Madhya Pradesh

StateCommission

A/22/526

LIC - Complainant(s)

Versus

SMT.SANTOSH - Opp.Party(s)

SH.NEELESH KHARE

21 Mar 2023

ORDER

M. P. STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,                         

                             PLOT NO.76, ARERA HILLS, BHOPAL

FIRST APPEAL NO. 526 OF 2022

(Arising out of order dated 24.05.2022 passed in C.C.No.556/2019 by the District Commission, Indore-2)

 

LIFE INSURANCE CORPORATION OF INDIA,

THROUGH SENIOR DIVISIONAL MANAGER,

JEEWAN PRAKASH, 19, M.G.ROAD,

INDORE (M.P.)                                                                                                        …         APPELLANT.

 

Versus                

SMT. SANTOSH W/O LATE SATYANARAYAN MAKWANA,

R/O VILLAGE-KANADIA, NEAR GAYATRI MANDIR,

INDORE (M.P.)                                                                                                         …      RESPONDENT.                                      

 

BEFORE:

                 HON’BLE SHRI A. K. TIWARI                      :  PRESIDING MEMBER

                HON’BLE DR. SRIKANT PANDEY               :  MEMBER    

 

COUNSEL FOR PARTIES :

      None for the appellant.

      Shri N. K. Khandelwal, learned counsel for the respondent.                                                               

                                                            O R D E R

                                       (Passed On 21.03.2023)

                   The following order of the Commission was delivered by A. K. Tiwari, Presiding Member:                 

                   This appeal by the opposite party/appellant is directed against the order dated 24.05.2022 passed by the District Consumer Disputes Redressal Commission, Indore-2 (for short ‘District Commission’) in C.C.No.556/2019, whereby the complaint filed by the complainant/respondent has been allowed.

2.                Brief facts of the case are that the complainant’s husband, Late Shri Satyanarayan Makwana (hereinafter referred to as ‘deceased-insured’) during his life time had obtained one life insurance policy no. 346008932

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from the opposite party-LIC for a period w.e.f. 15.09.2009 to 15.09.2039. The said policy was lapsed in the year 2014 which was revived in the year 2016. It is submitted that the said policy was revived on the basis of medical examination. He died on 15.02.2016. The claim form was submitted with the opposite party-LIC. The opposite party rejected the insurance claim on 27.12.2017 on the ground that the deceased-insured did not give the correct answers of policy condition no. 2 & 4. It is alleged that the opposite party-insurance company committed deficiency in service and unfair trade practice. The complainant therefore alleging deficiency in service on part of opposite party filed a complaint seeking claim amount with compensation totaling Rs.6,35,000/- with interest @ 12% p.a.

3.                The opposite party-LIC resisted the complaint stating that earlier also the complainant filed a claim with the LIC on 27.04.2016 which was repudiated on 26.10.2016. Thereafter the complainant approached the “Lokupyogi Sewaon Ki Sthayi Lok Adalat, First Additional District Judge, Indore” in Case No. 58/2018 which was decided by the said Lok Adalat vide order dated 23.02.2019 whereby it was directed that the LIC may consider the claim of the complainant and if the complainant is aggrieved from the decision, she may proceed under the Consumer Protection Act. Since the claim had already been repudiated on 26.10.2016, therefore, the present complaint is barred by limitation under Section 24A of the Consumer

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Protection Act, 1986. It is submitted that when the claim was repudiated, the complainant ought to have approached the Regional Office, State Office and thereafter Lok Pal in appeal.

4.                The deceased-insured was treated by Dr.Subodh Banzal and from the medical treatment papers, it is clear that he was suffering from Diabetes Mellitus since 2011 and was a chronic alcoholic. He was taking continuously taking treatment for the period from 30.09.2011 to 26.10.2012, from Diabetes Specialist. On investigation carried out by the LIC it was found that the deceased-insured had given wrong information about his health at the time of revival of the policy. The policy was declared null and void and the claim was repudiated on the ground that the deceased-insured had suppressed material information regarding his health in the proposal form while obtaining the policy. 

5.                The District Commission allowed the complaint and directed the opposite party -LIC to pay to the complainant sum insured of Rs.5,00,000/- with interest @ 6% p.a. from the date repudiation i.e. 27.12.2017, till payment. Rs.5,000/- is awarded towards compensation and costs.

6.                Heard learned counsel for the complainant/respondent and perused the written arguments filed by the counsel for the opposite party/appellant-LIC. Also perused the record. 

