DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> C.C.No.203 of 18.7.2007<br /> Decided on : 30.11.2007 <br /> <br /> Jassi Ram S/o Sh. Babu Ram, R/o House No. C-386, IV type, Thermal Colony, Bathinda, Tehsil & District Bathinda.<br /> ...... Complainant<br /> <br /> Versus. <br /> <br /> 1.Life Insurance Corporation of India, Jeevan Jyoti Building, Bibiwala Road, Bathinda through its Branch Manager.<br /> 2.Life Insurance Corporation of India, Divisional Office, Ludhiana through its Divisional Manager.<br /> 3.Life Insurance Corporation of India, Norther Zonal Office, Jeevan Bharti, P.B. No. 630, Connaught Circus, New Delhi though its Zonal Manager.<br /> ...... Opposite parties<br /> <br /> Complaint under section 12 of the Consumer Protection Act, 1986<br /> <br /> QUORUM:<br /> <br /> Sh.Hira Lal Kumar, Member<br /> Dr.Phulinder Preet, Member<br /> <br /> For the complainant : Sh. H.S Joga, Advocate<br /> For the opposite party : Sh. Inderjit Singh, Advocate <br /> <br /> O R D E R.<br /> <br /> HIRA LAL KUMAR, MEMBER:- <br /> 1. Instant complaint has been filed under section 12 of the Consumer Protection Act, 1986 (Here-in-after referred to as the Act) by the complainant seeking direction from this Forum to the opposite parties for making payment to the tune of Rs.50,000/- of insurance policy alongwith interest and also compensation of Rs. 40,000/-.<br /> 2. The facts in brief enshrined in the complaint are that the wife of the complainant namely Devki Devi (now deceased) was a policy holder of Life Insurance Corporation of India. The policy was issued by its branch office at Bathinda for Rs.50,000/- starting from 28.3.2003 and she had been regularly paying premium to the opposite parties. Complainant is the nominee of the said policy. Due to non informing by the opposite parties regarding due date of premium of the above policy, the wife of the complainant could not deposit the premium of the policy within time. Therefore, the policy had lapsed in the month of March, 2005, but it was again got revived after paying due amount alongwith late fee on 13.3.2006 vide receipt No. 915659. Wife of the complainant namely Devki Devi had expired on 3.4.2006 and the opposite parties were informed about her death. He has applied for claim alongwith the requisite documents. The opposite parties vide letter dated 31.10.2006 rejected the claim without giving any explanation to the complainant. Complainant subsequently addressed a letter to the opposite parties on 30.11.2006 seeking clarification and documents on the basis of which the claim of the complainant has been rejected. Complainant received letter No. AP-4399 dated 5.12.2006 from opposite party No. 3 mentioning therein that the documents have been demanded from their Ludhiana office (opposite party No. 2). As and when the said documents are received by opposite party No. 3, the same will be supplied to the complainant. It has been further mentioned that complainant got revived the said policy on 8.3.2006 by depositing the requisite premium alongwith late fee for the purpose. At the time of issuing the said policy, policy holder was medically checked by the doctor deputed by the opposite parties who had given fitness certificate regarding her health and that she was not suffering from any disease. Legal notice was served upon the opposite parties on 1.3.2007, but till today, opposite parties have not taken any action in this regard. Thus, mental<br /> <br /> tension and harassment have occurred by the act of the opposite parties.<br /> 3. On notice, opposite parties submitted reply taking legal objections; that this Forum has got no jurisdiction to try and entertain the present complaint as deceased Devki Devi has not disclosed the true and correct facts at the time of revival of her policy and has thus, concealed true facts; contract of insurance including the contract of life insurance are contracts of “Oberima fides”; claim of the complainant has been rightly repudiated after thorough investigation keeping in view the terms and conditions of the policy; intricate questions of law and facts are involved which require voluminous and detailed evidence to be produced by the parties; complainant does not fall within the definition of consumer and he has got no locus-standi and cause of action to file the present complaint. On merits, it has been mentioned that the complainant is not a consumer and that all the legal heirs of the deceased have not been brought on record as parties. The policy in question was effective from 28.3.2003 and the deceased was to deposit regular premium instalments. Devki Devi failed to deposit the instalments and the policy was lapsed. The policy was revived and the policy holder was asked to submit her personal statement regarding her health and other documents for reviving the policy. She deliberately made mis-statement regarding her health against medical record produced on file. In view of concealment of facts, the claim of the complainant has been repudiated vide letter dated 31.10.2006. The complainant has also approached Zonal Office Review Committee against the order of repudiation dated 31.10.2006 and the Zonal Office Review Committee upheld the order of repudiation, thus making the order of repudiation as final. Legal notice was not received by the opposite parties. Hence, it is denied. In view of the above reply alongwith the medical evidence, the repudiation of claim has been rightly ordered. The complaint may be dismissed with costs.<br /> <br /> 4. In support of his allegations and averments in the complaint, Jassi Ram complainant tendered into evidence his own affidavits (Ex.C.1 & Ex.C.2), photocopies of receipts regarding payment of premium (Ex.C.3 to Ex.C.6), photocopy of Ordinary Revival Quotation (Ex.C.7), photocopies of letters dated 5.12.2006 & 31.10.2006 (Ex.C.8 & Ex.C.9), photocopy of legal notice dated 1.3.2007 (Ex.C.10), photocopies of postal receipts (Ex.C.11), photocopy of policy (Ex.C.12), photocopy of proposal for insurance (Ex.C.13) and photocopies of Medical Examiner's Confidential Reports dated 31.3.2003 & 13.3.2006 (Ex.C.14 & Ex.C.15).