BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
Complaint No.: 107 of 2016.
Date of Institution: 19.05.2016.
Date of Decision: 15.07.2019.
1. Shakuntla Devi wife of late Karan Singh son of Shri Banwari Lal, 2. Reetu minor daughter and 3. Vineet Punia minor son of late Karan Singh, residents of village Mandoli Kalan, Tehsil Loharu, District Bhiwani, minors under the guardianship of Smt. Shakuntla, real mother of the minors.
….Complainants.
Versus
1. The Senior Division Manager, Life Insurance Corporation, Divisional Officer, SCO No. 3, 4 and 5, Sector-1, Rohtak.
2. The Branch Manager, Life Insurance Corporation, Charkhi Dadri, District Bhiwani (now Charkhi Dadri).
…...Opposite Parties.
COMPLAINT UNDER SECTIONS 12 AND 13 OF
THE CONSUMER PROTECTION ACT, 1986.
Before: - Hon’ble Mr. Manjit Singh Naryal, President.
Hon’ble Mr. Parmod Kumar, Member.
Hon’ble Mrs. Saroj Bala Bohra, Member.
Present: Shri Surat Singh, Advocate for the complainant.
Shri Sanesh Chaudhary, Advocate for the OPs.
ORDER:-
PER MANJIT SINGH NARYAL, PRESIDENT
Brief facts of the case are that the complainant No.1’s husband and father of complainants No. 2 & 3 had got insured his life with the OPs vide insurance policies bearing No.179192371 and 179195823 from OP No. 1 for Rs.2,50,000/- each. It is alleged that Karan Singh at the time of issuance of insurance police was hale and hearty. It is further alleged that Karan Singh died all of a sudden a natural death and after his death, claim regarding the said policies was sent to the OPs along with all the requisite documents. It is further alleged that the OP No. 1 has now repudiated the claim of the complainants illegally and unlawfully and without any right. It is further alleged that the OP No. 1 has repudiated the claim without being heard, arbitrarily and without any basis vide letter dated 6.4.2015. It is further alleged that OPs have got deposited the premium of the insurance regularly and now it cannot be allowed to say that the insurer was ill or suffering from any disease. It is further alleged that the insured in those days was posted as Havaldar Clk (IM) SS 505 Army Base at Sr. No. 20 and he was selected Hav to Nb Sub Prom Cadre Courses Ser No. 523 commencing from 7.1.2013 to 9.3.2013 at cadre coy No.2, Trg Bn. AOC Centre Secunderabad – 15 vide letter bearing No.C/3128/HNS-523/Prom/CA – 2 OSS 505 ABW at Sr. No.20 by the officer Lt. Col. Chief Record Officer dated 16.11.2012. It is further alleged that he was at appx A. It is further alleged that the said Lt. Col. Officer Commending had also given certificate to the effect that it is certified that No.6930510x Late Hav. Clk (IM) Karan Singh was served in OSS, 505 Army Base Wksp, Delhi Cantt c/o 56 APO w.e.f. 26.4.2010 to 4.1.2013 and during this period the individual has never been admitted in the Base Hospital, Delhi Cantt. And hence, at the time of death he was fit for and was not suffering from any kind of disease. It is further alleged that the 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 and hence, this complaint.
2. On appearance, the OPs filed written statement alleging therein that the OPs issued policy No.179192371 and 179195823 on the life of Shri Karan Singh son of Shri Banwari Lal w.e.f. 15.6.2012, sum assured Rs. 2,50,000/- each policy. It is further alleged that at the time of proposal for the life insurance the deceased Karan Singh concealed the material facts with regard to his health. It is further alleged that Karan Singh (DLA) was taking treatment from Military Hospital and was taking radiotherapy prior to date of proposal, as per the treatment record/discharge summery. It is further alleged that the complainants have not mentioned the date of death of said Karan Singh. It is further alleged that in terms of declaration signed by Karan Singh 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 policies in question and same has been informed to complainants vide letter dated 6.4.2015. Hence, there is no deficiency in service on the part of OPs and complaint is liable to be dismissed with costs.
3. The complainant No. 1 has placed on record her duly sworn affidavit Annexure-C1 and documents Annexure C2 to Annexure C4 and closed the evidence.
4. On the other hand, the ld. Counsel for the OPs has placed on record documents Annexure R1 to R6 and closed the evidence.
