STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA
Date of Institution: 21.08.2017
Date of final hearing: 16.08.2023
Date of pronouncement: 30.10.2023
First Appeal No.1003 of 2017
IN THE MATTER OF:-
Life Insurance Corporation of India, opposite Civil Hospital, GT Road, Hansi, Tehsil Hansi, District Hisar through Sh. K.S. Johar, Manager Legal at Divisional Office, Sector-17/B, Chandigarh.
....Appellant
Versus
Sonam minor daughter of Late Sh. Jagmahender Singh S/o Sh. Om Prakash (minor through her mother Reshmi Devi W/o Late Sh. Jagmahender Singh being the natural guardian) R/o Village Rampura, P.O. Dhana Kalan, Tehsil Hansi, District Hisar.
…..Respondent
CORAM: Naresh Katyal, Judicial Member
Argued by:- Ms. Preeti Singh, proxy counsel for Sh. A.K. Goyal, counsel for the appellant.
Sh. Manjinder Singh, proxy counsel for Sh. J.S. Thind, counsel for respondent.
ORDER
NARESH KATYAL, JUDICIAL MEMBER:
Delay of 12 days in filing of present appeal stands condoned for the reasons stated in application for condonation of delay.
2. Challenge in this appeal No.1003 of 2017 has been invited by OP/Insurer to the legality of order dated 30.06.2017 passed by District Consumer Disputes Redressal Forum-Hisar (In short “District Commission”) in complaint case No.194 of 2015.
3. Jagmahender Singh-father of minor complainant-Sonam, during his life time, obtained LIC Policy No.179291901 in name of his minor daughter viz. complainant-Sonam from insurer/appellant against proposal No.7605 dated 24.12 2012. Policy’s date of commencement was from 24.12.2012, Table & Term 102-15-15. Sum assured was Rs.1,00,000/- and mode of payment of premium is/was half-yearly @ Rs.3,449/-. Date of payment of last premium is 24.06.2027. It is pleaded that: complainant had been declared as his nominee in said policy and life assured-Jagmahender Singh-father of complainant had died natural death on 12.04.2013. Prior to his death, life assured (Jagmahender Singh) had already deposited all half yearly premiums of Rs.3,449/- which fell due, against valid receipts. Complainant-Sonam, being his minor daughter, as well as duly declared nominee in LIC policy automatically became entitled to get all benefits i.e. sum assured of Rs 1,00,000/-, accrued bonus etc., relating to LIC policy in question. She approached OP/insurer by lodging claim; has been requesting for release of final payment and all consequential benefits of policy to her and completed formalities. Insurer has repudiated her genuine and legitimate claim on non-existing and concocted ground vide letter No. Claims/Rep/2014-15 dated 05.05.2015 by attributing responsibility to her late father Sh. Jagmahender Singh having withheld correct information regarding his health at the time of effecting assurance with LIC by stating that in proposal for assurance dated 24.12.2012 signed by him on 24.12.2012; he answered all five questions relating to his health as "NO". Above acts of omissions and commissions on part of OP/insurer in illegally repudiating her genuine and legitimate claim and not releasing benefits of policy in question to her being beneficiary by virtue of nominee of her father policy in question tantamount to deficiency in service on its part. On these allegations; complaint for direction to OP/insurer, to release claim amount to her with interest @ 24% p.a. from 12.04.2013-date of death of life assured, till realization; to pay her Rs.1,00,000/- on account of compensation for causing her physical, mental and financial harassment etc. and to pay her Rs.11,000/- as litigation expenses has been filed .
4. Upon notice, OP/insurer/appellant raised contest. In defence; it is asserted in
5. Parties to this lis led their respective evidence, oral as well as documentary.
6. On subjectively analyzing the same; learned District Consumer Commission-Hisar vide order dated 30.06.2017 (impugned herein) has allowed the complaint and issued directions to insurer-LIC to pay insured amount of Rs.1.00 lacs to complainant, on maturity of policy through Guardian Reshmi Devi-mother.
7. Feeling aggrieved; insurer-LIC of India has filed this appeal.
8. Learned counsel for parties have been heard at length. With their able assistance; record too has been perused.
9. Learned counsel for appellant/insurer has contended that impugned order dated 30.06.2017 passed by learned District Consumer Commission-Hisar is erroneous on all fronts, legal and factual. Facts have not been appreciated in right legal perspective. It is urged that beneficiary of policy is minor complainant-Sonam. Her father, while acting as proposer got the policy issued in name of his daughter-Sonam. He was not life assured. Premium waiver benefit was opted and taken under policy which has been rightly repudiated as proposer concealed material facts about his health status, at the time of proposer for insurance. He was suffering from chronic liver disease, alcoholic liver disease for last three years. It is urged that complainant minor has to continue till date of its last premium payment. On these submissions; learned counsel for appellant/insurer has urged for acceptance of appeal.
