State Consumer Disputes Redressal Commission
Babli Goyal And Another vs Icic Prudential Life Insurance Company ... on 6 March, 2019
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
Consumer Complaint No.601 of 2018
Date of Institution: 23.07.2018
Order reserved on: 26.02.2019
Date of Decision : 06.03.2019
1. Babli Goyal aged about 40 years W/o Late Sh. Rajinder Kumar
2. Sheenu Rani aged about 19 years D/o Late Sh. Rajinder
Kumar
3. Mukesh Goyal aged about 17 years minor under the
guardianship of her mother and through next friend Babli
Goyal, all residents of ward no.10, near Janak Raj Hospital,
Budhlada, District Mansa-151502 (Punjab).
.....Complainants
Versus
1. ICICI Prudential Life Insurance Company Limited, Registered
Office, ICICI Pru Life Towers, 1089, Appasaheb Marathe Marg,
Prabha Devi, Mumbai-400025, through its M.D.
2. ICICI Prudential Life Insurance Company Limited, Unit No.1A
& 2A, Raheja Tipco Plaza, Rani Sati Marg, Malad (East),
Mumbai-400097.
.....Opposite Parties
Complaint U/s 17(1)(a) of the Consumer
Protection Act, 1986 (as amended up to
date).
Quorum:-
Shri J. S. Klar, Presiding Judicial Member
Shri Rajinder Kumar Goyal, Member Present:-
For the complainants : Sh. Sanjeev Goyal, Advocate For the opposite parties : Sh. K.S. Cheema, Advocate .................................................................................. J. S. KLAR, PRESIDING JUDICIAL MEMBER:-
The complainants have instituted this complaint U/s 17(1)(a) of the Consumer Protection Act 1986 (in short the "Act") against opposite parties (in short the 'OPs') on the premise, that in the month of June 2017, Gagan Jyoti, the agent of OPs, approached Consumer Complaint No.601 of 2018 2 complainant no.1 and her husband Rajinder Kumar, since deceased (in short 'deceased') with new term plan of OP company for getting high assured sum of Rs.50 lakh by paying annual premium of Rs.20,000/-, whereas the other life insurance companies have been charging Rs.50,000/- to Rs.60,000/- per annum for the same plan. The deceased opted for term plan of Rs.50 lakh assured sum for 28 years by paying annual premium of Rs.20,100/-. The deceased told the said agent that he had been suffering from high blood pressure and cholesterol and was taking 20 mg tablet for the last three years therefor and there was no other ailment afflicting him. The doctor of Amrit Nursing Home Mansa, being doctor of OP conducted complete medical checkup of the deceased and also conducted all the medical tests upon the deceased. After some time, the agent of OP informed the deceased that his medical reports were OK and OP issued policy bearing no.21088414 dated 19.06.2017 for an amount of Rs.50,000/- for 28 years, vide Ex.C-1 to him. Unfortunately, at about 2:30 am on 23.01.2018, the deceased suffered heart attack and was immediately taken to Jindal Nursing Home Mansa, where he was referred to higher hospital at Bathinda due to his serious condition, but on the way he breathed his last. Complainant no.1, being nominee of Rajinder Kumar deceased lodged the claim with OPs alongwith documents and original policy documents, but OPs wrongly and arbitrarily repudiated the claim of the complainant, vide letter dated 24.03.2018 on the ground that deceased was suffering from heart disease since 2012 and the said fact was not disclosed by Consumer Complaint No.601 of 2018 3 the deceased in his proposal form at the time of taking the insurance policy. It is further averred that neither proposal form was signed by the deceased nor the same was ever filled or read over to deceased.
