BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FEROZEPUR.
C.C. No. 215 of 2015 Date of Institution: 21.5.2015
Date of Decision: 31.8.2015
Sonia, Aged 36 years, Wife of Late Ravi Kumar, Son of Banarasi Dass, Resident of House No.62/4, WQ-II Zone MES Gurudawara, Ferozepur Cantt.
....... Complainant
Versus
- Life Insurance Corporation of India, Branch Office Malwal Road, Ferozepur City through its Divisional Manager.
- Life Insurance Corporation of India, Divisional Office 4-5 District Shopping Complex, Ranjit Avenue, Amritsar through its Divisional Manager.
........ Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986.
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PRESENT :
For the complainant : Sh. Manish Khera, Advocate.
For opposite parties : Sh. Vishal Arora, Advocate.
QUORUM
S. Gurpartap Singh Brar, President
Mrs. Inderjeet Kaur, Member
ORDER
GURPARTAP SINGH BRAR, PRESIDENT:-
Brief facts of the complaint are that Ravi Kumar (since deceased) was the husband of the complainant, who got issued one life insurance policy from opposite party No.1 was valid up to 28.10.2030. The complainant is nominee of Ravi Kumar(since deceased). Further it has been pleaded that at the time of proposal of the insurance policy, the agent of opposite party No.1 obtained the signatures of the husband of the complainant on blank papers without explaining its contents. Thereafter, empanelled doctors of the LIC conducted health examination of the husband
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of the complainant and found the life insured fit. Further it has been pleaded that the husband of the complainant was admitted in Mission Hospital, Ferozepur and on 23.4.2014 he was referred to C.M.C Hospital Ludhiana, where he died on 10.5.2014. After the death of husband of the complainant, the complainant being the sole legal heir approached the opposite parties and submitted claim papers alongwith requisite documents to the opposite party. The complainant many a times approached the opposite parties, but the opposite parties lingering on the matter on one pretext or the other and lastly the opposite party issued a letter dated 31.3.2015 whereby the claim of the complainant was repudiated by the opposite parties on account of deceased having with held the correct information from the opposite parties regarding his ill health and consequent treatment prior to date of proposal, at the time of affecting insurance with the opposite parties. The claim of the husband of the complainant was wrongly and illegally repudiated by the opposite parties. The husband of the complainant has not concealed any material facts from the opposite parties at the time of taking the insurance policy. Moreover, medical leaves were taken by the husband of the complainant casually and he did not remain admitted anywhere for those medical leaves for the medical treatment. Infect, the husband of the complainant was not suffering from
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any ailment at the time of purchase of policy. Pleading deficiency in service and unfair trade practice on the part of the opposite parties, the complainant has prayed that the opposite parties be directed to pay an amount of insurance of Rs.2 Lac alongwith interest till payment alongwith Rs.40/- as bonus against per Rs.1000/- per year from the date of the policy and to pay Rs.50,000/- as compensation and to pay Rs.5500/- as legal fee.
- Upon notice, the opposite parties appeared and filed its written reply to the complaint. In its written reply, the opposite parties took some preliminary objection interalia that that the deceased life assured had made deliberate misstatement and had withheld material fact regarding his health at the time of filling up the proposal form; that the deceased life assured had concealed the disease of diabetes mellitue-II in the proposal form dated 27.11.2012; that the deceased life assured took 83 medical leaves prior to date of filing up the proposal form and deliberately concealed the same at the time of filling up the proposal form; that cause of death of the deceased life assured had no nexus with the disease and that the opposite parties denied that the concerned agent obtained the signatures on the blank papers and filled it up later without providing any evidence in support of his allegations. On merits, it has been pleaded that the claim of the complainant
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has been rightly repudiated vide repudiation letter dated 31.3.2015, in which he made deliberate miss-statement and withheld the correct information from the opposite parties regarding his ill state of heath and consequent treatment at the time of effecting the assurance. The claim of the husband of the complainant has been rightly repudiated by the opposite parties because the husband of the complainant concealed the material facts regarding his health and treatment from the opposite parties at the time of obtaining the insurance policy. Other allegations of the complaint have been denied and dismissal of the complaint has been prayed for.
