BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, JALANDHAR.

  Complaint No.408 of 2018

       Date of Instt. 01.10.2018

       Date of Decision:30.05.2022

Balwinder Singh S/o Sh. Nirmal Singh, VPO Dhurhe, via Adampur Doaba, District Jalandhar.

..........Complainant

Versus

1.       Life Insurance Corporation of India, Divisional Office, ‘Jeevan          Parkash’, Model Town Road, Jalandhar-144001 Through its          Senior Divisional Manager.

2.       Life Insurance Corporation of India, Branch Office, I.A.B, Third       Floor, Rajinder Nagar, Opp. Tehsil Complex, Jalandhar City-         144001, Through its Branch Manager.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before:        Dr. Harveen Bhardwaj             (President)

                   Smt. Jyotsna                            (Member)

                   Sh. Jaswant Singh Dhillon       (Member)   

Present:       None for the Complainant.

                   Sh. S. C. Sood, Adv. Counsel for the OPs.

Order

Dr. Harveen Bhardwaj (President)

1.                The instant complaint has been filed by the complainant, wherein it is alleged that the son of the complainant namely Sandeep Singh whilst alive had taken Money Back Life Insurance Policy with profits with Double Accident Benefit on his life for Rs.3,00,000/- Sum Assured Table No.75 for Term 16 years as per Proposal Form dated 26.04.2013. The Proposal was assigned policy no.133666219 with date of commencement and date of risk 26.11.2013 and maturity date 26.11.2033. The mode of premium installment was half yearly. The half yearly installment of premium was fixed at Rs.9557/-. The occupation of life assured was agriculture. DLA was hale and hearty for and not afflicted with any disease at the time proposing for life insurance. DLA health profile and habits were sober and temperate with insurability and no trace of any physical impairment at the time of proposing for insurance. DLA was doing his professional work and domestic responsibility. The OP No.2 after scrutiny and verifying particulars of Proposal Form, also obtained agent’s confidential report from securing agent and development officer and after fully satisfying as to health and habits, physical condition and insurability and age evaluated and underwritten proposal. Thereafter underwriter recorded its decision on Proposal Review Slip as standard life and accepted risk at ordinary without raising any kind of objection as to the details given in proposal and personal statement in all these reports collected premium at the tabular rate of premium as standard life and accepted risk of life insurance without any demur. All these reports with OPs would reveal that there was no adverse feature found in the life of DLA regarding health profile and age, occupation and habits. DLA could not be found fault with for alleged non-disclosure at the time of proposing for life insurance policy and acceptance of risk later on. To misfortune and ill luck of the complainant, DLA died on 27.10.2015. The death was natural. The policy was alive on the date of death. Subsequent to the death of the life assured, the complainant being nominee lodged death claim of the policy in question with OP No.2, but the claim of the complainant was repudiated. The claim had been repudiated after expiry of period of three years from the date of policy was effected. The refusal to pay rightful and genuine claim by OP No.1 is arbitrary, wrongful, malafide and perverse. The repudiation of life insurance policy claim was made vide letter after expiry of three years from the date of risk covered and proposal hence exceeding the period mentioned in Section 45 of the Insurance Act. The OPs baselessly and artificially assumed and presumed on speculation and fiction from purported claim form no.3816 that the life assured obtained said policy was addicted to Alcohol for eight years smack, heroin, cocaine, tobacco etc. The allegations and averments so made and imputed against the life assured in letter of repudiation are absolutely wrong and totally false, perverse and erroneous which the complainant emphatically, specifically and vehemently deny in toto. The OP is guilty of deficiency in rendering service, negligent and resorting to unfair trade practice as envisaged under the provisions of the Consumer Protection Act and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay claim amount with interest @ 12% per annum from the date of death of the life assured upto the date of actual payment. Further, OPs be directed to pay compensation of Rs.50,000/- for causing mental tension and harassment to the complainant and Rs.10,000/- as litigation expenses.

2.                Notice of the complaint was given to the OPs, who filed reply and contested the complaint by taking preliminary objections that the complainant is stopped to file the present complaint by his own act, conduct and acquiescence. It is further averred that the contract between the life assured and the OP is the contract of good faith, but the life assured did not disclose true facts while taking the policy that the life assured was addicted to Alcohol since 8 years and Smack, Heroin, Cocaine, Tobacco, Sedative, Poppy Husk since 10 years. As per record, the life assured admitted in Aas Kiran Drug Counseling and Rehabilitation Centre, S. J. S. Nagar, Tanda Bye Pass Road, Hoshiarpur. The project director of Rehabilitation Centre has already certified vide his declaration dated 20.09.2016. Keeping in view all the above stated facts, the life assured did not disclose in the proposal form, as such, he obtained policy by suppressing the true facts, so the present complaint is to be dismissed. The facts recorded in DDR No.30 dated 27.10.2018 on the statement of his father corroborate the above facts about the health and habits of deceased life assured. The DLA was chronic drug addicted since the age of 15 years and while taking the policy the deceased life assured deliberately, misrepresented and given the wrong answers in the proposal form with fraudulent intent to obtain the insurance cover. On merits, the factum with regard to taking insurance policy by the life assured and the life assured was died on 27.10.2015, is admitted. It is also admitted that the claim was lodged by the complainant and the same was repudiated on 27.12.2016, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.

3.                Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.

4.                In order to prove their respective versions, both the parties produced on the file their respective evidence.

