Haryana

Karnal

CC/537/2020

Satpal Singh - Complainant(s)

Versus

Life isurance Corporation Of India - Opp.Party(s)

Ashok Kumar

12 Jul 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No.537 of 2020

                                                        Date of instt.01.12.2020

                                                        Date of Decision:12.07.2024

 

Satpal Singh, age 38 years son of Shri Shingara Ram, resident of village Bohla Khalsa,Tehsil Nilokheri, District Karnal.

 

                                                 …….Complainant.

                                              Versus

 

1. Life Insurance Corporation of India, P.O.no.106, Jiwan Parkash, 489, Model Town, Karnal through its Manager (Claims) DM.
2. Life Insurance Corporation of India, Jeevan Bharti, Tower-II, 124, Connaught Circus, P.B. no.630, New Delhi thorugh its Zonal Manager.
3. Life Insurance Corporation of India, Karnal, Kaithal main road, near HDFC Bank, Nissing, District Karnal through its Branch Manager.

                                                              …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.      

      Sh. Vineet Kaushik…….Member

              Ms. Sarvjeet Kaur…….Member

 

Argued by: Shri Ashok Kumar, counsel for the complainant.

   Shri Rahul Bali, counsel for the OPs.

 

                     (Jaswant Singh, President)

ORDER:   

                

                The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant purchased an Life Insurance Policy from the OPs, vide policy no.178176586 on 28.11.2017, valid from 28.11.2017 to 28.11.2038 through the agent namely Rishi Parkash Sharma, duly authorized by the OPs in the name of his wife Rani Devi (now deceased) and the sum assured was Rs.5,00,000/- and in this regard the OP no.1 had issued a policy in favour of the wife of the complainant on 28.11.2017 and Rs.13868/- was to be deposited with half yearly rests. There was no default on the part of the complainant in depositing the installment. At the time of issuance of the aforesaid policy, complainant has submitted all the requisite documents as per the instruction of the OP no.1 and the wife of the complainant was found suitable for the purchase of policy and after their full satisfaction, the OPs issued the policy for a sum of Rs.5,00,000/-. The wife of complainant fell ill and on 18.08.2019, she was admitted in Sadhbhavna Hospital, Jind. She took treatment from the above hospital. Various investigations/tests were conducted and the wife of complainant was discharged on 21.08.2019. Wife of complainant took treatment from Park Hospital, Karnal and various investigations/tests were also conducted in Park Hospital, Karnal but she did not get any relief and the complainant spent a huge amount. At the time of insurance, the wife of the complainant was not having any pre-existing disease and the disease so mentioned in the medical record has developed after sometime of the insurance. The wife of the complainant died on 22.12.2019. After the death of his wife, the complainant being nominee lodged the death claim with OPs and at the time of submitting the documents, OP no.1 did not raise any objection. Thereafter, complainant requested the OPs several times for releasing of the claim but OPs did not pay any heed to the request of complainant and lastly repudiated the claim of the complainant, vide letter dated 01.09.2020 on the false and frivolous ground, which is not justifiable..

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi and concealment of true and material facts. On merits, it is pleaded that life assured has not disclosed true and correct facts at the time of obtaining the policy and at the time of filling up the proposal form dated 30.01.2018. The policy in question was taken by Smt. Rani Devi wife of Satpal Singh for sum assured of Rs.5,00,000/- from OPs and she expired on 22.12.2019. The duration of the policy is one year 10 months and twenty two days from the date of commencement of risk, hence the claim was examined under section 45 of the Insurance Act 1938 and it was revealed that life assured was not having good health and was suffering from severe pulmonary disease and had history of old PTB and was on ATT and had complaint of SOB for 15 years and persistent SOB since 8 years and she was on MDI whereas in the proposal form she had given false answer. It is pertinent to mention here that she should have disclose about her previous long illness and treatment taken by her as it was material information and was in her knowledge at the time of taking the policy. It was the duty of the life assured to disclose these facts in the proposal form, but she gave false answers. Hence, the claim of the complainant was rightly repudiated by the OPs. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of premium receipts Ex.C2 to Ex.C5, copy of repudiation letter dated 01.09.2020 Ex.C6, copy of death certificate Ex.C7, copies of medical records Ex.C8 to Ex.C12 and closed the evidence on 16.11.2022 by suffering separate statement.

