DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.
Complaint No. 688
Instituted on: 08.12.2016
Decided on: 10.05.2017
Daljeet Kaur wife of Late Tara Singh son of Mukhtiar Singh, resident of Village Rampura, Tehsil and Distt. Sangrur.
…Complainant
Versus
1. Life Insurance Corporation of India, Jeevan Prakash, Sector 17-B, Divisional Office Chandigarh through its Divisional Manager.
2. Life Insurance Corporation of India, Branch Office, Railway Road, Sangrur through its Branch Manager.
..Opposite parties
For the complainant : Shri G.S.Nandpuri, Adv.
For OPs : Shri Amit Bedi, Adv.
Quorum: Sukhpal Singh Gill, President
Sarita Garg, Member
Vinod Kumar Gulati, Member
Order by : Sukhpal Singh Gill, President.
1. Smt. Daljeet Kaur, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that the husband of the complainant Shri Tara Singh obtained an insurance policy bearing number 165829316 from the OPs and the complainant was the nominee under the policy. It has been further averred that at the time of taking the insurance policy, Shri Tara Singh was hale and hearty. Further case of the complainant is that Shri Tara Singh died on 27.9.2015 due to heart attack and information in this regard was given to the Ops and further handed over all the required documents to the OPs for settlement of the claim. The complainant made so many requests to the Ops to settle the claim, but the OPs ultimately repudiated the claim without assigning any reason. As such, the complainant got served a legal notice dated 30.09.2016 upon the OPs and reply to that was sent by the Ops vide letter dated 6.10.2016 whereby it was said that the insured was not in good health at the time of taking the insurance policy. Thereafter the complainant also sent another letter dated 26.10.2016. Further case of the complainant is that the OPs alleged in letter dated 31.3.2016 that the answers regarding his health were falsely given by the insured as he was not keeping good health and was suffering from diabetes, hypertension, chronic kidney disease and chronic liver diseases. Thus, alleging deficiency in service on the part of the Ops, the complainant has prayed that the Ops be directed to pay to the complainant an amount of Rs.3,50,000/- along with interest @ 18% per annum and further claimed compensation for mental torture, agony and harassment and litigation expenses.
2. In the written reply filed by the Ops, preliminary objections are taken up on the grounds that the complainant has not come to the court with clean hands, as such is not entitled to get any relief. It is stated that the claim of the complainant has been rightly and legally repudiated and conveyed to the complainant vide letter dated 31.3.2016. It has been stated that the repudiation has been done after proper and necessary investigations into the genuineness of the claim, as the claim was an early claim, the policy having run just for two months 12 days of taking the policy in question and having been arisen within two years of availing the policy. It has been further stated that from the investigation it was concluded that the DLA had concealed material information about his state of health at the time of taking the insurance policy. It is stated that the DLA was a known case of diabetes, CKD, hypertension, CLD and admitted to DMCH Ludhiana with chief complaints of decreased oral intake and increased responsiveness. The policy was taken by the DLA after concealing the material and true facts. On merits, taking of the insurance policy has been admitted by Tara Singh from the OPs. It has been stated that the claim has rightly been repudiated vide letter dated 31.3.2016 as the DLA concealed material information at the time of taking the insurance policy. The other allegations levelled in the complaint have been denied in toto.
3. The learned counsel for the complainant has produced Ex.C-1 affidavit, Ex.C-2 copy of legal notice, Ex.C-3 and Ex.C-4 copies of postal receipts, Ex.C-5 copy of letter dated 6.10.2016, Ex.C-7 copy of postal receipt, Ex.C-8 and Ex.C-9 copies of letters, Ex.C-10 copy of status report of policy, Ex.C-11 copy of death certificate, Ex.C-12 copy of aadhar card of the complainant and closed evidence. On the other hand, the learned counsel for OPs has produced Ex.OP-1 affidavit, Ex.OP-2 copy of repudiation letter, Ex.OP-3 copy of claim inquiry report, Ex.OP-4 copy of discharge summary, Ex.OP-5 copy of form number 3816, Ex.OP-6 copy of proposal form, Ex.OP-7 copy of insurance policy and closed evidence.
4. We have very carefully perused the complaint, version of the opposite parties, evidence produced on the file and written submissions and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance, for these reasons.
5. It is an admitted case of the parties that the DLA Tara Singh took an insurance policy bearing number 165829316 from the OPs on 10.6.02015 for Rs.3,00,000/- as is evident from the copy of insurance policy produced on record as Ex.OP-7. It is also an admitted fact that the DLA died on 27.9.2015 and the information of death was duly given to the Ops immediately and the complainant submitted all the required documents to the OPs for settlement of the claim. But, the grievance of the complainant is that the Ops repudiated the claim of the complainant vide letter dated 31.3.2016 on the ground that at the time of taking the insurance policy, the complainant was not having a good health and was suffering from diabetes, hypertension, chronic kidney and chronic liver diseases, which is said to be wrong and without any basis, as the DLA was having a good health at the time of taking the insurance policy. On the other hand, the stand of the Ops is that the DLA took the insurance policy by concealing the true and material facts about status of his health on the date of applying for the said policy plan and the complainant gave wrong answers to the specific questions.
