BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, FATEHABAD.
Complaint no.410/2018.
Date of instt.26.11.2018.
Date of Decision:10.12.2019.
Sandeep Singh son of Jaswant Singh, resident of VPO Dhani Raipur, Tehsil Ratia, District Fatehabad.
..Complainant.
Versus
- Life Insurance Corporation of India, Branch Sector-3, HUDA Fatehabad through its Branch Manager.
- Life Insurance Corporation of India, Divisional Office SCO No.3, 4 and 5, Sector-1, HUDA, Rohtak through its Senior Divisional Manager.
..Respondents/OPs.
Complaint under Section 12 of Consumer Protection Act, 1986.
Before: Sh.Raghbir Singh, President.
Sh. Jasvinder Singh, Member.
Argued by: Sh. Vikasdeep Singh, Advocate for complainant.
Sh. S.K. Dharnia, Advocate for OPs.
ORDER
The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties (hereinafter to be referred as OPs) with the averments that late Sh. Jaswant Singh father of the complainant during his life time had obtained an insurance policy bearing no.179895592 dated 28.7.2014 for a sum of Rs.5 lakh. It is further submitted that prior to the issuance of the insurance policy the medical check up of the life assured was conducted and thereafter the insurance policy was issued by the OPs. The complainant was nominated as nominee in the abovesaid policy being son of life assured. All the installments were paid by the life assured regularly to the OPs.
2. It is further submitted that unfortunately the complainant suddenly died on 28.10.2016 and prior to his death he was not suffering from any disease. Thereafter, the complainant intimated to the OPs regarding death of life assured and all the requisite documents were submitted to the OPs as per their instructions for settlement of the insurance claim. After submitting all the documents it was assured to the complainant that the insurance claim will be settled very soon by the OPs. Thereafter, the complainant visited the office of OPs time and again and requested to settle the death claim of Sh. Jaswant Singh life assured and make payment of sum assured but all in vain. Now it has been told to the complainant that the insurance claim has been repudiated without any reason. It has been further submitted that refusing the insurance claim to the complainant by the OPs is arbitrary, illegal and in violation of the terms and conditions of the insurance policy. The abovesaid act on the part of OPs amounts to deficiency in rendering service to the complainant. The complainant has further prayed that the present complaint may be accepted and the OPs may be directed to make the payment of sum assured of Rs.5 lakh alongwith other benefits and interest at the rate of 18% per annum from the date of death till realization. The complainant has further prayed that an amount of Rs.50,000/- may be awarded as compensation in favour of the complainant on account of mental agony and physical harassment. Hence, the present complaint.
3. Upon notice, the OPs appeared through its counsel and resisted the complaint by filing a written statement wherein various preliminary objections with regard to maintainability, cause of action, locus standi and concealment of true and correct facts etc., have been raised.
4. In reply on merits, it is submitted that the life assured had withheld the correct information regarding his health at the time of affecting the insurance with the OPs. In the proposal form for assurance dated 15.11.2014 the life assured had answered the questions as under:-
11(a) During the last five years did you consult a medical practitioner for any ailment requiring treatment for more than a week- No.
11 (b) Have you ever been admitted to any hospital or nursing home for general check-up, treatment or operation? No
11 (c) Have you remained absent from place of work on grounds of health during the last five years._ No
11 (d) Are you suffering from or you have ever suffered from ailment for pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or nervous system? No
11(e) Are you suffering from or have ever suffered from Diabetes, Tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, Hernia, Leprosy or any other disease - No
5. All the abovesaid answers given by the life assured were false which is clear from the evidence collected by the OPs. The follow up and BHT issued by Sukhda Hospital, Hisar proves that life assured was suffering from Diabetes, Dilated Myocardiopathy and Chronic Kidney Disease at the time of taking the insurance policy on 31.12.2014. The life assured was suffering from above illness prior to the date of filing the proposal form i.e. 31.12.14 but did not disclose while submitting the proposal form dated 15.11.2014. The life assured deliberately did not disclose the abovesaid material fact and the same has been done with intent to mislead the OPs. The abovesaid insurance policy was obtained by the life assured by concealing the actual state of his health in order to grab money from the Ops. It is further submitted that the insurance policy of the life assured had not completed 3 years from the date of FPR i.e. 31.12.2014 and the life assured had died prior to the completion of 3 years. Hence, in view of the provisions of Section 45 of the Insurance Act 1938 the OPs have repudiated the insurance claim of the complainant. The repudiation of the insurance claim by the OPs is perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law. There is no deficiency on the part of Ops in rendering service to the complainant and as such the present complaint is liable to be dismissed.
