Haryana

Fatehabad

CC/79/2020

Sharwan Singh - Complainant(s)

Versus

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

Sanjeev Kumar

17 Nov 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL COMMISSION, FATEHABAD.

Complaint No.79 of 2020.

Date of instt.12.03.2020. 

                                                          Date of Decision: 17.11.2023.

 

Sharwan Singh son of Sh.Hardyal Singh r/o VPO Mohammadpur Rohi, Tehsil & District Fatehabad.

 

                                                                             ..Complainant.

                                      Versus

 

1. The Branch Manager, LIC of India Branch Office, HUDA Sector , Hisar Road, Fatehabad (Haryana)
2. Divisional Manager, Divisional Office, Life Insurance Corporation of India SCO 3-4-5 HUDA Sector 1, Rohtak.
3. Incharge cum Dealing Head, LIC Zonal Office, Jeevan Bharti Building Tower-II, Cannought Circles, Central Delhi.

 

..Opposite parties.

     

      Complaint under Section 12 of Consumer Protection Act, 1986.          

 

Before              Sh.Rajbir Singh, President.

                        Smt.Harisha Mehta, Member.

     Dr.K.S.Nirania, Member.

Present:           Sh.Sanjeev Kumar, Advocate for complainant.

                       Sh.P.K.Zora, Advocate for OPs.

 

ORDER

SH.RAJBIR SINGH, PRESIDENT

 

                         Brief facts of the present compliant are that son of the complainant namely Sukhwinder Singh (since deceased) got his life insured with Ops vide policy No.101522213 having commencement date 13.04.2018 for a sum of Rs.8 lac; that the complainant was nominated as nominee in the above said insurance policy; that life assured expired on 18.08.2018 due to sudden illness and regarding this the complainant intimated the Ops besides submitting all the requisite documents and serving of legal notice upon them; that instead of making the claim amount, the Ops repudiated  the claim of the complainant wrongly and illegally.  The repudiation of insurance claim of the complainant by the OPs amounts to deficiency in rendering service to the OPs.  Hence, this complaint.

2.                          On being served, OPs appeared through counsel and resisted the complaint by filing a joint written statement wherein it has been submitted that the replying Ops had received intimation regarding death of life assured Sukhwinder Singh on 18.08.2018; that since the policy had not completed three years from the date of first premium receipt dated 18.04.2018, therefore, the claim was examined as per Section 45  of the Insurance Act, 1938; that during examination of the claim, it was observed by the Ops that in the proposal form dated 16.04.2018 the deceased life assured had answering the following questions which are as under:

During the last five years, did you consult a medical practitioner for any ailment requiring treatment for more than a week?	No
Have you ever been admitted to any Hospital or nursing home for general check-up, treatment or operation?	No
Have you remained absent from place of work on grounds of health during last five years?	No
Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, Hernia, Leprosy, or any other disease?	No
Are you suffering from or have you ever suffered from ailment pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or nervous system?	No
What has been your usual state of health:	Good

 

that  all the answers given by the life assured were found false as he was old case of brain tumor  which was diagnosed eight months ago as per death summary of Dr.Ram Manohar Lohiya Hospital, New Dehli dated 18.08.2018 CR No.201848379; that the life assured had not disclosed the material facts about his state of health as he was having pre-existing disease before the inception of the policy; that due to suppression of material fact the claim of the complainant was rightly repudiated on 28.11.2019 in terms of provisions of Section 45 of the Insurance Act. Preliminary objections such as cause of action, locus standi, concealment of material facts and complaint being false and frivolous have been taken. The OPs have further prayed for dismissal of the present complaint being devoid of merits.

3.                          In evidence, the complainant has tendered affidavit Annexure CW1/A with documents Annexure C1 to Annexure C10. On the other hand, learned counsel for the Ops has tendered affidavit Ex.CW1/A and documents Annexure R1 to Annexure R6.

4.                          In his arguments, the learned counsel for the complainant contended that nothing was concealed by the life assured regarding his state of health while filing the proposal form for getting the insurance claim.  The entire information regarding his health was provided by the life assured to OPs.  Therefore, it cannot be said that the particular of life assured were not disclosed by him at the time of signing of the contract of insurance.  It is further contended by the learned counsel that the documents relied upon by the OPs regarding the medical treatment record/Death summary of Dr.Ram Manohar Lohiya is only photo copies and the same cannot be read in evidence being not supported with any affidavit.  Nor any employee of the above-said hospital has been examined by the OPs to prove the above-said document.  It is also contended by the learned counsel that a genuine claim of the complainant has been repudiated by the OPs on false and flimsy grounds. 