3. Ld. Counsel for the complainant tendered into evidence Ex. C-1 to Ex. C-4 and closed evidence on behalf of the complainant. On the other hand, learned counsel for the opposite parties tendered into evidence Ex. OP-1&2/1 to Ex. OP-1&2/7 and closed evidence on behalf of opposite parties.
4. We have heard the learned counsel for parties and have also gone through the file.
5. It is admitted case of the parties that the husband of the complainant Sonia was ensured with the opposite parties. It is also admitted case of the parties that the husband of the complainant has since died. The grievances of the complainant is that the opposite parties repudiate the claim
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of the husband of the complainant vide letter dated 31.3.2015 on the ground that the husband of the complainant Sonia has made deliberate miss statement and with held the correct information from the opposite parties regarding his ill state of health and consequent treatment at the time of effecting the insurance. The version of the complainant that empanelled doctor of the L.I.C conducted the health examination of the husband of the complainant and found the life insured fit. The husband of the complainant has not concealed any material fact from the opposite parties at the time of taking of insurance policy and the medical leave were taken by the husband of the complainant were casually and the husband of the complainant did not remain admitted anywhere during this medical leave for the medical treatment. On the other hand, the version of the opposite parties is that the claim of the complainant has been rightly repudiated vide repudiation letter 31.3.2015 on the ground the husband of the complainant with held the correct information from the opposite parties regarding his ill state of health and consequent treatment at the time of effecting the insurance. The husband of the complainant took 83 medical leave prior to date of filing up proposal form and deliberate conceal the fact at the time of filing up the proposal form. The agent of the opposite party has not obtained the signature of the
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husband of the complainant on blank papers and filed it up later. To prove their version the opposite parties have placed on file the proposal form EX.OP-1&2/1, form No.3816 is EX.OP-1&2/2 which is filled by Dr. David Masih, Sr. Medical Officer of Frances Newton Hospital. Certificate of the Dr. J.Solomon EX.OP-1&2/3, certificate by employer EX.OP-1&2/4, repudiation letter EX.OP-1&2/5, EX.OP-1&2/6 copy of policy, affidavit of Yogender Singh Sisodia, Manager(Legal), Divisional Office, LIC of India, Amritsar EX.OP-1&2/7. The complainant pleaded in the complainant that the husband of the complainant was duly medical examined by doctors of the LIC when he has obtained the insurance police from the opposite parties. The version of the opposite parties is that when the husband of the complainant obtained the insurance policy, he was not medical examined. From the proposal form EX.OP-1&2/1 it is proved that Dr. P.K. Garg was present when the proposal form was filled and Dr. P.K. Garg signed on the last page of proposal form. From which it is proved that the husband of the complainant was medical examined at the time of obtaining the insurance policy. One simply wonders as to how and under what circumstances, the insurance policy was issued to the person who was not keeping good health either at the time of taking the policy originally. We must regard that the opposite parties also owed some
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duties to the Corporation in which they are served. It was for them to have assured that a person to whom they are going to issue an insurance policy is keeping good health after subjecting him to a medical examination. The opposite parties have produced on the record copy of form No.3816 EX.OP-1&2/2 and Certificate of the Dr. J. Solomon EX.OP-1&2/3 to prove that the husband of the complainant was admitted in Frances Newton Hospital on 3.7.2012 and discharged on hospital on 6.7.2012. The onus was on the opposite parties to prove that deceased life insured was suffering from diabetes pancreatitis prior to take the policy in question. In the certificate EX.OP-1&2/3 it is certified by the Dr. J. Solomon, only Mr. Ravi was admitted in Frances Newton Hospital with the diagnose of pancreatitis. He was discharged on 6.5.2011. He needs further rest till 12.5.2011. From the document EX.OP-1&2/3 it is proved that Dr. J. Solomon was not treating doctors of the husband of the complainant. The opposite parties have not placed any affidavit of the Dr. J. Solomon to prove that the husband of the complainant was admitted in Frances Newton Hospital with the diagnose of pancreatitis and he was discharged on 6.5.2011. The opposite parties have not placed any medical certificate of Frances Newton Hospital to prove that the husband of the complainant was admitted in the Frances Newton Hospital