10. Per contra, learned counsel for complainant has supported impugned order dated 30.06.2017 of learned District Consumer Commission by urging that it is outcome of proper appreciation of facts and evidence brought on record warranting no interference.
11. This Commission has critically analyzed the submissions noted above. Policy in question is Annexure C-1. It is in the name of Sonam D/o Jagmahender Singh. Sum Assured under policy was Rs.1.00 lacs. It commenced on 24.12.2012 and has currency period of 15 years. Maturity/deferred date is 24.12.2027. Admittedly, as per positive stance of appellant/insurer in pleading as well as through duly sworn affidavit Ex.R-8 of its Manager; premium waiver benefit was opted under policy in question. As per document Annexure C-3; Jagmahender Singh answered “NO” to five material questions concerning state of his health. He died on 12.04.2013. Specific stand of insurer, while repudiating the claim qua premium waiver benefit is centered on concealment of material health related facts by proposer Jagmahender Singh at the time of proposal of insurance. As per the case so set up; he was suffering from chronic liver disease and alcoholic liver disease for last three years. Insurer has placed on record document Ex.R-4 of Jindal Institute of Medical Science to fortify its stance. This document recites that Jagmahender Singh was admitted in this Hospital on 24.06.2009 and discharged, after 14 days stay in hospital, on 07.07.2009. Policy in question commenced more than three years thereafter from 24.12.2012. There is no documentary evidence led by insurer to establish that during intervening period of more than three years (reckoning from 07.07.2009 i.e. date of discharge from hospital till 24.12.2012 i.e. date of commencement of policy in question); proposer Jagmahender Singh continued to suffer from alleged ailments. Evidence to this effect was required to be led by insurer/appellant alone in view of its positive case in written statement. Also, because of positive case set up by complainant is that Jagmahender Singh suffered natural death on 12.04.2013; only appellant/insurer was required to lead express evidence, in order to nullify complainant’s plea as burden of proof lay upon it under mandate of Evidence Act. More so, admittedly no affidavit of any doctor of concerned hospital has been placed on record by insurer/appellant, in order to stimulate credibility to document Ex.R-4. This being so, it is held that there was no fundamental and acceptable base before insurer/appellant to repudiate premium waiver benefit to minor complainant. Palpably, insurer/appellant has repudiated the premium waiver benefit, merely on assumptions on the foundation of document Ex. R-4. Assumptions have no place in law. Once, admittedly, insurer/appellant has conferred premium waiver benefit to insured under policy, than it cannot wriggle out from same on misconceived notions. Legal implications arising from opting premium wavier benefit in favour of minor complainant will have to follow.
12. It is the case set up by insurer in its written version and fortified through duly sworn affidavit Ex.R-8 that policy in question was issued under no medical general and no medical examination was done. Premium wavier benefit has been declined to minor complainant by appellant/insurer on the pedestal that her father (who was proposer of policy) had chronic ailments which have not been disclosed. Why the proposer Jagmahender Singh was not medically examined when he proposed life insurance for his minor daughter is certainly a mysterious and mystifying circumstance. Had, he been medically examined by insurer’s panel doctor and had his past medical history of proposer been majestically considered by insurer, then insurer/appellant should not have issued policy in question. Counsel for appellant/insurer has no legs to stand on these aspects.
13. Thus, by critically analyzing all relevant facets of this case and on account of above reasons; this Commission is of firm opinion that rightly, insurer/appellant has been non-suited. Impugned order dated 30.06.2017 does not suffer any manifest error, legal or factual. It is accordingly maintained and affirmed. Present appeal, being devoid of merits is hereby dismissed.
14. The statutory amount of Rs.25,000/- deposited by appellant at the time of filing the appeal be refunded to appellant/LIC against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.
15. Application(s) pending, if any stand disposed of in terms of the aforesaid judgment.
16. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986/2019. The judgment be uploaded forthwith on the website of the Commission for the perusal of the parties.
17. File be consigned to record room.
Date of pronouncement: 30th October, 2023
Naresh Katyal
Judicial Member
Addl. Bench-II
