering from bronchitis which he did not disclose at the time of purchasing the policy. It was held by the Hon'ble Punjab & Haryana High Court, that no question was ever put to the insured at the time of selling policy, with regard to ailment, suffered by him, as such, even if he was suffering from the said disease, he cannot be Contd........6 : 6 : accused, of suppressing of material facts in deceitful way. Learned counsel has relied upon 1999 JRC 175 The Divisional Manager, Life Insurance Corporation of India & Anr versus Smt.Savitri Devi wherein there was no evidence to show that proposal form filled by the Agent of the Insurance Company was ever explained, to the insured that he understood the questions and their implications and thereafter, only he gave such answers. It was held that it was incumbent, upon the LIC to produce the evidence that deceased insured was told that answers are intended to be comprehensive and its slightest mis-statement would be fatal, to him. The Hon'ble H.P.State Commission held, that repudiation, of claim mainly on so-called inaccurate statements in the proposal form is not justified. Lastly, learned counsel, has placed reliance upon 1999 JRC 140 Narbada Devi versus Life Insurance Corporation of India & others wherein proposal form was filled, in English, whereas signatures in the declaration form of the deceased were found affixed in Hindi. It was held by the Hon'ble H.P.State Commission, that there is no escape, from drawing a conclusion that it is the Agent who has filled-in, the proposal form and the deceased just affixed his signatures on the declaration form, in good faith and nothing more, as there was no evidence, to show that declaration form filled up in Hindi, by the deceased insured, was properly explained and, that he understood, the questions and their implications and gave answers only thereafter. It was held that LIC was not right, in repudiating the claim on inaccurate statement made in the proposal form. Learned counsel has urged that in view of the facts of the case and ratio of judgments cited above, the complaint is liable to succeed. 7. On the other hand, Sh.P.K.Arora, Advocate, learned counsel for the opposite parties, has submitted, that as per oral and documentary evidence, it stands established, that insured, had filed false declaration and concealed. the factum of ailments suffered by him and, that he underwent pathological and MRI tests, and remained admitted in hospital for his Contd........7 : 7 : treatment, before revival of his policy, as such, his claim, has been rightly repudiated, by the opposite parties, for concealing material facts , effecting his health. Learned counsel, has argued that insured, has expired seven days after he got revived his insurance policy, by suppressing the material facts touching his health and, has failed, to intimate about them, to the opposite parties, as such, there is no deficiency in service, on their part and complaint, is liable, to be dismissed. In support of his contentions, the learned counsel, has placed reliance upon 1999(I) CPJ 118 Divisional Manager, LIC of India versus Saramma Varghese wherein it has been held by the Hon'ble Kerala State Commission that failure to intimate change of health by the life assured before issuance of policy amounts to breach of terms and conditions thereof and rendered the policy as invalid, as such, there is no deficiency in repudiation of claim. The learned counsel has also relied upon 1995(I) CPJ (NC) 122 Marketing Manager, LIC of India versus Smt. S.Vijaya wherein complainant suppressed his health problems in the 'personal health statement' before submission for revival of policy and insurer repudiated the claim on account of which it was held that it does not amount to deficiency in service. Learned counsel has also relied upon 1996(I) CPJ (NC) 115 Life Insurance Corporation of India Ltd.& Anr. versus Kantaben wherein insured died three months after taking the policy secured by him by suppression of facts and Insurance Company repudiated all the liabilities on that score. The appeal filed by the LIC was allowed by the Hon'ble National Commission and order of State Commission was set aside. Learned counsel has also relied upon 2008 Legal Digest decided on 29.8.2007 titled as Life Insurance Corporation of India Ltd. Versus Karamjit Kaur, wherein husband of the respondent has been working as driver with State Transport Authority. He took policy, under SSS with double accident benefit, but concealed the factum of his accident and subsequent leave availed by him from service on medical ground and Contd........8 : 8 : doctor advised him to perform light duty, but he instead, hired the duty, to drive bus, which resulted, in his death. The