DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> CC. No. 292 of 18-10-07<br /> Decided on : 14-02-2008<br /> <br /> Amarjit Kaur aged about 52 years Wd/o Sh. Balbir Singh R/o LIG -96, Housing Board Colony, Bathinda, Tehsil & District Bathinda.<br /> .... Complainant<br /> Versus<br /> 1.Life Insurance Corporation of India, Zonal Office, Jeevan Bharti, Cannaught Circus, New Delhi, through its Zonal Manger/Manager<br /> 2.Divisional Manager, Life Insurance Corporation of India, Divisional Office, Sector 17, Chandigarh.<br /> 3.Sunita Gupta, LIC Agent, holding agency No. 0054316 L resident of 5160-A, Sector 38, West Mohali.<br /> 4.Life Insurance Corporation of India Limited, Jeevan Jyoti Building, Bibiwala Road, Bathinda, through its Branch Manager. <br /> ...Opposite parties<br /> <br /> Complaint under Section 12 of the Consumer Protection<br /> Act, 1986.<br /> <br /> QUORUM :<br /> Sh. Lakhbir Singh, President<br /> Sh. Hira Lal Kumar, Member<br /> Dr. Phulinder Preet, Member<br /> <br /> For the Complainant : Sh. Satvir Singh, Advocate.<br /> For the Opposite parties : Sh. Sandeep Baghla, Advocate, for opposite parties No. 1,2 & 4.<br /> Opposite party No. 3 exparte.<br /> O R D E R<br /> LAKHBIR SINGH, PRESIDENT<br /> 1. Instant one is a complaint under Section 12 of the Consumer Protection Act, 1986 (Here-in-after referred to as 'Act') which has been preferred by the complainant seeking direction from this Forum to the opposite parties to pay her insurance amount to the tune of Rs. 1,50,000/- alongwith Bonus and interest and Rs. 40,000/- as damages besides cost of the complaint.<br /> 2. Version of the complainant lies in the narrow compass as under :<br /> Balbir Singh S/o Nanak Singh was the husband of the complainant. He had got himself insured with opposite party No. 1 & 2 through opposite party No. 3 vide policy No. 162653204 for a sum of Rs. 1,50,000/- covering risk w.e.f. 26.01.04. He was got medically examined from the competent doctor by the opposite parties before issuance of the policy. Other facts and circumstances were also got verified. Complainant was appointed by him as his nominee. He has since died on 26.6.05 leaving the complainant as his sole legal heir. After his death, all the relevant documents were submitted by her to the opposite parties for claiming the insurance amount. They have repudiated the Insurance claim on the ground that assured had concealed the fact of his illness. He had remained on the sick leave. It is averred by her that he was not suffering from any ailment and was enjoying good health. Columns of the proposal form were filled by the agent of the Life Insurance Corporation of India. Claim has been illegally repudiated on the basis of the letter dated 11.9.06. Representation was made by her against the repudiation but the same has been rejected. Legal notice was got served by the complainant upon the opposite parties, but to no effect. In these circumstances, she alleges deficiency in service on the part of the opposite parties.<br /> 3. Registered A.D. post notice to opposite party No. 3 was issued on 25.10.07. Till 27.11.07, neither registered cover nor A.D. was received. Accordingly, opposite party No. 3 was deemed to have been duly served. She did not come present. Accordingly she has been proceeded against exparte.<br /> 4. Opposite parties No. 1,2 & 4 filed their version taking legal objections that complaint is not maintainable in the present form; complainant has got no locus standi and cause of action to file the complaint; she is not consumer; intricate and contentious questions of facts and law are involved which require extrinsic and voluminous documentary evidence which cannot be taken by this Forum in summary procedure; complainant is estopped from filing the complaint by her act and conduct; this Forum has got no territorial jurisdiction to entertain and try the complaint and complaint is false and frivolous. On merits, they admit that policy in question was issued. This policy was assigned to Employees Provident Fund Commissioner (EPFC). They deny that medical examination of the assured was got conducted. Proposal form was filled in by the assured under non-medical scheme. Policy was issued on the declaration made by the assured in the proposal form whereby he had represented that information given therein is true in all respects. They admit that assured has since died on 26.6.05. Complainant had submitted the claim papers as nominee. They deny that claim has been illegally repudiated. They do not admit that complainant was not suffering from any ailment before getting the Insurance policy issued and he was