5.             On the other hand, OPs no.1 and 2 have tendered into evidence affidavit of Anju Arora Manager Ex.OP1/A, copy of proposal form Ex.OP1, copy of insurance policy Ex.OP2, copy of repudiation letter dated 01.09.2020 Ex.OP3, copy of medical bills and prescriptions Ex.OP4, copy of letter regarding death intimation Ex.OP5, copy of form no.3801 Ex.OP6, copy of death certificate of Rani Devi Ex.OP7, copy of letter dated 15.01.2018 Ex.OP8, copy of policy bond Ex.OP9 and closed the evidence on 18.07.2023 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for the complainant, while reiterating the contents of complaint, has vehemently argued that on 28.11.2017, complainant purchased Life Insurance Policy from the OPs. In the said policy wife of complainant  Rani Devi also insured, for the sum insured of Rs.5,00,000/-. At the time of obtaining the policy, the wife of complainant was not having any pre-existing disease. On 18.08.2019, she admitted in the hospital and discharged on 21.08.2019. The wife of the complainant did not get any relief  and died on 22.12.2019. The complainant submitted claim with the OPs but same has been denied by the OPs on the false and frivolous ground and lastly prayed for allowing the complaint.

9.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that on receipt of claim form, the claim was duly examined and it was found that life assured was not having a good health and was suffering from severe pulmonary disease and had history of old PTB and was on ATT and had complaint of SOB for 15 years and persistent SOB since 8 years but said disease has not been disclosed by the life assured at the time of purchasing the policy and had concealed the true and material facts regarding her health. The claim of the complainant has rightly been repudiated by the OPs and lastly prayed for dismissal of the complaint.

10.           We have duly considered the rival contentions of the parties.

11.           Admittedly, life assured had purchased the policy in question from the OPs and complainant is the nominee in the said policy. It is also admitted the sum insured under the policy is Rs.5,00,000/-.

12.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.OP3 dated 01.09.2020 on the ground that life assured was having pre-existing disease and she has concealed the said fact at the time of purchasing the policy in question.

13.           The complainant has alleged that at the time of purchasing the policy, his wife was not having any pre-existing disease and disease mentioned in the medical report has been developed after sometime of purchasing the policy. The onus to prove his version was relied upon the complainant but complainant has miserably failed to prove his version by leading any cogent and convincing evidence. Complainant himself relied upon the medical record Ex.C8 to Ex.C12, on perusal of the said medical record, it has been proved that deceased life assured was suffering from severe pulmonary disease and had history of old PTB and was on ATT and had complaint of SOB for 15 years and persistent SOB since 8 years. The said medical history has not been disclosed by the life assured at the time of purchasing the policy. Thus, it has been proved on record that deceased life assured was having pre-existing disease and had concealed the true and material facts regarding her health at the time of purchasing the insurance policy. In this regard, we are fortified with the observations of Hon’ble Supreme Court in case titled as Branch Manager, Bajaj Allianz Life Insurance Company Ltd. and others Vs. Dalbir Kaur in civil appeal no.3397 of 2020 decided on 09.10.2020 wherein Hon’ble Supreme Court held that a policy of insurance is governed by the principles of utmost good faith. The suppression of material facts by the insured/policyholder entitles the OP to repudiate the policy under section 45 of the Insurance Act. The said authority is fully applicable to the facts of the present case.

14.           It is settled principle of insurance law that contract of insurance is a contract uberrima fides and utmost faith must be observed by the contracting parties. Every material fact must be disclosed, otherwise there is good ground for rescission of contract. If, there are misstatements or suppression of material facts, the policy can be called into question. In this regard reference may be made to the judgment of the Hon’ble Supreme Court in case titled Satwant Kaur Sandhu Versus New India Assurance Co. IV( 2009) CPJ 8 (SC) and judgment of Hon’ble National Commission in case Life Insurance Corporation of India and another Versus Bimla Devi Revision Petition no.3806 of 2009 decided on 12.8.2015 and Sunita Rani Versus PNB Metlife India Insurance Company Limited in appeal no.1252/2015 dcided on 21.04.2017.

15.           Keeping in view the ratio of law laid down in the aforesaid judgments, facts and circumstances of the case the present complaint is devoid of any merit and deserves to be dismissed and the same is hereby dismissed. No order as to costs.  The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:12.07.2024                                                                    

                                                                President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.       

 

 (Vineet Kaushik)            (Sarvjeet Kaur)

                     Member                       Member