case of the respondent was that proposal was filled by the Agent of the insurer, and the insured, has put his signatures on the back of the proposal form. It was held by the State Commission, U.T., Chandigarh, that insurer, was justified, in repudiating the claim when answer given, by the proposer, in the proposal form about his health, was wrong although the agent, has filled in, the proposal form. Lastly, learned counsel has relied upon 2007 Legal Digest decided on 9.1.2007 titled as Life Insurance Corporation of India & Ors. versus Murti Devi wherein in the proposal form, the life assured concealed that he was suffering from Tuberculosis, Phenomonia, CLVF and Koch's chest. Her claim was repudiated by the LIC. The Consumer Forum allowed the complaint holding that simply because deceased, was suffering from tuberculosis and had concealed material facts, it cannot be taken as sole ground for repudiation of the claim. In appeal, it was held, by the Hon'ble Haryana State Commission, that as there, was deliberate concealment, on the part of the deceased, about the true state, of his health, the contract of insurance entered into by him and the opposite parties stood vitiated on account of fraud committed by him, as such, Insurance Company has rightly repudiated, her claim, under the policy. Learned counsel, has urged, that in view of the ratio of judgments, on the above cited authorities and the facts of the case, the complaint is liable, to be dismissed, on merits. 8. Admittedly, the policy in question, was secured, by the deceased husband, of the complainant, and he had nominated her, as his nominee, to receive the amount, of insurance claim, in case of his death. It is also not disputed that, in addition, legal heir of deceased insured, being widow, complainant has also been nominated, as his nominee, by her deceased husband, as a person, to receive insurance claim, in case of his demise. As such, the complainant is the 'consumer', under the opposite parties, in the ambit of its definition, given in the Act. The complainant, Contd........9 : 9 : has placed on record her affidavit Ext.C-1, wherein she has reiterated all the averments made in the complaint. The contents of her affidavit, are corroborated, by the affidavit of Balwant Singh son of Waryam Singh, Ext.C-2, a co-villager, to the effect, that deceased insured, has been possessing sound health and did not suffer, from any serious ailment before he expired, due to heart attack suffered, all of a sudden, by him. The complainant, has also produced, on record copies of proposal form and insurance policy, Ext.C-4 and C-5, and also death certificate of her husband Ext.C-6, as per which, he breathed his last, on 17.1.2007, at his village Mal Singh Wala. The factum of death of the insured, has not been denied, even by the opposite parties. 9. The complainant, has also placed, on recored the letter dated 9.4.2008 Ext.C-7, written to her, by the Branch Manager, of the opposite parties informing that claim preferred, by her, against the insurance policy issued, in the name of her deceased husband, has been repudiated. She has also produced, on record, copy of letter, dated 29.2.2008, Ext.C-8, addressed to her stating that, her claim, had been repudiated, because, the insured, was suffering from hypertension and CVA, for which, he had been getting treatment, in hospital and remained admitted, from 25.11.2006 to 5.12.2006, but he did not disclose, these facts, in the personal statement submitted by him, at the time of revival of policy, under reference, which had lapsed earlier, due to non-deposit of amount of installment of premium. 10. The opposite parties, have also produced copy of letter written on 29.2.2008, Ext.OP-2, and affidavit of Sh.J.P.Arya, Manager of Legal & HPF, Ext.OP-1, wherein he has reasserted, the averments made in the written version, on solemn affirmation, giving reasons, about repudiation, of the claim, of the complainant. The opposite parties, have also produced, other documents, including letter, dated 6.12.2007, addressed, to the complainant, asking her, to furnish the affidavits, of some disinterested Contd......10 : 10 : persons, who was present, at the time of death of her husband and to submit Form No.3784, duly completed, by the doctor, who attended him, in the course of his sickness and declared him dead. They have also produced copies of Claim Inquiry Report and other documents, Ext.OP-4 to OP-16, showing that deceased, remained admitted, in the hospital, for the above said period and he underwent pathological tests in M/s Gursimran Clinical Laboratory, Bathinda, and was treated by Dr. Mohinder Singh. As mentioned, in these documents, deceased, has been suffering from hypertension and CVA