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and was treated there for diabetes and pancreatitis. The opposite party has not examined any other doctors or the person who wrote the history or the person who gave the history. To prove the proposal form No.3816 EX. OP-1&2/2 and certificate of Dr. J Solomon, the opposite party should examined the Dr. David Masih, Dr. J. Solomon, Dr. P.K. Garg. Even the opposite parties have not placed on file the affidavit of the doctors to prove the version that the husband of the complainant was suffered from the deceased as alleged by the opposite parties. The opposite parties have placed on file the certificate by employer is EX. OP-1&2/4 to prove that the husband of the complainant took 83 medical leave prior to date of filing up the proposal form. But the opposite parties have not placed on file any certificate of leave of department from which it is proved that the husband of the complainant took 83 medical leave prior to filing of proposal form. The opposite parties have not placed on file any copy of document from which it is proved that the husband of the complainant has took 83 medical leave before filing the proposal form. We are at loss to understand why the exercise undertaken to establish that the life assured was suffering from diabetes mellitue-II not carried out before issuing the policy. Had it been done before hand the insurer was at liberty to refuse the policy to the assured. Utmost good faith should also have some genuine
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basis on which it is formed. It seems that the company purposely keeps the policy open ended so that at convenient time it can be interpreted in the terms favorable to it, it is the duty of the insurer to satisfy himself about the state of health of the person to be insured. Merely, submitting that the company did not carry out any medical of the life assured and totally relied upon the information provided by the deceased does not absolve the insurer of his responsibility. The opposite parties have not placed on file any medical certificate of any hospitals to prove that the deceased was ever admitted or took any treatment from any hospital or the doctor regarding the alleged pre-existing disease. The case history and the discharge summary report from the hospital is neither supported by the affidavit of the doctor concerned nor he deposed before the District Forum. The Hon’ble State Consumer Disputes Redressal Commission Himachal Pradesh vide judgment titled Life Insurance Corporation of India Versus Smt. Krishna Devi reported at 2011 (CTJ) 227 (CP) SCDRC has held that “Chronic Alcoholism and Alcoholic withdrawal syndrome cannot be termed as decease.” . The opposite parties have not filed any affidavit of any treating doctor that he was suffering from diabetes mellitue-II. Reliance can be made in M/S ICICI Prudential Life Insurance Company Limited Versus Veena Sharma &
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others 2014 (4) CLT 507, Life Insurance Corporation of India Versus Priya Sharma and others 2011 (3) CLT 549 and Harjit Singh Padda Versus LIC of India and others 2010 (3) CLT 72.
6. In view of the above discussion, we are of the considered opinion that the case of the opposite parties has certain gray areas. The insurer should have satisfies himself about the state of health or medical history of the life assured before issuing the policy. Further, no evidence has been brought on record that the insured was indeed asked the questions to which he supposedly gave incorrect answers. By repudiating the insurance claim the opposite parties have resorted to deficiency in service.
7. Accordingly, the present complaint is allowed and the opposite parties are directed to pay the sum assured amount of Rs.2,00,000/- with bonus if any, alongwith interest @ 9% P.A. from the date of filing the claim with the opposite parties till the date of payment. The complainant has been harassed by the opposite parties are held to be entitled for a compensation of Rs.5,000/-. This order is directed to be complied with within a period of
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thirty days from the date of receipt of its copy. File be consigned to the record room.
Announced (Gurpartap Singh Brar)
31.08.2015 President
(Inderjeet Kaur) Member