At the time of taking the policy, the above late husband of complainant no.1 was hale and hearty except high blood pressure and cholesterol and OP also got conducted the complete detailed medical checkup and tests upon her late husband to their satisfaction regarding the health status of the deceased and thereafter issued the policy in question. Complainant no.1 requested OPs to release the claim, but to no effect. The complainants alleged deficiency in service on the part of OPs and prayed for below noted reliefs against OPs:
(a) OPs be directed to release Rs.50 Lakh as claim amount with interest @18% per annum from the date of death of Rajinder Kumar i.e. 23.01.2018 till its realization.
(b) to pay Rs.Five Lakh as compensation for mental harassment.
(c) to pay Rs.55,000/- as litigation expenses.
2. Upon notice, OPs appeared and filed joint written reply by raising preliminary objections that complaint is not maintainable and is liable to be dismissed due to suppression of material facts. It is admitted by OPs that policy bearing no.21088414 was issued by them on the basis of information provided by deceased life assured (DLA) in the proposal form dated 12.06.2017, which was found incorrect and OPs rightly repudiated the claim of complainant on that Consumer Complaint No.601 of 2018 4 conduct. During the claim evaluation process and investigation, it was highlighted that "DLA was an old case of AWMI i.e. anterior wall myocardial infarction and was diagnosed with CAD i.e. Chronic Artery Disease in the year 2012, as per documents provided by complainant no.1 herself and he was again diagnosed with CAD- SVD on 16.05.2017, wherein the letters SVD stands for single vessel disease, which is a type of CAD. He was so diagnosed by Dayanand Medical College and Hospital, vide Ex.OP-1/7, just 25 days prior to signing of the proposal form by him. The contract of insurance is based on principle of "utmost good faith", but DLA breached the contract by deliberately and fraudulently concealing his heart ailment from OP in the proposal form. It is denied that there is any deficiency in service on the part of OPs. The OPs controverted the other averments of the complainants and prayed for dismissal of the complaint.
3. We have heard learned counsel for the parties and have also gone through the record of the case. The counsel for the complainants argued that DLA purchased a term plan for the sum assured of Rs.50,00,000/- from OPs by paying annual premium of Rs.20,000/-. OPs issued policy bearing no.21088414 dated 19.06.2017 for the sum assured of Rs.50 Lakh for 28 years, after complete medical checkup of DLA. Unfortunately, on 23.01.2018, the DLA suffered heart attack and was immediately taken to Jindal Nursing Home Mansa, where he was referred to higher hospital at Bathinda, but he expired due to his cardiac arrest enroute. Consumer Complaint No.601 of 2018 5 Complainant no.1, being his nominee and one of his LRs lodged the insurance claim with OPs through their agent, but it was repudiated by OPs, vide letter dated 24.03.2018 Ex.C-3 on the ground that DLA was suffering from coronary artery disease with acute coronary syndrome since 2012. Furthermore, the DLA was suffering from coronary artery disease-single vessel since May 16, 2017. The version of complainant no.1 is that DLA was hale and hearty except high blood pressure and cholesterol and repudiation of the insurance claim by OPs is baseless. Complainant no.1 tendered in evidence her affidavit Ex.C-A in support of case of the complainants. Ex.C-1 is the copy of insurance policy in the name of Rajinder Kumar DLA for the sum assured of Rs.50 Lakh with policy term of 28 years with annual premium Rs.20,086/- with risk commencement date 19.06.2017. Ex.C-2 is the copy of death certificate of Rajinder Kumar DLA showing his date of death as 23.01.2018.
