State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Kuldeep Kaur Wife Of Late Sh. Baldev ... on 11 February, 2013
2nd Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB,
SECTOR 37-A, DAKSHIN MARG, CHANDIGARH
First Appeal No. 1490 of 2008
Date of institution : 26.12.2008
Date of Decision : 11.2.2013
1. Life Insurance Corporation of India, Divisional Office, 'Jeevan Parkash
Building', Sector-17, Chandigarh.
2. Life Insurance Corporation of India, Branch Office, Railway Road,
Sangrur.
Both the appellants through Authorised Officer, Smt. P. Kwatra, Manager
(Legal & HPF), Life Insurance Corporation of India, Divisional Office, 'Jeevan
Parkash', Sector-17, Chandigarh.
....Appellant.
Versus
Kuldeep Kaur wife of Late Sh. Baldev Singh son of Sh. Sadhu Singh, resident of
Village Manvi, Tehsil Malerkotla, District Sangrur.
...Respondent.
First Appeal against the order dated 26.11.2008 of
the District Consumer Disputes Redressal Forum,
Sangrur.
Before:-
Shri Piare Lal Garg, Presiding Member.
Shri Jasbir Singh Gill, Member.
Present:-
For the appellants : Sh. Rajesh Kumar Sharma, Advocate For the respondent : Sh. Liaqat Ali, Advocate PIARE LAL GARG, PRESIDING MEMBER:
This is an appeal filed by the appellants-L.I.C. of India (hereinafter called 'the appellants') against the order dated 26.11.2008 of the District Consumer Disputes Redressal Forum, Sangrur(hereinafter called the 'District Forum') vide which the complaint of the respondent/complainant (hereinafter called 'the respondent') was accepted by the District Forum.
2. Brief facts of the case are that the husband of the respondent Sh. Baldev Singh (hereinafter referred as 'LA') was insured with the First Appeal No. 1490 of 2008 2 appellants under policy No. 162845523 for an amount of Rs. 2 lacs from 13.1.2005. It was alleged by the respondent that at the time of taking the insurance policy her husband was hale and hearty and was not suffering from any disease. The LA died on 30.8.2006 due to sudden cardiac arrest. The claim was submitted with all requisite documents by the respondent with the appellants but nothing was paid. Legal notice was also served on the appellants on 18.1.2008 but all in vain. Complaint was filed by the respondent with the prayer that the appellants may be directed to pay Rs. 2 lacs alongwith interest @ 24% per annum and Rs. 2 lacs as compensation for mental tension and harassment as well as Rs. 11,000/- as litigation expenses.
3. Upon notice, reply was filed by the appellants taking legal objections of locus-standi, jurisdiction and limitation. On merits, the insurance of the LA as well as death of the LA were not denied. It was further pleaded that the policy lapsed on 13.1.2006 but the same was revived on 29.8.2006 against the payment of premium due from 1/2006 to 7/2006 and on the basis of personal statement of L.A. regarding his health. The LA did not make correct statement regarding his health at the time of revival of the policy as he was suffering from breathing and chest pain prior to the revival of the policy and he had also taken the medical treatment in a hospital before statement regarding his health. He was also suffering from the same disease at the time of taking the policy. The claim of the respondent was investigated and as per the investigation report the claim was not found payable and genuine, as such, the same was repudiated vide letter dated 29.3.2008 rightly. It was prayed that the complaint of the respondent may be dismissed with costs.
First Appeal No. 1490 of 2008 3
4. Rejoinder was also filed by the respondent alleging the averments made in the reply as totally wrong and the same were denied in toto and reiterated the version given in the complaint.
5. The complaint was accepted by the District Forum and the appellants were directed to pay Rs. 2 lacs alongwith interest @ 9% per annum from 29.3.2008 alongwith Rs. 5,000/- as litigation expenses within 60 days from the receipt of the copy of the order.
6. The appeal is filed on the grounds that the approach of the learned District Forum is suffering from material irregularities and illegalities in exercising its jurisdiction, the District Forum has failed to appreciate the statement made by the LA at the time of revival of the policy, who deliberately concealed the real facts regarding his health at the time of filing of proposal of the policy as well as revival of the policy, LA played a fraud with the appellants, as such, claim was rightly repudiated, there was no deficiency in service on the part of the appellants and the order of the District Forum is based on conjectures and surmises, which is liable to be set-aside.
7. We have gone through the complaint, reply, rejoinder, evidence produced by both the parties, order of the District Forum as well as grounds of appeal.
8. In para No. 5(b) of the grounds of appeal, it is pleaded that at the time of revival of the policy, the LA was admitted in the hospital with the abdomen problem, difficulty in breathing and chest pain but this information was concealed by the LA at the time of giving his statement regarding his health.
