DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANSA. Complaint No.137/13.08.2007 Decided on : 26.05.2009 Karamjit Kaur Widow of Sh.Gurjant Singh S/o Sh.Nek Singh, resident of Village Khiva Kalan, Tehsil and District Mansa. ..... Complainant. VERSUS 1.The Branch Manager, Life Insurance Corporation of India, Branch office Jeevan Jyoti, Lal Kothi, Railway Road, Sangrur. 2. Life Insurance Corporation of India, Northern Zone, Divisional Office, Jeevan Prakash, Sector 17-B, Chandigarh. 3.Life Insurance Corporation of India,Registered and Head Office Jeevan Bawa Marg, Mumbai. 4.Life Insurance Corporation of India, Naraynai Building, Near State Bank of India, Branch office Mansa. ..... Opposite Parties. Complaint under Section 12 of the Consumer Protection Act, 1986. ..... Present: Sh.B.D.Jindal, Advocate, counsel for the complainant. Sh.S.P.Gupta, Advocate, counsel for the opposite parties. Quorum: Sh.P.S.Dhanoa, President. Sh.Sarat Chander, Member. Smt.Neena Rani Gupta, Member. ORDER:- Sh.P.S.Dhanoa, President. Smt. Karamjit Kaur Widow of Sh.Gurjant Singh, a resident of village Khiva Kalan, Tehsil and District Mansa, has filed the instant complaint, under Section 12 of the Consumer Protection Act, 1986 (in Contd........2 : 2 : short called the 'Act'), against Life Insurance Corporation of India, for giving them direction to release the payment of claim in the sum of Rs.3,00,000/- alongwith interest at the rate of 18 percent per annum,for payment of compensation for mental and physical sufferings and costs of filing the instant complaint. 2. Briefly stated, the facts of the case, as projected, in the complaint, are that Sh.Gurjant Singh, husband of the complainant secured insurance policy No.163236053 on his life from the agent of the OP No.1, with assured sum of Rs.3,00,000/-. The amount of premium in the sum of Rs.10,259/- was paid by the complainant to the agent of OP No.1 on 6.9.2006 against receipt No.0949696 of even date. The insured expired on 25.10.2006 at village Khiva Kalan due to heart attack. He had nominated the complainant as his nominee, who being his widow, is otherwise entitled to succeed to his property as legal heir. The complainant submitted intimation about the death of her husband to OP No.1. As he did not take any action on her application, she served legal notice upon him alongwith requisite documents on 8.1.2007, after which he sent her letter dated 23.1.2007 raising demand of certain documents which were supplied by the complainant alongwith the application on prescribed performa duly certified to be true copies by notary public alongwith affidavits of two responsible persons, as desired. The OP No.1 again sent letter dated 18.2.2007 asking the complainant to again submit information alongwith documents on prescribed performa. In response to the said letter, complainant again sent information, but the Manager (Claims) of OP No.2 demanded further information and asked for submission of certificate from the doctor who treated the insured, accompanied by affidavits of two responsible persons living in his vicinity. The complainant has earlier informed the opposite parties that her husband suddenly fell sick and died at his village. However, she again sent the requisite documents to Manager (Claim) of OP No.2, but he has failed to settle the claim with Contd........3 : 3 : malafide intention, although the same should have been settled within a period of six months after the death of the insured because of which complainant has been subjected to mental and physical sufferings. Hence this complaint. 3. On being put to notice, the opposite parties filed written version resisting the claim, by taking preliminary objections; that no cause of action has accrued in favour of the complainant to file the complaint and she has failed to submit the requisite documents, as such, complaint is pre mature and is liable to be dismissed. On merits, the factum of issuance of insurance policy in the name of the husband of the complainant for assured sum of Rs.3,00,000/- is admitted alongwith the fact that insured has nominated her as his nominee to receive the amount of claim on his death. It is submitted that, as informed by the complainant, insured has expired due to heart attack within a period of one month and 19 days after issuance of insurance policy, as such, claim lodged by her is liable to be investigated and could not be settled due to non submission of documents sought from her by the opposite parties vide their office letter dated 19.3.2007, 10.5.2007 and 15.6.2007. The receipt of legal notice has been admitted, but it is submitted that reply to it has been given to the complainant vide letter dated 15.6.2007. It is denied that opposite parties have harassed the complainant and she has suffered mental and physical harassment due to delay in settlement of her claim or that there is any malafide on the part of the opposite parties. Rest of the averments made in the complaint have been denied and a prayer has been made for dismissal of the complaint with costs. 