enjoying good heath. Agent has nothing to do with the medical examination. Contract of insurance is based on “UBERREIMA FIDES”. It is further averred by them that life assured at the time of seeking Insurance policy had intentionally concealed material facts regarding his state of health as well as material information regarding his being on leave for considerable period. He was suffering from Kidney problem and was also a patient of Tuberculosis. Complainant herself has disclosed that he had taken treatment for Tuberculosis from PGI, Chandigarh. Assured had taken leave on medical grounds on several occasions since May, 2001. He had knowledge about his illness but he did not disclose it at the time of submitting the proposal form dated 22.12.03. He gave false answers which means willful suppression of material facts. Had these material facts been disclosed, policy would not have been issued. Life assured has died within a period of one year three months and 22 days from the date of issuance of the policy. Claim has been rightly repudiated vide letter dated 11.9.06. Representation moved by the complainant against repudiation has been rightly rejected by the Zonal Office Claims Review Committee vide letter dated 10.7.07. They deny the remaining averments in the complaint.<br /> 5. In support of her allegations contained in the complaint, complainant has produced in evidence her two affidavits (Ex. C-1 & Ex. C-6), photocopy of letter dated 16.10.06 (Ex. C-2), photocopies of premium receipts (Ex. C-3 & Ex. C-4), photocopy of legal notice (Ex. C-5), photocopy of policy (Ex. C-7), photocopy of death certificate (Ex. C-8), photocopy of letter dated 10.7.07, (Ex. C-9), photocopy of Proposal form (Ex. C-10), photocopy of nomination and declaration form (Ex. C-11) and photocopy of Agents Confidential report/Moral Hazard report (Ex. C-12). <br /> 6. In rebuttal, on behalf of opposite parties No. 1,2 & 4 affidavit of Sh. J P Arya (Ex. R-1), photocopies of letters dated 11.9.06, 9.7.06 and 18.4.06 (Ex. R-2 to Ex. R-4 respectively), photocopy of application for earned leave (Ex. R-5), photocopy of certificate dated 20.5.07 (Ex. R-6), photocopy of application for earned leave (Ex. R-7), photocopy of OPD Slip (Ex. R-8), photocopy of application for earned leave (Ex. R-9), photocopy of certificate (Ex. R-10), photocopy of application for earned leave (Ex. R-11), photocopies of applications for earned leave (Ex. R-12 & Ex. R-13), photocopies of applications dated 24.1.05, 7.6.05 and 2.4.05 (Ex. R-14, Ex. R-15 & Ex. R-16 respectively), photocopy of Policy (Ex. R-17), photocopy of Leave record (Ex. R-18) and photocopy of proposal form (Ex. R-19) have been tendered in evidence.<br /> 7. We have heard learned counsel for the parties except counsel for opposite party No.3. Apart from this, we have gone through the record.<br /> 8. Fact that Life Insurance Policy was obtained by the husband of the complainant covering risk w.e.f. 26.1.04 is not in dispute. Sum assured is Rs. 1,50,000/-. He has since died on 26.6.05. Copy of the death certificate is Ex. C-8. Insurance claim was submitted by the complainant after the death of her husband which was repudiated by Life Insurance Corporation of India vide letter dated 11.9.06, copy of which is Ex. R-2. Representation made against it by the complainant was rejected vide letter dated 10.7.07, copy of which is Ex. C-9.<br /> 9. Mr. Satvir, learned counsel for the complainant argued that assured was not suffering from any disease before obtaining the Insurance policy. He was enjoying good health. Moreover columns of the proposal form, copies of which are Ex. C-10 and Ex. R-19 were filled in by opposite party No. 3 who is the agent of Life Insurance Corporation of India. Insurance policy, copy of which is Ex. R-7, was issued by the opposite parties No. 1,2 & 4 after they were satisfied about the health of the assured. In these circumstances, Insurance claim submitted by the complainant has been illegally repudiated by the opposite Insurance Corporation.<br /> 10. Mr. Baghla, learned counsel for the opposite parties No. 1,2 & 4 submitted that complainant is not consumer as policy was assigned by the assured to the Central Board of Trustees, Employees Provident Fund. This Forum has got no territorial jurisdiction to entertain and try the complaint as policy was issued by Chandigarh Office of the opposite Insurance Corporation and claim was applied for by the complainant at that place and it has also been repudiated at Chandigarh. Next limb of his arguments is that assured had made deliberate mis-statement and withheld material information from the opposite Insurance Corporation regarding his health at the time of effecting the insurance. Accordingly, claim has been rightly repudiated. <br /> 11. We have given our thoughtful consideration to the rival arguments.