DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA CC.No.476 of 15-10-2010 Decided on 16-02-2011 Roshni Devi, aged about 42 years, wife of Late Sh.Indraj son of Mani Ram; Ajit Kumar, aged about 27 years, son of Late Sh.Indraj son of Mani Ram; Sunita Rani daughter of Late Sh.Indraj son of Mani Ram; All residents of House No.14547, Kheta Singh Basti, Bathinda.
.......Complainants
Versus Life Insurance Corporation of India, Jeevan Parkash, Divisional Office, Urban Estate, Phase-I, Dugri, Ludhiana, through its Senior Divisional Manager. Life Insurance Corporation of India, Bibi Wala Road, Bathinda, through its Branch Manager.
......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986.
QUORUM
Smt. Vikramjit Kaur Soni, President. Dr. Phulinder Preet, Member. Sh.Amarjeet Paul, Member. Present:- For the Complainant: Sh.Hitesh Kumar, counsel for the complainant. For Opposite parties: Sh.Inderjit Singh, counsel for the opposite parties.
ORDER
VIKRAMJIT KAUR SONI, PRESIDENT:-
1. The present complaint has been jointly filed by the complainants namely Smt. Roshni Devi wife of Indraj, Ajit Kumar and Sunita Rani son and daughter of deceased Indraj under Section 12 of the Consumer Protection Act, 1986 as amended up-to-date (Here-in-after referred to as 'Act'). The brief facts of the complaint are that deceased Indraj was an unskilled worker, working as labourer in Thermal Plant, Bathinda. One Hukam Chand who has taken an Insurance Agency in the name of his wife, induced Indraj to purchase the Policy and the premium of the said Policy would be deducted monthly out of the salary payable to him by his employer. The complainants had purchased Policy bearing No.300813 423 on 31.03.2006 for a sum of Rs.1,50,000/- and the premium was to be deducted monthly by his employer and the Proposal Form was duly filled up by Hukam Chand in his own hand writing without disclosing the contents to the complainant. The due date of premium was 15th of every month and the last premium was payable on 15.02.2022. At the time of purchasing the Policy, the deceased Indraj was of 41 years of age and the premium was calculated as Rs.743/- per month and sum assured was of Rs.1,50,000/-. The Life Assured declared Roshni Devi-complainant No.1 as nominee and the complainant Nos.2&3 are legal representatives of the deceased Indraj, died on 06.10.2008 due to Hepatitis-B and whole of the premium till that date has been paid by him. The complainants lodged the claim of sum assured i.e. Rs.1,50,000/- and completed all the formalities. The Divisional Office, Ludhiana repudiated the claim vide its letter No.Claims/Repdt/5157/82/779 dated 31.03.2010, the reasons assigned in the said letter had no nexus with the cause of death. The Proposal Form was filled by Hukam Chand himself as Indraj was totally illiterate person. The complainants had repeatedly approached the opposite parties to pay the claim of deceased but the opposite parties have failed to pay the said claim. Hence, the complainants have filed this complaint. 2. The opposite parties have filed their joint written statement and pleaded that the deceased Indraj has not disclosed the true and correct facts about his ill-health at the time of filling the Proposal Form. The contact of Insurance are contracts of “Oberrima Fides” and every fact of which forbids either party to disclose any wrong facts. The Insured has not disclosed at the time of obtaining the policy that he remained admitted in the Civil Hospital, Bathinda (Drug Addiction Center) from 22.03.2006 to 31.03.2006 for the treatment of Alcohol detoxification and also availed medical leave from 19.03.2006 to 31.03.2006. Mrs. Anju Bala is an agent of the opposite parties, Hukam Chand is not their agent as mentioned in the complaint. The opposite parties have further pleaded that on the receipt of the Proposal Form dated 31.03.2006 duly signed by the Life Assured Indraj (now deceased) and witnessed by Mrs. Anju Bala, the agent having Agency Code No.02878-174, Policy No.300813423 was issued in the name of Sh. Indraj with date of commencement i.e. 15.03.2006 for Rs.1,50,000/- with monthly premium of Rs.756/- and Roshni Devi was nominee in the said Policy. The opposite parties further pleaded that the Life Assured died on 06.10.2008 and the premium upto date has already been paid by the Life Assured and the claim Form was submitted by nominee i.e. complainant No.1-Roshni Devi. The Proposal Form was signed by the Life Assured (now deceased) himself in English and his educational qualification was Matric and he was skilled worker. As per investigation conducted by the opposite parties, the Life Assured remained admitted in Civil Hospital, Bathinda from 22.03.2006 to 31.03.2006 for Alcohol detoxification and also availed medical leave from 19.03.2006 to 31.03.2006 meaning thereby, at the time of filling the Proposal Form, DLA was in the hospital on 31.03.2006 not keeping in good health. DLA died due to Hapatitus-B which relates to the