Haryana

Yamunanagar

CC/289/2013

Chotti Devi W/o Gurdass - Complainant(s)

Versus

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

R.S.Saini

08 Feb 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

 

                                                                                          Complaint No. 289 of 2013.

                                                                                          Date of institution: 25.04.2013         

                                                                                          Date of decision: 08.02.2017

 

Chhoti Devi, aged about 35 years, wife of Late Gurdass, resident of village Haibatpur, Tehsil Bilaspur, District Yamuna Nagar.

 

                     …Complainant.

                                                  Versus

1. The Life Insurance Corporation of India, Northern Zonal Office, Jeewan Bharti Cannaught Circus New Delhi through its Zonal Manager.

 

2. The Life Insurance Corporation of India Divisional Office Jeevan Parkash 489, Model Town, PB No.106, Karnal 132001 through its Divisional Manager.

 

3. Life Insurance Corporation of India, Court Road Sector 17, HUDA Jagadhri, District Yamuna Nagar.

 

                                                                                                                             ...Respondents

 

BEFORE:         SH. ASHOK KUMAR GARG…………….. PRESIDENT.

                         SH. S.C.SHARMA………………………….MEMBER.

 

Present:           Sh. Randhir Singh, Advocate for complainant.

                         Sh. NS Sihnmar, Advocate for OPs.

 

ORDER  (Ashok Kumar Garg, President)

 

1                      The present complaint has been filed under section 12 of the Consumer Protection Act 1986 praying therein that respondents (hereinafter referred as OPs) be directed to pay a sum of Rs.50,000/- insured value of the policy in question and also to pay compensation as well as litigation expenses.

2.                     Brief facts of the present complaint, as alleged in the complaint, are that husband of the complainant namely Gurdass had got himself insured with the OPs Insurance company vide insurance policy bearing No.177548741 for a sum of Rs.50,000/-, date of commencement 13.08.2011 and date of maturity 08/2031. The mode of premium was quarterly and the premium was Rs.969/-. The husband of the complainant was paying the installments of premium regularly without any delay. However, the husband of the complainant fell ill and got treatment from the MLGH Hospital, Yamuna Nagar with effect from 03.10.2011 to 05.10.2011 as indoor patient and ultimately died on 05.10.2011 at 11.00 am. The deceased left behind the complainant as his wife and nominee and two unmarried sons namely Kamal Kumar and Neeraj Kumar. Being the nominee of her husband, the complainant applied for the benefits of the policy in question and completed all the formalities and also submitted the death certificate issued by the doctor. However, the official of the OPs insurance company repudiated the claim of complainant vide letter dated 22.12.2012 on the false ground that complainant was suffering from TB while at the time of getting himself insured with the OPs the husband of the complainant was hale and healthy and was not suffering from any disease. Complainant has made so many requests to the OPs to release the Insurance amount of Rs.50,000/- but all in vain. Hence, this complaint.

3.                     Upon notice, OPs Insurance Company appeared and filed its written statement by taking some preliminary objection such as complaint is not maintainable; complainant has concealed the true and material facts, the true facts are that the deceased Gurdas was not in good health at the time of taking insurance policy in question and he was suffering from TB from several months prior to taking policy in question and was under the treatment of ML General Hospital, Yamuna Nagar. The deceased Gurdas has concealed the fact of above disease from the OPs Insurance Company and further the proposal of the deceased Gurdas was accepted under non medical scheme of the corporation and no medical was done at the time of Insurance, as insurance is a subject matter of “UBRIMMAE FIDES” i.e. utmost good faith and it is the duty of life insured to disclose all facts which insurer himself can not know by his general prudence. Further, it has been mentioned that deceased Gurdas has suppressed the fact that at the time of giving his personal history in the proposal form, he gave the answering in “NO” to the question No.11(a,b,d and e) and “YES” to question No.11(i). All these material were concealed by deceased Gurdas at the time of taking Insurance policy in question. Hence, claim of the complainant has been rightly repudiated by the Insurance Company and on merit contents of the complaint were denied and reiterated the facts mentioned in preliminary objection.

4.                     Complainant failed to adduce any evidence despite so many opportunities subject to last and cost. Hence, evidence of the complainant was closed by Court order vide order dated 12.08.2016. However, at the time of filing the complaint, some documents has been placed on file such as affidavit of complainant Smt. Chhoti Devi as Annexure-A, photocopy of status report as Annexure C-1, photocopy of proposal form Annexure C-2, photocopy of hospital record of MLGH Yamuna Nagar as Annexure C-3, photocopy of heath care card as Annexure C-4, photocopy of repudiation letter dated 22.12.2012 as Annexure C-5, photocopy of letter issued by LIC as Annexure C-6, original death certificate as Annexure C-7.