4. The complainant filed rejoinder wherein all the averments made in the written version filed by the opposite parties have been denied and those made in the complaint have been reasserted. 5. On being called upon by this Forum, to do so, the learned counsel for the complainant tendered her affidavit and copies of Contd........4 : 4 : documents Exhibit C-1 to C-29 before her counsel closed evidence. On the other hand, learned counsel for the opposite parties tendered in evidence copies of documents Ext.OP-1 to OP-5 and closed their evidence. In additional evidence, complainant has tendered copy of letter of repudiation Ext.C-30 in response to which no evidence has been led in rebuttal by the opposite parties. 6. We have heard the learned counsel for the parties and gone through the oral and documentary evidence, adduced on record, carefully with their kind assistance. 7. At the outset, Sh.B.D.Jindal, Advocate, learned counsel for the complainant has submitted that contents of the duly sworn affidavit of the complainant that her husband met sudden death after suffering heart attack at his village, are corroborated by the affidavits of various other persons tendered in evidence on her behalf. Learned counsel has argued that the opposite parties have neither filed the affidavit of their investigator nor of any other person whose statement was recorded by him about the cause of death of the insured and his admission in the hospital. Learned counsel further argued that opposite parties have failed to settle the claim of the complainant despite lodging of claim and filing of various applications by her and supplying them requisite documents in her possession because of which she has been subjected to mental and physical harassment. Learned counsel urged that opposite parties were under obligation to settle the clam lodged by widow and nominee of the insured, within a reasonable time , but they have failed to do so, as such, they are also liable to make her payment of amount on account of compensation and costs in addition to amount of claim alongwith interest at the rate of 18 percent per annum. 8. On the other hand, learned counsel for the opposite parties Sh. S.P.Gupta, Advocate, has submitted that complaint is pre mature because as per documentary evidence adduced on record by the complainant herself, her claim has been repudiated by the opposite parties during the Contd........5 : 5 : pendency of the complaint. Learned counsel has further argued that initial onus was on the complainant to prove the cause of death of her husband and his death at his village, but she has neither proved on record any cogent and convincing evidence like postmortem report, F.I.R., nor examined any doctor who attended him, except the affidavits of certain persons, which are verbatim extract of each other, whereas the opposite parties have tendered in evidence the statements suffered by Chowkidar and Ex. Member Panchayat of the village of the complainant recorded their investigator that he died in D.M.C.,Hospital after suffering from cancer for a period of about three months. Learned counsel argued that as the insured has died within a short time after the issuance of insurance policy in his name, therefore, inference is that he had been victim of pre existing disease but he suppressed the same, as such, claim lodged by the complainant has been rightly repudiated by the opposite parties because no person can become victim of disease like cancer overnight. Learned counsel argued that in view of the peculiar facts and circumstances of the case, instant complaint is liable to be dismissed with compensatory costs. 9. Admittedly, insurance policy in question had been secured by the deceased husband of the complainant on 6.9.2006. There is no dispute between the parties that husband of the complainant had expired on 25.10.2006. The complainant has tendered her own affidavit and affidavits of several other persons Ext.C-16 to C-24 wherein they have affirmed on solemn affirmation that insured died due to heart attack at his village. These persons are either co villagers of the complainant or her relatives. In our opinion, duly sworn affidavit of a person cannot be rejected solely because he is related to the person, who has relied upon the same by relationship or otherwise until there is positive evidence to distrust the same. The opposite parties have repudiated the claim of the complainant vide their letter dated 19.2.2008 Ext.C-30 stating that insured had suffered from pain in the middle finger and for cure of the same, he had consulted a Contd........6 : 6 : medical practitioner and has taken treatment in his hospital, but he has given wrong answers to the questions in the proposal form/personal statement about the state of his health, disease suffered by