BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, JALANDHAR.

Complaint No.26 of 2018

      Date of Instt. 12.01.2018

      Date of Decision: 18.01.2022

Gurbax Kaur aged about 58 years Wd/O Joginder Singh, S/O Dogar Singh, Village Khojewal, Post Office Khaira Majja District Kapurthala.

..........Complainant

Versus

1.       Life Insurance Corporation of India, Divisional Office, “Jeevan         Prakash” Model Town Road, Jalandhar-144001, through its          Senior Divisional Manager.

2.       Life Insurance Corporation of India, Branch Office, “Jeevan Jyoti      Builsing”, Model Town, Near Water Pump, Kapurthala, through     its Branch Manager.

3.       Manager (Claims), Life Insurance Corporation of India, Divisional Office, “Jeevan Prakash” Model Town Road,   Jalandhar-144001.

4.       Manager (NB/Act) Life Insurance Corporation of India, Divisional Office, van Prakash, Model Town Road, Jalandhar- 144001

5.       Manager (CRM)/Central Public Information Office, Jalandhar Division, Life Insurance Corporation of India, Divisional Office,      “Jeevan Prakash” Model Town Road, Jalandhar-14401

6.       Balbir Singh, Agent/Agency code No.10572152, Life Insurance        Corporation of India, Branch Office, Village Bhandara Dona,       Post Office Sidhwan Dona, District Kapurthala.

….….. Opposite Parties

Complaint Under the Consumer Protection Act.

Before:        Dr. Harveen Bhardwaj             (President)

                   Smt. Jyotsna                            (Member)                                          

Present:       Smt. Harleen Kaur, Adv. Counsel for the Complainant.

                   Sh. Jasbir Singh, Adv. Counsel for the OPs No.1 to 5.

                   OP No.6 Given up.

Order

Dr. Harveen Bhardwaj (President

1.                The instant complaint has been filed by the complainant, wherein it is alleged that the complainant is wife of Joginder Singh, life assured (since deceased), who whilst alive was having life insurance policy on his life bearing No.133414278 for Rs.5,00,000/- sum assured obtained through authorized agent OP No.6 whose agency attached under Sh. Mukesh Anand, Development Office Code No.2337013 working in Branch Office of OP No.2 under the administrative and supervisory control of OP No.1. Proposal Form was dated 03.01.2012 was registered under number 27134 in Proposal Register by OP No.2. The policy was under Plan Jeevan Anand (With Profits) (With Accident Benefit) Table and Term 149/45/16. The risk under the policy was covered from 10.01.2012 with date of commencement 28.10.2011. The half yearly installment for an amount of Rs.22,982/- premium was paid regularly without any default on due date. That signature of DLA on blank prescribed Proposal Form No.300 printed in bilingual in English and Hindi was taken in routinely and mechanically on dotted lines. DLA had perfect and good health profile and insurability with no trace of physical impairment and pre existing disease and ill health at the time DLA was induced for life insurance policy. DLA was semi literate and studied to middle class standard, DLA signed Proposal Form and other related documents in Punjabi language since DLA was not conversant with English language and as such could not write read and sign in English language. That proposal for life insurance policy was under medical scheme. DLA underwent through, complete, comprehensive and careful medical checkup by panel doctor (Medical Exminer) of choice of OP No.2 at the time of submission of proposal for own life insurance and additional special medical test reports relating to health profile were also obtained. DLA good and perfect health, age insurability as Standard life with no trace of any physical impairment and disease/illness after clinical and physical check up and special test reports was duly certified by the panel doctor in prescribed medical examination in Form No.300 in answer to the specific query/question. The panel medical examiner further categorically certified that the panel medical examiner did not notice/observe any adverse feature of post history and habit or existence of any other complaint/complication and that the panel doctor had examined DLA personally in private and recorded true findings in his own hand on the eve of proposing for life insurance. That OP No.2 after scrutiny and verifying particulars of proposal form, medical examination and special additional medical reports on requisite prescribed forms also obtained Agent’s Confidential Report/Moral Hazard Report from securing agent and development Officer and after fully satisfying as to health and habits, physical condition and insurability and age of DLA evaluated and underwritten proposal on Prescribed Proposal Review Form for acceptance of risk of policy for RS.5,00,000/- sum assured fully described foregoing para of the complaint. That to misfortune and ill luck of the complainant, DLA expired on 16.09.2014 premature. The cause of death was sudden heart attack. That subsequent to death of DLA, the complainant lodged claim by death for paying claim amount of Rs.5,00,000/- sum assured with bonus accrued thereon and other benefits with OP No.2, but the claim had been repudiated vide repudiation letter dated 29.03.2017. The claim had been repudiated after expiry of statutory period of two years from the date life insurance policy was “effected”. Obviously, the provisions of Second Part of Section 45 of Insurance Act, 1938 were attracted because DLA expired on 16.09.2014 much before 26.12.2016, the deemed date insurance laws has come into force. However, OP No.1 erroneously perversely and illegally invoked the provisions of Section 45 of Insurance Laws which is not applicable and attracted to the policy resulted into death claim before coming into force on deemed date 26.12.2016 of the said Act arbitrary and malafide with oblique motive. The repudiation of liability of policy subject matter of complaint is vitiated and void and not binding on the complainant in any manner. On this ground alone repudiation of claim of Life Insurance Policy is not sustainable. The OPs are guilty of deficiency in rendering service, negligent and resorting to unfair trade practices as envisaged under the provisions of the Act and as such, the present complaint filed with the prayer that the complaint of the complainant may kindly be accepted and OPs be directed to pay claim of Rs.5,00,000/- total sum assured with vested bonus as per terms and conditions of the policy with interest @ 12% per annum from the date of death upto the date of actual payment to the complainant. Further OPs be directed to payRs.2,00,000/- as compensation 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 and accordingly, all the OPs except OP No.6 as he died, appeared through its counsel and filed joint written reply and contested the complaint by taking preliminary objections that no ground is made out for allowing the complaint, so on this score alone, 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. It is further averred 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. It is further submitted that the policy was taken in the name of Joginder Singh for a sum assured of Rs.5,00,000/- and the same was commenced on 28.10.2011 and date of risk 10.01.2012 with the table term 149-16 and the mode of payment of premium was half yearly and the duration of the policy was 2 years 8 months, the FUP was 10/2014. On merits, the factum in regard to taking life insurance policy by the husband of the complainant is admitted, 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.                In order to prove the case of the complainant, the counsel for the complainant tendered into evidence affidavit of the complainant Ex.CA and Ex.CB alongwith some other documents Ex.C-1 to Ex.C-10 and then closed the evidence of the complainant.

