DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> CC No. 353 of 19.12.2007<br /> Decided on : 14-05-2008 <br /> <br /> Mrs. Baljit Kaur W/o Late Sh. Resham Singh Q. No. 11, Lal Singh Basti, Bathinda. <br /> ... Complainant<br /> Versus<br /> <br /> 1.The Divisional Manager, Life Insurance Corporation of India, Jeevan Bharti, Bibiwala Road, Bathinda.<br /> 2.The Branch Manager, Life Insurance Corporation of India, Ferozepur Road, Faridkot. ... ...Opposite parties<br /> <br /> Complaint under Section 12 of the Consumer Protection<br /> Act, 1986.<br /> <br /> QUORUM :<br /> Sh. Lakhbir Singh, President<br /> Dr. Phulinder Preet, Member<br /> <br /> For the Complainant : Sh. Sanjay Goyal, Advocate.<br /> For the Opposite parties : Sh. Sanjay Goyal, Advocate.<br /> <br /> O R D E R<br /> <br /> LAKHBIR SINGH, PRESIDENT<br /> 1. Instant one is a complaint under Section 12 of the Consumer Protection Act, 1986 (Here-in-after referred to as 'Act') which has been preferred by the complainant seeking direction from this Forum to the opposite parties to pay her Rs. 15.00 Lacs i.e. three times of the sum as written on the policy being triple cover alongwith interest @12% P.A. till payment; Rs. 20,000/- as compensation for mental tension and Rs. 5500/- as cost of litigation.<br /> 2. Version of the complainant may be stated as under :<br /> 3. Resham Singh S/o Visakha Singh was her husband. He has since died on 9.6.06. He had purchased Life Insurance Policy No. 132430676 for Rs. 5.00 Lacs from the opposite parties. She was appointed as nominee. Apart from this, she is his natural legal heir. Terms and conditions of the policy were not supplied nor was he told that there are separate terms and conditions. Her husband did not commit any default in the payment of the premium. When her husband had purchased policies bearing No. 132430676, 161359178, 161359225 and 161454590, Insurance agent had obtained his signatures on blank forms in her presence with the assurance that all the documents will be filled by the office of the opposite parties. Assured had got himself checked from the empaneled doctors of the opposite parties. After his death, she has lodged claim with regard to the aforesaid four policies. All the relevant documents were submitted in the office of the opposite parties. It is alleged that claim for policy No. 132430676 has been rejected on the ground of concealment of facts. Rejection of the claim is on account of the negligence on the part of the opposite parties. Hence there is deficiency in service and unfair trade practice on their part.<br /> 4. Opposite parties filed their version taking legal objections that this Forum has got no jurisdiction to entertain and try the complaint as the Insurance policy was got issued from Faridkot ; complainant has not come with clean hands and complaint is false and frivolous. Policy in question was got issued by concealing the true facts about the health of the assured by way of mis-representation and wrong statement in the proposal form. Life assured had died within one year and 2-1/2 months of the issuance of the Insurance policy. They deny that terms and conditions of the policy were not supplied. Rather proposal was submitted by the assured after going through the terms and conditions. Complainant did not co-operate in the investigation of the case conducted by the Senior Branch Manager, Bathinda. As per report of Investigation officer deceased assured was not keeping good health before the date of proposal dated 30.3.05. Before taking policy, he was suffering from heart disease and stomach problem for which he had consulted a medical men and had taken treatment from the hospital. He was on medical leave from time to time. As per record, he remained on leave from 24.11.02 to 2.1.03, 19.2.03 to 20.3.03, 25.2.04 to 10.3.04 and 26.3.04 to 9.4.04. These facts were not disclosed by life assured in the proposal form. He made deliberate mis-statement and concealed material information regarding his health. Claim was repudiated vide letter dated 30.11.06. They deny the remaining averments in the complaint.<br /> 5. In support of her averments contained in the complaint, complainant has produced in evidence her affidavit (Ex. C-1), affidavit of Sh.Kaur Singh (Ex. C-2), photocopy of Identity Card of Sh. Kaur Singh (Ex. C-4), affidavit of Sh. Manjeet Singh (Ex. C-4), photocopy of affidavit of Sh. Manjit Singh (Ex. C-5), affidavit of Sh. Sukhdev Singh (Ex. C-6), photocopy of affidavit of Sh. Sukhdev Singh (Ex. C-7), affidavit of Sh. Jasbir Singh (Ex. C-8), photocopy of death certificate of Resham Singh (Ex. C-9) and photocopy of Insurance Medical Policy (Ex. C-10).