BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, FATEHABAD.

Complaint no.39/2018.

Date of instt.30.01.2019. 

                                                                                                Date of Decision:31.12.2019.

Vijay Singh S/o Sh. Manphool R/o Village Sardarpura Bass, Sadar Gandhi, Bari, Hanumangarh, Rajasthan.

                                                                                                                                ..Complainant.

                                                                Versus

1. PNB Metlife India Insurance Company Limited, Unit No. 701, 702, 703, 7^th Floor, West Wingh, Raneja Towes, 26/27 M, Banglore-560001
2. Punjab National Bank, Fatehabad Branch through its Manager.

..Respondents/OPs. 

      Complaint under Section 12 of Consumer Protection Act, 1986.                                                                                   

Before:         Sh.Raghbir Singh, President.

                                     Sh. Jasvinder Singh, Member.

Argued by:                     Sh. Vinod Godara, Advocate for complainant.

  Sh. Vijay Mahiya, Advocate for OP No. 1.

  Sh. Vinay Sharma, Advocate for OP No. 2.

ORDER

                The present complaint under Section 12 of Consumer Protection Act, 1986 has been filed by the complainant against the Opposite Parties (hereinafter to be referred as OPs) with the averments that late Smt. Vidya Devi W/o Vijay Singh complainant during his life time had obtained life insurance policy bearing no. 21863968 dated 31.03.2016 from OP No. 1 for an insured amount of Rs.4,25,000/-. It is further submitted that Smt. Vidya Devi also obtained another policy bearing no. 21864184 dated 31.03.2016 from OP No. 1 for an amount of Rs.4,25,000/-. The complainant being husband of life assured was nominated as nominee in the above said policies.

2.                                     It is further submitted that at the time of issuance of above said policies the doctors on the penal of the OPs had examined the health condition of life assured Vidya Devi and after being satisfied the OP company issued the above said insurance policies.

3.                                     It is further submitted that unfortunately on 14.05.2016, the life assured Smt. Vidya Devi died at her home due to failure of heart. However, before her death, life assured was very fit and she was not suffering from any illness or disorder. After death of the life assured the complainant informed the OPs regarding her death and requested for settlement of the insurance claim. All the relevant documents relating to her death were also submitted with the OPs. However the matter for settlement of the insurance claim was prolonged by the OPs and ultimately vide letter dated 21.08.2017 declined the insurance claim in the above said policies on the ground that she was suffering from Acute Renal Failure prior to the issuance of the insurance policies. However, the above said fact was not disclosed by the life assured at the time of obtaining the insurance policies.

4.                                     It is also further submitted that the aforesaid reason for declining the genuine insurance claim of the complainant by the OPs is against law and facts. The life assured was not having any disease prior to the taking of the insurance policies and she was never admitted in hospital prior to the taking of  the insurance policies in question. Therefore, declining of the insurance claim by the OPs in the present case amounts to deficiency on their part in rendering service to the complainant. The complainant has further prayed that the OPs may be directed for making a payment of Rs.8,50,000/- as insurance claim in both the policies alongwith interest at the rate of 18% and other benefits. Hence, the present complaint.

5.                                     Upon notice, the OP no. 1 appeared through its counsel and resisted the complaint by filing a written statement wherein various preliminary objections with regard to locus standi, cause of action, maintainability, estoppel and concealment of true and correct facts  etc., have been raised.

