National Consumer Disputes Redressal
Rajpal vs Lic Of India on 30 November, 2015
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 1991 OF 2011 (Against the Order dated 16/02/2011 in Appeal No. 1867/2006 of the State Commission Haryana) 1. RAJPAL R/O H.NO-830/12 JANTA COLONY , SONEPAT HARYANA ...........Petitioner(s) Versus 1. LIC OF INDIA SONEPAT BRANCH SONEPAT HARYANA ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE V.B. GUPTA, PRESIDING MEMBER HON'BLE MR. PREM NARAIN, MEMBER For the Petitioner : Mr. Vikas Deep, Advocate For the Respondent : Mr. Rajat Bhalla, Advocate Dated : 30 Nov 2015 ORDER In this revision petition there is challenge to impugned order dated 16.2.2011 passed by State Consumer Disputes Redressal Commission, Haryana, Panchkula (for short, 'State Commission').
2. Petitioner/Complainant is husband of Mrs. Raj Rani, the insured who had obtained insurance policy from Respondent/Opposite Party of Rs.one lac on 31.5.2003. It is petitioner's case, that his wife went to her uncle at Mohidinpur, Karnal on 10.10.2003. There on 13.10.2003, all of a sudden she expired due to chest pain. The petitioner being nominee, applied for insurance claim to the respondent but the same was repudiated on the ground, that deceased was suffering from abdominal cancer. Hence, petitioner filed consumer complaint against respondent alleging deficiency on its part.
3. Respondent/Opposite Party in its written statement took the plea, that deceased had declared in her proposal form that she was not pregnant on 31.5.2003 and date of last menstruation was 12.5.2003. During investigation, it was revealed that deceased was pregnant in March, 2003 and was admitted in Miglani Nursing Home, Old Kunjpura Road, Karnal, on 28.8.2003 with diagnosis of Ectopic Pregnancy, which means that development of baby was not in its proper place. The claim of petitioner was rightly and legally repudiated by the respondent, as life assured was suffering from abdominal cancer before purchase of the policy and she had given wrong answers to questions no.11(e) and 11(i). Thus, there was no deficiency in service on the part of respondent.
4. District Consumer Disputes Redressal Forum, Sonepat, Haryana (for short, 'District Forum') vide order dated 20.6.2006, accepted the complaint and directed respondent to pay a sum of Rs.one lac in respect of policy of Smt. Raj Rani alongwith 9% p.a. interest from the date of lodging of claim till its realization.
5. Aggrieved by the order of District Forum, respondent filed appeal before the State Commission, which accepted the same and dismissed the complaint.
6. We have heard learned counsel for the parties and gone through the record.
7. It is submitted by learned counsel for petitioner, that there was no pre-existing disease and deceased was not suffering from cancer as alleged by the respondent. Deceased has died due to chest pain and not due to cancer or pregnancy. Respondent has not produced any evidence in this regard. Therefore, impugned order is liable to be set aside.
8. On the other hand, it is submitted by learned counsel for respondent, that petitioner has concealed pre-existing disease in the proposal form and gave wrong information in this regard. As per affidavit of Dr. O.P. Miglani, deceased remained admitted in his Nursing Home from 28.3.2003 to 2.4.2003 and was diagnosed as a case of "Ectopic Pregnancy i.e. development of baby not in a proper place i.e. uterus". In support, learned counsel has relied upon following judgments;
"i) P.C. Chacko and another Vs. Chairman, Life Insurance Corporatoin of India and others, (2008)1 Supreme Court Cases 321;
ii) Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., Civil Appeal No. 2776 of 2002 (SC) decided on July 10, 2009;
iii ) Life Insurance Corporation of India Vs. Mansa Devi, II (2003) CPJ 135 (NC);
iv) Life Insurance Corporation of India Vs. Smt. Minu Kalita, III (2002) CPJ 10 (NC) and
v) Life Insurance Corporation of India Vs. Akhtarbi Sayyed Imam Ali, (R.P. No.2081 of 2009) decided by this Commission on 4th December, 2009."
7. The State Commission after reproducing the relevant extract of the proposal form in its impugned order, observed;
"Learned counsel for the appellant has drawn our attention to proposal form Annexure A-1 and particular column 13A where the life assured in the proposal form with respect to her personal particulars and with regard to pregnancy as under;
13-A Are you pregnant now ?
Date of last delivery Have you had any abortion or miscarriage of caesarian Section?
if so, give details Date of last Menstruation No 3.11.1996 No 12.5.2003 He has also drawn our attention to the Annexure A-6 affidavit of Dr. O.P. Miglani, MBBS, M.S. (Surgeon), who has treated life assured with respect to Ectopic Pregnancy mentioned specifically as under;
"That Smt. Raj Rani W/o Sh. Rajpal of Janta Colony, Sonipat remained admitted in my Nursing Home from 28.3.2003 to 2.4.2003 and was diagnosed as a case of Ectopic pregnancy i.e. development of baby not in a proper place i.e. uterus. She was admitted with the complaint of pain lower abdomen with bleeding per vagina."
