Haryana

Karnal

277/2011

rettan Singh S/o Shri Rattan Singh, Vikram Singh S/o Shri Rattan Singh, Ritu D/o Shri Rattan Singh - Complainant(s)

Versus

Life Insurance Company Of India - Opp.Party(s)

Sh. A.C. Batra

20 Aug 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                          Complaint No.277 of 2011

                                                               Date of instt. 13.05.2011

                                                               Date of decision: 24.08.2015

 

1.Rattan Singh son of late Sh.Dhan Singh

2.Vikram Singh son of Shri Rattan Singh

3.Ritu @ Ripy daughter of Shri Rattan Singh, all residents of village Bastali tehsil Nissing District Karnal.                                                        ……….Complainant.

 

                             Versus

 

Life Insurance Corporation of India, through its Branch/Divisional Manager, Model Town, Karnal.

                                                           ……… Opposite Parties.

                   Complaint u/s 12 of the Consumer

                   Protection Act.

 

Before          Sh.K.C.Sharma……. President.

                   Smt. Shashi Sharma ………Member.

                   Sh.Anil Sharma…… Member.  

         

 Present:         Sh.A.K.Batra, Advocate for the complainant.

                     Sh.N.K.Zak Advocate for the OP.

ORDER:

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act, 1986, on the averments that Smt.Sunder Devi wife of complainant no.1 obtained insurance policy No. 176186886 from the Opposite Party ( in short OP) for an amount of Rs.one lac. At the time of issuance of the insurance policy, Smt. Sunder Devi was got medically examined by the OP from the medical officer and was found hale  hearty.  Four premiums of the policy were deposited. In the month of April, 2009, Sunder Devi received injuries on her breast as she was attacked by a buffalo in the village. She  got treatment from a  hospital of Ludhiana, but expired on 5.8.2010. After her death the complainant no.1 approached the OP for payment of the claim under the insurance policy, but  the OP vide letter dated 22.2.2011 repudiated the claim on false grounds. There was deficiency in services on the part of the OP, which caused mental harassment to the complainants apart from financial loss.

 

2.                Notice of the complaint was given to the OP who put into appearance and filed written statement controverting the claim of the complainant. Objections have been raised that complaint is not maintainable in the present form; that the complaint is time barred; that the complainants are estopped  from filing the present complaint by their own acts and conduct; that the complainants do not fall within the definition of consumer; that the complaint is bad for mis joinder and  non joinder of the necessary parties; that this Forum has no jurisdiction to entertain and decide the present complaint and that the complainants have suppressed the material facts.

 

                   On merits, it has been submitted that the policy No.176186886 was issued to Sunder Devi on 6.10.2008 and the sum assured was Rs.one lac.  The life assured died on 5.8.2010.  An enquiry was conducted  and it came to the notice of the OP  that life assured was suffering from cancer forr which she was diagnosed  at Mohan Dai Oswal Cancer Treatment and Research Foundation Ludhiana where she remained admitted  from 11.10.2008 to 22.10.2008 with Ulcerative Lesion left breast for 6-7 months.  Such  fact was revealed by the life assured herself before the doctor. She  again  remained admitted in the said hospital  from 26.7.2010 to 5.8.2010.  These facts clearly show that life assured was not having good health at the time of proposal as well as  at the time of commencement of the policy in question and she   deliberately and malafidely concealed the information regarding her health just to extort money from the OP.  Had she revealed the ailment at the time of proposal, the OP might not have insured her.  It has further been averred that the medical officer of the OP examined the life assured by physical appearance as well as on the information given by the proposer at the time of medical examination. The other averments made in the complaint have been denied.

3.                In the evidence of the complainants, affidavit of complainant no.1 Ex.C1 and documents Ex.C2 to Ex.C7have been filed.

4.                On the other hand, in the evidence of the OP, affidavit of Sh.P.K.Sexana,  Manager legal, Ex.O1 and documents Ex.O2 to Ex.O5 have been filed.