4.                In order to rebut the evidence of the complainant, the counsel for the OPs No.1 to 5 tendered into evidence Ex.OPA alongwith some documents Ex.OP-1 to Ex.OP-8 and closed the evidence.

5.                We have heard the learned counsel for the respective parties and have also gone through the case file as well as written arguments submitted by counsel for the complainant very minutely.

6.                The fact of purchasing the insurance policy by the husband of the complainant is an admitted fact. The policy commenced from 28.10.2011 and the half yearly installment of the amount of Rs.22,982/- was a premium, which was paid regularly. As per the case of the complainant, the husband of the complainant died on 16.09.2014, when the policy was in force. The claim form was submitted by the complainant, which was repudiated by the OPs by taking the plea that the deceased had suppressed the material facts from the OPs and the policy had not completed three years from the date of commencement, therefore as per the provisions of Section 45 of the Insurance Act, the claim was repudiated.

7.                As per the contention of the learned counsel for the complainant, the claim has wrongly been repudiated as the original documents were not traceable with the OPs. Without the original policy and without going through the documents, the repudiation has been done by the OPs wrongly. The OPs themselves have admitted in reply to the RTI application filed by the complainant Ex.C-2 that the case file of the complainant is not traceable and the desire information related to said policy documents cannot be provided. As per Ex.C-1, the repudiation letter, it has been mentioned that as per record certain medical tests were required for evaluation of the risk profile of the proponent Sh. Joginder Singh at the time of proposal, but these medical requirements were not completed by him. It was the duty of the OPs to get all the medical tests done at the time of issuing the policy. As per the queries made by the LIC, the state of health of the complainant was stated to be good as per Ex.C-1 their own letter, if they had any doubt about the state of health of the complainant, the OPs could have completed all the medical tests, but nothing was got done by the OPs. This is not the case of the OPs that the complainant has refused to get the tests done. Ex.C-2 is the reply to the RTI and query no.5 and 6 shows that the information was not provided as the original case file of the complainant was not available. There is the statement of Resham Singh, which clearly shows that Joginder Singh was having good health and he died suddenly, which is Ex.OP-4. Therefore, the contention that the deceased did not disclose the true facts, is not tenable. The OPs have not led any evidence to show as to how the insured has not disclosed the true facts about his health.

8.                The OPs in the written statement have alleged that the claim of the complainant was repudiated as the policy had not completed three years from the date of commencement as per the provisions of Section 45 of Insurance Act, 1938. As per Section 45 of the Insurance Act, 1938, no policy of life insurance shall, after the expiry of two years from the date on which it was effected, be called into question by an insurer on the ground that a statement made in the proposal form insurance was inaccurate or falls. The period of three years as alleged by the OPs is after the amendment of the Insurance Act in 2015. In the present case, the policy commenced from 28.10.2011 and the risk was covered from 10.01.2012. The husband of the complainant died on 16.09.2014 i.e. after the expiry of two years, meaning thereby that after two years, the policy could not be called into even on the ground of false information. The complainant has filed on record the documents i.e. death certificate of the deceased and all the documents showing the admission of the deceased and his condition at the time of admission and his death. Thus, the complainant has proved on record that the repudiation letter Ex.C-1 has been wrongly and illegally repudiated by the OPs and thus, the repudiation letter is hereby set-aside and further hold that the complainant is entitled for the relief claimed.

9.                In the light of above detailed discussion, the complaint of the complainant is partly allowed and OPs are directed to pay the life insurance claim amount of Rs.5,00,000/- total sum assured with vested Bonus as per terms and conditions of the policy alongwith interest @ 6% per annum from the date of repudiation the claim i.e. 29.03.2017, till realization. Further, OPs are directed to pay compensation of Rs.15,000/-, to the complainant for causing mental harassment and agony to the complainant and further, OPs are directed to pay litigation expenses of Rs.5000/-. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.

10.              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                                       Jyotsna                  Dr.Harveen Bhardwaj     

18.01.2022                    Member               President