Punjab

StateCommission

A/1522/2014

Malkiat Singh - Complainant(s)

Versus

Life Insurance Corporation of India - Opp.Party(s)

Sandeep Kumar and Kashmir Singh

05 Feb 2015

ORDER

2^nd Additional Bench

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB

DAKSHIN MARG, SECTOR 37-A, CHANDIGARH

 

First Appeal No.1522 of 2014

                                                           

                                   Date of institution: 20.11.2014  

                             Date of Decision:      5.2.2015

 

1. Malkiat Singh son of Darshan Singh
2. Jasbir Kaur wife of Malkiat Singh

Both residents of Village Ghogra, Tehsil Dasuya, District Hoshiarpur.

…..Appellants/Complainants

                                      Versus

1. Life Insurance Corporation of India Model Town Road, Jallandhar, through its Regional Manager.
2. Officer of Life Insurance Corporation of India, Dasuya, District Hoshiarpur, through its Branch Manager.

…..Respondents/Opposite Parties

 

First Appeal against the order dated 7.10.2014 passed by the District Consumer Disputes Redressal Forum, Hoshiarpur.

 

Quorum:-

 

              Shri Gurcharan Singh Saran, Presiding Judicial Member

              Shri Vinod Kumar Gupta, Member

 

Present:-

 

          For the appellants            :         Sh. Sandeep Kumar, Advocate

 

Gurcharan Singh Saran, Presiding Judicial Member

ORDER

The appellants/complainants (hereinafter referred as “the complainants”) have filed the present appeal against the order dated 7.10.2014 passed by the District Consumer Disputes Redressal Forum, Hoshiarpur(hereinafter referred as “the District Forum”) in consumer complaint No.123          dated 3.6.2014 vide which the complaint filed by the complainant was dismissed.

2.                The complaint was filed by the complainants under the Consumer Protection Act, 1986 (in short ‘the Act’) against the respondents/opposite parties(hereinafter referred as ‘the OPs’) on the allegations that Ranjit Singh son of the complainants got himself insured with the Ops vide policy No. 133544110 dated 25.5.2012, which was accepted by the Ops on 28.5.2012 whereas Ranjit Singh died natural death on 19.9.2012. Complainants approached the Ops to settle the claim and to pay the death claim. Any information sought by the Ops was answered. However, the Ops had wrongly repudiated the claim of the complainants. Before taking the policy, Ranjit Singh was subject to medical examination and he was found to be physically fit. Repudiation of the claim amounts to deficiency in service. Hence, the complaint with a direction to the Ops to pay death claim of Ranjit Singh to the extent of Rs. 10 lacs alongwith interest @ Rs.  25,000/- as damages, inconvenience and harassment caused to the complainant and Rs. 10,000/- as cost of the litigation.

3.                The complaint was contested by the Ops, who filed written reply taking preliminary objections that the life assured(hereinafter referred as ‘L.A.’)  had purchased the policy in question under Table term 164-15 by way of fraud and mis-representation. In fact the LA had met with an accident on 13.4.2012 and was admitted in Civil Hospital, Dasuya whereas the LA failed to disclose this fact in his proposal form. Otherwise in case he would have purchased Endowment Policy for 15 years then he would have to pay a sum of Rs. 70,000/- approximately as yearly premium, therefore, the LA had violated the principle of utmost faith and equity with the Ops while purchasing the policy; the complainants had not come to the Forum with clean hands and were estopped to file this complaint by their act and conduct. On merits also, purchasing of the policy was admitted but it was submitted that it was purchased by way of fraud and mis-representation by not disclosing that the LA had met with an accident before purchasing the policy. It was also not disclosed that he was admitted in Civil Hospital, Dasuya and DMC, Ludhiana and had taken the treatment. In case any policy was purchased by way of fraud and mis-representation then the complainants were not entitled to any amount under such policy and the claim was rightly repudiated by the Ops.

4.                The parties were allowed by the learned District Forum to lead their evidence.

5.                In support of his allegations, the complainant had tendered in evidence his affidavit Ex. C-1, death certificate of Ranjit Singh Mark C-2, policy Mark C-3, letter Mark C-4, receipt Mark C-5, certificate Mark C-6, ID proofs Mark C-7 to Mark C-9, letters Mark C-10 to Mark C-12, policy Mark C-13, affidavits of - Hardial Singh Ex. C-14, Smt. Shabnam Saini Ex. C-15 and documents Mark C-16 to Mark C-19. The OPs had tendered in evidence copy of bed head ticket Ex.OP-1, copy of form no.3816 Ex.OP-2 affidavits of H.S.Gupta Ex. OP-3  Ex.OP-4, Manish Angrish Ex. OP-5, claim inquiry report Ex. OP-6, copy of policy Ex. OP-7, copy of proposal form Ex. OP-8, repudiation letter Ex. OP-9, status report of policy Ex. OP-10, death intimation letter dated 3.1.2013 Ex. OP-11, letter to complainant dated 30.3.2013 Ex. OP-12, letter to LIC by complainant dated 12.4.2013 Ex. OP-13, letter to complainant dt.6.5.2013 Ex. OP-14, letter to complainant dt.28.5.2013 Ex. OP-15, letter to LIC by complainant dt.4.6.2013 Ex. OP-16, payment statement Ex. OP-17, form No.3784 Ex. OP-18, form no.3816 Ex. OP-19, letter dated 24.1.2013 to Manish Angrish Ex. OP-20, letter to Manager claims, Ludhiana by Manager claims, Jalandhar dt.31.1.2013 Ex. OP-21, letter by Manager claims Ludhiana to Manager claims Jalandhar 13.2.2013 Ex. OP-22, Medical examiner report Ex. OP-23 and closed the evidence.

