DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, U.T. CHANDIGARH

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Amit Kumar S/o Sh. Ghasitoo Ram R/o 177/1, Sector 52, Kajheri, Chandigarh.

…..Complainant

                                V E R S U S

Life Insurance Corporation of India, Divisional Office “Jeevan Parkash Sector 17-B, Chandigarh through its Sr. Divisional Manager.

                                        ……Opposite Parties

CORAM:   SH.P.D.GOEL                                      PRESIDENT

                SH.RAJINDER SINGH GILL                   MEMBER

                DR.(MRS) MADANJIT KAUR SAHOTA    MEMBER

Argued by: Sh.Anish Babbar, Counsel for complainant

                        Sh.O.P.Sharda, Counsel for OP.

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PER P.D. GOEL, PRESIDENT

                    In brief, the case of the complainant is that his wife took an insurance policy No.164337898 from OP on 19.10.2009 for a sum of Rs.1,25,000/- valid from 3.11.2009 to 03.11.2024. His wife was required to pay  Rs.510/- per month as premium. The complainant further averred that on 19.10.2009 his wife was not feeling well, so he got her treatment from PGI where it came to light that she was having pregnancy of four months.  On 21.12.2009, the complainant got her wife admitted in the PGI with the complaint of shortness of breath and irregular respiration. It was diagnosed that she was a case of Swine Flu’ which ultimately led to her death on 24.12.2009 along with the foetus in the womb. Thereafter, the complainant submitted the claim form along with requisite documents but OP rejected the claim vide letter dated 19.1.2011 on the ground of suppression of material facts regarding her health at the time of proposing for the insurance policy. Ultimately the complainant got served a legal notice upon the OP but to no effect. Hence this complaint.

2.                OP in its reply while admitting factual matrix of the case pleaded that the claim of the complainant has not been repudiated on the ground that the life insured was suffering from any disease but the same has been rejected on the ground that the life insured did not act in good faith and suppressed the true and correct facts from the OP at the time of taking the policy. The OP further pleaded that the life insured became aware about her pregnancy on 19.10.2009 but she deliberately did not disclose it to the OP while filling up the proposal form dated 03.11.2009 and as such OP has rightly repudiated the claim of the complainant on account of non-disclosure of material facts. All other allegations of the complainant has been denied and prayer for dismissal of the complaint has been made.

3.                We have heard the learned counsel for the parties and perused the record very carefully.

4.                 The claim has been repudiated vide repudiation letter dated 19.01.2011 (Annexure C-12) on the ground that the deceased had withheld the material information regarding her heath at the time of effecting the assurance. In the proposal for assurance, the insured had answered the following questions as under:-

5.                It was argued by the learned counsel for the OP that the answers referred to above were false as the L.A. was pregnant (12-13 weeks) at the time of proposal. However, the L.A. did not disclose these facts in the proposal form and thereby induced the Company to issue the policy in question on her false statement. Had the L.A. disclosed the above facts regarding her pregnancy, the proposal would not have been accepted. So, it is evident that the L.A. had made deliberate mis-statements and withheld the material information regarding her health at the time of effecting the assurance. Thus the claim has been rightly repudiated.

6.                The close scrutiny of the repudiation letter (Annexure c-12) makes it clear that the OP had repudiated the claim as the L.A. had given false information in the proposal for assurance and also did not disclose the fact regarding her pregnancy.

7.                Admittedly, the OP has not produced on record the proposal form from where it can be gathered that the L.A. had given wrong answers to questions No.11(i) and 13(A) as stated in the repudiation letter (Annexure C-12).  The non-production of the proposal form is fatal to the OP and also amounts to withholding the best piece of evidence and for that purpose we have no hesitation to draw an adverse inference against the OP that if the said proposal form is produced it will not support the grounds mentioned in the repudiation letter (Annexure C-12).  It will not be out of place to mention here that without producing the proposal for assurance, which is signed by the LA, it cannot be concluded that the LA had given false statement with regard to the questions No.11(i) and 13(A) as referred to above.  

8.                Moreover without producing on record the proposal form,  it is difficult to ascertain whether the proposal form was filled up by the LA before 19.10.2009 or thereafter. In case, the proposal form is filled up by the LA before 19.10.2009, it can be concluded that the LA was not guilty of concealment of fact with regard to her pregnancy as the fact regarding pregnancy came to her knowledge on 19.10.2009 when the L.A. got treatment from PGI. The date of issuance of the insurance policy is also 19.10.2009 as is evident from the Annexure C-1. This fact also proves that the proposal form in question might be filled up by the L.A. prior to 19.10.2009. Reliance placed on Life Insurance Corporation of India Vs. Nishar Khan-II(2006) CPJ 317 (NC).

9.                The proposal form was available with the Insurance Co. but no effort was made to bring it on record and, therefore the documents placed on record by the OP cannot be given any credence particularly in view of the fact that no proposal form submitted by the Complainant has been produced by the Insurance Co. It is only proposal form which could show that the Complainant had suppressed some important facts from the Insurance Co. It is necessary as per law that the party shall prove their version by producing cogent and convincing evidence but in this case the OP badly failed to prove the same. As such, in the lack of evidence on record, we are not convinced with the submission of the OP that the L.A. had suppressed the material fact regarding her pregnancy and we reject the same. Reliance placed on National Insurance Co. Ltd. Vs. Sardar Kulbir Singh reported in III(2010) CPJ-276 (NC), Life Insurance Corporation of India and another Vs. veena Puri IV(2008) CPJ-362 and Life Insurance Corporation of India Vs.  Sudesh Gandhi-III(2006) CPJ 249.   Hence, it is held that the repudiation of the claim vide letter (Annexure C-12) by the OP is unjustified.

10.               As a result of the above discussion, this complaint is accepted with a direction to the OP to pay the sum assured of Rs.1,25,000/- under the insurance policy in question to the complainant. OP is also directed to pay a sum of Rs.30,000/- to the complainant as compensation for mental  agony and harassment besides Rs.10,000/- as cost of litigation.

11.               This order be complied with by the OP within one month from the date of receipt of the certified copy failing which OP shall be liable to pay the entire amount of Rs.1,55,000/- to the complainant along with interest @ 12% p.a. from the date of filing of the complaint till realization besides costs of litigation. 

12.               Certified copies of this order be sent to the parties free of charge. The file be consigned.