Haryana

Yamunanagar

CC/691/2012

Meena W/o Raj Kumar - Complainant(s)

Versus

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

Charan Singh

18 Apr 2016

ORDER

BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR AT JAGADHRI.

                                                                                                Complaint No. 691 of 2012.

                                                                                                Date of institution: 04.07.2012

                                                                                                Date of decision: 18.04.2016.

Meena aged about 32 years wife of late Sh. Raj Kumar C/o Somvati, H. No. 1348, Gomti Gali, Jagadhri, District Yamuna Nagar.                                                                                                                                                                                               …Complainant.

                                    Versus

1. Life Insurance Corporation of India, SCo No.184-185, Sector-17, HUDA, Jagadhri, District Yamuna Nagar through its Branch Manager.
2. Life Insurance Corporation of India, Jeevan Bharati, Connaught Circus, New Delhi through its Zonal Manager. 

                                                                                                                                                                                   …Respondents.

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT.

                        SH. S.C.SHARMA, MEMBER.

 

Present:           Sh.  Charan Singh, Advocate, counsel for complainant.

                        Sh. Rajiv Gupta, Advocate, counsel for respondents.

 

ORDER

 

1.                     Complainant Smt. Meena wife of insured Sh. Raj Kumar has filed the present complaint under section 12 of the Consumer Protection 1986 praying therein that the respondents (hereinafter referred as OPs) be directed to make the payment of Rs. 62,500/- on account of death of her husband according to the policy alongwith interest and further to pay Rs. 50,000/- as compensation for mental agony, harassment as well as Rs.5,000/- as cost of proceedings.

2.                     Brief facts of the present complaint, as alleged by the complainant, are that the husband of the complainant Sh. Raj Kumar was insured with the Ops vide policy bearing No. 177544842 with secured amount of Rs. 62,500/- and had made the payment of Rs. 789/- as premium vide receipt dated 25.4.2011 (Annexure C-17). After purchasing the said insurance policy, the husband of the complainant expired on 26.04.2011 at PGI, Chandigarh, due to severe abdomen pain, which is evident from Annexure C-15. After the death of her husband, the complainant lodged her claim with the OPs being the legal heir of deceased Raj Kumar and submitted all the requisite documents with the Ops i.e. original life insurance cover note and other relevant documents. Thereafter, the complainant repeatedly pursued her claim but it was very astonished to her when he received a letter dated 08.05.2012 (Annexure C-1) vide which the OPs have repudiated the claim of the complainant on the ground that at the time of purchase of said insurance policy, the deceased withheld the correct information regarding his health. After receipt of said repudiation letter, the complainant immediately approached the OPs but the OPs did not behave properly with the complainant rather insulted her and told that once they repudiate the claim of complainant then no one can force them to revert their decision. Hence this complaint.   

3.                     Upon notice, OPs appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable, no negligence or deficiency in services on the part of OPs, complainant is not the sole legal heir of deceased and the complaint is bad on account of non joinder and mis joinder of necessary and proper parties and on merit it has been mentioned that the deceased life assured Raj Kumar had obtained  life insurance policy bearing No. 177544842 from the OPs for a sum of Rs. 62,500/- date of commencement was 25.4.2011 under term and table 165-16-16 on payment of first quarterly premium of Rs. 789/-. The life assured expired on the very next day of taking of insurance policy i.e. 26.04.2011. On lodging of claim by complainant, the claim was investigated being very early in nature as the policy had run only for one day from the date of risk. The medical record was collected and it was found that the deceased life assured was not keeping good health before taking of insurance policy on 25.4.2011 and this fact was concealed by the life assured at the time of proposing for insurance and he gave false answers in respect of his state of health in the proposal form. The life assured was suffering from severe abdomen pain and he was hospitalized on the very same day i.e. on 25.04.2011 in Civil Hospital, Jagadhri and he was brought in emergency in Civil Hospital Jagadhri with the complaint of severe pain in abdomen and he was referred to Govt. Medical College Hospital, Sector 32, Chandigarh, where he died on 26.4.2011. The life assured suppressed the material facts regarding his state of health from the Life Insurance Corporation of India to defraud it and obtained the insurance policy by misrepresentation and by giving false statement regarding his state of health. By reaching a final conclusion a letter dated 23.12.2011 was written by the OPs to the complainant to submit necessary documents. On receipt of the medical record the OPs arrived at the conclusion as stated above that the life assured was not having good health at the time of proposing for insurance which he did not disclose, therefore, the OPs vide its letter dated 08.05.2012 repudiated the claim of complainant legally and justifiably. Lastly prayed for dismissal of complaint.