6.                After going through the allegations in the complaint, written reply filed by the OPs, evidence and documents brought on the record, the complaint filed by the complainant was dismissed as the complainant had purchased the policy by way of mis-representation and fraud.

7.                In the appeal, the counsel for the appellants has contended that the order passed by the Forum is against the law and facts. The learned District Forum has wrongly relied upon the oral evidence. The Ops had examined Dr. Vinay Sharma and Dr. Ranjit Singh and that the learned District Forum had mis-read their statements and had not appreciated the factum of their cross-examination. Ranjit Singh died a natural death. The claim has been wrongly dismissed by the learned District Forum. The order be set-aside.

8.                In case we go through the evidence of Dr. Vinay Kumar and Dr. Ranjit Singh, which has been reproduced in the grounds of appeal, it will make it clear that patient Ranjit Singh, aged 21 years son of Malkit Singh was admitted in Civil Hospital, Dasuya, Distt. Hoshiarpur was admitted vide CR No. 2838 with the history of injuries in a road side accident, which took place near Raj Scan Centre, Dasuya on 13.4.2012 at 4.30 p.m. and finding the following injuries:-

“1.     Injury above right eye brow

2.      Two injuries on forehead above the right eyebrow.

3.      Injury on the middle upper part of nose.

4.      Injury near right lateral malleolus.

5.      Injury adjacent to lower side of above injury.

6.      Injury in front of right lateral malleolus.

7.      Injury on right foot.

8.      Injury below right knee.”

9.                Similarly, Dr. Ranjit Singh had also stated that on 13.4.2012 at 5.00 p.m. Ranjit Singh was admitted in Civil Hospital with history of road side accident. On 27.1.2014, he had filled up the form No. 3816 of LIC as per the record.

10.              Now the proposal form duly filled in by the life assured at the time of taking the policy has been placed on the record and in Column No. 11 in personal history, he has replied as under:-

11.	Personal History	Answer ‘Yes’ or ‘No’	If ‘Yes’ Please give full details
(a)	During the last five years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week.	No
(b)	Have you ever been admitted to any Hospital or nursing home for general check-up observation, treatment or operation?	No
(c)	Have you remained absent from place or work on grounds of health during last five years	No
(d)	Are you suffering from or have you ever suffered from ailments pertaining to liver, stomach, Heart, Lungs, Kidney, Brain or Nervous System	No
(e)	Are you suffering from or have you ever suffered from Diabetes, Tuberoculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease?	No
(f)	Do you have any bodily defect or deformity?	No
(g)	Do you ever have any accident or injury?	No
(h)	Do you use or have you ever used:
(1)	Alcoholic Drinks	No
(2)	Narcotics	No
(3)	Any other Drugs	No
(4)	Tobacco in any form	No
(i)	What has been your usual state of health?	Good

 

Therefore, he had concealed the material fact with regard to his accident and injuries received in the accident and he had also received the head injury and that may be the reason leading for the death of Ranjit Singh, otherwise, young man of 21 years with good health cannot die all of a sudden, therefore, we are of the opinion that at the time of purchasing the policy, the LA had concealed the material facts with regard to his injuries received in the accident and the treatment taken for those injuries. The contract of insurance is of utmost faith and in case the life assured had taken the policy violating the principle of utmost faith then the complainants are not entitled to any claim. A reference can be made to the judgment “Mithoolal Nayak Vs. Life Insurance Corporation of India” AIR 1962 SC 814 wherein it was held by the Hon’ble Apex Court that the fraudulent suppression of material facts by the insured did not create a binding contract between the parties. In another judgment “P.C. Chacko and another Vs. Life Insurance Corporation of India”, Civil Appeal No. 5322 of 2007 decided on 20.11.2007, the Hon’ble Supreme Court held that non-disclosure and mis-statement in the proposal form to the various questions to which the answers were given by the insured entitled the insurance company to repudiate the contract of insurance. Therefore, we are of the opinion that the learned District Forum has rightly appreciated the preposition in hand and correctly dismissed the complaint.

11.              The counsel for the appellants was not able to make out any point in his favour to admit the appeal, therefore, the appeal is hereby dismissed in limine.

12.              The arguments in this appeal were heard on 23.1.2015 and the order was reserved. Now the order be communicated to the parties as per rules.

 

 (Gurcharan Singh Saran)

Presiding Judicial Member

 

February 5, 2015.                                                                                                                                                          (Vinod Kumar Gupta)

as                                                                                                                                                                                                     Member