4. The OPs also tendered in evidence affidavit of Suresh Kumar Investigator Ex.OP-1/11 and the other documents with regard to treatment of DLA Rajinder Kumar in DMC Ludhiana. The counsel for OPs argued that DLA suppressed the material fact of his previous heart ailment at the time of filling up the proposal form and OPs rightly repudiated the insurance claim of complainants on account of the conduct of insured. OPs relied upon policy documents Ex.OP-1/1 of DLA. Ex.OP-1/2 is the copy of customer's declaration filled in by Rajinder Kumar DLA on 12.06.2017 for taking above said policy. Ex.OP-1/3 is the copy of medical examination report of DLA Rajinder Consumer Complaint No.601 of 2018 6 Kumar dated 14.06.2017 by Dr. Pawan Kumar Garg panelist doctor of OPs. Ex.OP-1/4 is the copy of terms and conditions of the insurance policy. Ex.OP-1/5 is the copy of death claim submitted by complainant no.1. Ex.OP-1/6 is the copy of letter from OPs to complainant no.1 demanding some documents from her for processing the claim. Ex.OP-1/7 (colly) is the medical record of DLA Rajinder Kumar issued by Dayanand Medical College & Hospital Ludhiana (DMC), where his history and clinical details are recorded as "HTN AWMI(2012), CAD-SVD(16/05/2017), LVEF=35%". Ex.OP-1/8 is certificate issued by Jindal Nursing & Maternity Home Mansa dated 10.03.2018 to the effect that late Rajinder Kumar was known case of CAD/ILD for 2012 (SVD-2012) and at page no.58 of file, there is also out patient card of Rajinder Kumar DLA issued by PGI Chandigarh recording the fact of C/o CAD-ACS in 2012 and ACS:25/11/2017. This out patient card is dated 13.12.2017. Ex.OP- 1/9 is the copy of treating doctor's certificate dated 02.04.2018 Dr. Parshotam Jindal. Ex.OP-1/10 is the copy of repudiation letter dated 24.03.2018 by OP.
5. The counsel for the complainant contended that DLA was examined by the panelist doctor of OPs before issuing the insurance policy to him, but no such disorder was detected in his health. This fact goes a long way in proving that he was hale and hearty and did not suffer from any cardiac disorder and hence there is no question of concealment of material fact by suppressing it fraudulently on his part in this case. As held by the State Consumer Disputes Redressal Consumer Complaint No.601 of 2018 7 Commission U.T. Chandigarh in F.A.349 of 2013 titled as Ashok Kumar Vs. Apollo Munich Health Insurance, decided on 23.08.2013, no doubt the insured was subjected to medical examination by authorized doctor of OPs and only after due satisfaction, the policy was issued. The mere fact that he was subjected to medical examination before issuance of policy in question at the instance of the OPs did not absolve him of his duty of disclosure of material fact that he was suffering from the concerned disease, since he concealed this very fact and on the other hand gave answer in proposal form in the negative and he, thus, breached the principle of utmost good faith on which the contract of insurance is based. This submission of counsel for the complainants is not accepted on the above premise, as the insured was expected to disclose the correct answers in the proposal form to OPs, despite his examination by penalist doctor. Similarly, the next submission of counsel for the complainants is that the proposal form was in English, whereas the proposer signed the declaration in Punjabi and as such it is inconsequential. This document does not prove this fact that DLA was not aware of his pre-existing disease, but he deliberately concealed it by giving wrong answers in the proposal form regarding his state of health. Reference was also made by complainant to law laid down by our own State Commission in "Bajaj Allianz Life Insurance Company Vs. Major Singh" 2017(3)CLT- 383 that it is for the insurance company to prove that the contents of the form were explained to the insured in vernacular language, which Consumer Complaint No.601 of 2018 8 he understood. We find that the facts of the cited authorities are distinguishable because in this case, the policy was received by the insured and he had not opted for cancellation of the policy at any stage by exercising his option of free look period. Even otherwise, it is not believable that his signatures were obtained on it erroneously, as there is no such plea of any fraud in this case in obtaining his signatures on it. A person, who signs a document is supposed to be aware of the contents of the same and it can be taken that they were explained to him. Even, we find further confirmation to this point from his medical examination by panelist doctor of OP Ex.OP-1/3, wherein he also replied the questionnaire to the penalist doctor in the negative as well regarding his status of health. The submission of counsel for complainants is not accepted on this point by us.