5. We have heard ld. counsel for both the parties at length.
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 Karan Singh, husband of complainant No. 1 and father of complainants No. 2 & 3 was suffering from any disease, prior to commencement of insurance policy. Therefore, repudiation of claim vide letter dated 6.4.2015 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 National Insurance Company Limited Vs Ravidutt Sharma and another PLR (2011-4), 154.
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 complainants was rightly repudiated vide letter dated 6.4.2015. Hence, there is no deficiency in service on the part of OPs and the complaint of the complainants is liable to be dismissed. He placed his reliance upon Satwant Kumar Sandhu Vs New India Assurance Company Ltd., decided on 10.7.2009 by Hon’ble Supreme Court of India. But this judgment is not applicable to the facts of the present case due to peculiar facts & circumstances.
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 “No”. 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. This plea of the OPs cannot be taken into count, because no party can be allowed to take an undue advantage of its own acts and conduct and omissions. It was bounden duty of the company to get the person medically examined before insuring him. If the interpretation of insurance company is accepted, in that eventuality insurance company is not liable to pay any claim, whatsoever, because every person suffers from symptoms of any disease without the knowledge of the same. This policy is not a policy at all, as it is just a contract entered only for the purpose of accepting the premium without the bonafide intention of giving any benefit to the insured under the garb of pre-existing disease. Most of the people are totally unaware of the symptoms of the disease that they suffer and hence they cannot be made liable to suffer, because the insurance company relies on their Clause that the deceased life assured had concealed the true facts as every human being is born to die and diseases are perhaps pre-existing in the system totally unknown to him/her, which he/she is genuinely unaware of the same. Hindsight everyone relies much later that he or she should have known from some symptom. If this is so every person should do medical studies and further not to take any insurance policy. Even on the facts of record there is no material to show that the deceased life assured had any disease at the time of proposal form. Since there were no symptoms, the question of linking up the symptoms with a disease does not arise in any case. The OPs alleged that the life assured was taking treatment from Military Hospital and was taking radiotherapy prior to taking the insurance policy. But the complainants have placed on record copy of letter dated 16.11.2012 alongwith list for Promotion Cadre Course HAV to NB SUB (HNS-523) as Annexure C2 and the name of the deceased life assured was given at Sr. No.20 in the said list, which itself shows that he was hale & healthy. The complainants have also placed on record Certificate issued by Lt. Col. Officer Commanding OSS, 505 AB Wksp., Delhi Cantt -10 dated 29.5.2015, certifying that 6930510X late Hav Clk (IM) Karan Singh has served in OSS, 505 Army Base Wksp, Delhi Cantt, C/o 56 APO wef 26 Apr 2010 to 04 Jan 2013 and further certified that during this period the Individual has never been admitted in Base Bospital, Delhi Cantt. So, it cannot be said that he had concealed anything regarding his health at the time of submitting proposal form and taking the insurance policy. So, concealment of disease, if any, was not of such an important significance, because nothing prevented the OPs from getting the medical examination of the assured for prescribing certain tests. It appears that they did not do so either because the overzealousness to assure the people by supplementing their income through premiums or due to their cavalier and careless approach in insuring a person on the basis of self declaration. So, whenever a person is assured for policy minimum precaution, the insurance company is expected to take it to get the medical examination as well as other examinations which are required for the insurance policy. It is pertinent to mention here that there is no doubt medical examination might have been got done, as without getting the medical examination no insurance policy can be issued. It is also cannot be disputed that the medical board/MO certainly had declared the life assured fit and only then the insurance policy were issued in favour of life assured. So, it is clear that at the time of issuance of insurance policies the life assured now deceased was not suffering from any disease.