5.                We have heard the learned counsel for the OPs only as none has appeared on behalf of the complainant since last so many dates and have also gone through the case file as well as written arguments submitted by counsel for OPs, very minutely.

6.                   It is admitted fact that the life assured namely Sandeep Singh took the policy, which commenced on 26.112013 with the      date of maturity as 26.11.2033. The complainant has proved on record the proposal for the policy Ex.C-1 and Ex.C-2 is the proposal review slip and Ex.C-3 has been proved copy of policy bond. The life assured died as per Ex.C-6 on 27.10.2015. The death claim intimation was sent to the OPs vide Ex.C-4 and claim form alongwith Certificate of Identity and Burial or Cremation has been proved as Ex.C-5. It is also not disputed that the OPs repudiated the claim of the complainant, vide Ex.C-7. The complainant has alleged that the OPs have wrongly repudiated the claim of the complainant. They were supposed to settle the claim within 30 days, but they have intentionally not decided the claim even after the expiry of period of three years from the date of the policy was effected. The complainant has also proved the affidavit of Amarjit Singh Ex.C-8, who knew the deceased and affidavit of Manjit Singh Ex.C-9, who also knew the deceased and were on visiting terms with the complainant and his son.

7.                The fact of purchase of insurance policy is not denied at all. The death and repudiation of the claim has also not been denied. The only point is to be considered as to whether the claim has rightly been repudiated on the ground of non-disclosure of material facts from the OP or the repudiation order is wrong. The contention of the OPs is that the deceased was a drug addicted and remained admitted in Aas Kiran Drug Counseling and Rehabilitation Centre. He was also addicted to alcohol, smack, heroin, cocaine, tobacco, sedative, poppy husk etc. The OPs have proved on record the DDR regarding the missing of the deceased Sandeep Singh and it has been mentioned in this DDR that the son of the complainant i.e. the deceased was addicted to alcohol and other drugs. As per Ex.OP-4, he was admitted in Aas Kiran Drug Counseling and Rehabilitation Centre. In this document, it has been specifically mentioned that after leaving the studies, he started chewing tobacco at the age of 15 years and became addicted to other substitutes by the age of 25 years. As per the death cum intimation form and statement, it has been shown that he died of heart attack. As per Ex.OP-3, he was missing and it is also proved on the record that he was drug addicted. Ex.OP-5 is the post-mortem report. Perusal of Ex.OP-5 shows that he was having abrasion with contusion with multiple small puncture wounds on right zygomatic region and right side of face over cheek region, meaning thereby that he suffered injuries at the time of his death. The cause of death was not declared by the doctor as the same was to be declared after the receipt of report of chemical examiner, but the report of chemical examiner was not received. The post-mortem report clearly shows that his death was not due to heart attack as alleged by the complainant. The repudiation letter shows that he had not disclosed the material facts of his addiction to the alcohol and other drugs at the time of taking policy on 26.11.2013. He died on 27.10.2015. The record produced by the OPs shows that he was addicted to alcohol and other drugs for the last 10 years from the date of his death, meaning thereby that approximately from the year 2005/2007 i.e. prior to taking the policy. It has been held by the Hon’ble Consumer Dispute Redressal Commission Union Territory, Chandigarh, in Appeal Case No.839/2006, titled as “Mala Aggarwal Vs. Life Insurance Corporation of India Ltd.”, wherein it is held as under:-

                   “Statement made by the deceased was false and incorrect        about material facts. He fraudulently made statement that he       enjoyed good health and did not suffer from any disease which        was palpably wrong. The policy holder knew that at the time of        making statement that the statement was false. Thus the claim    was rightly repudiated and there is no force in appeal.”

                   It has been held by Hon’ble Supreme Court, in Civil Appeal No.3944 of 2019 date of decision 15.04.2019, titled as “Life Insurance Corporation of India Vs. Manish Gupta”, wherein it is held as under:-

                   “Consumer Protection Act, 1986, Section 23-Mediclaim-        Repudiation-Documentary material indicates there was clear   failure on part of claimant to disclose that he had suffered from rheumatic heart disease since childhood- Ground for repudiation     was in terms of exclusions contained in policy- Failure of insured       to disclose past history of cardiovascular disease was valid       ground for repudiation –Consumer for a have made fundamental         error in allowing claim for reimbursement of medical expenses.”

                   It has been held by Hon’ble National Commission, in Revision Petition No.1327 of 2008, titled as “Life Insurance Corporation of India Vs. Smt. Maya Devi”, wherein it is held as under:-

                   “Prior to taking the policy in question, for the last five   months the insured was suffering from Acute & Transient       Psychotic Disorder, for which he had consulted doctors; had    taken treatment in the hospital; and was also on medical leave          for 15 days, but these facts were not disclosed by the insured at    the time of taking the policy in question and           therefore, the claim         could not be paid for concealment of          material information.”

8.                The complainant has not rebutted the contention of the OPs that he was hale and hearty and did not die of the over dose of drugs nor has produced on record any law. So, from all the angles the complainant has failed to prove his case and accordingly, the complaint of the complainant is dismissed with no order of costs. Parties will bear their own costs. This complaint could not be decided within stipulated time frame due to rush of work.

9.                Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated          Jaswant Singh Dhillon    Jyotsna               Dr. Harveen Bhardwaj     

30.05.2022         Member                          Member           President