him and his treatment/admission in the hospital and consultation of a medical practitioner, but they have not produced on record any oral and documentary evidence to establish that insured had ever suffered from pain in middle finger, consulted any medical practitioner or remained admitted in the hospital. However, they have tendered in evidence copies of report dated 22.10.2008 Ext.OP-1 to OP-3 submitted by their investigator to the effect, as verified by him in the enquiry, entrusted to him, insured remained admitted in the D.M.C. Hospital, Ludhiana for a period of three months before his death on 25.10.2006, as he had been suffering from cancer because of which he has reasonable suspicion regarding genuineness of the claim. The opposite parties have also tendered in evidence statements of Sh.Ram Lal, Ex.Member of Gram Panchayat S/o Sh.Hardev Ram, and Sh.Gurmail Singh Chowkidar S/o Sh.Devi Lal of the village of the complainant to the effect that insured suffered from cancer three months prior to his death and remained hospitalized in D.M.C. Hospital at Ludhiana. These statements are shown to have been attested by two co-villagers of the complainants, but the opposite parties have neither examined their investigator nor they have tendered his affidavit or the affidavits of any other person whose statement has been recorded by him or the person who attested them. They have not taken any objection in the written version filed by them about the cause of death and admission of the insured in the hospital before his death. As such, the plea taken by them in the written version and evidence lacks consistency. As submitted above, investigator of the opposite parties has given his opinion merely on the basis of suspicion, which is no substitute for evidence, for a particular fact and conclusive proof thereof. 10. The insurer is required to settle the insurance claim within a Contd........7 : 7 : reasonable time especially when the complainant has submitted all the requisite documents and information, in her possession about the death of her husband, but they have failed to so and have rejected the claim during the pendency of the complaint. In 1998(II) CLT (Supreme Court) 489, United India Insurance Co.Ltd versus M.K. J. Corporation, it has been held by the Hon'ble Apex Court that a reasonable time of two months is justified to take decision about the validity of the claim from the date of submission of report by their surveyor. We are also of the view that initial onus was on the opposite party to prove that insured had deliberately and intentionally suppressed any pre existing disease suffered by him with the intention to secure wrongful gain for his legal heirs and to cause wrongful loss to the Insurance Company. In this regard, reference may be made to 1998(II) CLT (NC) 491 The New India Assurance Company Ltd & Anr versus P.P.Khanna, wherein it has been held by the Hon'ble National Commission that in case of fraudulent suppression of material facts by the insured, onus rests highly on the party alleging fraud namely the insurer. 11. The complainant has given enough time to the opposite parties to settle her claim before she knocked the door of this Forum by filing the instant complaint. As such, complaint cannot be termed as premature. 12. In the light of our above discussion and being fortified by ratio of judgments delivered in the authorities referred above, we have come to the conclusion that delay in filing of the claim cannot be attributed to the complainant and repudiation thereof by the opposite parties is not justified. The factum of lodging of claim and submission of requisite documents in possession of the complainant is not specifically denied by the opposite parties. As such, complainant deserves to be adequately compensated for mental and physical harassment due to delay caused by the opposite parties for settlement of the claim, but as we are inclined to award interest , therefore, compensation cannot be awarded simultaneously to her, as claimed in the complaint. However, she may be compensated for Contd........8 : 8 : unavoidable expenses incurred by her for filing of the instant complaint. 13. For the aforesaid reasons, we accept the complaint and direct the opposite parties to release the amount of claim in the sum of Rs.3,00,000/- in the name of the complainant alongwith interest at the rate of 9 percent per annum from the date of filing of the complaint i.e. 13.8.2007 till the date of actual payment with further direction to pay a sum of Rs.1,000/- as costs of filing of the complaint. The compliance of this order be made within a period of two months from the date of receipt of the copy of the order. 14. The copies of this order be supplied to the parties free of costs, as permissible, under the rules. File be indexed and consigned to record. Pronounced: 26.05.2009 Neena Rani Gupta, Sarat Chander, P.S.Dhanoa, Member. Member. President.