<br /> 12. Before discussing the merits of the case, we deem it fit that question as to whether complainant is consumer qua the opposite parties and this Forum has got territorial jurisdiction to entertain and try this complaint be adjudicated. Admittedly complainant is the widow of the assured. She is Class-I legal heir of the deceased. She has been appointed by him as his nominee in the proposal form as is evident from Ex. C-10. Accordingly, she is beneficiary regarding insurance claim. So far as assignment of the policy in favour of the Central Board of Trustee Employees Provident Fund is concerned, that was with regard to the sums in para No. 67(ii) and 68 (i) of the Employee Provident Fund Scheme if he was liable to pay to the fund. Learned counsel for the opposite parties failed to show us that deceased was liable to pay such sum to the Central Board of Trustees, Employee Provident Fund. Assignment of the policy was contingent. Since his liability towards Central Board of Trustees, Employee Provident Fund is not proved, complainant being the legal heir and nominee of the assured is certainly consumer qua Life Insurance Corporation of India being beneficiary.<br /> 13. Now we advert to the point of territorial jurisdiction of this Forum. No doubt it has been held by the Hon'ble National Commission in the case of Indian Airlines Corporation & Others Vs. Consumer Education & Research Society, Ahmedabad & Another 1992(1) CPR page 4 (NC) that “it does not appear to us to have been intended by Parliament that while instituting a complaint against the corporation which has its branches spread over all over India, a consumer should have the choice to file his complaint anywhere in the country irrespective of where the cause of action, arose, merely, for the reason that the corporation may have a branch office functioning in the particular place where the complaint is instituted.” In the case of Harinder Singh Vs. M/s. Seasky Cargo and Travels Limited and Anothers, First Appeal No. 1384 of 2005 decided on 1.3.06, Hon'ble State Commission, Punjab, has held that on given facts and circumstances, District Fora may refuse to entertain a complaint even though opposite party may have a Branch Office in the District if it is of the opinion that the case is being filed before a particular District Forum for some extraneous reasons. Admittedly in this case opposite Life Insurance Corporation has its branch office at Bathinda. In our view it is not a case where it can be held that complaint has been filed by the complainant before this District Forum at Bathinda for extraneous reasons. Hon'ble State Commission in the case of Harinder Singh Vs. M/s Seasky Cargo and Travels Limited (supra) has observed that “ For instance in a given case, the complainant may not be residing in a particular District, may not be having any business in a particular District, yet he may file a complaint in that District Forum simply because the opposite party has a Branch office there.” In this case, complainant is residing at Bathinda. Insurance claim submitted by her was repudiated on 11.9.06. Representation made against it by her was rejected on 10.7.07. Repudiation of the claim and the rejection of her representation were conveyed to her at Bathinda through letters, copies of which are Ex. R-2 & Ex.C-9 respectively. So, it cannot be said that no part of the cause of action has arisen at Bathinda for the complainant to institute the complaint before this Fora. Accordingly, this Forum is well within its right to entertain and try this complaint.<br /> 14. As regards repudiation, assured had submitted proposal form, copies of which are Ex. C-10 & Ex. R-19. Questions No. 11 ( ) of the proposal form and their answers given by the assured are as under :-<br /> ) Have you remained absent from place of work on No<br /> grounds of health during the last 5 years ? <br /> <br /> ) Are you suffering from or have you ever suffered from No<br /> Diabetes, Tuberculosis, High Blood Pressure, Low Blood<br /> Pressure, Cancer, Epliepsy, Hernia, Hydrocele, Leprosy or <br /> any other disease ?