6. We have also perused the copy of repudiation letter dated 31.3.2016, Annexure R-1, wherein it has been stated that the complainant gave wrong answers to the questions, whereas he was suffering from diabetes, hypertension, chronic kidney disease and chronic liver disease. To support this contention, the learned counsel for the complainant has drawn our attention towards the discharge summary Annexure R-3. On the other hand, the stand of the complainant is that the OPs have wrongly repudiated the claim of the complainant vide letter dated 31.3.2016 and as such after receipt of the repudiation letter, the complainant got served a legal notice dated 26.10.2016 Ex.C-7 upon the OPs, who sent the reply thereto. The learned counsel for the Ops has vehemently contended that the claim of the complainant has rightly been repudiated, but we are unable to go with such a contention, as we have perused the copy of Discharge against Medical Advice Ex.OP-4, which has not been signed by any representative of the complainant and has only been signed by one Dr. Bhupinder Singh DM (Cardiology), whereas the columns of other five persons are lying blank, meaning there are no signatures of other five doctors. We may mention that Dr. Bhupinder Singh, DM Cardiology, DMCH Ludhiana also appeared on 28.4.2017 for cross examination, wherein he has clearly stated that the patient was suffering from hypertension for the last one year and diabetic for the last twenty years, but we may mention that diabetic and hypertension are the normal things and the same are not the diseases. During cross examination it has been admitted by Dr. Bhupinder Singh that there are no signatures of patient in the record, meaning thereby the Ops have not produced any cogent, reliable and trustworthy evidence on record to show that the DLA was suffering from any such chronic diseases as mentioned by the Ops in the repudiation letter. The learned counsel for the complainant has cited National Insurance Company Limited versus Suraj Parkash 2005(2) CPJ 3 (Punjab State Commission), wherein the claim of the complainant was repudiated on the ground of suppression of pre existing disease. The complainant filed the complaint which was allowed by the District Forum. Hence, the appeal. In the appeal, it was held that there was no evidence produced in support that the complainant knew about disease at the time of taking the policy and it was held that the complaint was rightly allowed by the District Forum. Similarly, in another case namely Life Insurance Corporation of India versus Sheetla Devi 2011(1) CPJ 128 (HP State Commission), wherein it has been held that high blood pressure is not a serious disease and it is a part of ordinary stress and strain. As per the law laid down by the Supreme Court of India, section 45 is applicable only in cases of deliberate concealment of facts/fraud made by policy holder, but in view of the oral and documentary evidence which had come on record, this case does not come within the ambit of suppression of material facts/fraud by policy holder, where upon policy can be repudiated by appellants and as such repudiation of the policy is not legally warranted in present case. On the other hand, the learned counsel for the Ops has also cited Life Insurance Corporation of India versus Gurpreet Kaur 2016(2) CLT 196, wherein the claim of the insurance was repudiated by the opposite parties on the ground that the complainant suppressed the material information with regard to his earlier policy, in case, he would have disclosed this fact, insurer might have refused to accept the proposal or might have undergone more test of insured before issuing the policy in question. But, in the present case, there are no such circumstances. Another point in the case supra Life Insurance Corporation of India versus Gurpreet Kaur was that the death of insured was due to cardiac arrest. The case of the insured was a known case of seizures for the last 20 years and an old case of Epilepsy with bronchial asthma. No affidavit of treating doctor has been placed on the record. Epilepsy is not fatal. It is a disease of intermittent nature which could be kept under control by medicines. Insured was suffering from Epilepsy for the last 20 years. If it had been fatal, he would have not survived for such a long time. Therefore, suppression of Epilepsy disease is not sufficient for the appellants to repudiate the claim. The same is the position in the present case, if the DLA was a diabetic for the last 20 years, then he would not have survived for such a long time. In the circumstances of the case in hand, we are of the considered opinion that the Ops are not justified in repudiating the rightful claim of the complainant. Moreover, the Ops have not produced any supporting evidence to show that the DLA was suffering from various diseases as mentioned above.
7. Now, coming to the point of quantum of compensation payable to the complainant. The complainant has claimed an amount of Rs.3,50,000/-, whereas the insurance policy is only for Rs.3,00,000/-. There is no explanation from the side of the complainant that why he did so and claimed an amount of Rs.3,50,000/-.
8. So, in view of our above discussion, we find it to be a case of deficiency in service and accordingly, we allow the complaint and direct OPs to pay to the complainant an amount of Rs.3,00,000/- along with 9% interest from the date of repudiation of the claim i.e. 31.3.2016 till realisation in full. We further direct OPs to pay to the complainant a sum of Rs.10,000/- on account of compensation for mental tension, agony and harassment and a sum of Rs.5,000/- as litigation expenses. This order of ours shall be complied with by the OPs within a period of thirty days of receipt of a copy of this order. A copy of the order be issued to the parties free of cost. File be consigned to records.
Pronounced.
May 10, 2017.
(Sukhpal Singh Gill)
President
(Sarita Garg)
Member
(Vinod Kumar Gulati)
Member
