Punjab

Fatehgarh Sahib

CC/143/2014

Gurjinder singh - Complainant(s)

Versus

Life insurance corporation of india - Opp.Party(s)

Sh Hardev singh Rai

26 Sep 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHGARH SAHIB.

                         Consumer Complaint No.143 of 2014

                                                                Date of institution:  28.11.2014                                  

                                                              Date of decision   :  26.09.2016

Gurjinder Singh son of late Gurmukh Singh, resident of village Sarana, P.O. Chalela, Tehsil and District Fatehgarh Sahib.

……..Complainant

Versus

1. Life Insurance Corporation of India, Divisional office, " Jeevan Prakash" Sector 17-B, Chandigarh 160017 through its Senior Divisional Manager/Authorized person.
2. Life Insurance Corporation of India through its branch office, G.T.Road, Mandi Gobindgarh Tehsil Amloh, District Fatehgarh Sahib through its Area Manager/Authorized person.

 

 

 …..Opposite parties

     

Complaint under Sections 12 and  14 of the Consumer Protection Act

Quorum

                  

Smt. Veena Chahal, Member           

Sh. Amar Bhushan Aggarwal, Member

         

Present :      Sh. H.S.Rai, Adv. Cl. for the complainant

                Sh. M.L.Singhi, Adv.Cl. for OPs.    

 

 

 

ORDER

By Amar Bhushan Aggarwal, Member

                Complainant, Gurjinder Singh son of late Gurmukh Singh, resident of village Sarana, P.O. Chalela, Tehsil and District Fatehgarh Sahib, has filed this complaint against the Opposite parties (hereinafter referred to as “the OPs”) under Sections 12 and 14 of the Consumer Protection Act. The brief facts of the complaint are as under:

2.              The father of the complainant; namely Gurmukh Singh son of Amarjit Singh, took a LIC policy bearing No.165268969 for the sum assured of Rs.1,00,000/- from OP No.2 in the month of September 2012. He deposited Rs.3914/- as half yearly installment regularly and never defaulted in depositing the installment of the said policy.  The complainant is the nominee of said Gurmukh Singh, who was hale and hearty and was serving as Librarian Attendant in Govt. High School Panjoli Kalan, Tehsil and District Fatehgarh Sahib. The said Gurmukh Singh had no disease at all and was neither a drug addict nor chronic alcoholic.   At the time of taking the insurance policy he disclosed entire facts relating to his health to the  OPs by filing proposal      form.  On 12.10.2013 the said Gurmukh Singh died in Rajindra Hospital, Patiala   due to Jaundice. The disease occurred to said Gurmukh Singh about 15-20 days prior to his death. After the death of said Gurmukh Singh, the complainant filed a claim application, being his nominee, in the office of OP No.2 for obtaining the entire benefits of the said policy but the OPs were postponing the matter on one pretext or the other. Ultimately after due deliberation, OP No.1 issued letter dated 31.03.2014 informing the complainant that his insurance claim stands repudiated as said Gurmukh Singh suppressed the material facts relating to his diseases and health in proposal form by falsely mentioning that he had no disease and falsely stated that he bears a good health and he is not a alcoholic. The grounds mentioned in the said letter for repudiating the claim are false and bogus one and there is no truth in the same. The complainant time and again requested the OPs to disburse the claim but OPs again postponing the matter on the pretext that the case will be sent for reconsideration. The act and conduct of the OPs amounts to deficiency in service. Hence this complaint for giving directions to the OPs to pay Rs.1,00,000/- i.e. sum assured along with interest and further to pay Rs.20,000/- as damages, Rs.10,000/- as cost of harassment, Rs.3,300/- as counsel fee and Rs.1000/- as miscellaneous expenses.

3.             The complaint has been contested by the OPs, who filed joint written reply. In reply to the complaint OPs stated that as per record furnished by the complainant, said Gurmukh Singh expired on 12.10.2013. The deceased life assured (DLA) was not hale and hearty. He was a known case of Alcoholic liver disease(K/C/OLD) as he was chronic Alcoholic. The OPs got the certificate of medical treatment taken by said Gurmukh Singh from Rajindra Hospital , which shows that he concealed the true facts regarding his health affairs at the time of taking the policy. It is further stated that DLA was used to remain on earned leave for many times on health grounds, which shows that he was not hale and hearty and was Chronic Alcoholic.  It is further stated that the contract of insurance is based upon utmost faith and trust. The person taking the policy is supposed to fill up the true and correct information in the proposal form and he is also required to give declaration regarding the correctness of the proposal form but the DLA had not furnished the true detail of his health affairs; rather concealed the true and material facts knowingly and intentionally with the intention to commit fraud and to take the policy from the OPs. Hence, in terms of the policy contract and the declaration contained therein the form of proposal for assurance and personal statement are quite wrong and false. The death claim was accordingly repudiated. There is no deficiency in service on the part of the OPs. After denying the other allegations made in the complaint it prayed for dismissal of the complaint.

