DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA(PUNJAB)<br /> <br /> C.C. No. 12 of 4.1.2008<br /> Decided on : 1.4.2008 <br /> <br /> Shimla Devi Wd/o Sh. Hem Raj S/o Sh. Babu Ram C/o M/s. Shaddi Ram Babu Ram, Grain Market, Goniana Mandi, District Bathinda.<br /> ...... Complainant<br /> <br /> Versus. <br /> 1.Life Insurance Corporation of India, Jeevan Jyoti Building, Branch Office, Bibiwala Road, Bathinda.<br /> 2.Life Insurance Corporation of India, Jeevan Prakash, Divisional Office, Urban Estate, Phase 1, Dugri, Ludhiana-140002.<br /> ...... Opposite parties<br /> <br /> Complaint under section 12 of the Consumer Protection Act, 1986<br /> <br /> QUORUM:-<br /> <br /> Sh.Lakhbir Singh, President<br /> Dr.Phulinder Preet, Member<br /> <br /> For the complainant : Sh. Sushil Kumar Goyal, Advocate<br /> For the opposite parties : Sh. Inderjit Singh, Advocate<br /> <br /> O R D E R.<br /> <br /> LAKHBIR SINGH, PRESIDENT:- <br /> 1. Hem Raj was the husband of the complainant. He was to purchase life insurance policy from the opposite Insurance Corporation for a sum of Rs. 2,00,000/-. Opposite party No. 1 got him medically examined from its empanelled doctors. Other formalities were also completed. A sum of Rs. 12,920/- was got deposited from him. Thereafter, insurance policy bearing No. 300527756 was issued in his favour on 27.5.2006. Complainant was his first nominee. On 22.1.2007, he died of a sudden heart attack. An application was moved by the complainant on 7.6.2006 for claiming assured amount. Necessary documents were submitted including Form No. 3790. Letter was received on 17.10.2006 from opposite party No. 2 informing her that claim was under consideration. She was further intimated that it had come to their knowledge that life assured was suffering from heart problem and he had got treatment for the same. It was further alleged that he had undergone byepass surgery. Details of treatment were demanded from her. She was directed to submit Form No. 3816 duly got completed from the doctor/hospital. She was also asked to send Form No. 3790 on non-judicial stamp paper duly attested by two disinterested persons who were present at the time of death. She paid visit to the office of opposite party No. 1 and informed that her husband was not suffering from any heart problem nor did he get any treatment and undergo byepass surgery. In such a situation, there was no question of sending Form No. 3816. So far as Form No. 3790 is concerned, that was already submitted by her. On 19.11.2007 and 20.11.2007, letters were issued by opposite party No. 2 asking her to submit Forms No. 3816 and 3790. On 26.12.2007, Form No. 3790 was again submitted. Opposite party No.1 intimated her that her claim cannot be settled unless she submits Form No. 3816. Her allegation is that opposite parties are trying to back out from paying the insurance amount on one pretext or the other. Their adamant attitude has caused her mental and physical agony. There is deficiency in service on their part. In the these circumstances, she has preferred this complaint under section 12 of the Consumer Protection Act, 1986 (Here-in-after referred to as the Act) seeking direction from this Forum to the opposite parties to release the insurance claim amount; pay Rs. 50,000/- to her for physical and mental harassment and Rs. 10,000/- as litigation expenses.<br /> 2. On being put to notice, opposite parties filed their version that complaint is not maintainable in the present form; complainant has no locus-standi and cause of action to file it; she has not come with clean hands; intricate questions of law and facts are involved which require voluminous evidence and as such, matter should be decided by the civil court; complaint is pre-mature and it is false and frivolous. Inter-alia, their plea is that life assured i.e. Hem Raj had concealed factum of disease from which he was suffering at the time of submitting the proposal form and while obtaining the insurance policy. On receipt of the claim papers on account of death of Hem Raj, complainant was asked to submit