Haryana

Karnal

383/2013

Pooja W/o Anil Kumar - Complainant(s)

Versus

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

Sh. K.G. Sharma

24 Aug 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                          Complaint No.383 of 2013.

                                                               Date of instt. 10.09.2012

                                                               Date of decision: 13.08.2015

 

Smt.Pooja wife of late Sh.Anil Kumar resident of house No.629, Ward No.9, Opposite Channa Sweets, near Bhim Goda Chowk,Panipat.

                                                             ……….Complainant.

                             Versus

 

Life Insurance Corporation of India, Branch Unit -1, 489, Model Town, Karnal through its Branch Manager.

                                                           ……… Opposite Party.

                    Application u/s 27 of the Consumer

                   Protection Act.

 

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

                   Sh.Anil Sharma ………Member. 

                   Smt.Shashi Sharma…. Member. 

         

 Present:       Sh.K.G.Sharma Advocate for the complainant.

                   Sh.Parveen Narwal 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 her husband Anil Kumar (since deceased)  was  Auto driver and he purchased insurance policy bearing No.177483953 on 19.2.2011 for a sum of Rs.two lacs, from Opposite Party ( in short OP) and paid an amount of Rs.9589/- as premium. He also deposited the second installment of the same amount. At the time of purchasing the policy, he was not suffering from any disease and was examined by the doctor of the OP. Unfortunately,  after lapse of  about 1.  year he came to know that he was suffering from  Liver disease and was admitted in the G.B.Pant Hospital, New Delhi on 11.4.2012.  Despite medical treatment, he died on 12.4.2012. It has further been submitted that after the death of her husband, she lodged claim under the said policy being nominee and deposited all the requisite documents with the OP, but the OP kept postponing the matter on one pretext or the other and ultimately repudiated the claim vide letter dated 21.7.2012 on the ground that deceased life assured  withheld the information regarding his health at the time of taking insurance policy.  However, no document was provided by the OP to substantiate its allegations  for justifying the repudiation of the claim. Thus, there was deficiency in services on the part of OP, which caused mental agony and harassment to the complainant 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 the complainant has no loucs standi  to file the complaint; that the complaint is an abuse of the process of law; that the complaint is liable to be dismissed on account of  acts and conduct of the complainant and her husband and that the complaint is not maintainable.

 

                   On merits, it has been submitted that husband of the complainant obtained insurance policy No. 177483953 on his life under plan No.179 for a term of  20 years for a sum assured Rs.2.00 lacs, commencing risk from 22.2.2011 and premiums  @ Rs.9589/- each were to be paid till 28.1.2030. Premiums for two years upto 28.1.2012 were paid. At the time of  proposing for insurance,  the deceased life assured had suppressed the true and material facts regarding ailment, from the OP. He had been suffering from  Cirrhosis Liver disease since 2010 and was aware of the disease, but he did not disclose the same in the proposal form which formed  the basis of acceptance of risk  on his life and thus he  succeeded in obtaining the policy by  misrepresentation. Therefore, claim of the complainant was legally and validly repudiated by the competent authority, vide order dated 21.7.2010.

 

3.                In evidence of the complainant, she filed her affidavit Ex.CW1/A and documents Ex.C1 to Ex.C6.

 

4.                On the other hand in the evidence of the OP, affidavit of Sh.Surender Kumar,  Administrative Officer, 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.                 The parties are not at dispute regarding purchase of the insurance policy by the deceased life assured  Sh.Anil Kumar, from the OP for  sum assured of Rs.two lacs and had paid two installments of Rs.9589/- each. The policy was effective from 22.2.2011 to 28.1.2030. He died on 12.4.2012.The OP repudiated the claim on the ground that at the time of  submitting the proposal form,  the deceased life assured  was suffering from Liver  Cirrhosis  and he was having knowledge about his ailments, but he knowingly and deliberately suppressed the factum of ailments.