9. The further arguments of the learned counsel for the OPs is that claim of the complainant is not tenable because the said policy had run 24 months from the date of first premium. This plea of the OPs is not tenable at all because neither any instruction has been produced by the OPs nor it has been brought into the notice of the complainant. It is also not disputed that the husband of the complainant had obtained the insurance policy bearing No. 179192371 and 179195823 for a sum of Rs. 2,50,000/- each. Meaning thereby the policies were issued after conducting medical examination. From this fact it is clear that as soon as the cover notes were issued, life assured becomes entitled to get the insurance amount. It is worthwhile to mention here that as soon as insurance policies commenced then the contract becomes complete on that date. Hence, plea of early claim cannot be accepted. From the perusal of record no instruction has been brought on record. So, instructions if any it cannot be disentitled the claim of the complainant. Annexure R1, Repudiation letter, Annexure R2 Leave records of Karan Singh, Annexure R3, Medical Certificate: Cause of Death of all ranks, Annexure R4 Medical Certificate and Annexure R5 treatment history of deceased life assured. Annexure R3, Medical Certificate: Cause of death of all ranks dated 16.6.2014 issued by Medical Officer/doctor, in which the treating doctor has not given his complete opinion. The doctor has mentioned that the life insured was suffering from Recurrent GBM (OPTD) Post Chemotherapy, but he has no where mentioned that how much old the disease was from which life assured was suffering. He has not mentioned the particular period of the disease. The onus to prove on record the facts mentioned in proposal form beyond doubt is upon the OPs by placing on record some cogent and convincing evidence, but they failed to do so. Moreover, OPs have accepted the proposal form at the time of issuing the policy. It is the duty of the OPs to complete all formalities with open eyes before issuing the insurance policy to avoid unnecessary harassment of assured. The Insurance Companies adopt very unethical and wrong procedure just grab the money from the poor peoples and harass them and their legal heirs when they are in need of the money. It is also moral & social duty of the insurance companies to conduct proper medical checkup of the buyers of the insurance policies before they accept the hard earned money on account of premium from policy buyers, as lateron they were on giving hand and they cannot escape from their liability and also cannot harass the poor people on unnecessary excuses especially at the time of giving the claim to the insured or his legal heirs. Generally it is routine practice that as and when a common person searches on internet about insurance/mediclaim policies, then he receives many unwanted telephone calls from the different insurance companies and these companies try to induce the poor people through their agents without disclosing the entire terms & conditions and at that time the only purpose of their agents is to extort money from public and to get the commission on that amount and they complete all the formalities by themselves including filling of proposal form and they also obtained the signature of assured on some blank forms and for this they always adopt the unethical, unsocial and un-genuine procedure to issue the insurance policy. As and when the assured need for claim and apply for the same, then agents of the insurance companies some-times unethically bargains for settling the claim. So after considering all above mentioned important issues, we come to the conclusion that the insurance companies should have held liable for their errors & negligence committed on their part and to protect the interest of genuine buyers of the insurance policies. The Insurance Companies and their agents are also duty bound to disclose all hidden terms & conditions of the insurance policy to protect the interest of the consumers and these companies are also duty bound to get investigate the assured with their entire satisfaction before issuing the insurance/mediclaim policies. In our view, generally only 2-3 persons approached the insurance company for claiming the insurance claim, out of every 10 persons, but the insurance companies use to raise baseless objections to harass them for getting their insurance claims. It cannot be said that insured has suppressed material facts regarding his health, because everything was within the approachable hand of the OPs and they must investigate all the facts pertaining to the insured before repudiation of the claim to provide proper justice to the needy claimants. Thus, there is clear cut deficiency in service and unfair trade practice on the part of the OPs. Hon’ble Punjab & Haryana High Court, Chandigarh titled as National Insurance Company Limited Versus Ravidutt Sharma and another PLR (2011-4) 154 held as under:-
The insurance companies, in my view, are not acting fairly in all such matters after charging huge premium intention is always to repudiate the claim on one ground or the other. The conditions of the insurance agreements are so minutely printed that per-son gets hardly any time to go through such conditions to make it legally binding in any appropriate manner.
10. Moreover, the Insurance Companies deliberately with malafide intention does not settle the claim of its consumers in time and harassed them without any reason. So in our view the complainant is also entitled for compensation on account of mental and physical harassment & punitive damages for deficiency in service & mal trade practice on the part of the Insurance Company. Therefore, in view of the facts and circumstances mentioned above, complaint of the complainant is partly allowed and the OPs are directed: -
i) To pay the insured amount of two policies i.e. total Rs.5,00,000/- (Five lacs only) along with interest @ 9% p.a. from the date of filing of the complaint till its realization.
ii) To pay Rs.10,000/- (Ten thousand only) as compensation on account of mental agony, physical harassment & hardship, due to deficiency in service & mal trade practice on the part of OPs and punitive damages.
iii) To pay Rs.5000/- (Five thousand only) as counsel fee as well as the litigation charges.
The compliance of the order shall be made within 30 days from the date of the order. Certified copies of the order be sent to parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: - 15.07.2019.
(Saroj Bala Bohra) (Parmod Kumar) (Manjit Singh Naryal)
Member. Member. President,
District Consumer Disputes
Redressal Forum, Bhiwani.