<br /> 6. In rebuttal on behalf of the opposite parties photocopy of application dated 13.11.02 (Ex. R-1), photocopy of application for leave (Ex. R-2), photocopies of orders dated 20.3.05 (Ex. R-3 & Ex. R-4), photocopy of office note (Ex. R-5), photocopy of report of Line Officer (Ex. R-6), photocopy of DDR No. 50 Dated 19.2.03 (Ex. R-7), photocopies of DDRs (Ex. R-8 to Ex. R-10), photocopy of OPD slip of Civil hospital (Ex. R-11), photocopy of discharge certificate (Ex. R-12), photocopy of absence report (Ex. R-13), photocopy of show cause notices (Ex. R-14 & Ex. R-15), photocopy of report of Lines Officer (Ex. R-16), photocopies of DDRs (Ex. R-17 & Ex. R-18), photocopies of applications (Ex. R-19 & Ex. R-20), photocopy of leave form (Ex. R-21), photocopy of application dated 10.3.04 (Ex. R-22), photocopy of leave form (Ex. R-23), photocopy of order (Ex. R-24), photocopy of order (Ex. R-25), photocopy of office note (Ex. R-26), photocopy of report of Lines Officer (Ex. R-27), photocopies of DDRs (Ex. R-28 & Ex. R-29), photocopy of Prescription slip of Rohtak Nursing Home (Ex. R-30), photocopy of order (Ex. R-31), photocopy of report (Ex. R-32), photocopy of letter dated 16.11.05 (Ex. R-33), photocopy of report (Ex. R-34) photocopy of DDR (Ex. R-35), photocopy of letter dated 29.10.05 (Ex. R-36), photocopy of report (Ex. R-37), photocopy of DDR (Ex. R-38), photocopy of discharge ticket of S.M.S. Medical Hospital (Ex. R-39), photocopy of DDR (Ex. R-40), photocopy of Discharge Ticket (Ex. R-41), photocopy of report dated 16.11.05 (Ex. R-42), photocopy of Treatment advised and Investigation (Ex. R-43), photocopy of Discharge Ticket (Ex. R-44), photocopy of order dated 26.6.06 (Ex. R-45), photocopy of letter dated 30.11.06 (Ex. R-46), photocopy of Claimant's statement (Ex. R-47), photocopy of Identity and Burial or cremation (Ex. R-48), photocopies of Form No. 3801 (Ex. R-49 to Ex. R-51), photocopy of Insurance Policy (Ex. R-52), photocopy of letter (Ex. R-53), photocopy of proposal form (Ex. R-54), affidavit of Sh. J P Arya, Manager legal (Ex. R-55), photocopy of Claim Inquiry report (Ex. R-56), photocopy of letter dated 15.9.06 (Ex. R-57), photocopy of certificate of employer (Ex. R-58), photocopy of details of leave (Ex. R-59), photocopy of order dated 20.5.03 (Ex. R-60), photocopies of DDRs (Ex. R-61 to Ex. R-63), photocopies of Leave applications (Ex. R-64 & Ex. R-65), photocopies of DDRs (Ex. 66 to Ex. R-70), photocopy of report (Ex. R-71) and photocopy of DDR (Ex. R-72) have been tendered in evidence.<br /> 7. We have heard learned counsel for the parties. Besides this, we have gone through the record.<br /> 8. Some are the undisputed facts in this case. They are that the husband of the complainant namely Resham Singh had purchased Life Insurance Policy known as Jeevan Mitra – Triple Cover with DAB copies of which are Ex. C-10 and Ex. R-52. He has expired on 9.6.06 as is evident from the copy of Death Certificate Ex. C-9. Complainant is the nominee of the deceased under the policy. After the death of her husband, claim was submitted by her and it has been repudiated by the opposite parties vide repudiation letter dated 30.11.06 copy of which is Ex. R-46 on the ground that deceased had made incorrect statement and withheld correct information from them regarding his health at the time of affecting the insurance. Accordingly as per terms and conditions of the policy and declaration contained in the form of proposal for assurance and personal statement, claim has been repudiated.<br /> 9. One of the objections taken in the reply of the complaint submitted by the opposite parties is that this Forum has got no jurisdiction to entertain and try the complaint as the Insurance policy was got issued from Faridkot. This objection is not tenable as the Life Insurance Corporation of India has its Divisional Office at Bathinda. Claim was lodged at Bathinda. Assured had died at Bathinda. In these circumstances, we conclude that this Forum is well within rights to entertain and try the complaint.<br /> 10. Material question for determination is as to whether the life assured i.e. Reshan Singh husband of the complainant made incorrect statement and withheld correct information regarding his state of health at the time of effecting the assurance. Onus to justify the repudiation is upon the opposite parties. <br /> 11. Contention of Mr. Sanjay Goyal, learned counsel for the complainant is that the husband of the complainant did not conceal any material fact about his health from the opposite parties while submitting the proposal form and giving the declaration. He was hale and hearty and was not suffering from any ailment. He has died all of a sudden and prior to his death, he was keeping good health. He further argued that mere fact that deceased being in Police Department availed medical leave is no ground to hold that he was suffering from any heart or stomach problems. For this, he drew our attention to the affidavits Ex. C-1, C-2, Ex. C-4 to Ex. C-8.<br /> 12. To the contrary learned counsel for the opposite parties vehementally argued that there is abundant evidence on the record which proves that deceased Resham Singh concealed material information regarding his health from the opposite Insurance Corporation before taking the policy. Infact he was suffering from heart disease and stomach problem. He did not disclose them at the time of taking the policy although he was having knowledge of pre-proposal illness.