 

7.                  The learned counsel for the complainant vehemently argued that the deceased life assured was not suffering from any disease and he was even examined by the doctor of OP  and was found  fit for purchasing the insurance policy. There is no material, which may show that he had knowledge at the time of submitting the proposal form that he was suffering from  liver Cirrhosis . Therefore, the repudiation of the claim of the complainant by the OP is illegal  and  unjustified.  In support of his contention he placed reliance on Abdul Lateef and others Vs. LIC of India 2014(3) CLT 386,  OIC  Vs. Baby Simran Kaur 2014(2) CLT page 362,Nirmala Devi Versus Birla Sunlife Insurance Company 2014(3) CLT 207  LIC Versus Mathura Devi 2008(1) CPC 313 and LIC Vs. Ms.Satya Devi 2006(2) CPC 610.

 

8.                To wriggle out of the aforesaid contention, the learned counsel for the OP contended that deceased life assured was admitted in  G.B.Pant Hospital, New Delhi and the medical record of the said hospital, out patient registration card Ex.OL3 indicates that he was suffering from  PHTN(Portal hypertension), ESOV (Eesophageal varicies), EVL ( Esophageal  Varicies Ligation),   ALD (alcoholic Liver Diseases) HCV

( Hepatitis  C Virus)  and  SOP (spontaneous Bacterial peritonitis).  As per the said medical record he had been  suffering from these diseases since 2010 and he died on account of these diseases on 12.4.2012 and that  he had knowledge about the  same at the time of submitting proposal form and in this way he concealed the true and material facts regarding his health, from the OP, therefore, the claim of the complainant regarding death of her husband was rightly repudiated.  In support of his contention, he made reference to the judgment of Hon’ble National Commission in case LIC of India Vs. Sheetla Devi  in revision petition No.825 of 2011 decided on 19.3.2015.

 

9.                There is no dispute regarding the propositions of law laid in the Judgments cited by the learned counsel for the complainant, but the same were based upon the facts peculiar to those cases, whereas the facts of the present case are obviously at different footings. Therefore, these authorities do not render any assistance to the complainant. In Abdul Latheef’s case (Supra)  deceased life assured was suffering from  Bipolar mood disorder at the time of submitting proposal form for purchasing the policy, but he died due to Cancer.  LIC repudiated the claim on the ground that insured suppressed previous ailments i.e. Bipolar mood disorder.  Under those circumstances,  it was held by the Hon’ble National Commission that there was no nexus at all between the ailments suppressed and cause of death i.e. cancer. The deceased life insured did not suppress any material fact  with any fraudulent intention.  Revision petition was allowed and the OP was directed to pay the sum assured alongwith interest.     In  Baby Simran Kaur’s case (Supra)  the claim was repudiated by the Oriental Insurance Company on the ground that claiment had a pre-existing congenital disease, which was not disclosed while taking the insurance policy.  In  the said case  it was held by the Hon’ble National Commission  that a person  suffering from something like a defect in the heart valve since birth, aberrant pancreas ectopic pancreas or any other ailment in the internal organs of the body, it  could  be termed as an internal congenital disease.  Therefore, exclusion clause in the insurance policy was not  attracted and  that there was  no suppression of material fact  or misrepresentation  on the part of the  policy holder.      In  Nirmala Devi’s case (Supra). Insurance company repudiated the claim only on the ground that though in the proposal form,  husband of the appellant had  written that he was not suffering from any disease, however, as per information of the insured, deceased life assured was suffering from  Hepatitis – D and tuberculosis at the time of his death.  Under those circumstances, it was held by the  Hon’ble Rajasthan State Consumer Disputes Redressal Commission, Jaipur that “ burden  heavily lies on the Insurance company to prove the allegations of deliberate concealment and mis representation.  It was further held that a common man is not supposed to know all the niceties and  technicalities of law.  Once accepting the premium and having entered into an agreement without verifying the facts, the insurance company cannot wriggle out of the liability merely by saying that the contract was made by mis representation and concealment. In  Mathura Devi’s case (Supra) insured remained on leave for  certain period.  It was held by Hon’ble H.P.State Consumer Disputes Redressal Commission, Shimla camp at Mandi that  merely that insured remained on leave for certain period does not  raise a presumption that he had concealed the disease from which he was suffering.  Insurer failed to prove a case of suppression of ailment by insured deceased. No fraud  was played by  suppressing the fact of his illness.         In Satya Devi’s case (Supra)  it was held by the Hon’ble  H.P.State Consumer Disputes Redressal Commission, Shimla that  before  supporting repudiation of claim the insurer is required to prove  that the insured was suffering from  Tuberculosis  at the time of submitting the proposal.  No medical evidence or affidavit was furnished  in support of version of concealment of disease.  Under,  those circumstances, repudiation of the   claim was set aside.