ailment. Some questions were asked, the answers of these questions are as under:- S.No.Questions Answer (a) During the last five years did you consult any ailment No practitioner for any ailment requiring treatment for more than a week? (b) Have you ever been admitted to any Hospital or nursing No home for general check-up observation, treatment or Operation? (h) Do you use or have you ever used? (i) Alcoholic Drinks No (ii) What has been your usual state of Health Good After investigation, it was found that the DLA has got the policy by misstatement of facts and his claim was repudiated by the competent authority on 31.03.2010 due to concealment of material information at the time of filling up Proposal Form by the Life Assured (deceased). The opposite parties have further pleaded that wife/nominee of the deceased, Smt. Roshni Devi filed false affidavit dated 31.12.2009 to the effect that her husband has never been admitted in the Hospital and has taken the medicines for cough problem only. The claim of the complainant has rightly been repudiated after through investigation. 3. Parties have led their evidence in support of their respective pleadings. 4. Arguments heard. Record alongwith written submissions submitted by the parties perused. 5. The complainant has purchased Policy bearing No.300813423 on 31.03.2006 for a sum of Rs.1,50,000/-. The premium was to be deducted from his salary by his employer. The Proposal Form was duly filled up by Hukam Chand. The complainant had paid all premiums with regard to the said Policy and the commencement date of the Policy was 31.03.2006. The Policy holder-Indraj died on 06.10.2008, till date all the premiums were paid. The complainants lodged claim for a sum of Rs.1,50,000/- and necessary documents were filled up by the complainants. The cause of death of Indraj was Hepatitis-B. The Divisional Officer, Ludhiana repudiated the claim of the complainant vide its letter No.Claims/Repdt/5157/82/779 dated 31.03.2010. The reasons assigned in the said letter had no nexus with the cause of death. The deceased Indraj was totally illiterate person, unskilled labourer and the Proposal Form was filled by one Hukam Chand. The complainants have been repeatedly visiting the office of the opposite parties for paying the claim to the complainants but the opposite parties have refused to pay the claim. The claim of the complainants was repudiated on 31.03.2010 vide Ex.C-1 on the grounds which were reproduced as under :- “With reference to your claim under the above Policy on the life of your deceased husband Sh.Indraj, we have to inform you that we have decided to repudiate all liability under the policy on account of the deceased having withheld material information regarding his health at the time of effecting the assurance with us.” Further, the deceased Indraj had given the answers of the following questions:- “Questions Answer (a) During the last five years did you consult any ailment No practitioner for any ailment requiring treatment for more than a week? (b) Have you ever been admitted to any Hospital or nursing No home for general check-up observation, treatment or Operation? (h) Do you use or have you ever used? (i) Alcoholic Drinks No (ii) What has been your usual state of Health Good” 6. The opposite parties have submitted that the complainants deliberately misrepresented and withheld the material information from them regarding his health at the time of effecting the insurance. As per Medical Certificate Ex.C-3 which is read as under :- “Certified that Indraj s/o Sh. Mani Ram was under my treatment since 18.05.2008 to 30.05.2008 as indoor patient. He was discharged on 30.05.2008. He was further advised rest upto 25.07.2008. He is now fit to resume his duty w.e.f.26.07.2008 Period of rest – 18.05.2008 to 25.07.2008. Fitness – 26.07.2008” 7. The complainant has submitted that the Proposal Form was filled by one Hukam Chand as the Life Assured person was illiterate. At the time filling the Proposal Form, he has not disclosed the contents of the Proposal Form whereas the opposite parties have submitted that the educational qualification of the deceased was matric and he was a skilled worker. The Proposal Form was signed by the Life Assured on 31.03.2006 that too in English. The opposite parties have further submitted that they had repudiated the claim of the complainant as he has not disclosed the true and correct facts about his ill-health. He has concealed the facts regarding his health. The contacts of Insurance are contracts of “Oberrima Fides” and every fact of which forbids either party to disclose any wrong facts. The Insured has not disclosed at the time of obtaining the policy that he remained admitted in the Civil Hospital, Bathinda (Drug Addiction Center) from 22.03.2006 to 31.03.2006 for Alcohol detoxification and also availed medical leave from 19.03.2006 to 31.03.2006. The Proposal Form dated 31.03.2006 was duly signed by life assured Indraj (now deceased) and witnessed by Mrs. Anju Bala having Agency Code No.02878-174. The Policy bearing No.300813423, was issued in the name of Indraj, Roshni Devi was/is appointed nominee of deceased Indraj in the said insurance policy. The Life Assured died on 06.10.2008. 