5.                          On the other hand, the learned counsel for the OPs vehemently controverted the arguments advanced by learned counsel for the complainant and further contended that since the life assured had concealed the pre-existing disease while submitting the proposal form for obtaining life insurance and as such the insurance claim of the complainant has been rightly repudiated by the OPs vide letter dated 28.11.2019 (Annexure RIV).  It is further contended by the learned counsel that repudiation of the insurance claim of the complainant 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. 

6.                          We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record.  It is not disputed that the life assured died on 18.08.2018 i.e. during the subsistence of the insurance policy.  It is also admitted fact that the complainant being father of the life assured was nominated as nominee in the policy in dispute.  The OPs in the present case has repudiated the insurance claim of the complainant on the ground that the deceased life assured had not disclosed the true and material fact with respect to state of his health in the proposal form filed by him for taking the insurance policy.

7.                          After hearing arguments and examining the material placed on record, we find force in the contention raised by learned counsel for the OPs.  From perusal of the record, it is revealed that in the proposal form there were specific questions regarding medical details and state of health of the life assured under Para No. 11 of the Proposal Form signed by the life assured.  All the questions were replied by the life assured in negative. The aforesaid questions and reply thereto is reproduced as under:-

Personal history:-

During the last five years, did you consult a medical practitioner for any ailment requiring treatment for more than a week?	No
Have you ever been admitted to any Hospital or nursing home for general check-up, treatment or operation?	No
Have you remained absent from place of work on grounds of health during last five years?	No
Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, Hernia, Leprosy, or any other disease?	No
Are you suffering from or have you ever suffered from ailment pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or nervous system?	No
What has been your usual state of health:	Good

 

 

8.                          A perusal of the above details reveals that the life assured had answered in negative to most of the questions put to him and claimed his state of health Good. However, from perusal of the death summary (Annexure RIII) issued by Dr.Ram Manohar Lohiya, Hospital, it is revealed that the patient was a diagnosed case of round Cell Tumor on nasal biopsy, pt. had episode of epistaxis 8 months before. Patient had received 1 cycle of Chemo-radiation at Pvt. In Hisar. Therefore, we are of the considered opinion that the DLA had concealed the material fact regarding his state of health and the previous disease intentionally for obtaining the insurance policy. It is a well settled principle of law that the contract of insurance is a contract of aberrima fides and there must be complete good faith on the part of the assured and thus the assured is under a solemn obligation to make full disclosure of material fact, which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not. The declaration in the proposal form and the statement given by the life assured were the basis of contract of mutual trust between the insurer and the assured and any false statement given with respect to state of health or disclosing the false information would make the contract vitiate as has been done in the present  case. Reliance is placed on the case law titled Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. reported in IV(2009)8 SCC Page 316 and P.C.Chacko and anr. Vs. Chairman L.I.C. India 2008 (1) SCC 321.

9.                The Contention of the learned counsel for the complainant to the extent that original record has not been produced by the OPs and the photo copies of the same cannot be read in evidence and cannot be relied upon, is not tenable as the provisions of Indian Evidence Act are not strictly applicable in the Consumer Protection Act, 2019. Therefore a photo copy of the document which is clear and legible can be relied upon provided that otherwise or contrary is not proved on the file. The complainant could have summoned the officials of the concerned hospital to prove that the document/death summary of DLA has not been issued by the said hospital. Moreover the functionaries of hospital do not have any interest in the OPs nor they are inimical to the complaint nor did they have motive to issue a false certificate. Therefore in case the medical record/death summary is not supported by the affidavit of the concerned doctor, does not take away the beneficiary value of the document. Therefore, we are of the considered opinion that it is a valid piece of evidence. It is not the case of the complainant that the life assured had not affixed his signature on the proposal form.  It is a presumption of law that a person signs a document after reading and understanding the contents of the document.

10.              A perusal of death summary reveals that prior to filing of proposal the DLA was suffering from Tumor. The said disease is a progressive disease and gets worsen with the lapse of time and is susceptible to life threatening complications and concealment of the same amounts to suppression of a material fact. In view of the aforesaid discussions, we are of the considered opinion that the repudiation of insurance claim of the complainant by the Ops is in order and sustainable in the eyes of law.

11.                        On the basis of above mentioned discussion, we are of the considered opinion that there was no deficiency in service at all or any unfair trade practice, on the part of any of the Ops, as alleged, so as to make any of them liable to any extent in this matter. Hence, the complaint is dismissed in view of the facts and circumstances stated above.  All the parties are left to bear their own costs. A copy of this order be supplied to both the parties free of cost as per rules.  This order be uploaded, forthwith, on the website of this Commission as per rules for the perusal of the parties. File be consigned to record room, as per rules, after due compliance.

 

Announced in open Commission.                                                            Dated: 17.11.2023

 

 

                                                                                                        

(K.S.Nirania)                       (Harisha Mehta)                (Rajbir Singh)                         Member                                     Member                                     President