<br /> 13. After giving our thoughtful consideration to the rival arguments, we feel ourselves inclined to agree with the learned counsel for the opposite parties. Date of proposal for Insurance is 30.3.05. Life assured breathed his last on 9.6.06. It means that he died within two years from the date proposal was submitted for assurance. In the proposal for assurance dated 30.3.05, personal statement signed by the deceased assured and at the time of medical examination, he answered the following questions as under :-<br /> QUESTION ANSWER <br /> 11.(a) During the last five years did you consult a Medical No<br /> Practitioner for any ailment requiring treatment for more <br /> than a week ?<br /> <br /> (b) Have you ever been admitted to any Hospital No<br /> or Nursing Home for general check-up, observation,<br /> treatment or operation ?<br /> <br /> (c) Have you remained absent from place of work on No<br /> grounds of health during the last 5 years ?<br /> (i) What has been your usual state of heath ? Good<br /> 14. Question for determination is as to whether the replies of the questions given by the deceased assured were correct ? Answer to our minds is in the negative. Ex. R-1 is the copy of the application dated 13.11.02 submitted by C-II Reshan Singh i.e. Husband of the complainant for getting sanctioned long leave of 40 days from 20.11.02 onwards. This application was submitted to the Police Authorities and leave was sanctioned. In this application, he stated in so many words that he was suffering from heart disease and was getting treatment from Sigma Heart Centre Ludhiana, Long leave was applied for by him for treatment. Vide order dated 20.5.03, copy of which is Ex. R-3 Senior Superintendent of Police, Bathinda allowed earned leave to him on the ground that he remained on medical rest for 30 days. It is also evident from this order that he had gone on 19.2.03 for medical check-up from Civil Hospital, Bathinda. He was discharged from the hospital on 20.2.03 and was advised medical rest for 15 days. Another medical rest for 15 days was from 6.3.03 onwards. This fact is also clear from the application of the Lines Officer, Police Lines, Bathinda, copy of which is Ex. R-6. Ex. R-11 is the copy of OPD slip concerning the husband of the complainant which was issued by doctor of Civil Hospital, Bathinda. According to it, Resham Singh was diagnosed to be a case of Cardiomyopathy on 6.3.03. Ex. R12 is the Discharge Certificate from Civil Hospital, Bathinda on 20.2.03. In this document as well, he was shown to be suffering from Cardiomyopathy. Deceased assured was absent from duty on 15.9.03. He had submitted his written explanation to the Police Authorities regarding his absence to the effect that he had gone to take medicines as he was suffering from heart disease. In this respect, reference can be made to Ex. R-16 and copy of his application Ex. R-19. On 12.2.04 an application, copy of which is Ex. R-20, was submitted by him to the Police Authorities for long leave for 20 days due to heart disease and on account of the fact that he was undergoing treatment. Leave was sanctioned. Likewise are the documents Ex. R-21 & Ex. R-22. He availed medical rest from 20.1.05 to 25.1.05 as is clear from Ex. R-25 & Ex. R-26. Deceased assured had submitted chit from Rohtak Nursing Home on 20.1.05 in which he was advised rest for seven days. For this relevant documents are Ex. R-27 to Ex. R-30. Matter regarding genuineness of the medical rest availed by Reshan Singh for 41 days 7 hours and 10 minutes was inquired into by Deputy Superintendent of Police and certificates of medical rests were found genuine. Not to speak of this, deceased assured was getting treatment for heart disease from SMS Hospital, Jaipur as emerges from Ex. R-35 to Ex. R-39, Ex. R-41, Ex.. R-42 to Ex. R-44. From this abundant evidence on the record, conclusion is that answers given by the deceased assured of questions 11(a)(b)(c) and (i) were false. Infact he was suffering from heart disease etc., and he had consulted medical men and had taken treatment. He remained on medical leave as well. These facts were not disclosed by him in his proposal/personal statement. Hence, he withheld the correct information from the opposite parties at the time of effecting the assurance. Since he withheld material information and his death was within two years from the date of proposal, repudiation of the claim by the opposite parties through letter copy of which Ex. R-46 is wholly justified. No deficiency in service on the part of the opposite parties is proved.<br /> 15. In the premises written above, complaint is meritless. Accordingly it is dismissed. Parties are left to bear their own costs.<br /> 16. Copy of this order be sent to the parties concerned and file be also consigned. <br /> Pronounced :<br /> 14-05-2008 (Lakhbir Singh )<br /> President<br /> <br /> <br /> (Dr.Phulinder Preet)<br /> Member <br />