BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, JALANDHAR
Complaint No.288/2017
Date of Instt: 17/08/2017
Date of Decision: 09.02.2021
Amit Kumar aged 41 years son of Late Sh.Vijay Parkash R/o House No.1244, Urban Estate, Phase-1, Jalandhar.
..........Complainant
Versus
1. Life Insurance Corporation of India, Plot No.630, Jeevan Bharti Building, Connaught Place, New Delhi through its MD/Chairman.
2. The Zonal Manager, Life Insurance Corporation of India, Plot No.630, Jeevan Bharti Building, Connaught Place, New Delhi.
3. The Branch Manager, Life Insurance Corporation of India, Industrial India Branch, 3rd Floor, PUDA Complex, Jalandhar.
......Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Sh. Kuljit Singh (President)
Smt. Jyotsna (Member)
Present: Sh. Jatinder Arora, Advocate Counsel for the complainant.
Sh. M.S.Sachdev, Advocate Counsel for the OPs No.1 to 3
Order
Kuljit Singh (President)
1. The instant complaint has been filed by the complainant, wherein alleged that the complainant is permanent resident of above mentioned address and the sister of the complainant namely Ms.Poonam had taken two policies of LIC namely Jeevan Saral No.133596841 dated 11.08.2012 date of maturity 11.08.2037 and 133599127 dated 21.09.2012 date of maturity 21.09.2037. That the insurer died on 21.02.2014 and the complainant was nominee in both the policies. That the clam with regard to Policy No.133596841 dated 11.08.2012 was disbursed to the complainant as he was nominee in the said policy. However the claim with regard to Policy No. 133599127 dated 21.09.2012 was declines and repudiated on dated 08.02.2016 on the ground that factum regarding previous policy has not been mentioned in the second policy i.e. policy no. 133599127 dated 21.09.2012. That the insurer had disclosed all the required information to the agent as well as the principal i.e. opposite parties, the negligence or fault if any if that of the opposite parties and its agent and non approval of the entire claim of the above said policy No. 133599127 dated 21.09.2012 amounts to deficiency and negligence in service, especially when the insurer is no more alive. That the cause of action accrued to the claim on 08.02.2016 when the claim was repudiated by the opposite parties and after that finally in the last week when the opposite parties refused to accede to the request of the complainant. That in the above circumstances, the complainant is left with no other efficacious remedy except to file the present consumer complaint. It is, therefore, prayed that the present complaint may kindly be accepted with costs and opposite parties may kindly be directed :-
i) To pay Rs.6,25,000/- as sum assured in case of death of the insurer.
ii) To pay interest @ 18% w.e.f. The date of lodging of claim till its realization.
iii) To pay Rs.2,00,000/- towards in convenience mental tension, loss of work, inter alia as described in the above complaint.
iv) To Pay Rs.22,000/- towards the cost of the litigation.
2. Upon notice, Opposite Parties appeared through its Counsel and filed its written reply and contested the complaint of the complainant by raising preliminary objections that neither the M.D. nor the Zonal Manager of Life Insurance Corporation of India is necessary party in the consumer complaint are the necessary party to the present complaint because they have got no privity of contract with the complainant or the deceased nor they have anything to do with the facts and circumstances of the present case. That no ground is made out for allowing this complaint, so on this score along, this complaint is liable to be dismissed with costs. That no cause of action has accrued to the complainant to file the present complaint and as such, the same is liable to be dismissed with special and compensatory costs. That the complainant has got no locus standi to file the present complaint and the same is liable to be dismissed with special and compensatory costs as the same is false, frivolous and vexatious to the knowledge of the complainant and he has suppressed the material facts from the Hon'ble Forum while filing the present complaint, so on this score also, this complaint is liable to be dismissed with special and compensatory costs. On merits, it is admitted that the Life Assured namely Poonam had purchased the Policy bearing No.133596841 on 11.08.2012 and another Policy bearing No. 133599127 on 21.09.2012. It is also admitted that the Insurer claimed to have died on 21.02.2014 and the complainant was nominee in both the policies but the other allegations as made in the complaint are categorically denied and lastly submitted that the complainant is not entitled to any relief as claimed by her and the present complaint being false, frivolous and vexatious, is liable to be dismissed with special and compensatory costs and it may be dismissed accordingly.
