Haryana

Karnal

CC/536/2019

Sita Devi - Complainant(s)

Versus

The Zonal Manager, LIC Of India - Opp.Party(s)

Sanjeev Kumar Rana

18 Nov 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 536 of 2019

                                                        Date of instt.21.08.2019

                                                        Date of Decision:18.11.2022

 

Sita Devi (age 49 years) wife of late Shri Dalip Singh, resident of house no.274, old LIG, Madhuban Police Complex, Karnal presently residing at house no.261, old LIG, Madhuban, District Karnal.

 

                                               …….Complainant.

                                              Versus

 

1.     The Zonal Manager, LIC of India, Jeevan Bharti, Tower-II, 124, Connaught Circus, PB no.630, New Delhi.

 

2.     The Senior Manager, LIC of India, Divisional office at 489, Model Town, Karnal.

                                                                      …..Opposite Parties.

 

Complaint under Section 12 of the Consumer Protection Act, 1986 as amended under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri Sanjeev Rana, counsel for the complainant.

                    Shri L.R. Chuchra, counsel for the opposite parties.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that one Dalip Singh son of Shri Uttam Chand got a LIC policy no.479086195 on his life from the OP. The amount of policy is Rs.2,00,000/-. Unfortunately, said Dalip Singh died on 01.02.2018 in natural death and had left behind the legal heirs i.e. Sita Devi (widow), Sourabh son, Arman  and Priyanka daughters. At the time of obtaining the abovesaid policy, husband of complainant was quite hale and hearty and was not having any illness. At the time of insurance, the doctor of OPs fully examined the body of said Dalip Singh and found that he was not suffering from ay disease. After the death of her husband, complainant approached the OPs and requested to settle the claim but OPs on 25.02.2019 declined/refused to pay the policy amount to the complainant on the false and frivolous ground and arbitrarily informed the complainant that the legal heirs of Dalip Singh are not entitled to get the insured amount. In this way there is deficiency in service on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability and concealment of true and material facts. On merits, it is pleaded that husband of complainant expired on 01.02.2018 in Park Hospital, Panipat where he was admitted on mechanical ventilator as K/C/O of COPD (chronic obstructive pulmonary disease) with history of severe dysponea. Prior to this he took treatment from Arpana Hospital, Madhuban in the year 2017 and 2018. Further, he availed number of earned leaves from his department for treatment as he was patient of Asthma. The policy no.479086195 was taken by deceased life assured with date of commencement of  28.07.2016 for sum assured of Rs.2,00,000/- under T/T-814/12 (LIC’s New Endowment Plan) for which premium amount of Rs.1608 was payable per month under salary saving scheme. The date of commencement of risk was 30.07.2016 and life assured expired on 01.12.2018. The duration of policy was only year six months one day from the date of commencement of risk. Being early claim it was examined under section 45 of Insurance Act 1938 and during investigation it was revealed that life assured was suffering from Asthma. Further leave record of deceased life assured was called for from his employer for the period of 28.07.2013 to 28.07.2016 and on perusal of the same it was revealed that the life assured was not having good health prior to taking policy as he was suffering from Chronic Asthma Disease and one of his lungs was completely damaged and he was taking treatment from Jallandhar. He availed earned leave from his department due to illness and treatment purpose. The detail of leave availed by deceased life assured from 08.05.2012 to 18.07.2017, 30.05.2013 to 30.07.2013, 30.09.2014 to 06.10.2014, 13.01.2015 to 03.02.2015. It is established that the life assured was not having good health prior to the purchase of the policy in question. The life assured did not disclose the facts of his illness in the proposal form and instead the life assured gave false answers in his proposal form. Thus, the suppression of material facts was done fraudulently with bad intention, biased and prejudiced mind with intent to deceive the OPs, hence the death claim under the policy was repudiated. The life assured gave wrong information to the OPs as he was suffering from Asthma and his one of his lungs had already completely damaged and he was taking treatment from Jallandhar as per his leave applications submitted to the department. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence her affidavit Ex.CW1/A, copy of letter dated 25.02.2019 by OP to complainant Ex.C1, copy of insurance policy Ex.C2, copy of letter of OP regarding rejection of claim Ex.C3, copy of cremation certificate Ex.C4, copy of hospital treatment report Ex.C5, copy of statement of claimant Ex.C6, death certificate Ex.C7, copy of hospital treatment report Ex.C8, copy of doctor certificate Ex.C9, copy of LIC New Endowment Plan Ex.C10, copy of application of claimant Ex.C11, copy of statement of claimant Ex.C12 and closed the evidence on 04.08.2021 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Puneet Kumar, Manager Ex.RW1/A, copy of letter dated 25.02.2019 Ex.R1, copy of LIC New Endowment Plan Ex.R2, copy of proposal form Ex.R3, copy of medical examination certificate report Ex.R4, copy of complete leave record page 1 to 6 Ex.R5, copy of letter dated 18.07.2018 written by OP to department of deceased life assured Ex.R6,  copy of investigation report Ex.R7, copy of medical record of Dalip Singh dated 21.08.2018 of Arpana Hospital Ex.R8, copy of medical report and emergency certificate of Dalip Singh Ex.R9 and closed the evidence on 18.04.2022 by suffering separate statement.