10.               In the instant case, the  copy of the  treatment record of the Deceased life assured from the G.P.Pant Hospital, New Delhi, shows that  he was diagnosed for     Portal hypertension, esophageal varicies, Esophageal varicies Ligation, alcoholic   “C” virus and spontaneous Bacterial peritonitis since 2010 and he died on account of those diseases on 12.4.2012.  Thus, emphatically clear that disease life assured was suffered from these ailments at the time of purchasing the policy on 28.1.2011. The ailments mentioned in the medical record are of such nature that deceased life assured must be having knowledge of the same since very beginning and  it cannot be said by any stretch of imagination   that he had no knowledge  of  those ailments at the time of submitting  proposal form.  However, the copy of  Ex.O4 shows that deceased life assured had not disclosed about those ailments. It is quite evident from the certificate issued by the medical officer Ex.O2 that deceased life assured died on account of   Cirrhosis  with postal  Hypertension Esophageal  Varicies Ligation. Thus,  there was direct nexus between the ailment, with which deceased was suffering  at the time of taking of the policy and his death. Therefore,   concealment of the ailments in the proposal form is quite material.

 

12.               In Sheetla Devi’s case (Supra)  it was contended by the learned counsel for the OP that  DLA remained under the treatment of a doctor  and was treated for Hemoptysis, therefore, he was suffering from  Tuberculosis prior to the date of taking policy.  On several medical prescriptions  it was categorically  mentioned that he  was  a chronic  alcoholic and was also  suffering from hypertension.  This information was also concealed in the proposal form.  Under those, circumstances, it was held  by the Hon’ble National Commission that it was  clear that insurance policy was obtained by the  insured by  concealing the material information, which if  disclosed would have impacted the decision of the Insurance company whether or not to accept the insurance proposal.  In the cited case judgment of the Hon’ble Supreme Court in  case Satwant Kaur Sandhu  Vs.New India Insurance Co.Ltd. 2009(8) SCC, 316, was also referred, wherein it was held that  if the Insurance policy  is obtained by deceased life assured by concealment  of material fact or  mis presentation, the insurance contract itself is void and the claim under the insurance policy is not payable.  It was also held  that  that contract of insurance falls in the category of Ubbrema fides i.e. utmost good faith.

 

13.               Thus,  proposition of law laid down in the afore  discussed authorities cited on behalf of the OP squarely cover the facts of the present case, because it is established from the medical record  that deceased life assured was suffering from     Portal hypertension, esophageal varicies, Esophageal varicies Ligation, alcoholic   “C” virus and spontaneous Bocterial peritonitis since 2010, whereas the policy was purchased by him on 19.1.2011 and in the proposal form he concealed the factum of  aforesaid ailments and thus misrepresented the OP.  Had he disclosed about the ailments, the insurance company must or not  have accepted the insurance proposal.

 

14.               In view of the foregoing discussion, we have no  hesitation  in concluding that deceased life assured  had been suffering from      Portal hypertension, esophageal varicies, Esophageal varicies Ligation, alcoholic   “C” virus and spontaneous Bocterial peritonitis since 2010 at the time of submitting proposal  form, but he did not disclose about his ailments and thus concealed the material facts and misrepresented to the OP. Thus, the contract of insurance was void. Therefore, repudiation of the claim of the OP cannot be termed as illegal and unjustified in any manner. Consequently, we find no merit in the present complaint, therefore, we dismiss the same. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:13.08.2015                                                                            

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

   (Anil Sharma)  (Smt.Shashi Sharma)

      Member.        Member.

 

 

 

 

Present:        Sh.K.G.Sharma Advocate for the complainant.

                   Sh.Parveen Narwal Advocate for the OP.

 

                   Arguments heard. 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:13.08.2015                                                                            

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

   (Anil Sharma)  (Smt.Shashi Sharma)

      Member.        Member.