9. To prove this version, the appellants had not disclosed the name of the hospital from where the LA had taken the treatment in its reply or in the grounds of appeal. No certificate of any hospital was produced by First Appeal No. 1490 of 2008 4 the appellants to prove its allegation that at the time of revival of the policy, the LA was admitted in the hospital.
10. We have also perused the investigation report Ex. R-5 and as per para No. 16 of the same, the LA had taken the treatment from Deep Hospital, Ludhiana but neither certificate of any doctor of Deep Hospital nor any record of Deep Hospital was produced by the appellants to prove its version that at the time of revival of the policy, the appellant was admitted in Deep Hospital, Ludhiana. Neither any affidavit of the investigator was filed nor he was examined by the appellants before the District Forum to prove that the LA was admitted in Deep Hospital and he made wrong replies at the time of revival of the policy. Even the name of the investigator was neither disclosed by the appellants in the reply nor in the affidavit of Smt. P.K. Kwatra, Manager, Legal which was tendered into evidence as Ex. R-1 by the appellants before the District Forum in support of their version. The appellants neither tendered into evidence the affidavit of the agent to whom the LA made personal statement regarding his health Ex. R-4 nor he was examined by the appellants before the District Forum to prove its version. It was held by the Hon'ble National Commission in its recent judgment in case "Sahara India Life Insurance Co. Ltd. And Anr. Versus Smt. Hansaben Deepak Kumar Pandya", 2012(4) CPR 231 (NC) that the insurance company must prove the allegations of pre-existing disease by producing some concrete evidence in support of its case and held in paras No. 8 & 9 as follows:-
"8. The entire case of the petitioner hinges upon the above said history. This kind of evidence is exiguous. It carries no value in the eyes of law. The petitioner should have produced some concrete evidence in support of its case. The examination of a Doctor who checked the patient, prior to the obtaining of the policy in question, some treatment papers, some prescriptions etc., should have been produced. There is no evidence which may go to show that he had ever consulted the Doctor for taking treatment for the said disease. In the absence of solid and unflappable evidence, dallops of mystery surrounds petitioner's case.First Appeal No. 1490 of 2008 5
The State Commission has referred to an authority of this Commission, reported in Pravin Damani v. Oriental Insurance Co. Ltd. which fully dovetails with the facts of this case and favours the complainant.
9. The revision petition is without any merit and, therefore, the same is dismissed."
11. We have also perused the personal statement of L.A. regarding his health Ex. R-4 but no name of the agent and his Code No. is mentioned in the same and also not bears the signature of the agent, who explained the questions to the life assured and recorded the answer given by the life assured truthfully. No date is also mentioned against the column, which is prescribed for the same. From the perusal of the Ex. R-4, it is proved beyond doubt that the same is prepared by the appellants to save its skin only after filing the complaint by the respondent and to repudiate the claim of the respondent.
12. If we accept the version of the appellants that at the time of revival of the policy the LA was admitted in the hospital then why the policy was revived. If the same was revived in the LA with the connivance of its Agent then why no action was taken by the appellants against the Agent and his agency was not terminated. It was also held by the Hon'ble National Commission in its recent judgment "Life insurance Corporation of India and Anr. Versus Chaitanya Das, Advocate and Anr.", 2013(1) CPR 199(NC) that the insurance companies are responsible for the act of its Agent and held in para No. 6 as follows in this regard:-
"6. This contention is at best a very feeble attempt to find an explanation for what has happened. We have already quoted from the written response of the Ops before the District Forum. It comes very close to admitting the allegation of the Complainant that the proposal form was filled by the agent himself. Even before the District Forum, the revision petitioners confined themselves to merely arguing that:-
"The complainant is an educated and legal expert person. If he had appended his signatures on the simple papers on the directions of the Opposite Party No. 3 Agent, in that event the complainant himself is liable for this lapse."First Appeal No. 1490 of 2008 6
This again is an indirect admission of the allegation of the OP-3 before the District Forum, not did it lead any other evidence to show that the proposal form was not filled up by OP-3. Therefore, this contention of the revision petitioner has no leg to stand."
13. The order passed by the learned District Forum is legal and valid and there is no ground to interfere with the same. The appeal being without any merit is dismissed and the impugned order of the District Forum is affirmed and upheld. No order as to costs.
14. The arguments in this appeal were heard on 5.2.2013 and the order was reserved. Now the order be communicated to the parties.
15. The appellants had deposited an amount of Rs. 25,000/- with this Commission at the time of filing the appeal. This amount of Rs. 25,000/- with interest accrued thereon, if any, be remitted by the registry to the respondent by way of a crossed cheque/demand draft after the expiry of 45 days under intimation to the learned District Forum and to the appellants.
16. Remaining amount shall be paid by the appellants to the respondent within 30 days from the receipt of the copy of the order.
17. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Piare Lal Garg)
Presiding Member
February 11, 2013. (Jasbir Singh Gill)
as Member