 

5.                We have heard the learned counsel for the parties and have gone through the case file very carefully.

6.                Smt.Sunder Devi life assured obtained insurance policy for a sum of Rs.one lac on 6.8.2008 and she died on 5.8.2010. As per the case of the complainants, she was hale and hearty at the time of obtaining insurance policy and was even examined by the doctor of the OP, but in the month of April, 2009 she received injury on her  breast, when she was attached by a buffalo and during treatment she expired on 5.8.2010. The OP has disputed the claim of the complainants on the ground that  deceased – life assured remained admitted in the Mohan Dai Oswal Cancer Treatment and Research Foundation Ludhiana  from 11.10.2008 to 22.10.2008 and she was diagnosed of Ulcerative Lesion left breast for 6-7 months, which shows that she was suffering cancer at the time of submitting proposal form for obtaining the policy, but this fact was concealed by her, therefore, insurance company is not liable.

7.                The Learned counsel for the complainants vehemently argued that deceased life assured was thoroughly medically examined  by the doctor of OP and she was found hale and hearty. There is no evidence that at the time of obtaining the insurance policy, she was suffering from cancer or any other disease. Therefore, it cannot be said in any manner that she  had concealed the  factum of her suffering from cancer in the proposal form and as such insurance company cannot escape from its liability to pay claim of the complainants regarding death of the life assured.  In support of his contention he has placed reliance on  New India Assurance Company Ltd. Vs.Dinesh Kumar Mittal III(2008) CPJ 389 and  Insurance Corporation of India Vs. Gorammma CPJ 2009 (3) 25,

8.                To wriggle out of the aforesaid contention, the learned counsel for the OP laid emphasis on the contention that as per the certificate issued by Mohan Dai Oswal Cancer Treatment and Research Foundation Ludhiana, copy of which is Ex.O4,  the deceased life assured remained admitted in the said hospital  from 11.10.2008 to 22.10.2008 with  Ulcerative Lesion left breast  and she told at the time of admission that she  was having  ulcerative lesion left breast for 6/7 month. From this document it is clear that she was suffering from cancer even at the time of submitting the proposal form and obtained the policy  by concealing the fact that was well within her knowledge, therefore, the insurance company cannot be held liable. In this regard , he placed reliance on the   Bhanwari Vs. Bharatiya Jeevan Bima Nigam and another 2011(3) CPC 609, LIC of India Vs.N.P.Nagarathna  2012(2) CPC 576,  LIC of India  Vs.Smt.Rukma 2012(2) CPC 243,  and Satwant Kaur Sandhu Vs.New India Assurance Co.  IV (2009) CPJ 8 (SC).

9.                In Bhanwari Devi’s case (Supra) the deceased life assured husband of the complainant took the LIC insurance policy in December, 2007  whereas he died in March, 2008.It came into light that insured was suffering from cancer but he did not disclose this fact when the policy was demanded. It was held by the Hon’ble National Commission that material fact was concealed by the deceased life assured, therefore, repudiation of the claim was justified.         In  N.P.Nagarathna’s case (Supra),  the insured  died only 39 days after purchase of the policy. She was suffering from  Non Hodgkin’s Lymphoma disease at the time when the policy was taken, but it was not disclosed.   It was held by Hon’ble National Commission that non disclosure about the ailment amounted to breach of contract and  principle of utmost good faith.     In Smt. Rukma’s case (Supra),  insured died  of  epilepsy disease, which was not disclosed at the time of submitting proposal. He also suffered head injury due to  epilepsy,  but the cause of death  was this disease, which was concealed. It was held by the Hon’ble National Commission that it amounted to breach of terms and conditions of the policy.     In Satwant Kaur’s case (Supra) insured was   suffering from chronic diabetes and renal failure and was fully aware of the state of his health, but in the proposal form that fact was not disclosed. It was held by the Hon’ble Supreme Court  that suppression of material fact proved and repudiation of claim was justified. It was further held that contract of insurance is contract of Uberrimae fide. Insured is under obligation to make true and full disclosure of information within his knowledge.

