DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> CC. No. 163 of 22-07-2009<br /> Decided on : 23-12-2009 <br /> <br /> 1.Davinder Kaur @ Jagwinder Kaur aged about 51 years Wd/o Late Sh. Iqbal Singh.<br /> 2.Khushwinder Singh aged about 22 years S/o Late Sh. Iqbal Singh<br /> both R/o Village Balam Garg, District Mukatsar.<br /> .... Complainants<br /> Versus<br /> <br /> 1.SBI Life Insurance Co. Ltd., through its Chairman-cum-Managing Director, 2nd Floor, Kapas Bhawan, Plot No. 3 A, Sector 10, CBD Belapur, Navi Mumbai 400614.<br /> 2.State Bank of Patiala, through its Branch Manager, Raman Mandi, Tehsil Talwandi, District Bathinda.<br /> 3.SBI Life Insurance Co. Ltd., through its Branch Manager, 83/1, Liberty Chowk, Guru Kanshi Marg, Gupta Complex, Bathinda 151 001.<br /> <br /> ... Opposite parties<br /> <br /> Complaint under Section 12 of the Consumer Protection<br /> Act, 1986.<br /> <br /> QUORUM <br /> <br /> Ms. Vikramjit Kaur Soni, President<br /> Sh. Amarjeet Paul, Member<br /> <br /> For the Complainant : Sh. Navneet Kumar, counsel for the complainant <br /> For the Opposite parties : Sh. Sanjay Goyal, counsel for the opposite party Nos. 1 & 3. <br /> Opposite party No. 2 exparte.<br /> <br /> O R D E R<br /> <br /> VIKRAMJIT KAUR SONI, PRESIDENT<br /> <br /> 1. Briefly stated the case of the complainants is that complainant No. 1 is the widow and complainant No. 2 is the real son of S. Iqbal Singh who had joined as an insured to the master Insurance Policy No. 86000055509 (Group Insurance Policy). The period of the policy was from 01-12-2006 to 01-12-2016. The said policy was issued by opposite party No. 1 and opposite party No. 2 was master policy holder. As per the terms and conditions of the policy, if the insured dies during the policy period, his heirs/nominee will be entitled to get a lump sum money of Rs. 3,00,000/- and in case of maturity of the policy, the insured will be entitled to 100% of the total basic payment i.e. Rs. 3,00,000/-.<br /> 2. On 05-08-2007, the insured Iqbal Singh fell down from Charpoy/Wooden bed and his head stuck down on its wooden pole and he expired within few minutes. Complainant No. 1 filed claim papers with opposite party No. 2 and it forwarded the papers to opposite party No. 1, but till today, the opposite parties have not made the payment of the insurance amount. Ultimately, the opposite party No. 1 repudiated their claim on the ground that prior to the insurance, the insured was suffering from Renal Cell Carcinoma and the same was not disclosed to the insurer at the time of Insurance. They allege that at the time of the insurance, the insured was not suffering from the said problem. Moreover, if for arguments sake, it be admitted, even then the insured had not been died due to the alleged disease. He asserts that repudiation of their genuine claim, amounts to unfair trade practice as well as deficiency in service. Hence this complaint for issuing directions to the opposite parties to pay Rs. 3,00,000/- (insured amount) plus Rs. 50,000/- as compensation alongwith interest @18% P.A. from the date of submission of claim papers.<br /> 3. The opposite party Nos. 1 & 3 filed joint reply taking preliminary objections that Life Insurance Contract is a contract of “Utomost Good Faith”; there is no negligence or deficiency in service on their part and the complaint has been filed with malafide intention to harass them. On merits, it has been admitted that deceased Life assured Mr. Iqbal Singh, was covered under Master policy commenced on 01-12-2006 for a sum of Rs. 3,00,000/-. <br /> It has been submitted that any suppression of material fact in the Declaration of Good Health constitutes a breach of “Doctrine of Utmost Good Faith”. In the instant case, the Deceased Life Assured had signed the Declaration for Good Health in which he declared that “I am in sound health, do not have any physical defect/deformity and perform my routine activities independently. I have never suffered or have been suffering from diabetes, hypertension (blood pressure) or have not been hospitalized for any ailment during the last 3 years for critical illness or a condition requiring medical treatment for a critical illness, as on date. The Deceased Life Assured Iqbal Singh died on 05-08-2007. The policy resulted in a claim in 8 months 5 days and hence, the opposite parties investigated the matter and it revealed that Iqbal Singh was suffering from Renal Cell Carcinoma prior to the date of enrollment into the insurance cover.<br /> It has been pleaded that since there was deliberate suppression of material facts with a fraudulent intention to obtain insurance, the repudiation of claim is legal and valid.<br /> 4. Registered A.D. notice was sent to opposite party No. 2, but none appeared on its behalf. Hence, exparte proceedings were taken against it.<br /> 5. In support of their averments made in the complaint, the complainants have produced in evidence affidavit of Sh. Dawinder Kaur Ex. C-1, photocopy of Pass Book Ex. C-2, photocopy of list of member Ex. C-3, photocopy of certificate of Insurance Ex. C-4, photocopy of legal notice Ex. C-5, reply of notice Ex. C-6, photocopy of certificate Ex. C-7 and affidavit of Satnam Singh Ex. C-8.