4.                     To prove the case, counsel for complainant tendered into evidence affidavits of complainant  as Annexure CX & CY  and documents such as Photo copy of claim repudiation letter dated 08.05.2012 as Annexure C-1, Photo copy of letter for clarification on repudiation as Annexure C-2, Photo copy of receipt of premium as Annexure C-3, Photo copy of Discharge slip of General Hospital, Jagadhri as Annexure C-4, Photo copy of death report issued by GMC&H, Sector 32, Chandigarh as Annexure C-5, Photo copy of certificate issued by Medical officer, Civil Hospital, Jagadhri as Annexure C-6, Photo copy of medical certificate as Annexure C-7,  Photo copy of identification & cremation certificate as Annexure C-8, Photo copy of claim form as Annexure C-9, Photo copy of status report of policy as Annexure C-10, Photo copy of statement of Sh. Pardeep Kumar son of Sh. Kishori Lal as Annexure C-11, Photo copy of statement of Arun Kumar son of Sh. Rajinder Kumar as Annexure C-12, Photo copy of statement of Vinay Kumar son of Sh. Ravinder Kumar as Annexure C-13, Photo copy of statement of Tara Chand son of Sh. Mange ram as Annexure C-14, Photo copy of death certificate as Annexure C-15, Photo copy of letter dated 23.12.2011 as Annexure C-16, First Premium Receipt as Annexure C-17, Death Certificate as Annexure C-18, Photo copy of ration card as Annexure C-19 and closed the  evidence on behalf of complainant.

5.                     On the other hand, counsel for the OPs tendered into evidence affidavit of P.K.Sexena, Manager Legal, Life Insurance Corporation of India as Annexure RX and documents such as Photo copy of claim repudiation letter dated 08.05.2012 as Annexure r-1, Photo copy of Insurance Policy as Annexure R-2, Photo copy of certificate of Hospital treatment as Annexure R-3, Photo copy of discharge slip as Annexure R-4, Photo copy of death report as Annexure R-5, Photo copy of certificate issued by Medical Office, Civil Hospital, Jagadhri as Annexure R-6, Photo copy of status report of policy as Annexure R-7, Photo copy of death certificate as Annexure R-8  and in additional evidence tendered into evidence Proposal form Annexure R-9 and attested photocopy of admission register of hospital Annexure R-10 and  closed the evidence on behalf of OPs Insurance Company.

6.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully. The counsel for the complainant reiterated the averments mentioned in the complaint and prayed for its acceptance whereas the counsel for OPs reiterated the averments made in the reply and prayed for dismissal of complaint.

7.                     It is admitted fact that the husband of the complainant purchased a life insurance policy bearing No. 177544842 and paid a premium of Rs. 789/- for a sum of Rs. 62,500/-, which is evident from Annexure C-17/R-2. It is also not disputed that the husband of the complainant died on the very next day from the date of commencement of policy due to severe abdomen pain, which is evident from Annexure C-18/R-8. It is further not disputed that a claim was lodged with the OPs Insurance Company on account of death of Sh. Raj Kumar husband of complainant.

8.                     The only plea of the OPs Insurance Company is that the husband of complainant obtained the insurance policy on 25.04.2011 from Jagadhri and died on 26.04.2011 at Government Medical College & Hospital Sector 32, Chandigarh  by playing fraud and suppressing the material facts regarding his state of health from the Life Insurance Corporation of India and hence in terms of the policy contract and the declaration contained in the forms of proposal for assurance, the claim of the complainant has rightly been repudiated and lastly prayed that there is no deficiency in service on the part of OPs Insurance Company and the complaint of the complainant is liable to be dismissed. Learned counsel for the Ops referred the case law titled as Smt. Vidya Devi etc. Versus Life Insurance Corporation of India, 2002 (1) CPC page 159 wherein it has been held that Insurance policy- concealment of disease- Two Double Benefit Life Policies obtained by assured in favour of his wife and mother respectively within a short span of 3 months- Actual disease was not disclosed by deceased assured who died within one month of taking the policies- Wife and mother of insured deceased claimed the insurance amount after his death which were repudiated by Insurance Company- Repudiation upheld- National Commission committed no illegality in the impugned order.