3. In order to prove the case of the complainant, the counsel for the complainant tendered into evidence affidavit Ex.CA and some documents Ex.C-1 to Ex.C-4 and then closed the evidence.
4 In order to rebut the case of the complainant, Counsel for the Opposite Parties No.1 to 3 tendered into evidence Affidavit as Ex.OPA along with some documents Ex.OP-1 to Ex.OP-8 and then closed the evidence on behalf of Opposite Parties.
5. We have heard the learned counsel for the respective parties and have also gone through the written arguments submitted by learned counsel for the complainant as well as case file very carefully.
6. The complainant has tendered evidence copy of insurance policy bearing no.133596841 dated 11.08.2012 Ex.C-1 on the record. Ex.C-2 is copy of another policy bearing no.133599127 dated 21.09.2012 on the record. Ex.C-3 is copy of repudiation letter dated 08.02.2016. Ex.C-4 is copy of death certificate Poonam Kapoor.
7. To refute this evidence of the complainant, OP has tendered affidavit of Parvaty Krishanan Claims LIC as Ex.OP-A on the record. This witness stated that repudiation is justified. This witness stated that insured had suppressed the material fact with an intention to defraud with OPs when the policy was commenced. Ex.OP-1 is copy of insurance policy bearing no. 133596841 dated 11.08.2012. Ex.OP-2 is copy of insurance policy bearing no. 133599127 dated 21.09.2012. Ex.OP-3 is letter dated 15.01.2008 regarding review of underwriting practices –chart of special reports. Ex.OP-4 is copy of death certificate of Poonam Kapoor. Ex.OP-5 is copy of claimants statement. Ex.OP-6 is copy of hand written letter dated 29.01.2016 addressed to OP by Amit Kumar complainant on the record. Ex.OP-7 is copy of certificate issued by Dr. Dhiraj Bhatia MD Medicine from Global Hospital Jalandhar. Ex.OP-8 is copy of repudiation letter dated 08.02.2016 on the record.
8. It is an established fact that the complainant purchased two polices from OPs, first namely Jeeval Saral No. 133596841 dated 11.08.2012 date of maturity 11.08.2017 and second one is 133599127 dated 21.09.2012 date of maturity 21.09.2037. The insurer Poonam had died on 21.02.2014 and complainant was nominee in both the policies. The claim with regard to policy no.133596841 dated 11.08.2012 was disbursed to the complainant but claim with regard to policy no.133599127 dated 21.09.2012 was declined and repudiated on 08.02.2016 on the ground that factum regarding previous policy has not been mentioned in the second policy. But the complainant alleged that he had disclosed all the required information to the agent as well as principal i.e. OPs. The complainant has not placed on record to prove that he had disclosed all the required information to OPs.
9. From perusal of entire record it has transpired that the complainant had taken above said two policies from agent of OPs but he has not disclosed the true facts to OPs. From perusal of Discharge Summary, which is document placed on record issued by Patel Hospital Jalandhar, in this document Diagnosis mentioned as : Tuberous Sclerosis and Chronic renal failure and History : Insured Poonam Kapoor 43 years old female with tuberous sclerosis with pain abdomen for two years. Impression :- CT FINDIGS ARE SUGGESTIVE OF MULTIPLE INNUMERABLE THIN WALLED CYSTS IN Bl LUNGS
LYMPHANGIOLEIOMY OMYOMATOSIS
To be correlated clinically.
Patient investigate and results show evident of cysts in lung, liver adexa likely secondary to primary disease tuberous sclerosis.
Patient advised to follow up with primary physician, nephrologists and pulmonologist.
The above said document not exhibited by the complainant and it is duty of the complainant to placed on record this document. This act of complainant shows that he has concealed the material fact from OP. Further, the certificate also placed on record the issue date of this certificate as 2l8.12.2015 issued by Patel Hospital Jalandhar in which it has specifically mentioned that :
A diagnosed case of Tuberous sclerosis presented to us with complaint of pain abdomen for two years.USG abdomen done previously was suggestive of enhancing hepatic lesion, CECT chest was done on 15.05.2013 which showed multiple thin walled cyst in bilateral lungs ? Lymphangioleiomyomatosis. And MRI abdomen also done on 15.05.2013 which showed hepatic SOLs? Haemagiomas, bilateral renal cysts and bilateral overian cysts.