relevant papers i.e. Form No. 3790 on non judicial stamp paper. She had submitted Form No. 3790 on plain paper. She was again asked to submit it on non judicial stamp paper. During investigation, it came to their knowledge that deceased life assured was suffering from severe heart problem and had undergone byepass surgery prior to the filing of the proposal form and issuance of the insurance policy. Even the cause of death is heart attack. She was asked to submit Form No. 3816 disclosing the history of disease of life assured . She was avoiding and it created suspicion about the genuineness of the claim. They have also got one letter in writing from one Dev Raj S/o Sh. Maghi Ram of Goniana Mandi, who has disclosed that deceased life assured (DLA) was suffering from severe heart attack and had undergone byepass surgery from Escorts Hospital, Delhi. Again she was asked to submit From No. 3816, but she did not make compliance. Claim is under process. It has not so far been finalised. Letter dated 19.11.2007 was issued. Form No. 3790 on judicial stamp paper was submitted, but she avoided to furnish Form No. 3816. She was intimated that claim cannot be passed without submission of Form No. 3816. They deny the remaining averments in the complaint.<br /> 3. In support of her allegations, Smt. Shimla Devi complainant tendered into evidence her own affidavit (Ex.C.1), photocopy of Claimant's statement (Ex.C.2), photocopy of policy (Ex.C.3), photocopy of receipt (Ex.C.4), photocopy of certificate of Identity and Burial or Cremation (Ex.C.5), photocopy of Form No. 3801 (Ex.C.6), photocopy of application dated 26.12.2007 (Ex.C.7), photocopies of Declarations of S/Sh. Harnam Singh & Naresh Kumar (Ex.C.8 & Ex.C.9) respectively, photocopies of letters dated 17.10.2007, 19.11.2007, 20.12.2007 and 31.1.2008 (Ex.C.10, Ex.C.12, Ex.C.13 & Ex.C.23) respectively; photocopy of Proforma of Claim Form No. 3816 (Ex.C.11), photocopy of Proposal Form (Ex.C.14), photocopy of Medical Examiner's Confidential Report (Ex.R.15), photocopy of Identity Card of Sh. Hem Raj issued by Election Commission of India (Ex.C.16), photocopy of Form No. 5096/3260'A'/3179/3179'A' (Ex.C.17), photocopy of Agent's Confidential Report (Ex.C.18), photocopy of Declaration by the Proposer (Ex.C.19), photocopy of Blood Sugar Tolerance Report (B.S.T) (Ex.C.20), photocopy of E.C.G film (Ex.C.21) & photocopy of Form No. IC 03-002 (Ex.C.22).<br /> 4. On behalf of the opposite parties, reliance has been placed on affidavit (Ex.R.21) of Sh. J.P. Arya, Manager (Legal), photocopies of letters (Ex.R.1 to Ex.R.7 & Ex.R.10 to Ex.R.17) respectively, photocopy of Form No. 3816 (Ex.C.9), photocopy of Claimant's statement (Ex.R.17), photocopy of Policy (Ex.R.18), photocopy of Medical Examiner's Confidential Report (Ex.R.19) & photocopy of Proposal for Insurance (Ex.R.20).<br /> 5. We have heard the learned counsel for the parties and gone through the record. Apart from this, we have considered written arguments submitted by the complainant.<br /> 6. Some facts do not remain in dispute. They are that husband of the complainant namely Hem Raj had obtained an insurance policy, copy of which is Ex.C.3. Sum assured is Rs. 2,00,000/-. Before insurance policy was issued by the opposite parties, his medical tests were performed by the doctors as is evident from Ex.C.15 & Ex.C.20 to Ex.C.22. Deceased-life assured had died on 22.1.2007 due to sudden heart attack. Claim was submitted by the complainant. Copies of the relevant claim papers are Ex.C.2 to Ex.C.6. On 17.10.2007, opposite parties issued letter, copy of which is Ex.C.10, informing the complainant to supply them the details of the treatment taken by her husband and submit Form No. 3816 duly completed by the doctor/hospital. She was further directed to submit Form No. 3790 on non-judicial stamp paper duly attested by two disinterested persons who were present at the time of death. Complainant had previously submitted Form No. 3790, but not on non-judicial stamp paper. Again opposite parties issued letters dated 19.11.2007 and 20.12.2007, copies