Punjab

Nawanshahr

CC/136/2015

Neelam Rani - Complainant(s)

Versus

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

Shammi Kapoor

16 Jun 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

SHAHEED BHAGAT SINGH NAGAR

Consumer Complaint No.         :    136 of 21.12.2015

Date of Decision:                    :    16.06.2016

Neelam Rani wife of Satwinder Singh Resident of Ward No.1, Mohalla Khosla, Rahon, Tehsil Nawanshahr, District SBS Nagar.

                                                                             …Complainant

Versus

1. Life Insurance Corporation of India, Branch Office Banga Road, Nawanshahr, District SBS Nagar through its Manager.
2. Life Insurance Corporation of India, Divisional Office Jeevan Parkash, Model Town, Jalandhar through its Divisional Manager.
3. Life Insurance Corporation of India, Northern Zonal Office, Jeevan Bharti Building, 124, Cannaught Circus, New Delhi through its Zonal Manager.

               …Opposite Parties

Complaint under the Provisions of Consumer Protection Act, 1986

QUORUM:

SMT.NEENA SANDHU, PRESIDENT

S.KANWALJEET SINGH, MEMBER

ARGUED BY:

For complainant                      :         Sh.K.K. Thukral, Advocate,

For OPs                                   :         Sh.D.B. Bhalla, Advocate,

ORDER

SMT.NEENA SANDHU, PRESIDENT

1.       Smt.Neelam Rani has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘the OPs.)  Prayed that O.Ps. be directed to pay to the complainant:-

1.       Rs.1,00,000/- as death claim of insurance policy alongwith interest @12% per annum.

2.       Rs.1,00,000/- as compensation/damages.

2.       In brief, the case of the complainant is that on 16.12.2013, her deceased husband namely Satvinder Singh had purchased insurance policy bearing No.133902960, plan 14, term 18 years, sum proposed Rs.1,00,000/- on half yearly mode by paying Rs.4252/- as first premium of the policy.  She is nominee in the said policy.  At the time of purchase of the policy, the official of OPs told that as per scheme of policy, if natural death of the policyholder occurs within the policy term, the nominee will get full payment of the sum assured alongwith the premiums as paid by the policyholder. Medical formalities were also done while purchasing policy in question as required by LIC.  Her husband died on 28.02.2014 and after that she approached the OPs at Nawanshahr branch and completed all the formalities to get the death claim and deposit original policy.  The OPs assured the complainant that the payment of death claim would be deposited in her account after some enquires.  After lapse of 20 months, the Ops did not pay any amount and clearly refused the death claim.  In this way, the OPs are negligent and deficient in providing services.  Hence this complaint.     

3.       On being put to the notice, the OPs filed written version taking preliminary objections that complaint is legally and factually not maintainable; the relief prayed for in the complaint is violation of the terms and conditions of the policy.  The terms and conditions are the base of the insurance contract and have paramount importance in the eyes of law and as such both the parties can neither go, nor claim beyond the terms and conditions of the contract; complainant has not come to this Forum with clean hands, as she has suppressed the material & relevant facts.  The claim of the complainant was repudiated on the account that deceased had suppressed & withheld material information regarding his health while filing of the proposal form.  As per medical certificated of DMC Ludhiana dated 19.03.2015, the life assured admitted in hospital on 07.07.2012 with ALD Cirrhosis, PHT Ascites c Hepatic Encephalopathy Grade – 1 and was discharged on 13.07.2012 and this information was deliberately withheld by the life assured and moreover the deceased also obtained medical leaves from 06.07.2012 to 31.07.2012 & 02.03.2013 to 31.03.2013; it is evident that deliberately incorrect statements were given by the deceased and material information was suppressed by the deceased regarding his health & habits while taking the policy in question.  As such claim of the complainant rightly repudiated and was duly informed vide letter dated 28.04.2015. On merits, each and every averment of the complaint has been denied.     

