Haryana

Yamunanagar

CC/698/2013

Smt. Rekha Rani w/o Shri Moti Lal, - Complainant(s)

Versus

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

Parmod Bansal

10 Oct 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR AT AJGADHRI.

 

                                                                        Consumer Complaint No.698 of 2013.

                                                                        Date of Institution:24.9.2013.

                                                                        Date of Decision: 10.10.2017.

 

Smt. Rekha Rani wife of Late Sh. Moti lal, Aged 42 years , Resident of 371 Lajpat Nagar,  Yamuna Nagar  Tehsil. Jagadhari , Distt. Yamuna Nagar.

 

                                                                                               …Complainant.

                                                Vs.

The Life Insurance Corporation of India, though its Branch Manager, Opp. Madhu Cinema , Jagadhari Road, Yamuna Nagar

…Respondent.

 

                                          Complaint under section 12 of the

                                                Consumer Protection Act.

 

CORAM:        SH.SATPAL, PRESIDENT,

                        SH.S.C.SHARMA,    MEMBER.

                        SMT. VEENA RANI SHEOKAND, MEMBER.

 

Present:          Sh.Parmod Bansal, Adv. for complainant.

                      Sh.Rajiv Gupta, Adv. for OP.

 

ORDER:         (SH.SATPAL, PRESIDENT)

 

1.            The complainant-Smt. Rekha Rani has filed this complaint under section 12 of the Consumer Protection Act against the respondent (hereinafter the respondent shall be referred as OP).

2.                 Brief facts of the complaint are that Sh. Moti Lal, husband of the complainant purchased two policies bearing No.174790495 to the tune of Rs.1,00,000/- which commenced from 10.7.2006 and the same was to be matured on 10.7.2022.  Similarly, policy No.174791195 for Rs.1,00,000/- was also purchased and premium of both the policies was paid to the Op.  Unfortunately, Sh.Moti Lal had died on 2.11.2007 and after his death the complainant being his nominee stepped into the shoes of Moti Lal.  However, Smt. Urmila claiming herself to be wife of deceased Moti Lal as-well-as Laxmi, Raman, Manisha as daughters and son and Smt.Lal Devi as mother filed a suit for declaration and Permanent Injunction that they are only legal heirs of deceased Moti Lal and also claimed the amount of said policy vide Civil Suit No.95 on 10.3.2008 by arraying the applicant/complainant as defendant No.2 and LIC as defendant No.1 which remained pending before the court up to 22.8.2012.  Similarly, complainant Rekha Rani, Deepika, Jyoti, Sachin also filed one Civil Suit No.216 of 3.5.2008 to declaration claiming themselves as legal heirs of Moti Lal and claimed his service benefits by arraying the said Urmial etc. as defendants and Ballapur Industries ltd. as defendant No.1.  In both the cases, a compromise had taken place between the present complainant and Smt. Urmila etc. according to which the said Smt. Urmila has left her right over the said policies in favour of complainant and complainant has left her right over the rest of the estate of Sh.Moti Lal and on the basis of said compromise the above said suits have been decided by the Court of Ravneet Garg, Addl. Civil Judger, Senior Division, Jagadhri vide order dated 22.8.2012.  Thereafter, the complainant approached the OP and requested to release the claim being nominee of the above said policies and as per compromise mentioned above but the OP evaded the matter on one pretext or the other and since 22.8.2012, the complainant is running from pillar to post and requesting the OP to do the needful but they instead of doing the needful stated that they have already repudiated the claim of the complainant.  OP never informed the complainant regarding the repudiation of the claim of the said policies and the said repudiation, if any, is illegal, null and void.  There is gross negligence and deficiency in service on the part of the Op and prayed for acceptance of complaint by directing the OP to make the payment of maturity amount against the policies mentioned above to the complainant being nominee of the said policies along interest @15% p.a. from the date of maturity till its realization and to pay Rs.100000/- as compensation for mental agony, harassment and financial loss and further to pay Rs.22000/- as cost of unnecessary litigation. 

