Haryana

Ambala

CC/68/2018

Suresh Kumar Goyal - Complainant(s)

Versus

LIC - Opp.Party(s)

27 Mar 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AMBALA

 

 

                                                          Complaint case no.        : 68 of 2018

                                                          Date of Institution         : 27.02.2018

                                                          Date of decision   : 27.03.2019

 

 

Suresh Kumar Goyal age about 52 years s/o Late Sh. Vilayti Ram r/o VPO Rajouli, Tehsil Barara, District Ambala.

 

……. Complainant.

 

1.       Life Insurance Corporation of India, Triveni Chowk, Barara District Ambala.

2.       Harish Kumar authorized  agent of LIC of India vide agency  code no. 06882-161, Triveni Chowk, Barara, District Ambala.

3.       The Manager (CRM) LIC of India, Divisional Office “Jeevan Parkash” 489, Model Town, Karnal.

 .…. Opposite Parties.

 

 

Before:-       Ms. Neena Sandhu, President.

Ms. Ruby Sharma, Member.

Sh. Vinod Kumar Sharma, Member.

 

 

Present:       Sh. Rajesh Sharma,  counsel for complainant.

                   Sh. R.K.Jindal, counsel for Op Nos. 1 & 3.

Sh. VPS Duggal, counsel for OP No.2.

 

Order:         Smt. Neena Sandhu, President.

Complainant has filed this compliant under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Parties(hereinafter referred to as ‘Ops’) praying for issuance of  following directions to them:-

1. To pay sum assured amount of Rs. 1,00,000/- along with interest @ 18% w.e.f. 25.05.2015 (i.e the date of death of Rimpi Devi).
2. To pay of Rs.30,000/- as compensation for mental agony and physical harassment suffered by complainant.  
3. To pay Rs.11,000/- as cost of litigation expenses.

Or

any other relief whichthis Hon’ble Forum may deemfit.

 

                   In nutshell, brief facts of the present complaint are that the wife of the complainant namely Smt. Rimpi Devi, during her life time had taken a life insurance policy “Jeevan Rakshak” from Life Insurance Corporation of India i.e OP Nos. 1 & 3 through OP No.2 vide policy no. 479060401, for sum assured of Rs. 1,00,000/- , having commencement  date of 28.12.2014 and maturity date of 28.12.2030. The deceased, Rimpi Devi paid Rs. 2,531/- as premium to OPs. After verifying all the facts regarding the health of Rimpi Devi, the OP no.2, issued the above said policy in favour of Rimpi Devi. She appointed her husband as nominee. Unfortunately, the wife of complainant died on 25.05.2015, at home. Before death, Rimpi Devi was not suffering from any disease and she was never admitted for treatment in any hospital. After the death of the Rimpi Devi, the complainant being nominee lodged the claim with the insurance company. However, it repudiated his claim vide letter dated 28.05.2016 with the remarks that the life insured had made deliberately incorrect statements and with-held correct information regarding her health at the time of taking insurance policy. By repudiating the genuine claim of the complainant, the OPs have committed deficiency in service. Hence, the present complaint.

2.                 Upon notice, OP Nos.1 & 3 appeared through counsel and filed written version, raising preliminary objections qua complaint is not maintainable; has not come with clean hands; no cause of action; bad for non joinder and mis-joinder of necessary parties; complaint is hopelessly time barred and suppressed material facts. On merits, it is stated that the deceased/life assured late Smt. Rimpy Devi filled  the proposal form for taking the policy in question on 31.12.2014 and at that time she was suffering  from numbness in ®Upper Limb & ® Lower Limb. Diagnosis was (L) temporo parietal SOL with perilesional granuloma and same was the cause of her death. But she did not disclose the fact about said disease, at the time of filling up the proposal form intentionally and made a false  answers to the questions mentioned in the proposal form and has also suppressed  material information regarding her health. Had she disclosed   about the aliment, the answering OPs, would not have issued the policy. The answering OPs came to know about the disease suffered by Life assured from Form No.3816 and treatment record of PGI Chandigarh, which was submitted by the complainant to them, for the settlement of claim. As per said record, the deceased life assured was under treatment from PGI Chandigarh prior to taking the policy and considering all facts , Ops have rightly repudiated the claim vide letter dated 28.05.2016. Thus, there is no deficiency in service on their part and in the interest of justice the present complaint may kindly be dismissed against them with cost.

Upon notice, OP No.2 appeared through counsel and filed written version, raising preliminary objections qua complaint is not maintainable; false and frivolous; has not come with clean hands;  no cause of action; bad for non joinder and mis-joinder of necessary parties; complaint is hopelessly time barred and suppressed material facts. On merits, it is stated that the life assured had taken insurance policy through him. At the time of taking the policy, the life assured did not disclose him that she was suffering from any disease and was taking treatment from PGIMER, Chandigarh and he sent the duly filled in and signed proposal form of the life assured to the insurance company.  All others averments made by the complainant are denied and prayed that the complaint qua it be dismissed with cost.

3.                To prove his version complainant tendered his affidavit Annexure C-A along with documents as annexure C-1 to C-5 and closed the evidence. On the other hand, counsel for the OP Nos.1 & 3 has tendered affidavit of Sh.Ravi Mohan Manager Legal(L&HPF) LIC of India Karnal, Annexure R-A alongwith documents, Annexure R-1 to R-13 and closed the evidence. Learned counsel for OP No.2 has made a statement that he does not want to lead any evidence on behalf of the OP No.2 and closed the evidence.