10.               The proposition of law emerges from  the afore discussed  authorities that contract of insurance is of utmost good faith and insured is under an obligation to disclose true information, which is within his knowledge at the time of submitting proposal form for taking policy.   When information of specific aspect is asked for in the proposal form  an insured is   under solemn obligation to make true and full disclosure of the information  which is within his knowledge. Any inaccurate answer will entitle the insurer to repudiate his liability.

11.               The Judgments cited by the learned counsel for the complainants were based upon the fact peculiar to those cases and do not render any help to the complainant under the facts and circumstances of the present case. In Dinesh Kumar’s case (Supra), claim was repudiated on the ground that insured was suffering from heart disease at the time of taking policy, but that was not disclosed. It was held by the Hon’ble Rajasthan State Consumer Disputes Redressal Commission, Jaipur, that Onus probandi rests heavily on insurer. Suppression of material fact must be conscious operation of answer given, which he knowingly not disclosed.  Heart disease could not be diagnosed unless necessary tests conducted.  It was not proved that insured was taking treatment of those diseases, therefore, repudiation of the claim was not justified.        In  Goramma’s case (Supra),  evidence on record showed that deceased was suffering from cancer in the year 1999, which was 3.5 years after the taking of the original policy. It was  held that onus to prove that deceased had suppressed the fact was on the insurance company, but it failed to discharge that burden by leading evidence that insured was suffering from cancer at the time of taking policy.

12.               In the instant case policy was taken by the deceased life assured on 6.10.2008.  Copy of the medical record of Mohan Dai Oswal Cancer Treatment and Research Foundation Ludhiana Ex.O4 indicates that she was admitted in the said hospital  on 11.10.2008 with Ulcerative Lesion left breast and told that she was having said problem for the last 6/7 months. She was diagnosed as cancer patient having   Carcinoma breast left side. She got treatment from the said hospital and ultimately expired on 5.8.2010.  Thus, it is clear that just after four days of the taking policy, she was admitted in the said hospital with problem of Ulcerative Lesion left breast, which she was having for the last 6/7 months. In such a situation it cannot be said that she had no knowledge regarding his problem of Ulcerative Lesion left breast at  the time of taking policy, because Ulcerative Lesion could be visible from naked eyes and no test was required for that purpose. However, she did not disclose such fact in the proposal form rather claimed that she was not suffering from any disease and enjoying good health.  This medical record falsifies the allegations and evidence of the complainants that deceased life assured suffered injury on her breast in April, 2009.  In this way, deceased life assured concealed material fact regarding her health problem at the time of taking policy and as such the repudiation of the claim of the complainant’s by the OP cannot be termed as illegal or unjustified in any manner.

 

13.               As a sequel to the foregoing discussion, we do not find any merit in the present complaint and consequently the same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced
dated:24.08.2015                                                                         

                                                

                                                                   (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

               

 

 (Anil Sharma)          (Smt.Shashi Sharma)        

     Member.            Member.

 

 

 

Present:         Sh.A.K.Batra, Advocate for the complainant.

                     Sh.N.K.Zak Advocate for the OP.

 

                   Arguments heard. For orders, the case is adjourned to 24.8.2015,

Announced
dated:20.08.2015                                                                         

                                               

                                                                   (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

              

 

 (Anil Sharma)          (Smt.Shashi Sharma)        

     Member.            Member.

 

 

Present:         Sh.A.K.Batra, Advocate for the complainant.

                     Sh.N.K.Zak Advocate for the OP.

 

                   Vide our separate order of the even date, the present complaint has been dismissed. The parties concerned be  communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced
dated:24.08.2015                                                                          

                                               

                                                                   (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

              

 

 (Anil Sharma)          (Smt.Shashi Sharma)        

     Member.            Member.