6. The next point raised by counsel for complainants is that there is no affidavit of the doctor who treated him and mere photocopies of outpatient card, certificate, etc. are unable to prove his pre-existing ailment. Reference was made to law laid down by the National Commission in "SBI Life Insurance Company Limited Vs. Harivinder Kaur and another" 2014(3)CPJ-552, "Kamla Devi Vs. LIC of India" 2016(2)CPJ-649, "United India Insurace Co. Limited & another Vs. S.K. Gandhi" 2015(2)CLT-71. We find that facts of each arose from its peculiar circumstances. Herein, there is record of DMC and Hospital Ludhiana specifically stating that he was a patient of myocardial perfusion imaging. He was suffering from cardiac artery disease, as depicted in the record of DMC and Consumer Complaint No.601 of 2018 9 Hospital, the renowned medical institute of Northern India. Similarly, the record of PGI is also placed on record at page no.58 to the effect that DLA was examined in cardiological wing of PGI Chandigarh and it is recorded CAD-ACS in 2012. In addition to that, the record of Jindal Nursing & Maternity Home Mansa further corroborated this fact that he was a patient of CAS, (SVD-16-5-17). It is not possible that the above referred medical records of DLA could be fabricated one. The PGI is the government institute and one of the prestigious institute in India and it also found him to be a patient of heart ailment since 2012. It is not believable that DLA was not aware of pre- existing disease, when he went to PGI Chandigarh, DMC Ludhiana and Jindal Nursing Home Mansa. The policy in this case was taken by DLA on 19.06.2017, whereas he suffered from the cardiac ailment on 16.05.2017 for single vessel disease, which is a type of CAD, as per history of clinical details of DMC and Hospital record on the file. It is, thus, clear that he was even struck with cardiac problem i.e. single vessel disease on 16.05.2017, as per DMC and Hospital record on the file, whereas he took the life term policy subsequently by filling the proposal form on 12.06.2017 of the policy. He died within few months from the commencement of the policy on 23.01.2018 vide Ex.C-2. The inference is clear that he was already suffering from single vessel disease i.e. cardiac artery disease and had not disclosed this material fact to OPs in proposal form and inveigled it to issue the insurance policy to him by keeping insurer in darkness about correct facts. The OPs are justified in repudiating the Consumer Complaint No.601 of 2018 10 contract of insurance on the basis of law laid down by the Apex Court in "P.C. Chacko and another Vs. Chairman, Life Insurance Corporation of India & others" AIR2008 (SC)-424 and "Satwant Kaur Sandhu Vs. New India Assurance Company Limited"
2006(SCC)-2776. The repudiation of the insurance claim of complainants by OPs is, thus, justified on account of breach of principle of good faith by him, which is bed-rock of the contract of insurance.
7. As a result of our above discussion, there is no merit in the complaint and the same is hereby dismissed.
8. Arguments in this complaint were heard on 26.02.2019 and the order was reserved. The certified copies of the order be communicated to the parties, as per rules.
9. The complaint could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR) PRESIDING JUDICIAL MEMBER (RAJINDER KUMAR GOYAL) MEMBER March 06, 2019.
(MM) FIRST ADDITIONAL BENCH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
Consumer Complaint No.601 of 2018 Date of Institution: 23.07.2018 Order reserved on: 26.02.2019 Date of Decision : 06.03.2019
1. Babli Goyal aged about 40 years W/o Late Sh. Rajinder Kumar
2. Sheenu Rani aged about 19 years D/o Late Sh. Rajinder Kumar
3. Mukesh Goyal aged about 17 years minor under the guardianship of her mother and through next friend Babli Goyal, all residents of ward no.10, near Janak Raj Hospital, Budhlada, District Mansa-151502 (Punjab).
.....Complainants Versus
1. ICICI Prudential Life Insurance Company Limited, Registered Office, ICICI Pru Life Towers, 1089, Appasaheb Marathe Marg, Prabha Devi, Mumbai-400025, through its M.D.