6.             We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents mentioned in the complaint, has vehemently argued that the husband of complainant (since deceased) insured his life from the OPs. The sum assured was Rs.2,00,000/-. On 01.02.2018 husband of complainant expired due to natural death. After the death of her husband, complainant approached the OPs and requested to settle the death claim but OPs did not settle the claim and  declined/refused to pay the policy amount, vide letter dated 25.02.2019 to the complainant on the false and frivolous ground and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that husband of complainant expired on 01.02.2018 in Park Hospital, Panipat where he was admitted on mechanical ventilator with history of severe dysponea. Prior to this he took treatment from Arpana Hospital, Madhuban in the year 2017 and 2018. Further, he availed number of earned leaves from his department for treatment as he was patient of Asthma. The policy in question was taken by deceased life assured with date of commencement of  28.07.2016 for sum assured of Rs.2,00,000/-. The date of commencement of risk was 30.07.2016 and life assured expired on 01.12.2018. The leave record of deceased life assured was called for from his employer for the period of 28.07.2013 to 28.07.2016 and on perusal of the same it was revealed that the life assured was not having good health prior to taking of policy as he was suffering from Chronic Asthma Disease and one of his lungs was completely damaged and he was taking treatment from Jallandhar. He availed earned leaves from his department due to illness and treatment purpose.. The life assured did not disclose the facts of his illness in the proposal form and instead the life assured gave false answers in his proposal form. Thus, the suppression of material facts was done fraudulently, hence the death claim under the policy was repudiated and lastly prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, the life assured was insured with the OPs for the sum assured of Rs.2,00,000/- and the policy in question was issued on 28.07.2016. It is also admitted that life assured was servig in Police Department. It is also admitted that complainant is the nominee of the deceased life assured. The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.R1 dated 25.02.2019 on the ground that concealment of material facts with regard to pre-existing disease at the time of filling the proposal form.

11.           The onus to prove that the life assured was having pre-existing disease at the time filling of the proposal form lies upon the OPs. To prove its case OPs have placed on record copies of applications Ex.R5 with regard to leave availed by the life assured, E/ASI Dalip Singh. As per information report from the concerned Department, life assured availed leaves for two months on 28.05.2013, thirty days on 05.01.2015, two months on 26.08.2015, thirty five days on 24.09.2014. All the leaves availed by the life assured are for the purpose of taking treatment. All the applications have been certified by the department of the life assured. Thus, it is proved on record deceased life assured was having pre-existing disease and has concealed the true and material facts regarding his health at the time of obtaining the insurance policy. In this regard, we are fortified with the observations of Hon’ble Supreme Court in case titled as Branch Manager, Bajaj Allianz Life Insurance Company Ltd. and others Vs. Dalbir Kaur in civil appeal no.3397 of 2020 decided on 09.10.2020 wherein Hon’ble Supreme Court held that a policy of insurance is governed by the principles of utmost good faith. The suppression of material facts by the insured/policyholder entitles the OP to repudiate the policy under section 45 of the Insurance Act. The said authority is fully applicable to the facts of the present case.

12.           It is settled principle of insurance law that contract of insurance is a contract uberrima fides and utmost faith must be observed by the contracting parties. Every material fact must be disclosed, otherwise there is good ground for rescission of contract. If, there are misstatements or suppression of material facts, the policy can be called into question. In this regard reference may be made to the judgment of the Hon’ble Supreme Court in case titled Satwant Kaur Sandhu Versus New India Assurance Co. IV( 2009) CPJ 8 (SC) and judgment of Hon’ble National Commission in case Life Insurance Corporation of India and another Versus Bimla Devi Revision Petition no.3806 of 2009 decided on 12.8.2015 and Sunita Rani Versus PNB Metlife India Insurance Company Limited in appeal no.1252/2015 dcided on 21.04.2017.

13.           In the present case deceased life assured has concealed the true and material facts regarding his health at the time of obtaining the policy in question. Hence, we are of the considered view that OPs have rightly repudiated the claim of the complainant. Thus, we found no deficiency in service on the part of the OPs, while repudiating the claim of the complainant.

14.           Thus, present complaint is devoid of any merits and same deserves to be dismissed and the same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Dated:18.11.2022

 

                                                                       

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                    Member                         Member