diseases. However, the opposite parties, have not examined, either the doctor, who attended the insured, or the person, who may be conversant with his signatures and handwriting. It is well settled, that mere marking of a document as an 'Exhibit', does not dispense with, the mode of proof. In the absence of any corroborating evidence, much reliance cannot be placed, on these copies of documents, tendered in evidence, by the opposite parties regarding admission, of the insured, his treatment and sufferance of any serious ailment by him. It was for the Insurance Company, in its own interest to subject the life insured to medical examination, before his policy was issued or revived, but there is no document, on record, to show that such an action was taken, by the opposite parties, to protect their own interest. Moreover, it is not the case of the opposite parties, that at the time policy was originally issued, to the insured, he was suffering from physical ailment, which he intentionally concealed, in his personal statement. The perusal of Personal Statement Ext.C-3, furnished by the insured, at the time of revival, of the policy, reveals that he had affixed, his thumb impressions thereon and one Surekha Rani has appended her signatures, as witness, to the declaration, that contents of declaration were read over and explained to life insured before he affixed his thumb impressions admitting them to be correct, but she has not been examined, by the opposite parties. Since the insured was an illiterate, rural rustic person, therefore, in the absence of any positive Contd......11 : 11 : evidence, plea of the opposite parties, cannot be accepted, that he affixed his thumb impressions after understanding the contents of declaration and gave wrong answers, to the questions posed to him with malafide intention. Moreover, no specific question has been put, to the insured, in his personal statement that he had been suffering from hypertension and CVA diseases. In view of the facts and circumstances of the case, discussed above, we are constrained, to reject the plea of the opposite parties, that illiterate insured, had concealed the material facts concerning his health, while he got revived his policy. 11. We have carefully gone through the ratio of judgments delivered, in the authorities relied upon by the learned counsel for the opposite party, and have come to the conclusion, that their facts and circumstances are quite distinguishable from those of the cases in hand. In those cases, it was established that insured, had deliberately and with malafide intention, concealed the material facts and furnished false declaration about his health, because of which, repudiation of the claims of the complainants, were found, to be justified. As such, the verdict delivered in the above authorities, relied upon by the opposite parties, does not advance their case, so far as, repudiation of the insurance claim, is concerned. 12. For the aforesaid reasons, we have come to the irresistible conclusion, that action of the opposite parties, in repudiation of the claim lodged by the complainant is not justified and 'there is deficiency in service' on their part. 13. Learned counsel, has further argued, that since complicated questions, of law and medical science, are involved, therefore, the controversy can be adjudicated, in just and proper manner, by the Civil Court, as such, this Forum, if deems fit, can grant liberty, to the complainant, to agitate the matter, in the civil court and may dismiss the complaint, as the controversy cannot be decided in summary manner. At Contd......12 : 12 : the stage, learned counsel has argued that case is based upon adjudication on technical plea taken by the opposite parties, as such, it can be decided by this Forum in summary manner. We are of the opinion that controversy can be adjudicated in summary manner and there is no necessity to refer the parties to the Civil Court. 14. For what has been discussed above, by us, we accept the complaint and direct the opposite parties, to make the payment, of the amount of insurance claim, along with compensation, in the sum of Rs.2,000/-, for physical and mental agony, suffered by the complainant, and also a sum of Rs.1,000/- on account of costs, incurred by her, for filing the complaint, within a period of two months, from the date of receipt, of the copy of this order, failing which the opposite parties, shall also be liable to pay interest @ 9% per annum, to the complainant till actual payment. 15. The copies of the order be supplied, to the parties, free of costs as per rules on the subject. 16. File be indexed and consigned to record. Pronounced: 31.12.2008 Neena Rani Gupta, Sarat Chander, P.S.Dhanoa, Member. Member. President.