2. ICICI Prudential Life Insurance Company Limited, Unit No.1A & 2A, Raheja Tipco Plaza, Rani Sati Marg, Malad (East), Mumbai-400097.
.....Opposite Parties Complaint U/s 17(1)(a) of the Consumer Protection Act, 1986 (as amended up to date).
Quorum:-
Shri J. S. Klar, Presiding Judicial Member Shri Rajinder Kumar Goyal, Member Present:-
For the complainants : Sh. Sanjeev Goyal, Advocate For the opposite parties : Sh. K.S. Cheema, Advocate .................................................................................. J. S. KLAR, PRESIDING JUDICIAL MEMBER:-
The complainants have instituted this complaint U/s 17(1)(a) of the Consumer Protection Act 1986 (in short the "Act") against opposite parties (in short the 'OPs') on the premise, that in the month of June 2017, Gagan Jyoti, the agent of OPs, approached Consumer Complaint No.601 of 2018 2 complainant no.1 and her husband Rajinder Kumar, since deceased (in short 'deceased') with new term plan of OP company for getting high assured sum of Rs.50 lakh by paying annual premium of Rs.20,000/-, whereas the other life insurance companies have been charging Rs.50,000/- to Rs.60,000/- per annum for the same plan. The deceased opted for term plan of Rs.50 lakh assured sum for 28 years by paying annual premium of Rs.20,100/-. The deceased told the said agent that he had been suffering from high blood pressure and cholesterol and was taking 20 mg tablet for the last three years therefor and there was no other ailment afflicting him. The doctor of Amrit Nursing Home Mansa, being doctor of OP conducted complete medical checkup of the deceased and also conducted all the medical tests upon the deceased. After some time, the agent of OP informed the deceased that his medical reports were OK and OP issued policy bearing no.21088414 dated 19.06.2017 for an amount of Rs.50,000/- for 28 years, vide Ex.C-1 to him. Unfortunately, at about 2:30 am on 23.01.2018, the deceased suffered heart attack and was immediately taken to Jindal Nursing Home Mansa, where he was referred to higher hospital at Bathinda due to his serious condition, but on the way he breathed his last. Complainant no.1, being nominee of Rajinder Kumar deceased lodged the claim with OPs alongwith documents and original policy documents, but OPs wrongly and arbitrarily repudiated the claim of the complainant, vide letter dated 24.03.2018 on the ground that deceased was suffering from heart disease since 2012 and the said fact was not disclosed by Consumer Complaint No.601 of 2018 3 the deceased in his proposal form at the time of taking the insurance policy. It is further averred that neither proposal form was signed by the deceased nor the same was ever filled or read over to deceased.
At the time of taking the policy, the above late husband of complainant no.1 was hale and hearty except high blood pressure and cholesterol and OP also got conducted the complete detailed medical checkup and tests upon her late husband to their satisfaction regarding the health status of the deceased and thereafter issued the policy in question. Complainant no.1 requested OPs to release the claim, but to no effect. The complainants alleged deficiency in service on the part of OPs and prayed for below noted reliefs against OPs:
(a) OPs be directed to release Rs.50 Lakh as claim amount with interest @18% per annum from the date of death of Rajinder Kumar i.e. 23.01.2018 till its realization.
(b) to pay Rs.Five Lakh as compensation for mental harassment.
(c) to pay Rs.55,000/- as litigation expenses.