Contention of learned counsel for respondent-complainant that since life assured has given the last date of menstrual 12.5.2003 and proposal form was filled up on 31.5.2003, there was no concealment. This contention is without any basis when life assured was admitted for treatment with Dr. O.P. Miglani and remained so from 28.3.2003 to 2.4.2003 and was diagnosed as "Ectopic Pregnancy" i.e. development of baby not in a proper place i.e. uterus. When life assured was pregnant during March-April 2003 and the date of last delivery has mentioned as 8.11.1996. Complainant not challenging evidence that the pregnancy was terminated, there was no question of delivery as life assured has given the last date of delivery as 8.11.1996 and denied pregnancy, the contention that life assured had menstruation in May 2003 is not acceptable.
While dealing with the contention raised on behalf of the appellant, we have to follow the observations made by the Hon'ble National Commission in case cited as Kolilaben Narendrabhai Patel Vs. Life Insurance Corporation of India 2010 CTJ 920 (CP) (NCDRC), which are reproduced under;
"Insurance-Deficiency in service-Consumer Protection Act, 1986-Section 2(1)(g)-Section 2(1)(o)- Insured died due to heart attack-His wife nominated to receive the insured amount in the event of his premature death-Repudiation of her claim-Allegedly correct answers not given by the deceased regarding his health in the proposal form-Complaint by his wife allowed by the District Forum-State Commission accepted the appeal and set aside the order passed by the Forum-Hence, the present revision petition-Admittedly the insured suffered from Enteric fever eleven months prior to the taking of the policy-Further, for getting it treated, he even took leave for seventeen days-These two facts not disclosed by him in the proposal form-Non-disclosure thereof was clearly a material fact having a bearing on the risk involved -Repudiation of the claim fully justified-View taken by the State Commission upheld-Revision dismissed.
Another observation made by Hon'ble National Commission in case titled The Marketing Manager, LIC of India Versus S. Vijaya, CPC (1995) (1) 341 which is as under;
"Insurance Claim-Complainant's husband had taken a life insurance policy for Rs.30,000/- who died due to illness-The claim was repudiated on the ground that the deceased had suppressed the fact that he was already suffering from Circhsis of liver-This fact was revealed from the record of the Hospital-Repudiation of claim justified-Order of State Commission giving relief the respondent set aside."
The case law cited above is fully applicable in this case.
Another observation made by Hon'ble National Commission in case titled LIC of India Versus Smt. Ayesha in Revision Petition No.3362 of 2004 passed on 21.9.2004, which is as under;
"In a contract of insurance, there is a requirement of uberrimae fide on the part of assured. Assured had died within six months of the commencement of the said second policy. Ultimate cause of death of assured had no relevance as regards disclosing of information regarding state of health as required by above clause 18 of the proposal form. Petitioner had, thus rightly repudiated the claim under the policies and the Fora below committed error in passing the order for payment of other amounts under the two policies with interest holding the petitioner to be deficient in service. Those orders, thus cannot be legally sustained."
The case law cited above is fully applicable in this case.
The District Consumer Forum passed the impugned order by ignoring these aspects and as such the impugned order being an illegal one cannot be sustained.
For the reasons recorded above, this appeal is accepted, the impugned order is set aside and the complaint is dismissed."
8. As per affidavit of Dr. O.P. Miglani in whose Nursing Home, wife of petitioner had undergone treatment, it is categorically stated;
"1. That Smt. Raj Rani W/o Sh. Rajpal of Janta Colony, Sonipat remained admitted in my Nursing Home from 28/3/03 to 2/4/03 and was diagnosed as a case of 'Ectopic Pregnancy i.e. development of baby not in a proper place i.e. uterus.' She was admitted with the complaint of pain lower abdomen with bleeding per vagina.
2. That I have issued certificate of Hospital Treatment (Form 3816) dtd. 10/4/04 to that effect".
9. According to the above affidavit of the Doctor, deceased had undergone treatment from 28.3.2003 to 2.4.2003 in his Nursing Home. There could be no reason for the aforesaid Doctor, to file a false affidavit in this case.
10. In view of above facts, it is apparently clear that deceased had concealed material facts. Accordingly, we have no hesitation in holding, that the finding recorded by the State Commission are based on correct appreciation of the evidence on record. The impugned order does not suffer from any illegality, material irregularity or jurisdictional error, which could justify intervention of this Commission in exercise of powers under Section 21(b) of the Act. Complaint dismissed. There being no merit in present revision petition, the same is dismissed with no order as to cost.
......................J V.B. GUPTA PRESIDING MEMBER ...................... PREM NARAIN MEMBER