4.       On being called to do so, the learned counsel for complainant has tendered in evidence affidavit of complainant as Ex.CW1/A, alongwith copy of proposal deposit receipt Ex.C-1, copy of Form No.300 Ex.C-2 and death certificate of Satwinder Singh husband of complainant Ex.C-3 and closed the evidence.  Learned counsel for Ops has tendered in evidence affidavit of Hari Shankar Gupta Manager (L&HPF) Ex.OP1/A alongwith documents copy of proposal form Ex.OP-1 running into four pages, copy of medical record department Ex.OP-2, copy of certificate of employer Ex.OP-3, copy of letter dated 28.04.2015 Ex.OP-4, copy of letter dated 02.07.2014 Ex.OP-5, copy of letter dated 11.07.2015 Ex.OP-6, copy of letter dated 15.12.2014 Ex.OP-7, copy of policy bond Ex.OP-8, copy of medical opinion Ex.OP-9 and closed the evidence.

5.       We have heard the learned counsel for the parties and also gone the record carefully.

6.       Admittedly, the deceased husband of complainant-Satvinder Singh had purchased the policy in question from the LIC of India.  During the subsistence of the policy, he died on 28.02.2014 as is evident from death certificate Ex.C-3.  After the death of life assured, the complainant being nominee lodged the claim with OPs, however, the same was repudiated by OPs vide letter dated 28.04.2015 Ex.OP-4 on the ground that the life assured deliberately had made incorrect statement and had withheld correct information from the OPs regarding his health & habits at the time of taking this policy.

          The learned counsel for the complainant submitted that before issuance of the policy in question medical formalities were done by the OPs.  Therefore, the OPs are liable to pay the death claim to the complainant. 

On the contrary, learned counsel for the OPs vehemently argued that the said policy was issued to the life assured on the basis of information provided by him and declaration made in the proposal form.  Since, the life assured had suppressed the material fact regarding his health from OPs, therefore, they are rightly repudiate the claim of the complainant.  There is no document on the record on the basis of which it can be said that the Ops have conducted any medical tests before issuance of said policy, therefore, we do not find any force in this submission of the complainant. 

The question for determination is, as to whether the life assured had concealed any material fact relating to her health at the time of taking the policy in question.  Our answer is in affirmative because on perusal of proposal form, Ex.C-2/OP-1 it is found that the proposal form contained specific questions regarding health under the column No.11 - ‘personal history’.  The life assured had answered the following questions as under:-

     11   (a)   During the last five years did you consult a medical practitioner for any ailment requiring treatment for more then a Week?          (No)

            (b)  Have you ever been admitted to any hospital, or nursing home for general checkup observation, treatment or operation?                        (No)

            (c)   Have you remained absent from place of your 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, brain or nervous system     (No)

            (e)   Are you suffering from or have you ever suffered from diabetes, tuberculosis, High BP, low BP, cancer, epilepsy, hernia or any other decease?     (No)

            (i)    What has been your usual state of health    (Good)

          However, from the perusal of medical certificate dated 19.03.2015, Ex.OP-2 issued by Dayanad Medical College & Hospital Ludhiana, it is evident that the life assured was admitted in the said hospital in the department of Gastroenterology on 07.07.2012 vide Admn. No.30125 C.R. No.99068 as a case of ALD Cirrhosis, PHT c Ascites c Hepatic Encephalopathy Grade – 1 and was discharged on 13.07.2012.  Even, in the employer’s certificate Ex.OP-3, it is clearly mentioned that life assured was on medical leave for the period from 06.07.2012 to 31.07.2012 and from 02.03.2013 to 31.03.2013.  From the above referred documents it is evident that the life assured was suffering from pre existing disease and had availed medical leave.  But the life assured did not disclose said fact, while taking the policy in question, and had given incorrect statement in the proposal form, therefore, as per term No.5 of the terms and conditions of the policy Ex.OP-8, the policy has become void and as such the complainant is not entitled for any claim and the OPs cannot said to be wrong in repudiating the claim of the complainant.

7.       In the light of our above observations and findings, the complaint filed by Neelam Rani – complainant is dismissed with no order as to costs. 

8.       Let copies of the order be sent to the parties, as permissible, under the rules.  The file be indexed and consigned to record room.

Dated:  16.06.2016

                                                                                                                                                                                                (Neena Sandhu)

                                                                   President

 

                                                                                                                                                                             (Kanwaljeet Singh)

                                                                   Member