6.                                  In reply on merits, it is submitted that on the basis of proposal forms submitted by the life assured the subject policies were issued to the DLA. It is further submitted that on 16.05.2017, OP No. 1 received death claim intimation under the subject policies dated 31.03.2016 informing that the life assured had died on 14.05.2016 due to heart failure. Being an early death claim the OPs conducted investigation through an independent investigation agency. After careful evaluation of the records obtained by the company during the claim processing, it was revealed that the life assured had provided incorrect information and suppressed material facts to the effect that she was suffering from acute renal failure prior to the issuance of the subject policy and took treatment for the same. It is further submitted that the investigator while visiting the vicinity of the DLA was verbally told by the neighbors that the life assured was suffering from kidney ailments. On the basis of above said information the investigator visited Shah Satnam Ji Speciality Hospital, Sirsa where the life assured had taken treatment on 10.03.2016 which is just prior to the proposal of the subject policies. The investigator obtained medical reports from the said hospital and the medical documents were further referred to Chief Medical Officer of the company who after examining the documents observed that the DLA was suffering from Acute Renal Failure.

7.                             It is further submitted that on the basis of the above mentioned documentary evidence, it is proved that the information which was sought in the proposal form was a material information and same was found incorrect. The above said illness was well within the knowledge of life assured at the time of obtaining the insurance policy and she had deliberately and intentionally concealed the said illness and taking treatment for the same. Therefore the repudiation of the insurance claim of the complainant by the OPs is perfectly in accordance with the terms and conditions of the insurance policies and sustainable in the eyes of law. The present complaint is without any merits and as such the same is liable to be dismissed.

8.                             The OP No. 2 also resisted the complaint by filing the written statement wherein various preliminary objections with regard to abuse of process of law, jurisdiction, cause of action, concealment of true and correct facts, non-joinder of necessary parties, maintainability and locus standi etc. have been raised.

9.                             In reply, on merits, it is denied that the life assured Smt. Vidya Devi had purchased life insurance policy from OP No. 2. It is further submitted that the OP No. 2 is not carrying the business of life insurance, therefore question of obtaining life insurance policy from OP No. 2 does not arise. The OP No. 2 has no concern or connection with the issuance of policy issued by OP No. 1 and repudiation of the insurance claim of the complainant. The OP No. 2 is neither provider of insurance policy nor beneficiary of the premium. Therefore, the complainant does not fall within the definition of the consumer of OP No. 2 and the OP No. 2 does not fall within the definition of service provider. The present complaint against OP No. 2 is without any merit and as such the same is liable to be dismissed.

10.                           The learned counsel for the complainant tendered in evidence affidavit of the complainant as Ex. CW-1/A alongwith documents as Annexure C1 to Annexure C-8 and closed the evidence of the complainant. On the other hand, learned counsel for the OP No. 1 tendered in evidence affidavit as Ex. RW-1/A alongwith the documents as Annexure R-1 to Annexure R-7. No evidence was tendered by OP No. 2.

11.                           We have heard learned counsel for the parties and have also perused the documents placed on record. In his arguments the learned counsel for the complainant contended that nothing was concealed by the DLA  regarding her state of health while obtaining the insurance policy in question. Moreover, her state of health was duly checked by the doctors on the penal of the Ops before issuance of the insurance policies in question. It is further contended by the learned counsel that the documents relied upon by OP No. 1 regarding medical treatment record of Shah Satnam Ji Speciality Hospital Sirsa are only photocopies and the same cannot be read in evidence. Moreover, the Ops have not filed affidavit of doctors who gave treatment to the DLA and no employee of the above said hospital has been examined by the OP No. 1 to prove the said documents. It is further contended by the learned counsel that a genuine claim of the complainant has been repudiated by the Ops on false and flimsy grounds. The above said act amounts to deficiency on the part of Ops in rendering service to the complainant. In support of his case the learned counsel for the complainant has placed reliance on the judgments rendered by Hon’ble National Commission in case titled as “Bajaj Alliance Life Insurance Company Vs. Raj Kumar cited as Volume 3(2014) CPJ Page 221, Life Insurance Company Vs. Harwinder Kaur reported as volume 3(2014) CPJ Page 552, National Insurance Company Limited Vs. Sardar Kulbir Singh and cited as 2010(3) CPJ Page 276 (National Commission), LIC Vs. Smt. Mahenderjit Kaur cited as 1998(1) CPJ Page 159 (State Commission Punjab) Vs. Dharamdev Verma cited as 2011 (1) CPC 77 (State Commission Punjab).