4.             In order to prove his case the complainant tendered in evidence his affidavit Ex. C-1, copy of repudiation letter Ex. C-2 and closed the evidence. In rebuttal the OPs tendered in evidence affidavit of Smt. Hemlata, Manager Legal, as Ex. OP-1, true copies of documents i.e. registered letter dated 31.03.2014 Ex. OP-2, policy Ex. OP-3, letter dated 03.01.2014 Ex. OP-4, reminder dated 18.02.2014 Ex. OP-5, status report Ex. OP-6, letter dated 06.03.2014 Ex. OP-7, discharge slip (5 pages) Ex. OP-8,   leave applications Ex. OP-9 to OP-12, letter dated 01.02.2014 Ex. OP-13,   leave applications Ex. OP-14 to OP-18, copy of certificate from Principal GSSS Panjoli Kalan, Ex. OP-19, certificate of employer Ex. OP-20, certified copy of detail of medical reimbursement pertaining to the period from 01.01.2010 to 12.10.2013 Ex. OP-24,  certified copies of application forms for leave Ex. OP-25 to OP-49, true copies of C.R. file No.28804/13(in 24 pages) as Ex. OP-50, true copies of treatment charts and OPD slips  Ex. OP-51 to OP-54, true copy of CR file No.32204/13( in 41 pages) Ex. OP-55 and closed the evidence.

5.             The Ld. counsel for the complainant argued that the father of the complainant had taken LIC policy in September 2012 but unluckily he died on 12.10.2013. The death claim was filed with the OPs but it was repudiated on false ground. The insured was hale and hearty at the time of taking insurance policy from the OPs and all facts were mentioned correctly in the proposal form. He did not suppress any material fact from the OPs. He was not suffering from any disease at the time of taking insurance policy. He was down with Jaundice about 15-20 days prior to his death, otherwise he had no disease. He had taken a few days medical leave when he was admitted in the Government Rajindera Hospital Patiala for the treatment of Jaundice. The Ld. counsel pleaded for the acceptance of this complaint and OPs be directed to make payment of insured amount alongwith interest, other benefits under policy alongwith compensation and litigation costs etc.

6.             On the other hand, the Ld. counsel for the OPs argued that the claim of the complainant has been rightly repudiated. That the contract of insurance is based upon utmost faith and trust. The person taking the policy is supposed to fill up the true and correct information in the proposal form. The policy holder has wrongly mentioned about his state of health, as he was suffering from certain diseases and was chronic alcoholic at the time of taking the insurance policy. The state of health & chronic alcoholic nature of the policy holder is evident from the hospital record and leave record and other record maintained by his employer. The OPs have not committed any deficiency in service and are not liable for payment of any death claim or other benefits. The Ld. counsel pleaded for dismissal of the complaint with heavy cost.

7.             After hearing the Ld.counsel for the parties and going through the pleadings, evidence produced by the parties and the oral arguments, we find that there is force in the plea of the Ld. counsel for the complainant. The insurance policy was taken on 24.09.2012 and the insured died on 12.10.2013. He remained on medical leave from 22.08.2013 to 12.10.2013(the date of death) and was admitted in the Govt. Rajindra Hospital, Patiala from 29.08.2013 to 09.09.2013 and from 21.09.2013 to 06.10.2013. There is no certificate or document available on record showing cause of death of deceased. Furthermore, mere concealment of some facts will not amount to concealment of material facts. It was laid down by the Hon'ble Supreme Court in case titled as Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd (2009) 8 SCC 316 that "Any fact, which goes to the root of the contract of insurance and has a bearing on the risk involved would be "material" and if the proposer has knowledge of such fact, he is obliged to disclose it, particularly while answering questions in the proposal form. Any inaccurate answer will entitle the insurer to repudiate their liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance". It was also laid down by the Hon'ble Supreme Court in the judgment reported as Mithoolal Nayak Vs. Life Insurance Corporation of India, AIR 1962 SC 814, "that it is not the concealment of every fact which entitles the insurance company to repudiate the insurance claim. For this purpose, the insurance company has to prove that the information suppressed by the insured was material and that it was suppressed by the insured with fraudulent intention".

8.             The OPs in the repudiation letter Ex. OP-2 had submitted that the insured in the proposal for assurance dated 24.09.2012 had answered the following questions:-

a	Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease?	NO
b	Do you use or have you ever used (i) Alcoholic drinks	NO
c	What has been your usual state of health?	Good

In the admission/discharge certificate of the Govt. Rajindra Hospital, Patiala, there is no mention of the disease mentioned above except chronic alcoholic. There is no proof that deceased died due to any of the above mentioned diseases. Thus, there was no concealment of material fact, as held by the Hon'ble Supreme Court in the above mentioned Judgment titled as Mithoolal Nayak Vs. Life Insurance Corporation of India(Supra), "that it is not the concealment of every fact which entitles the insurance company to repudiate the insurance claim".

9.             The affidavit submitted by the OP No.1, Ex. OP-1, page 1 para 1 reads as, " said Gurmukh Singh expired on 12.10.2013 after one month and twenty eight days taking the policy", which is a wrong fact. Actually the insured died after more than one year. He took the policy on 24.09.2012 and died on 12.10.2013. Thus, the OPs have misstated the facts on oath in their affidavit.

                Moreover, there is no document available on record, which shows that the insured died due to any of the above mentioned diseases.

10.                    In view of the above discussion we accept the present complaint and find that the OPs have committed deficiency in service by not paying the claim to the complainant. Hence, we direct the OPs to pay Rs.1,00,000/-(Rs. One lac), i.e. the sum assured alongwith interest @ 6% per annum from the date of repudiation i.e. 31.03.2014 till its realization and any other benefit payable under the said policy to the complainant. The complainant is also held entitled to the damages suffered by him on account of deficiency in service, harassment and mental agony. The damages are assessed at Rs.5000/- and litigation cost of Rs.3000/-.

11.                    The arguments on the complaint were heard on 19.09.2016 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.

Pronounced

Dated:26.09.2016

 

(Veena Chahal)

Member

                                                                                                                                                                                                            (A.B.Aggarwal)

                                                                                    Member