2. Upon notice, OPs appeared and filed joint written reply by raising preliminary objections that complaint is not maintainable and is liable to be dismissed due to suppression of material facts. It is admitted by OPs that policy bearing no.21088414 was issued by them on the basis of information provided by deceased life assured (DLA) in the proposal form dated 12.06.2017, which was found incorrect and OPs rightly repudiated the claim of complainant on that Consumer Complaint No.601 of 2018 4 conduct. During the claim evaluation process and investigation, it was highlighted that "DLA was an old case of AWMI i.e. anterior wall myocardial infarction and was diagnosed with CAD i.e. Chronic Artery Disease in the year 2012, as per documents provided by complainant no.1 herself and he was again diagnosed with CAD- SVD on 16.05.2017, wherein the letters SVD stands for single vessel disease, which is a type of CAD. He was so diagnosed by Dayanand Medical College and Hospital, vide Ex.OP-1/7, just 25 days prior to signing of the proposal form by him. The contract of insurance is based on principle of "utmost good faith", but DLA breached the contract by deliberately and fraudulently concealing his heart ailment from OP in the proposal form. It is denied that there is any deficiency in service on the part of OPs. The OPs controverted the other averments of the complainants and prayed for dismissal of the complaint.
3. We have heard learned counsel for the parties and have also gone through the record of the case. The counsel for the complainants argued that DLA purchased a term plan for the sum assured of Rs.50,00,000/- from OPs by paying annual premium of Rs.20,000/-. OPs issued policy bearing no.21088414 dated 19.06.2017 for the sum assured of Rs.50 Lakh for 28 years, after complete medical checkup of DLA. Unfortunately, on 23.01.2018, the DLA suffered heart attack and was immediately taken to Jindal Nursing Home Mansa, where he was referred to higher hospital at Bathinda, but he expired due to his cardiac arrest enroute. Consumer Complaint No.601 of 2018 5 Complainant no.1, being his nominee and one of his LRs lodged the insurance claim with OPs through their agent, but it was repudiated by OPs, vide letter dated 24.03.2018 Ex.C-3 on the ground that DLA was suffering from coronary artery disease with acute coronary syndrome since 2012. Furthermore, the DLA was suffering from coronary artery disease-single vessel since May 16, 2017. The version of complainant no.1 is that DLA was hale and hearty except high blood pressure and cholesterol and repudiation of the insurance claim by OPs is baseless. Complainant no.1 tendered in evidence her affidavit Ex.C-A in support of case of the complainants. Ex.C-1 is the copy of insurance policy in the name of Rajinder Kumar DLA for the sum assured of Rs.50 Lakh with policy term of 28 years with annual premium Rs.20,086/- with risk commencement date 19.06.2017. Ex.C-2 is the copy of death certificate of Rajinder Kumar DLA showing his date of death as 23.01.2018.
4. The OPs also tendered in evidence affidavit of Suresh Kumar Investigator Ex.OP-1/11 and the other documents with regard to treatment of DLA Rajinder Kumar in DMC Ludhiana. The counsel for OPs argued that DLA suppressed the material fact of his previous heart ailment at the time of filling up the proposal form and OPs rightly repudiated the insurance claim of complainants on account of the conduct of insured. OPs relied upon policy documents Ex.OP-1/1 of DLA. Ex.OP-1/2 is the copy of customer's declaration filled in by Rajinder Kumar DLA on 12.06.2017 for taking above said policy. Ex.OP-1/3 is the copy of medical examination report of DLA Rajinder Consumer Complaint No.601 of 2018 6 Kumar dated 14.06.2017 by Dr. Pawan Kumar Garg panelist doctor of OPs. Ex.OP-1/4 is the copy of terms and conditions of the insurance policy. Ex.OP-1/5 is the copy of death claim submitted by complainant no.1. Ex.OP-1/6 is the copy of letter from OPs to complainant no.1 demanding some documents from her for processing the claim. Ex.OP-1/7 (colly) is the medical record of DLA Rajinder Kumar issued by Dayanand Medical College & Hospital Ludhiana (DMC), where his history and clinical details are recorded as "HTN AWMI(2012), CAD-SVD(16/05/2017), LVEF=35%". Ex.OP-1/8 is certificate issued by Jindal Nursing & Maternity Home Mansa dated 10.03.2018 to the effect that late Rajinder Kumar was known case of CAD/ILD for 2012 (SVD-2012) and at page no.58 of file, there is also out patient card of Rajinder Kumar DLA issued by PGI Chandigarh recording the fact of C/o CAD-ACS in 2012 and ACS:25/11/2017. This out patient card is dated 13.12.2017. Ex.OP- 1/9 is the copy of treating doctor's certificate dated 02.04.2018 Dr. Parshotam Jindal. Ex.OP-1/10 is the copy of repudiation letter dated 24.03.2018 by OP.