12.                           On the other hand, learned counsel for the OP No. 1 reiterated the averments made in the written statement filed by OP No. 1 and further contended that since the life assured had concealed the pre existing  disease while submitting the proposal Forum for obtaining the life insurance and as such the insurance claim of the complainant has been rightly repudiated by OP No. 1 vide letter dated 21.08.2017. It is further contended that repudiation of the insurance claim of the complainant in the present case as perfectly in accordance with the terms and conditions of the insurance policy and the same is sustainable in the eyes of law. The learned counsel also placed reliance on the judgments mentioned by the OP NO. 1 in its written statement.

13.                           We have examined the pleadings, documents and affidavits filed by the parties and have also given thoughtful consideration to the arguments advanced by learned counsel for the parties. It is not disputed that life assured Smt. Vidya Devi wife of the complainant was insured by OP No. 1 vide two insurance policies dated 31.03.2016 for an amount of Rs.4,25,000/- each. It is also not disputed that the life assured had died on 14.05.2016 i.e. during the subsistence of the insurance policies in question. It is also not disputed that the premium in the above said policies was duly paid by the life assured to the OP No. 1. The insurance claim of the complainant in the present case has been repudiated by OP No. 1 on the ground that the diseased life assured had not disclosed the true and material facts with respect to state of her health in the proposal form submitted by her for taking the insurance policies in question. After hearing the arguments and examining the material placed on record, we are of the considered opinion that the contention raised by the counsel for the OP No. 1 has force. From perusal for 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 and the same were replied by the DLA in negative. The aforesaid question and reply thereto is reproduced as under:-

14.                           A perusal of the above reveals that the DLA had answered in negative to both the questions put to her. However from perusal of the medical treatment taken by the DLA from Shah Satnam Ji Speciality Hospital, Sirsa dated 10.03.2016 placed on record as Annexure R-5 (Page 1 to 6), the above said of information given by the DLA was not correct. From perusal of the above medical treatment reports dated 10.03.2016, it is evident that the life assured was suffering from Acute Renal failure as the blood urea and creatnine were on the very high side from the normal range. The above said treatment was taken by the life assured just 21 days before filing of the proposal forum. We are of the considered opinion that the DLA had concealed the material fact regarding her state of health and 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 the 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.

15.                           Contention of the learned counsel for the complainant to the extent that original record of the treatment of DLA 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, 1986. 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 also summon the doctor of the concerned hospital to prove that the document of medical treatment 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 enimical to the complainant nor they have motive to issue a false certificate. Therefore in case the medical treatment record is not supported by the affidavit of the concerned doctor, does not take away the beneficiary value of the document.  It is a settled proposition of law that information regarding state of health of the proposer for obtaining a life insurance policy is a material information.  On account of the concealment of aforesaid information by the life insured the insurance company was deprived of an opportunity to consider the proposal in the light of all the relevant facts including the state of health of the life assured.  It was clearly and specifically agreed by the life assured himself by way of declaration contained in the proposal form that in case of any mis-statement or suppression of material information the company had the right of repudiate the claim.

16.                           For the reasons discussed hereinabove, we hold that since the life assured had withheld material information from the OP company and mis-represented with regard to her state of health, the company was entitled to repudiate the claim.  Consequently no amount is payable to the complainant on the strength of aforesaid insurance policies.

17.                           In view of aforesaid discussion, we are of the considered opinion that the complainant has not been able to prove any deficiency on the part of the OPs in rendering service to him.  The present complaint is accordingly dismissed with no order as to costs. Copy of this order be communicated to the parties free of costs. File be consigned to the record after due compliance. 

Announced in open Forum.

Dated: 31.12.2019.

(Jasvinder Singh)                                   (Raghbir Singh)            

     Member                            President