8. A perusal of documents placed on file shows that the complainant was on leave from 19.03.2006 to 31.03.2006 as he was not well as per Ex.R-8. This leave record issued by his Employer, does not show that he was suffering from long lasting disease. Moreover, getting the treatment in Drug Addiction Center does not confirm that he was suffering from Hepatitis-B. The opposite parties have nowhere mentioned in their reply that the complainant had died because of excess consumption of Alcohol. All the documents placed on file shows that he had died due to Hepatitis-B. There is no nexus between the cause of death and treatment taken for detoxification. As per medical study, Transmission of hepatitis-B virus results from exposure to infectious blood or body fluids. The acute illness causes liver inflammation, vomiting, jaundice and rarely, death. Chronic hepatitis-B may eventually cause liver cirrhosis and liver cancer – a fatal disease with very poor response to current chemotherapy. The infection is preventable by vaccination. Hepatitis-B virus is an hepadnavirus – hepa from hepatotrophic and dna because it is a DNA virus – and it has a circular genome composed of partially double-standard DNA. The virus replicate through an RNA intermediate form by reverse transcription and in this respect they are similar to retroviruses. Although replication takes place in the liver, the virus spreads to the blood where virus-specific proteins and their corresponding antibodies are found in infected people. Blood tests for these proteins and antibodies are used to diagnose the infection. 9. A perusal of Proposal Form shows that it has been filled on 31.03.2006 and according to the record as well as the version of the opposite parties, the complainant has been discharged from Drug Addiction Center on 31.03.2006 which means, the opposite parties themselves have got filled the Proposal Form of the complainant in the Drug Addiction Center, knowing all the facts about the health of the complainant. Moreover, the complainant had died on 06.10.2008 which means he had died approximately after 2-1/2 years of purchasing the policy. It does not show anywhere on record that being alcoholic he had been suffering from hepatitis-B since his treatment in the drug addiction centre till his death. Hence, his ailment and cause of death has no nexus with his hospitalization for the treatment in drug de-addiction centre. Moreover, the opposite parties sent a repudiation letter to the complainant on 31.03.2010 which has been issued after a lapse of long time. 10. From what has been discussed above, this Forum concludes that there is deficiency in service on the part of the opposite parties. Regarding this, the support can be sought by the precedent laid down by the Hon'ble Punjab State Consumer Disputes Redressal Commission, Chandigarh in case titled Life Insurance Corporation of India Vs. Smt. Mohinderjit Kaur, 1998(I) CPJ 159, wherein it has been held that :- “Consumer Protection Act, 1986 – Sections 2(1)(c)(iii), 14(1)(d) – Repudiation of Claim – Insurance – Deficiency in Service – Compensation – Insured made false representation and suppressed material fact – Burden of proof on Insurance Corporation – No nexus between cause of death and disease – Incorrect answers have no connection with death of insured – Corporation not justified in repudiating the claim – Delay in settling the claim – Deficiency established.” 11. As per Section 45 of the Insurance Act (4 of 1938), Policy not to be called in question on ground of mis-statement after two years – No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement [was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made] by the policy holder and that the policy holder knew at the time of making it that the statement was false [or that if suppressed facts which it was material to disclose]. 12. Hence, in view of what has been discussed above, this complaint is accepted with Rs.1,000/- as cost and Rs.5,000/- as compensation and the opposite parties are directed to pay the insurance claim of Rs.1,50,000/- to the complainants in equal shares. The cost and compensation will also be paid to the complainant in equal shares. Compliance of this order be done within 30 days from the date of receipt of copy of this order. In case of non compliance of this order, interest @ 9% p.a. will yield on sum assured from filing of this complaint till realization. 13. A copy of this order be sent to the parties concerned free of cost and file be consigned for record. ' Pronounced in open Forum 16-02-2011 (Vikramjit Kaur Soni) President
(Dr. Phulinder Preet) Member (Amarjeet Paul) Member
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