6. The learned counsel for the complainant tendered in evidence affidavit of the complainant as Annexure CW1/A alongwith the documents as Annexure C1 to Annexure C9. On the other hand, the learned counsel for the OPs tendered in evidence affidavit of Rajendra Singh Manager as Annexure R-1 alongwith the documents as Annexure R-2 to Annexure R-17.
7. The learned counsel for the complainant in his arguments reiterated the submissions made in the complaint and has further contended that the repudiation of the insurance claim of the complainant by the Ops is arbitrary, illegal and in violation of the terms and conditions of the insurance policy. It is further contended by the learned counsel that nothing was concealed by the life assured regarding his state of health at the time of obtaining the insurance policy in question. The life assured was hail and healthy at the time of filing the proposal form for obtaining the insurance policy in question and he had not taken any treatment from any hospital for any ailment prior to obtaining the policy in question. Moreover, the complainant has not placed on record any medical treatment record of the complainant regarding taking any treatment before the date of filing of the proposal form. In support of his case, the learned counsel for the complainant has relied upon the judgment titled as PNB Metlife Insurance Company Vs. Vanita Devi cited as I (2019) CPJ Page 441(NC) and the judgment cited as Neelam Chopra Vs. LIC cited as IV (2018) CPJ Page 321 (NC).
8. On the other hand, the learned counsel for the OPs vehemently rebutted the arguments advanced by learned counsel for the complainant and has further contended that repudiation of the insurance claim of the complainant in the present case is perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law. The learned counsel further contended that the life assured before obtaining the insurance policy was suffering from Chronic Kidney Disease, Diabetes and Dilated Myocardiopathy and the same is evident from Annexure 7 to Annexure 16. However, the life assured did not disclose the abovesaid ailments at the time of filing the proposal form and the same amounts to suppression of material facts deliberately. The abovesaid policy was obtained by the life assured by concealing actual position of his health. Therefore, the repudiation of the insurance claim of the complainant in the present case is perfectly in accordance with the terms and conditions of the policy and the same is sustainable in the eyes of law. The learned counsel for the OPs in support of his case has relied upon the judgment rendered by the Hon’ble Supreme Court in case titled as Satwant Kaur Sandhu Vs. New India Assurance Company cited as (2009) 8 SCC Page 316 and the judgment rendered by National Commission in case titled as LIC Vs. Maya Devi cited as 2016 (2) CPJ Page 396.
9. We have duly considered the arguments advanced by learned counsel for the parties and have also perused the documents placed on record. It is not disputed that the policy in question for a sum of Rs.5 lac was issued by the Ops to late Sh. Jaswant Singh father of the complainant. It is also not disputed that the life assured Sh. Jaswant Singh died on 28.10.2016 i.e. during the subsistence of the insurance policy. It is also not disputed that till the date of death of the life assured all the installments of premium had been paid to the insurance company. The insurance claim of the complainant in the present case has been repudiated by the Ops vide letter dated 31.5.2017 (Annexure R-17) on the ground that the life assured was suffering from Diabets, Dilated Myocardiopathy and Chronic Kidney Disease at the time of taking of the policy on 31.12.2014 but the life assured did not disclose the abovesaid fact regarding the state of his health while filing the proposal form. In view of the above, the onus was upon the Ops to prove that at the time of filing the proposal form the life assured was suffering from the abovementioned disease. However, to prove the abovesaid fact the OPs have not placed on record any cogent, convincing, credible or any direct evidence to prove that prior to filing of the proposal form i.e. 15.11.2014 the life assured was suffering from the abovementioned disease and he had taken medical treatment for the same. The OPs have not placed on record any medical treatment record taken by the life assured from any hospital prior to 15.11.2014. The medical treatment record placed on record by the OPs as Annexure 7 to Annexure 16 pertains to the period after 15.11.2014 i.e. the date of filing the proposal form. Moreover, the OPs have not examined the doctors of the concerned hospital or the dealing official of the concerned hospital to prove the abovesaid medical treatment record. Merely, photocopies of the treatment of the life assured has been placed on record. Therefore, the same cannot be read in evidence.
10. In view of the aforesaid discussion, we are of the considered opinion that the complainant has been able to prove deficiency on the part of OPs in rendering service to him. The present complaint is accordingly allowed and the OPs are directed for making a payment of Rs.5 lac as insured amount to the complainant. The Ops are further directed for making a payment of Rs.5,000/- as compensation and litigation charges. The present order be complied with within a period of 45 days from the date of receipt of copy of this order, otherwise the amount shall carry an interest at the rate of 8% per annum for the default period. Copy of this order be supplied to the parties free of costs. File be consigned to record room after due compliance.
Announced in open Forum:
Dt.10.12.2019.
(Jasvinder Singh) (Raghbir Singh)
Member President DCDRF, Fatehabad.