9.                     Learned counsel for the Ops further referred the case law titled as Surinder Kaur Versus ICICI Prudential Life Insurance Company ltd. & Others 2015(1) CLT Page 365 (U.T.Chandigarh) wherein it has been held that Insurance Claim- Repudiated on the ground of suppression of material facts by insured at the time of making proposal- Death due to cardiac arrest and severe myocardial infarction- Treatment taken for depression not disclosed- Plea of complainant that cause of death i.e. cardiac arrest had no nexus with the ailment not disclosed i.e. depression- Held- Plea is devoid of merit- Nexus or no nexus of the disease hardly matter- the question was of suppression of material facts and not , as to whether, the disease, on account whereof the life assured died, had any nexus with his death or not- Claim rightly repudiated. Further referred the case law titled as Life Insurance Corporation of India Versus Minu Kalita 2003(2) CLT Page 201 National Commission and Sapna Arora Versus Life Insurance Corporation of India & others, 1 (2009) CPJ page 588 (Punjab State Commission).

10.                   On the other hand, counsel for the complainant hotly argued that the case of the complainant is duly proved from the evidence on the file and the genuine claim of the complainant has been wrongly repudiated by the OPs Insurance Company on the flimsy ground that the husband of complainant has concealed the material facts at the time of taking the insurance policy whereas the husband of the complainant feels the  abdomen pain in the evening of 25.04.2011, which is evident from Annexure C-11 to C-14 and his death took place on 26.04.2011 at G.M.C.&H Sector 32, Chandigarh.  Learned counsel for the complainant argued that the insurance company cannot reject the claim of the complainant and insurance company cannot escape from its liability and lastly prayed for acceptance of complaint. Learned counsel for the complainant referred the case law titled as The Senior Divisional Manager, LIC and others Versus Satya Devi, 2002(2) CLT page 331 (U.T. Chandigarh) wherein it has been held that Insurance claim- Repudiation- On the ground that the illness suffered by the deceased was not disclosed in the relevant column in the proposal for assurance/ personal statement signed by the deceased-Annexure R-1 showing that the skin disease and the disease of diabetes with which the deceased was suffering were not the cause of his death- Appellant has failed to show a nexus between the aforesaid illness and the cause of the death of the deceased- Held that the repudiation of the claim by the appellant was not justified and it resulted in deficiency in service on the part of the appellant- Order of the District Forum allowing the claim with interest @ 12% upheld-Appeal dismissed. Further referred the case law titled as LIC of India and another versus Kamla Devi III (2009) CPJ page 186 (NC) wherein it has been held that Consumer Protection Act, 1986-Section 21(b)- Insurance- Suppression of material facts- Contention, insured consuming alcohol for a decade in high doses- Bed head ticket of hospital relied by insurer- Statement of history of deceased not given by insured, as insured admitted in unconscious state- No certificate given by doctor indicating how he elucidated information- Record produced cannot be relied upon as admission of insured- insurer held liable under policy.

11                    After hearing both the parties and after going through the documents on the file, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of OPs and the claim of the complainant has been rightly repudiated by the OPs insurance company as the complainant has obtained the insurance policy in question just to extract the money from the insurance company by suppressing the material facts which is evident from Annexure R-10 Photo copy of register of admission of hospital at 7.A.M. on 25.4.2011 on account of vomiting pain in abdomen and further from the certificate dated 15.1.2012 (Annexure R-6) issued by the treating doctor of Civil Hospital, Jagadhri mentioning therein that deceased Raj Kumar was brought on 25.4.2011 in emergency of General Hospital, Jagadhri with a complaint of severe pain in abdomen. Meaning thereby that the deceased admitted in General Hospital at 7.A.M. on 25.4.2011 and on the same day obtained an insurance policy from the OPs by suppressing the material facts which is against the principle of UBERRIMA FIDES i.e. on utmost good faith and it was the duty of the proposer to disclose all the facts which the insurer cannot know with its general prudence. When an insurance policy has been issued on 25.4.2011 then there is a presumption that the policy might be issued after opening the office hours i.e. 10 A.M. Meaning thereby that at the time of taking insurance policy on 25.04.2011 after opening the office hours i.e. 10 A.M. to onwards, the complainant was under treatment in the General Hospital, Jagadhri as he was admitted at 7.00 A.M. which is evident from the photo copy of register of admission (Annexure R-10) mentioned at serial No.991 dated 25.4.2011. The law referred by the counsel for the complainant is not applicable  to the facts of the present case whereas the law cited by the counsel for the OPs is fully applicable to the present case. So, the arguments advanced by the counsel for the complainant is not tenable.

12.                   In the circumstanced noted above, we are of the considered view that there is no deficiency in service on the part of Ops and the claim of the complainant has been rightly repudiated vide letter dated 8.5.2012.

13.                   Resultantly, we find no merit in the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court. 18.04.2016.

 

                                                (S.C.SHARMA)                        (ASHOK KUMAR GARG)

                                                MEMBER                                 PRESIDENT