<br /> 6. In rebuttal, opposite party Nos. 1 & 3 have tendered in evidence copy of Master Policy Ex. R-1, photocopy of certificate of Insurance Ex. R-2, photocopy of Membership Form Ex. R-3, photocopy of letter/report of Investigation Ex. R-4, photocopy of discharge card of DMC Ludhiana Ex. R-5, photocopy of certificate of Hospital Ex. R-6, photocopy of repudiation letter Ex. R-7 and affidavit of sh. V Srinivas Ex. R-8.<br /> 7. We have heard learned counsel for the parties and have gone through the record and written submission of the parties.<br /> 8. The claim of the complainants has been repudiated by the opposite parties on the ground that at the time of obtaining the Insurance Policy for the period from Ist December, 2006 to 1st December, 2016, the deceased Iqbal Singh was suffering from Renal Cell Carcinoma and that he had not disclosed this disease at that time.<br /> 9. In order to prove this case on this score, the opposite party Nos. 1 & 3 have relied upon Ex. R-5 which is Discharge Card of the deceased issued by DMC, Ludhiana. A perusal of it shows that deceased remained admitted in that hospital from 28-01-2006 to 15-02-2006 with diagnosis of Renal Cell Carcinoma. Further perusal of Ex. R-5 shows that Radical Nephatectomy was conducted upon him. Post operative wound infection occurred as a result of which sutures were opened and re-suturing was done on 14-02-2006. The patient was also discharged on the same date. His condition was stated to be satisfactory.<br /> 10. Certificate of Hospital Treatment Ex. R-6 also corroborates that deceased was suffering from the above said disease.<br /> 11. The deceased had obtained Insurance policy Ex. R-3 on 28-10-2008 wherein he has signed the following declaration :<br /> “DECLARATION FOR GOOD HEALTH<br /> I declare that I am in sound health, do not have any physical defect/deformity and perform my routine activities independently. I have never suffered or have been suffering from diabetes, hypertension (blood pressure), or have not been hospitalised for any ailment during the last 3 years for critical illness or a condition requiring medical treatment for a critical illness as on date.<br /> Critical illness is defined as follows :The life to be insured should not – have suffered or be suffering from cancer, be taking treatment for heart disease, have undergone/or have been advised medically to undergo chest/heart surgery/surgery requiring full anesthesia within the following six months, have kidney and/or liver failure, have suffered or be suffering from stroke, paralysis, or any mental illness, have not undergone any major surgery requiring full anesthesia during the last 12 months, have suffered or be suffering from AIDS or venereal diseases.” <br /> 12. As already stated deceased Iqbal Singh, was discharged from the hospital on 15-02-2006 after operation of Radial Nephatectomy. Therefore, he had been suffering from Renal Cell Carcinoma falling within the category of Cancer. Thus, when he obtained Insurance Policy on 28-10-2006, he had violated above said declaration by not disclosing that he had been hospitalised during the last three years and that he had been suffering from cancer and had undergone surgery during the last 12 months prior to obtaining of policy.<br /> 13. Learned counsel for the complainants contended that as per<br /> special clause of above said declaration, the deceased was to disclose the disease, if any, he had suffered six months following the date of policy. This contention had no merit because the case is covered under the clause which envisages that the insured should disclose about his serious ailment during the last 3 months and operation during the last 12 months prior to policy.<br /> 14. Learned counsel for the complainants also contended that deceased did not die of the disease which he had allegedly been suppressed at the time of obtaining Insurance Policy. There is no post mortem report of the deceased to corroborate contention of the learned counsel for the complainants. His contention that post mortem was not required, has also got no merit because the complainants were aware that deceased was suffering from Renal Cell Carcinoma. Therefore, in order to strengthen their hands to claim insurance money, they were required to get the body of deceased subject to post mortem. Thus, in our opinion deceased was guilty of suppressing a material fact/disease at the time of obtaining Insurance Policy. Therefore, claim of the complainants has been rightly repudiated by the opposite parties. In this view of the mater, we get support from the observations of the Hon'ble State Commission, Punjab, Chandigarh in the cases titled Life Insurance Corporation of India Vs. Smt. Pritam Kaur 2009(3) CPC 559 & National Insurance Company Ltd., Vs. Shri Vinay Kumar Sehgal 1999(2) CPC 88 and of the Hon'ble National Commission, New Delhi in the case Goparatnam & Others Vs LIC of India & Ors., 2006(1) CPC 364.<br /> 15. In view of the finding recorded above, this complaint fails and is hereby dismissed with no order as to costs.<br /> Copy of this order be sent to the parties concerned free of costs and the file be consigned.<br /> Pronounced :<br /> 23-12-2009 <br /> (Vikramjit Kaur Soni)<br /> President<br /> <br /> <br /> <br /> <br /> (Amarjeet Paul) Member <br /> <br />