<br /> <br /> ) What has been your usual state of health ? Good<br /> <br /> Stance of the complainant that her husband was got medically examined before issuance of the insurance policy is without any substance as it was a non-medical case as is evident from copy of the policy which is Ex. R-17. This fact also becomes evident from the affidavit of Sh. J P Arya, Manager, L&HPF, which is Ex. R-1 in which he has stated in so many words that proposal form was filed by life assured under Non-medical scheme where no medical is conducted and that policy was issued on the declaration made by him in the proposal form. It is not a case where life assured was an illiterate person. In the proposal form assured had given the declaration that statements and answers have been given after fully understanding the questions and the same are true and complete in every particular and that he did not withhold any information.<br /> 15. Admittedly life assured has died within two years from the date of taking the policy i.e. 26.6.05. Policy was taken on 26.1.04. In such a case, Section 45 of the Insurance Act is applicable. There are three conditions for application of second part of this Section which are that :-<br /> “(a) the statement must be on a material matter or must suppress facts which it was material to disclose;<br /> (b) the suppression must be fraudulently made by the policy holder and'<br /> (c) the policy-holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose.”<br /> 16. Now question arises as to whether the life assured has fraudulently suppressed the material facts which was in his knowledge before taking the policy. The answer to it in our minds is in the positive. Life assured had taken leave on medical grounds on several occasions since May, 2001 as below :<br /> 21.5.01 to 31.5.01 11 days Due to illness HPTN CRF from <br /> Usha Madan of Madan Nursing & <br /> Maternity Home<br /> 10.9.01 to 26.9.01 17 days CRF-from Punjab Health System<br /> & OPD slip<br /> 18.10.01 to 29.11.01 43 days CRF due to illness<br /> 30.11.01 to 31.1.02 63 days CRF from Anmol Hospital<br /> 1.2.02 to 31.3.03 58 days Illness<br /> 1.4.02 to 30.4.02 30 days Kidney problem<br /> 1.5.02 to 31.7.02 61 days Under treatment of PGI<br /> 1.8.02 to 30.9.02 61 days Illness<br /> <br /> All this is evident from Ex. R-4 to Ex. R-13. He was suffering from Hypertension and and it continued even after obtaining the policy as is obvious from Ex. R-14 to Ex. R-16. In other words, he was suffering from kidney disease before taking the policy. This disease has direct nexus with health. He did not disclose this disease. He remained on leave due to his illness. He was not enjoying good health before taking the policy. Despite all this, he answered the questions referred to above in the manner stated above. Mere fact the columns of the proposal form were filled in by the agent of the opposite Insurance Corporation does not absolve the life assured from his liability to give correct answers of the questions about his health. Contract of Insurance is based on “UBERREIMA FIDES”. Both the insurer and the insured are required to act in good faith. Since life assured was fully aware about his illness and despite this, he gave wrong answers, suppression of material information about is health was certainly fraudulent. Every fact of materiality was required to be disclosed honestly and correctly, but he failed to do so. Had he given correct answers of the questions referred to above, opposite Life Insurance Corporation might not have accepted the proposal. Suppression of material facts within the knowledge of life assured has been rightly considered by opposite Insurance Corporation with all seriousness and claim has been repudiated. Accordingly, repudiation of the claim and rejection of representation of the complainant by opposite parties No. 1,2 & 4 are justified as the life assured violated Clause No. 5 of the terms and conditions of the Insurance Policy copy of which is Ex. R-17 and gave false declaration in the Proposal Form. In this view of the matter, we get support from the observations of their Lordships of the Hon'ble Supreme Court in the case of P.C. Chacko & Another Vs. Chairman, Life Insurance Corporation of India & Others 2008(1) Civil Court Cases 206 (S.C.) . Reference can also be made to the authorities Smt. B. Jayamma Vs. Sr. Branch Manager, LIC & Ors 2004(2) CPR 33(NC) and LIC of India & Another Vs. Naveen Dhingra I(2004) CPJ 88 (NC).<br /> 17. In the premises written above, no deficiency in service on the part of the opposite parties is proved. Complaint being devoid of merits, is dismissed. Parties are left to bear their own cost.<br /> Copy of this order be sent to the parties concerned free of cost and file be consigned to record room. <br /> Pronounced :<br /> 14-02-2008 (Lakhbir Singh )<br /> President<br /> <br /> <br /> (Hira Lal Kumar)<br /> Member<br /> <br /> <br /> (Dr. Phulinder Preet)<br /> Member <br /> <br /> <br /> <br />