 

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7.                In the written arguments filed on behalf of opposite party/appellant-LIC, it is submitted that the claim of the deceased/insured is not payable because he had concealed the facts that he was suffering from Diabetes Mellitus earlier from the date of taking insurance policy. Exhibit ‘R-2’ filed before the District Commission was not challenged by the complainant wherein he had given wrong answers in the proposal for revival of the policy of query no. 2(a)(b) and 4.  Even then the District Commission allowed the complaint and therefore, the impugned order deserves to be set-aside. He placed reliance on number of judgments passed by the Hon’ble National Commission in RP No.897 of 2001 LIC Vs Naveen Dhingra decided on 15.03.2002, LIC of India Vs Memuna II (2006) CPJ 86 (NC), Life Insurance Corporation of India Vs Gurvinder Kaur III (2013) CPJ 116 (NC), Life Insurance Corporation of India Vs Geeta Devi IV (2016) CPJ 264 (NC), Paramjit Kaur Vs Life Insurance Corporation of India & Anr IV (2014) CPJ 132 (NC) and orders of this Commission in Appeal No.1192/2006 (Sushri Mankala & Ors Vs Life Insurance Corporation of India) decided on 21.08.2006, Appeal No.602/2009 (Life Insurance Corporation of India Vs Ms. Ranu Gautam) decided on 15^th July 2009, Poonam Singh Vs Life Insurance Corporation of India III (2011) CPJ 111, Appeal No.2011/2010 (Smt. Sita Bai Vs Life Insurance Corporation of India) decided on 27.09.2012 Appeal No.1537/2011 (Life

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Insurance Corporation of India Vs Smt. Sumitra Bai) decided on 2^nd November 2012, Appeal No.2707/2010 (Smt. Chhaya Bai Lilhare Vs Life Insurance Corporation of India) decided on 12.06.2012, First Appeal No.1051/2014 (Smt. Pushpa Shrivastava Vs Life Insurance Corporation of India) decided on 06.08.2021, Appeal No.1572/2014 (Life Insurance Corporation of India Vs Smt. Durga Bai & Anr) decided on 26.12.2022 and First Appeal No. 17 of 2015 (Life Insurance Corporation of India Vs Ankit Kashyap) decided on 12.09.2022.

8.                Learned counsel for the complainant/respondent argued that the appellant insurance company cannot take the ground of concealing the material information while filling up the proposal form more particularly when the policy was revived after medical examination.  The District Commission has rightly passed the impugned order on the basis of evidence available in the record of the District Commission and this appeal deserves to be dismissed.

9.                After hearing learned counsel for the parties and on perusal of record, we find that the complainant has filed 11 documents as per list wherein P-2 containing three documents of different investigations and on the strength of which the complainant has stated that the policy was revived after medical examination conducted by the panel doctor of LIC.  From the order sheet dated 03.01.2022 it is clear that the opposite party-LIC has filed documents R-1 to R-4 as per list. Annexure R-3 is the letter dated 23.08.2016 of Dr. Subodh Banzal addressed to the Branch Manager, LIC,

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Indore stating that the deceased-insured Satyanarayan Makwana was suffering from Diabetes Mellitus and he was under his treatment from 30.06.2012 to 28.10.2013 for the same. It is further stated that he was insulin dependent and under medication till date. R-3 also contains four medical prescriptions confirming the statement of Dr. Subodh Banzal.  Annexure R-2 is the proposal form for revival of the policy in which answer to the queries raised with regard to medical history in clause 2(a) (b) that whether are you suffering from any disease, whether you were operated or met with an accident, the deceased-insured had given answer as ‘No’ and in clause 4, At present, are you healthy, he had given answer as ‘Yes’.

10.              However, from the record, we find that neither the complainant was provided those documents nor she was afforded an opportunity to controvert those documents. In the interest of justice, the complainant ought to have been given opportunity to controvert those documents.  In this view of the matter we are of a considered opinion that the matter deserves to be remanded back to the District Commission for decision afresh after giving proper opportunity to parties.

11.              In view of the aforesaid, it is directed that the matter be remanded back to the District Commission. Record of the case be sent to the District Commission at the earliest.

 

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12.              Parties are directed to appear before the District Commission on 28.04.2023.

13.              The District Commission is directed to proceed further in the matter, in accordance with law.  All the contentions of the parties are kept open. Parties be afforded opportunity to contest their respective claims and to file additional evidence, if any. Needless to mention that observations made hereinabove shall not come in way of the District Commission, while passing the order.

14.              With the aforesaid observations and directions, this appeal stands disposed of. However, no order as to costs.

 

                      (A. K. Tiwari)                  (Dr. Srikant Pandey)

               Presiding Member                      Member