Punjab

Fatehgarh Sahib

CC/142/2014

Narinder 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.142 of 2014

                                                                Date of institution:  28.11.2014                                             

                         Date of decision   :  26.09.2016

Narinder 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, Narinder 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.165562266 for the sum assured of Rs.2,50,000/- from OP No.2 in the month of August 2013. He deposited Rs.6,065/- 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 addicted and nor chronic alcoholic. Earlier he had also taken life insurance policies in 2008 and 2012. 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.2,50,000/- i.e. sum assured along with interest and further to pay Rs.40,000/- as damages, Rs.20,000/- as cost of harassment, Rs.6,600/- 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 only the first half yearly premium of Rs.6065/- was paid under the policy in question. As per record furnished by the complainant, said Gurmukh Singh expired on 12.10.2013 i.e. after one month and twenty eight days of taking the policy. 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, status report Ex. OP-3, letter dated 06.03.2014 Ex. OP-4, discharge summary (two pages) Ex. OP-5, Test reports(three pages) Ex. OP-6,  leave applications Ex. OP-7 to OP-10, letter dated 27.02.2014 Ex. OP-11, letter from Principal GSSS Ex. OP-12,  leave applications Ex. OP-13 to OP-17,  certificate dated 13.12.2013 Ex. OP-18, letter dated 10.12.2013 Ex. OP-19, copy of policy Ex. OP-20, proposal form Ex.OP-21, certificate of employer Ex. OP-22, letter dated 10.12.2013 Ex. OP-23, 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 August 2013 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 and 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 OPs. The insurance policy was taken on 14.08.2013 and the insured died on 12.10.2013, just after one month and twenty eight days after taking the policy. 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.The insured was admitted in the hospital just after 15 days of taking the policy, which shows that he was in full knowledge about his ailment when filling up information about his health in the proposal form. 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".

                And the Hon'ble Supreme Court has held 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 11.08.2013 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

Undoubtedly, these were material facts and were within the knowledge of the insured and he was obliged to disclose the same correctly in the proposal form on 11.08.2013. It clearly reveals, therefore, that while filling up the proposal form, Mr. Gurmukh Singh, the DLA had wrongly stated about the state of his health. Having concealed the said material facts while answering these questions, we are of the opinion that the insurance company was within its rights to repudiate the claim of the complainant. It proves that the insured was not having good health at the time of filling up the proposal form.

9.             In view of the above discussion we dismiss the present complaint and find that the OPs have not committed any deficiency in service by not paying the claim to the complainant.  No order as to costs. Parties to bear their own expenses.

10.                    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