4.                We have heard counsel for the parties and carefully gone through the case file.

5.                Admittedly, the wife of the complainant, late Smt. Rimpi Devi(hereinafter referred to as Deceased Life Assured i.e. DLA), had taken an insurance policy from the LIC of India i.e. OP Nos.1  & 3, for  sum assured of Rs. 1,00,000/-, having commencing date 28.12.2014 and maturity date 28.12.2030. The DLA paid half yearly premium of Rs. 2,531/-. Unfortunately, the DLA died on 25.05.2015, during the subsistence of the policy. After her death the complainant being the nominee, lodged the claim with the insurance company. However, the insurance company repudiated the claim vide letter dated 28.05.2016, on the ground that the DLA has taken the policy by concealing the material facts about her health. The learned counsel for the complainant has argued that at the time of taking the policy, DLA was not suffering from any disease and  the OP Nos.1 & 3 have wrongly repudiated the claim on the ground of withholding of the material information by the DLA regarding her health, at the time of inception of the policy. On the contrary, the learned counsel for OP Nos.1 & 3 has argued that DLA was suffering from cancer and was taking treatment from PGIMER, Chandigarh but she did not disclose this fact at time of taking the policy in question. The learned counsel for the OP No.2 has also submitted that at the time of taking the policy, the life assured did not disclose him that she was suffering from any disease and taking treatment from PGIMER, Chandigarh. In support of this contention that the DLA was taking treatment from PGIMER, Chandigarh, the learned counsel for parties have placed reliance on the certificate of hospital treatment, Annexure R-4, out patient card issued by PGIMER, Chandigarh, Annexure R-5. From the perusal of the certificate of hospital treatment, it is evident that the DLA was admitted in PGIMER, Chandigarh on 02.02.2015. In the said certificate, the history reported by the patient at the time of admission has been mentioned in column no. 5 which is as under:-

1. ®UL(Upper Limb)weakness        x 6 months

®LL weaknessx 6 months

Dysarthria x 1 month

In the column no.6,  what was the diagnosis  arrived at the hospital?- Astrocytoma(Grade II) has been mentioned. The said certificate duly signed by the Senior Resident Doctor, Deptt. Of Radiology, RCC, PGIMER, Chandigarh. Perusal of out patient card issued by PGIMER, reveals that the DLA was taking treatment from the said hospital w.e.f. 03.07.2014. In the letter, Annexure R-13, it is stated that all the medical record of Chandigarh OPD has been submitted with the insurance company by the complainant. Meaning thereby there is no dispute regarding taking of treatment by the DLA from PGIMER, Chandigarh. In the case of Guddi Devi Vs. Life Insurance Corporation of India & Anr. decided on 21.02.2018(NC), the Hon’ble National Commission has held that the hospital records cannot be rejected as there is no dispute with regards to fact that deceased was admitted and treated in the hospital. In the certificate of hospital treatment, it is clearly mentioned that the DLA was taking treatment from PGIMER, six months prior to her admission in PGIMER, Chandigarh on 02.02.2015. From the out patient card, it further got clarified that the DLA was taking treatment from the said hospital from 03.07.2014. However, the DLA, in the proposal form, Annexure C-3/R-1, so submitted by her on 31.12.2014 with insurance company for  taking the insurance policy in question, had answered the following questions as under:-

8( C) During the last five years did you consult medical practitioner for

any ailment requiring treatment for more than a week? No.

 

8(D) Are you currently taking, or have you previously taken, any medication or treatment for a continuous period of more than 14 days? No.

 

8(G)  Have you currently been advised to undergo any medical investigation or are you awaiting results of any investigation (other than routine health check) at this point? No.

 

10.     Are you at present in good health? Yes

 

6.                From the medical record it is established that the DLA was taking treatment from PGIMER, Chandigarh prior to the date of submission of proposal form dated 31.12.2014 but she had given  answers in negative to the questions mentioned at serial no.8 (C), 8(D) & 8(G) and in affirmative to the question mentioned at serial no.10 of the proposal form. As such the DLA by giving wrong answers to the questions, put to her at the time of taking the insurance policy, has concealed the material information about her health from the insurance company.  In the case of  Satwant Kaur Sandhu Vs. New India Assurance Company Ltd, IV(2009) CPJ 8 (SC), the Hon’ble Supreme Court has held that in a contract of insurance, any fact which  would  influence the mind of a prudent  insurer  in deciding  whether  to accept  or not to accept  the risk is a “material fact”. If the proposer has knowledge of such fact,  he is  obliged  to disclose  it  particularly while  answering questions  in the proposal from. Needless  to emphasise  that any inaccurate answer will entitle  the insurer  to repudiate his liability  because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering  into a Contract of Insurance. Since in the present case, the DLA had taken the insurance policy in question by concealing the material facts about her health, therefore, in view of the law laid down by the Hon’ble Supreme Court in the case Satwant Kaur Sandhu Vs. New India Assurance Company Ltd (supra), the complainant is not entitled to get any benefit under the policy and the complaint filed by him, is liable to be dismissed.

7.                In view of the aforesaid discussion, we hereby dismiss the present complaint being devoid of merits. The parties are left to bear their own cost. Certified copies of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

Announced on : 27.03.2019

 

 

 

          (Vinod Kumar Sharma)              (Ruby Sharma)     (Neena Sandhu)

                      Member                     Member                       President