3.                Upon  notice, the Op appeared and filed their written statement by taking some preliminary objections alleging therein that the complaint is not maintainable; the deceased life assured Sh.Moti Lal son of Sh.Karia Ram had taken two Life Insurance Policies bearing no.174791195 which commenced from 21.4.2007 for Rs.1,00,000/- and policy No.174790495 which commenced from 10.7.2006 for Rs.1,00,000/- from the Op.  For obtaining the above said policies, the deceased-life assured submitted two separate proposal forms dated 10.4.2007 and 13.7.2006 respectively in which the Life Assured submitted his entire history including his state of health which were solely in the personal knowledge of the deceased life assured.  The Op taking the personal history and the contents of the proposal forms to be true and correct issued the above said two policies and the Life assured appointed one Rekha (his wife) as nominee.  Life Assured died on 2.11.2007 and after his death Smt.Rekha lodged a claim with OP vide their letter dated 28.2.2008, besides this an intimation/claim was also lodged with the OP by one Smt. Urmila claiming herself to be widow of deceased Moti Lal.  On receipt of said intimation, the claim was duly processed by the OP and since as per record Smt. Rekha was the appointed nominee under the policies in question, therefore, the OP vide letter dated 23.5.2008 desired her to complete the necessary formalities to enable the Op to process the claim.  Both the claims were early in nature therefore, as per procedure of OP, both the cases were got investigated by OP and during the investigation it was found that the deceased life assured Moti Lal took treatment from ESI Hospital, Jagadhri where he remained admitted w.e.f. 14.10.2006 to 27.11.2016 as a case of chronic Alcoholic and Diabetic Mellitus.  Besides this, he was again admitted in ESI Hospital, Jagadhri on 24.1.2007 as a case of chronic Alcoholic and diabetic Millitus and he absconded from the hospital as LAMA on 2.2.2007.  At the time of proposing for insurance, the life assured was not hale and hearty and was suffering from Chronic Alcoholism and diabetic Mellitus diseases but the life assured did not disclose the said fact at the time of proposing for insurance policy.  The deceased was under obligation to disclose the true and material facts regarding his state of health at the time of proposing for insurance policies but he made deliberate mis-statement and withheld the material information regarding his health and thereby misrepresenting the same obtained the life insurance policy in question; on receipt of said documents, the claim was duly processed by the Op and legally and justifiably repudiated the claim under the policies in question vide its letter dated 31.12.2010 addressed to Smt. Rekha.  On merits, controverted the plea taken by the complainant and reiterated the stand taken in the preliminary objections.  There is no deficiency in service on the part of the Op and prayed for dismissal of complaint with costs. 

4.                 The complainant to prove her case tendered into evidence her own affidavit as annexure-CW/A, documents such as copy of order of  learned  Addl. Civil Judger, (Sr.Div.) Jagadhri as annexure C.1 to C.5, copy of letter dated 30.12.2010 as annexure C.6, copy of application of Smt. Rekha as annexure C.7, copy of receipt dated as annexure C.8, copy of death certificate as annexure C.9, copy of policies, receipts etc. as annexure C.10 to C.16 and closed her evidence. 

5.                   The counsel for the OP tendered into evidence affidavit of Shri Ajay Gupta (Manager Legal) as annexure RW/A, documents such as copy of letter dated 20.12.2010 as annexure R1, record of hospital as annexure R2 to R8, copies of policies along with proposal form as annexure R9 to R13 and closed evidence on behalf of Op. 

6.                  Arguments heard.  Ld. Counsel for the complainant argued that Sh. Moti Lal, husband of the complainant had purchased two policies dt. 10.07.2006 and  dt. 21.04.2007 for a sum assured of Rs.1,00,000/- each and paid the premium regularly.  The life assured had expired on 02.11.2007.  The claim of afore-said policies have been repudiated by the Op-insurance company on the false and frivolous ground that the life assured was having pre-existing disease and before taking the policy, suppressed the true and material facts from the Op, however, the husband of complainant was hale and healthy at the time of taking the policy and ld. Counsel for complainant referred the case law cited in 2014(3) CPC page 114 titled as New India Assurance Co. Ltd. Vs. Rakesh Kumar, wherein the Hon’ble National Commission has held that “The plea of petitioner that respondent was suffering from pre-existing disease of diabetes and establish from evidence-since how long complainant was suffering and which medi-claim he was taking not proved from the facts of case-people can live for months without knowledge that they had some diseases which is known all of sudden by medical check-up-in the present case, no evidence shows that complainant had concealed the fact of pre-existing disease of diabetes-order of fora below cannot be disturbed-petition dismissed.”

                        Similarly, ld. Counsel for the complainant has also referred the case law reported in 2014(3) CPC page 585 titled as Abhishekh Jain Vs. HDFC Standard Life Insurance Co. Ltd. & others, wherein same question of law has been discussed. 

                        On the other hand, ld. Counsel for the Op argued that both the claims were early in nature and on investigation, it was found that the deceased life assured Moti Lal took treatment from ESI Hospital, Jagadhri where he remained admitted w.e.f. 14.10.2006 to 27.11.2006 (Annexure-R2) as a case of ‘Chronic Alcoholic and Diabetic Mellitus’.  Again, the life assured was admitted in ESI Hospital on 24.01.2007 (Annexure-R2) as a case of ‘Chronic Alcoholic and Diabetic Mellitus’ meaning thereby the life assured was having pre-existing disease and habitual in  taking alcohol but in the proposal forms, the life assured had given wrong answers that he is not suffering from any pre-existing disease.  The claim of complainant was rightly repudiated by the Op.  Ld. Counsel for the Op has also referred the case law titled as Usha Rani & others Vs. Life Insurance Corporation & others, bearing revision petition No.4875 of 2012 decided on 05.02.2013, wherein the Hon’ble National Commission held that “On account of giving wrong answers to the questions put to him with respect to his state of health, Op-insurance company cannot be held liable to pay any insurable benefits to the complainant.”