10. From perusal of discharge summary, it is clear that the insured Poonam Kapoor admitted in the hospital on 15.05.2013 and discharged on 16.05.2013. From this , it is clear that the complainant admitted in the hospital for treatment with advice “ to follow up with primary physician, nephrologists and pulmonologist. “ But the complainant has not brought this fact to the knowledge of OPs. In document of LICs at page no.24, in this document column no.7 sub clause ( c ) Date when first observed by the patient : 19.04.2015 mentioned. But the complainant admitted in the Patel Hospital Jalandhar on 15.05.2013 and discharged on 16.05.2013. This information was not given by complainant to OPs in the above form.
11. We find that most of the documents relied upon by the OPs in this case, which have manifested the symptoms of cysts in lung, liver, adnexa likely secondary to primary disease tuberous sclerosis in the life assured. We are mainly to decide this controversy, whether life assured was in the knowledge that she was suffering from above disease, when she took the policy by filling up the proposal form and deliberately gave wrong answers. The discharge issued by Patel Hospital Jalandhar, certificate dated 28.12.2015 issued by Patel Hospital Jalandhar and Medical Attendant Certificates are vital documents on the record and significance to the effect that life assured was suffering from cysts in lung before taking the insurance policy. The Apex Court has held in Satwant Kaur Sandhu versus New India Assurance Company Ltd, reported in IV (2009) CPJ 8 (SC) that if proposer has knowledge of such fact, he is obliged to disclose the same - Failure to do so entitled the insurer to repudiate his liability under the policy. The judgments relied upon by OPs are applicable in the present case.
12. The learned counsel for the complainant has placed on record judgments in support of his case, which are reproduced as under :-
LIC of India and others versus Krishna Devi and others, reported in 2016(4) CPR 523 of Hon’ble National Commission in which held that “ LIC refused to pay death claim for remaining policies on ground that deceased suppressed the factum of obtaining first policy while filling the proposal form for obtaining subsequent policies.” This judgment is not applicable in the present case, because there is no suppression the factum of obtaining first policy, but there is material concealment of disease. The event of non-disclosure of a material fact, the LIC was within their right to repudiate the claim. The complainant further placed on the record judgment titled as LIC of India and others versus Krishna Devi and others, reported in 2016(4) CPR Page 523, this judgment also not applicable in the present case. This judgment are on different footings.
13. On the other hand, learned counsel for OPs relied upon judgment in case titled as Reliance Life Insurance Co. Ltd. & another versus Rekhaben reported in Civil Appeal No. 4261 of 2019 of Hon’ble Supreme Court of India, wherein it has been held that “insurer is not required to establish that non-disclosure, suppression or falsity of response by the proposer is material. “ “Disclosure of pre-existing life insurance cover of the proposer is necessary to enable the insurer to assess the human life value of the proposer before the insurance of a policy.”
Section 45 modifies the common law where a life insurance policy is repudiated due to a misstatement or suppression of facts. The claim under the life insurance policies cannot be termed as compensation as envisaged by Section 14(1) (d) of the Act. The Contract of Insurance is a contract based on the principle of "UBERRIMAFIDE" and the proposer is duty bound to give true and correct history not only on the basis of the past history but also of any change in health or illness after submission of proposal papers to the insurer till the time of acceptance of risk by them.
14. In the light of our above discussion, we are of the considered opinion that the complainant has concealed the material fact of his disease from OPs at the time of filing up the proposal form. This act of complainant proves that there is no deficiency and unfair trade practice on the part of OPs and repudiation of claim is justified. Therefore, we do not find any force in the submissions of complainant and the present complaint is hereby dismissed with no order as to costs.
15. The copies of the order be sent to the parties, as permissible, under the rules.
16. File be indexed and consigned to the record room its due compliance.
ANNOUNCED IN THE OPEN COMMISSION:
9th Day of February 2021
(Kuljit Singh)
President
(Jyotsna)
Member