of which are Ex. C.12 & Ex. C.13. Thereafter, she submitted Form No. 3790 on non-judicial stamp paper. In response to the letter dated 17.10.2007, she intimated that Form No. 3816 is not applicable because her husband had died due to sudden heart attack. Again on 31.1.2008, opposite parties demanded details of treatment in the shape of Form No. 3816 duly completed by the doctor/hospital as is evident from Ex.C.23. She was further intimated by them that it had come to their knowledge that life assured was suffering from heat problem and he had got treatment for the same. He had also undergone byepass surgery. Complainant did not submit Form No. 3816. Ultimately, claim has been repudiated vide letter dated 21.3.2008, copy of which is Ex.R.11 on the ground that deceased withheld correct information regarding his health at the time of effecting the insurance with them. He had answered the following questions as under :-<br /> 1. Q. No. 11(d) Are you suffering from or have you ever suffered from : No <br /> ailments pertaining to Liver, Stomach, Heart, Lungs,<br /> Kidneys, Brain or Nervous system?<br /> 2. Q. No. 11 ( i ) What has been your usual state of health : Good <br /> 7. In the repudiation letter, it has been brought to her notice that all the answers were false as he had suffered from TVD, CAD, IWMI and had remained under treatment for these ailments. These facts were not disclosed by him in the proposal/personal statement.<br /> 8. Material question for determination is as to whether the repudiation of the claim made by the opposite parties is justified. Onus to prove it is upon the insurer. Contention of the learned counsel for the complainant is that deceased husband of the complainant was not suffering from any ailment prior to the date of purchasing the insurance policy and on that account, Form No. 3816 was not submitted. So far as copies of Forms No. 5152and 3816, copies of which are Ex.R.8 and Ex.R.9 are concerned, they do not pertain to the husband of the complainant as the address on them is not of the deceased. He further argued that the claim has been illegally repudiated as the cause of death of the deceased was sudden heart attack. For this, he drew our attention to the authorities Gurram Varalakshmi Vs. LIC of India-III(2006)CPJ-304(NC), Laxman Prasad Pandey Vs. LIC of India-IV(2006)CPJ-139(NC), Senior Divisional Manager, Life Insurance Corporation of India & Ors. Vs. Smt. J. Vinaya-I(2003)CPJ-50 (NC) & Parumal Choudhary Vs. Life Insurance Corporation of India-IV(2004)CPJ-488.<br /> 9. Mr. Inderjit Singh, learned counsel for the opposite parties argued that claim has been rightly repudiated as the deceased husband of the complainant had withheld material information about his health in the proposal form while giving reply of questions No. 11(d) and 11( i ).<br /> 10. We have considered the rival arguments. Admittedly, deceased had purchased insurance policy on 27.5.2006 and he has died on 22.1.2007 due to heart attack. In his affidavit Ex.R.21 Sh. J.P Arya, Manager (Legal & HPF) of the opposite-Insurance Company has made it clear that complainant was not submitting Form No. 3816 disclosing the history of the disease of life assured alongwith Form No. 3790 on non-judicial stamp paper and this had created suspicion regarding the genuineness of the claim. Opposite parties had received letter from one Sh. Dev Raj S/o Sh. Maghi Ram of Goniana Mandi who had disclosed that deceased life assured was suffering from heart problem and had undergone byepass surgery from Escorts Hospital, Delhi. In these circumstances, opposite parties issued three letters to the complainant on 11.7.2007, 19.11.2007 & 20.12.2007, copies of which are Ex.R.16, Ex.R.15 and Ex.R.14 respectively. Manager of the opposite parties also sent letter to Sh. Ravinder Kumar, Assistant Branch Manager(S), Bathinda as he was investigating the claim for knowing the admission details, CR No. etc. of the deceased for obtaining Form No. 3816 from Escort Hospital. Opposite parties had held correspondence with Escort Hospital, New Delhi as is evident