                        Similarly, ld. Counsel for the Op relied upon the case law titled as Manju Bhattacharya Vs. Senior Manage, Life Insurance Corporation of India bearing revision petition No.1367 of 2014 decided on 28.11.2014, case titled as Annu Sanan Vs. Life Insurance Corporation of India in revision petition No.1338 of 2008 decided on 10.10.2014, Roshan Akhtar Vs. Regional Manager, Zonal Office, Life Insurance Corporation of India & others in revision petition No.2549 of 2014 decided on 28.10.2014 and  LIC of India Vs. Mamta in revision petition No.3223 of 2010 decided on 12.01.2015, wherein the Hon’ble National Commission discussed on the point of concealment of material fact regarding previous ailment by the life assured-repudiation of claim is justified by the insurance company.                 

7.                     After hearing the learned counsel for the parties and going through the pleadings as well as documents placed on the file, it is clear and an admitted fact that the complainant purchased two policies first bearing policy No.174790495 dated 10.7.2006 for a sum assured of Rs.1,00,000/- and second bearing No.174791195 dated 21.4.2007 for a sum assured of Rs.1,00,000/-.  The point of controversy between the parties is whether the repudiation of claim made by the OP is illegal or not?  There are two policies detailed above and from the perusal of the proposal forms (Annexure-R10 and Annexure-R11), it is clear by seeing the same with necked eyes that the same have not been filled-up by the complainant and that might have been filled up by any official/agent of the Op and only the signatures of the life assured were obtained thereon.  The Op had never bothered to investigate the matter at the time of accepting these proposal forms.    From the perusal of the proposal forms, it is also clear that neither any agent nor any officer of the Op company who accepted the proposal form have taken any pain to look into the history of the life insured.

8.                     Though the Op had not verified the facts at the time of taking the premium and issuing the policies but it is settled law that in case of concealment of facts, the claim is not payable and in the present case, the complainant purchased the second policy bearing No.174791195 on 21.4.2007 but prior to getting this policy, the life assured  remained admitted in the ESI, Hospital, Jagadhri from 24.01.2007 to 02.02.2007 (Annexure-R2) with the history “Chronic Alcholic & Diabetic” but in the proposal form which was filled-up at the time of purchasing the policy, the complainant in the column of Personal History recorded the remarks “NIL” in the column of ailment, whereas he had already remained under treatment on the date of filling up the proposal form for the second policy dated 21.04.2007. So, concealment of fact on the part of the deceased-life assured is proved and the complainant is not entitled for any relief for this insurance policy.

9.                     Secondly, so far as the payment of claim of first policy No.174790495 dt. 10.07.2006 is concerned, it is an admitted fact that this policy was purchased by the deceased life assured on 10.7.2006 and prior to purchase of the said policy, no record has been produced by the Op-insurance company from which it could be clear that the life assured was having any pre-existing disease and as per the record of the ESI Hospital, Jagadhri (Annexure-R-2), the life insured was firstly admitted in the hospital on 14.10.2006 and discharged on 27.11.2006.  From the perusal of both records of admission of deceased life assured Sh. Moti Lal, Annexure-R2, it is nowhere mentioned that since how long, the life assured was suffering from the diseases mentioned above.  From the perusal of the record, it is crystal clear that the life assured had purchased the first policy on 10.07.2006 and he was diagnosed as diabetic patient after about 3 months of taking the policy.  It is known that, many times the healthy person are unaware of such silent ailments of diabetes and hyper tension, which come to their knowledge first time during health check-up camps or in any emergent situation.  Thus, the Op cannot apply a hard and fast rule to presume that the life assured was suffering from long duration i.e. before taking the policy.  So, the plea taken by the Op that the deceased Moti Lal had made mis-statements and with-held material information from the OP is not tenable.  The repudiation of claim regarding first policy No.174790495 dated 10.07.2006 is illegal and unjustified and amounts to deficiency in service on the part of the OP as they have withheld the genuine claim of the complainant relating to this insurance policy valid from 10.07.2006 to 10.07.2022 without any cogent reason, hence, the complainant is entitled for relief.

10.                   Resultantly, we partly allow the complaint of the complainant by directing the Op to pay Rs.1,00,000/- along with all benefits to the complainant with regard to first policy bearing No.174790495 dated 10.7.2006 along with interest @6% p.a. from the date after three months from the date of death of life assured till its realization and further to pay Rs.5500/- as cost of proceedings.  Order be complied within 30 days from the date of preparation of this order failing which the complainant is at liberty to invoke the jurisdiction of this Forum as per law.  Copies of this order be supplied to the parties concerned free of costs.  File be consigned to the record-room after due compliance.

Announced in open Court:10.10.2017.

                                                                                                (SATPAL)

                                                                                                PRESIDENT

 

(VEENA RANI SHEOKAND)                    (S.C.SHARMA)

MEMBER                                                      MEMBER.