5.                     On the other hand, learned counsel for the OPs tender into evidence affidavit of Shri Ajay Gupta, Manager LIC as RW/A, photocopy of claim form as Annexure R-1, intimation letter as Annexure R-2, claim forms as Annexure R-3 to R-6, photocopy of death certificate as Annexure R-7, photocopy of ration card as Annexure R-8, photocopy of first page of insurance policy as Annexure R-10, photocopy of pass book as Annexure R-11, photocopy of repudiation letter as Annexure R-12, Miscellaneous internal letter as Annexure R-13 and R-14, photocopy of proposal form as Annexure R-15, photocopy of claim notice as Annexure R-16, photocopy of doctor claim form filled by doctor as Annexure R-17, photocopy of letter dated 01.11.2012 as Annexure R-18, photocopy of letter dated 01.10.2012 as Annexure R-19, photocopy of letter dated 23.08.2012 as Annexure R-20, photocopy of letter dated 04.09.2012 as Annexure R-21, photocopy of confidential /claim inquiry report as Annexure R-22, photocopy of reminder dated 01.08.2012, 05.07.2012 and 13.06.2012 as Annexure R-23 to R-25 and closed the evidence on behalf of OPs.

6.                     We have heard the learned counsels of both the parties and have gone through the pleadings as well as documents placed on the file very carefully and minutely.

7.                     It is not disputed that husband of the complainant namely Late Shri Gurdas got himself insured with the OPs Insurance Company vide insurance policy bearing No.177548741 for a sum of Rs.50,000/-, with the date of commencement 13.08.2011 till the date of maturity 08/2031 and the mode of the premium was quarterly i.e. Rs.969/- per quarter, which is duly evident from the copy of status report of the policy (Annexure C-1/R-10). It is also not disputed that husband of the complainant remained under treatment from 03.10.2011 to 05.10.2011 as indoor patient in Mukand Lal General Hospital, Yamuna Nagar and died on 05.10.2011 which is duly evident from the copy of bed head ticket (Annexure C-3).

8.                     The only plea of the complainant is that the genuine claim of the complainant has been wrongly repudiated by the OPs Insurance Company whereas from the documents placed on file it is duly proved that complainant is entitled to get the insured amount of Rs.50,000/- from the OPs Insurance Company.

9.                     On the other hand learned counsel for the OPs insurance company hotly argued at length that claim of the complainant has been rightly repudiated by the OPs Insurance Company vide its letter dated 22.12.2012 (Annexure R-12) on the valid and reasonable ground as the patient i.e. deceased Late Gurdass was suffering from TB for which he was taking treatment from ML General Hospital, Yamuna Nagar from several months prior to taking the policy in question.  However, he did not disclose these facts in his proposal form and gave false answer therein. Learned counsel for the OPs draw our attention towards Bed Head Ticket of Mukand Lal General Hospital, Yamuna Nagar (Annexure C-3) and patient health care card dated 29.09.2011 (Annexure C-4) and argued that as per these medical records, the patient was suffering from TB and was not taking the medicine properly and the condition of the decease was chronic but he obtained the insurance policy  by suppressing the true and material facts about his health status just prior to the 1 ½ month from the date of death. As the policy in question was issued on 13.08.2011 and the deceased Gurdas expired on 05.10.2011. Learned counsel for the OPs lastly prayed for dismissal of the complaint quo the OPs and referred the case law titled as LIC of India and others Vs. NP Nagarathna, 2012(2) CPC, Page No.576:

Consumer Protection Act, 1986 – Section 14(1) (d) and 21 (b)- Insurance-Insured covered under life insurance policy of Rs.2 lac- Unfortunately, he died only 39 days after purchase of policy- He was suffering from Non Hodgkin’s Lymphoma disease at the time when policy was taken- But it was not disclosed which amounted to a breach of contract and principles of utmost good faith- Order of For a below accepting the claim set aside- Revision Allowed.