<br /> 5. On behalf of the opposite parties, reliance has been placed on affidavit (Ex.R.1) of Sh. J.P Arya, Manager Legal, photocopies of letters dated 20.7.2007, 31.10.2007and 8.3.2006 (Ex.R.2, Ex.R.3 & Ex.R.13), photocopy of certificate of hospital treatment (Ex.R.4), photocopy of Admission Record (Ex.R.5), photocopy of OPD Slip (Ex.R.6 & Ex.R.7), photocopy of Lab Report (Ex.R.8), photocopy of admission slip dated 14.3.2006 (Ex.R.9), photocopy of one page of Indoor Record of Civil Hospital, Bathinda (Ex.R.10 to Ex.R.12), photocopy of Medical Examiner's Confidential Report (Ex.R.14), photocopy of personal statement (Ex.R.15), photocopy of policy alongwith terms and conditions (Ex.R.16) and photocopy of proposal form (Ex.R.17). <br /> 6. We have heard the learned counsel for the parties and gone through the record. Apart from this, we have considered written arguments submitted by the parties. <br /> 7. Learned counsel for the complainant has reiterated the version of the complainant mentioned above. It was argued that the policy in dispute was revived on 13.3.2006 after depositing requisite amount alongwith late fee. The policy holder died on 3.4.2006. The complainant being nominee of the insured submitted claim to the opposite parties and the claim was repudiated<br /> <br /> by the opposite parties vide their letter dated 31.10.2006 on the ground that the illness was concealed by the policy holder. It has been contended that since policy dates back to 2003, there is nothing regarding illness within two years of the date of policy. The doctor of the opposite parties carried out medical check up and there was nothing adverse regarding the health of the deceased (policy holder) the repudiation could not have been ordered by the opposite parties. In the absence of any medical report, the repudiation is bad as per the rules and regulations of the opposite parties. The complainant is entitled to payment of the policy alongwith interest.<br /> 8. Learned counsel for opposite parties argued that the policy holder had failed to deposit the instalment of the policy and thus, the policy had elapsed and the same was revived on 13.3.2006. It was further argued that the deceased-insured remained under treatment in the Civil Hospital, but she did not disclose that she took treatment on 6.3.2006 and had undergone medical test on 10.3.2006. This fact was not declared at the time of renewal/revival of the policy. In this connection, our attention was invited to Ex.R.4 certificate of hospital treatment according to which the insured was admitted in the hospital 14.3.2006 and duration of the disease was reported as 15 to 20 days back and Ex.R.8 medical test got conducted from Mittal Laboratory on 10.3.2006. Further attention was invited to Ex.R.5 cover note of the Indoor File in which date of admission is 14.3.2006 and on 15.3.2006 patient left the hospital against medical advice (LAMA). All these facts were not brought to the notice of the opposite parties. Thus, concealment of facts has been made by the insured while renewing the policy. Even complainant approached Zonal Office Review Committee against the order of repudiation dated 31.10.2006 and the said authority also upheld the repudiation order passed by the opposite parties vide order dated 12.7.2006. In order to fortify his arguments, learned counsel for the opposite parties drew our attention to the rulings Ashok Kumar Gupta Vs. Life Insurance Corporation of India through Sr. Divisional Manager-2004(3)CLT-319, LIC of India and another Vs. Naveen Dhingra-2003(2)CLT-199, Prema and others Vs. Life Insurance Corporation of India Ltd.-2006(3)CLT-574 and Goparatnam and others Vs. LIC of India and others-2005(2)CLT-174. In the ruling cited as 2003(2)CLT-199, it has been held that repudiation was ordered on account of suppression of information of illness at the time of revival of policy and that the repudiation was held to be valid by the Hon'ble National Commission. Similar view has been expressed by the Hon'ble National Commission in ruling cited as 2006(3)CLT-574(N.C). All the above rulings are very much applicable to the position and circumstances of the present case. Complainant is not entitled to any claim and that the repudiation has been correctly made out. Complaint may be dismissed.<br /> 9. We have considered the arguments of both the parties and have also given our thoughtful consideration to the written arguments as well as evidence brought on file. As per medical record brought on file (Ex.R.4, Ex.R.5 & Ex.R.8), it is quite clear that the insured remained under treatment even before the renewal/revival of the policy. The assured was suffering from chronic renal disease and had undergone treatment for the same as indicated above. The insured remained under treatment before and after renewal/revival of the policy for the same chronic disease. As regards the law, above cited rulings are fully applicable to the position and circumstances of the present case. Even higher authority of LIC i.e. Zonal Office Review Committee has also declared the repudiation of the claim as valid on the facts of concealment of chronic disease by the insured. Under these circumstances, we are of the considered view that it is a fit case where the complainant is not entitled to payment of any claim in view of the medical evidence as well as prevalent settled law on the subject. <br /> 10. Viewed in this context, complaint is meritless and the same is hereby dismissed with no order as to costs. Copy of this order be sent to the parties free of cost. File be also consigned. <br /> <br /> Pronounced (Hira Lal Kumar)<br /> 30.11.2007 Member<br /> <br /> <br /> (Dr.Phulinder Preet)<br /> Member <br /> <br /> 'bsg' <br /> <br /> <br /> <br />