from Ex.R.1 & Ex.R.4 to Ex.R.7 requesting to supply the hospital record about Hem Raj (Deceased), S/o Sh. Babu Ram, R/o M/s. Shaddi Ram Babu Ram, Commission Agent, Grain Market, Goniana Mandi, District Bathinda on the ground that it had come to their knowledge that he was suffering from heart problem and had taken treatment and that he had also undergone byepass surgery. Ultimately, record was sent, copies of which are Ex.R.8 & Ex.R.9. Ex.R.8 is the questionnaire which has been answered by the doctor who had treated the deceased. Ex.R.9 is the certificate of Escort Hospital concerning the deceased. No-doubt, the address given in Ex.R.8 and Ex.R.9 of Sh. Hem Raj does not meticulously coincide with his address given in the complaint, yet complainant cannot derive any benefit from this fact. In Ex.R.9, father's name of Sh. Hem Raj has been recorded as B. Ram in short form. Infact, full name of his father is Babu Ram. Information has been supplied by the Escort Hospital on the basis of the correspondence held by the opposite parties with it. As mentioned above, information was sought by the opposite parties about the deceased husband of the complainant giving his proper address. In this manner, record prepared and sent by the Escort Hospital cannot be said to be of any other person than that of the deceased husband of the complainant. It appears that some mischief was played either by the deceased or his attendants with ulterior motive in giving somewhat different address in the hospital so that he may not be connected with the life assured in case of death. From the evidence on the record and the affidavit Ex.R.21, there remains no room to doubt the fact that deceased husband of the complainant had got treatment from Escort Hospital, New Delhi. As per information supplied by this hospital, deceased was suffering from Coronary Artery Disease and interior wall myocardial infarction since 2002. He was suffering from triple Vessel disease since 14.3.2002. He had dyspnoea on exertion (Class III). He was also suffering from diabetes Mellitus and dyslipidemia. Dr. R.K Gupta, M.D (Medicine) gave his opinion, copy of which is Ex.R.10, on the basis of the Form No. 5152 sent by the doctor of Escort Hospital. According to this letter, deceased had undergone Coronary Artery byepass. Despite the fact that deceased was getting treatment and he was type II diabetic as well before purchasing the insurance policy, he withheld this information in the proposal form for insurance by way of giving wrong answers of questions No. 11 (d ) and 11 ( i ). He expired within two years from the date of purchasing the policy. Hence, section 45 of the Insurance Act is fully applicable. In this manner, deceased violated condition No. 5 of the Insurance Policy. He gave false declaration in the proposal for insurance by giving wrong replies to the questions referred to above about his true state of health, illness and hospitalization. In our view, claim has been rightly repudiated and repudiation is legal and valid. In this view of the matter, we get support from the authorities Shanmugha Mudaliar and another Vs. Senior Divisional Manager, LIC of India and another-2004(3)CLT-91, Narinder Kaur Vs. Zonal Manager, Life Insurance Corporation of India and another-2004(2)CLT-393, Rattan Kumar @ Rattan Lal Vs. Life Insurance Corporation of India-2006(1)CLT-14, Shakuntala Kumari Sahni Vs. Life Insurance Corporation of India and another-2004(3)CLT-8 and L.I.C of India and others Vs. K Muthammal-2005(1)CLT-116. With utmost regard and humility to the authorities relied upon by the complainant, they are distinguishable on facts.<br /> 11. For the reasons aforesaid, we find no deficiency in service and unfair trade practice on the part of the opposite parties. Complaint being devoid of merits, is dismissed. Parties are left to bear their own costs. Copy of this order be sent to the parties free of cost. File be also consigned.<br /> <br /> Pronounced (Lakhbir Singh)<br /> 1.4.2008 President<br /> <br /> <br /> (Dr.Phulinder Preet)<br /> Member <br /> <br /> 'bsg' <br /> <br />