 

            Learned counsel for the OPs also referred the case law titled as Komal Sharma and others Vs. Life Insurance Corporation of India and other, 2013(1) CPC Page No.646:

Consumer Protection Act, 1986- Section 14 (1) (d)- Insurance claim- concealment of fact- The assured was suffering from Hepatitis and liver disease at the time when he obtained life insurance policy- He remained in hospital for treatment from 04.09.1996 to 16.09.1996- But this fact was not disclosed to insurer- Unfortunately, he expired on 01.08.2006 whereas tow policies were obtained in 1999 and 2004- District Forum allowed complaint and directed OP to pay a sum of Rs.150000/- with 9% interest in one car but upheld repudiation of claim in another case- State Commission set aside the order of District Forum, hence this revision-  Concealment of disease is well proved from the medical certificates- Assured was under obligation to reveal the real facts which he failed to comply with- There is no illegality in the impugned order- Petition Dismissed.

 

                        and also referred the latest citation titled as Laxmibai, through her LRS and others Vs. Birla Sun Life Insurance Co. Ltd., 2016(2) CPR 533 (NC):

Consumer Protection Act, 1986- Sections 15,17,19, and 21- Insurance-Repudiation  of death claim on ground of suppression of material facts by insured- insured was suffering from problem of both kidneys since much prior to filing of proposal form- Earlier to purchase of subject insurance policy insured had two insurance policies- Petitioner  having known his adverse medical condition with a view to secure his family member deliberately purchased subject insurance policy by misleading insurer and concealing material fact- Contract of insurance is based on doctrine of utmost good faith-Life assured while obtaining insurance policy is under obligation to disclose relevant material aspect with respect to his life- Insured had obtained insurance policy by concealment of material facts- Order of State Commission setting aside order of District Forum affirmed- Revision petition dismissed.      

10.                   After hearing both the parties and going through the documents placed on file, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of the OPs as it is contended by the learned counsel for the OPs that contract of insurance is based on PRINCIPLE OF UTMOST FAITH- “UBERRIMA FIDES” and good faith forbids either party from non disclosure of the facts which the party privately knows, to draw the other into the bargains, from his ignorance of that fact and his believing the contrary. It is also argued that deceased Gurdas in proposal form (Annexure R15/C2) gave reply in “NO” to the question No.11 (a,b,d and e) and “YES” to the question No.11(i) of these material questions. However, in the hospital treatment, copies of which (Annexure C-3 and Annexure C-4), it is clearly mentioned by doctor regarding post illness/disease history/duration and diagnosis “TB” from last many years. Further, it has also been mentioned that deceased was not taking the medicine of the “TB” from the last (02) two months properly and condition of the deceased was chronic. All these facts were  concealed by the deceased Gurdass at the time of taking policy and further all these facts have also been concealed by the complainant in her complaint.

11.                   The version of the OPs Insurance Company has not been rebutted by the complainant. The Law cited by the counsel for the OPs titled as “LIC of India and others Vs. NP Nagarathna, 2012(2) CPC, Page No.576” and “Komal Sharma and others Vs. Life Insurance Corporation of India and other, 2013(1) CPC Page No.646” and “Laxmibai, through her LRS and others Vs. Birla Sun Life Insurance Co. Ltd., 2016(2) CPR 533 (NC)” (Supra) are fully applicable to the facts of the present case. Even, further Hon’ble Supreme Court of India in case titled as “Santwant Kaur Sandhu Vs. New India Assurance Company Limited, 2009(8), SCC 316”, has made the observation with regard to the material fact that “it is to be understood in general terms to mean as any fact which would influence the judgment of the prudent insurer, in deciding whether to accept the risk or not. If proposer has knowledge of such fact, he is obligated to disclose it particularly while answering question in the proposal form. It was also held that contract of the insurance is based on PRINCIPLE OF UTMOST FAITH- “UBERRIMA FIDES” and good faith forbids either party from non disclosure of the facts which the party privately knows, to draw the other into a bargain from his ignorance of that fact and his believing the contrary.  So, as per above said authority, the proposer should not conceal the fact, regarding his disease which in fact has been concealed in the present case.

12.                   Resultantly, in the circumstances noted above we are of the considered view that there is no merit in the present complaint and the claim of the complainant has been rightly repudiated by the OPs Insurance Company. Accordingly, the complaint of the complainant is hereby dismissed with no order as to cost. Copies of this order be supplied to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Pronounced in open court: 08.02.2017.

                                                                                          (ASHOK KUMAR GARG)

                                                                                           PRESIDENT

                                                                                           DCDRF Yamuna Nagar

 

 

                                                                                          (S.C.SHARMA)

                                                                                           MEMBER