5. The counsel for the complainant contended that DLA was examined by the panelist doctor of OPs before issuing the insurance policy to him, but no such disorder was detected in his health. This fact goes a long way in proving that he was hale and hearty and did not suffer from any cardiac disorder and hence there is no question of concealment of material fact by suppressing it fraudulently on his part in this case. As held by the State Consumer Disputes Redressal Consumer Complaint No.601 of 2018 7 Commission U.T. Chandigarh in F.A.349 of 2013 titled as Ashok Kumar Vs. Apollo Munich Health Insurance, decided on 23.08.2013, no doubt the insured was subjected to medical examination by authorized doctor of OPs and only after due satisfaction, the policy was issued. The mere fact that he was subjected to medical examination before issuance of policy in question at the instance of the OPs did not absolve him of his duty of disclosure of material fact that he was suffering from the concerned disease, since he concealed this very fact and on the other hand gave answer in proposal form in the negative and he, thus, breached the principle of utmost good faith on which the contract of insurance is based. This submission of counsel for the complainants is not accepted on the above premise, as the insured was expected to disclose the correct answers in the proposal form to OPs, despite his examination by penalist doctor. Similarly, the next submission of counsel for the complainants is that the proposal form was in English, whereas the proposer signed the declaration in Punjabi and as such it is inconsequential. This document does not prove this fact that DLA was not aware of his pre-existing disease, but he deliberately concealed it by giving wrong answers in the proposal form regarding his state of health. Reference was also made by complainant to law laid down by our own State Commission in "Bajaj Allianz Life Insurance Company Vs. Major Singh" 2017(3)CLT- 383 that it is for the insurance company to prove that the contents of the form were explained to the insured in vernacular language, which Consumer Complaint No.601 of 2018 8 he understood. We find that the facts of the cited authorities are distinguishable because in this case, the policy was received by the insured and he had not opted for cancellation of the policy at any stage by exercising his option of free look period. Even otherwise, it is not believable that his signatures were obtained on it erroneously, as there is no such plea of any fraud in this case in obtaining his signatures on it. A person, who signs a document is supposed to be aware of the contents of the same and it can be taken that they were explained to him. Even, we find further confirmation to this point from his medical examination by panelist doctor of OP Ex.OP-1/3, wherein he also replied the questionnaire to the penalist doctor in the negative as well regarding his status of health. The submission of counsel for complainants is not accepted on this point by us.
6. The next point raised by counsel for complainants is that there is no affidavit of the doctor who treated him and mere photocopies of outpatient card, certificate, etc. are unable to prove his pre-existing ailment. Reference was made to law laid down by the National Commission in "SBI Life Insurance Company Limited Vs. Harivinder Kaur and another" 2014(3)CPJ-552, "Kamla Devi Vs. LIC of India" 2016(2)CPJ-649, "United India Insurace Co. Limited & another Vs. S.K. Gandhi" 2015(2)CLT-71. We find that facts of each arose from its peculiar circumstances. Herein, there is record of DMC and Hospital Ludhiana specifically stating that he was a patient of myocardial perfusion imaging. He was suffering from cardiac artery disease, as depicted in the record of DMC and Consumer Complaint No.601 of 2018 9 Hospital, the renowned medical institute of Northern India. Similarly, the record of PGI is also placed on record at page no.58 to the effect that DLA was examined in cardiological wing of PGI Chandigarh and it is recorded CAD-ACS in 2012. In addition to that, the record of Jindal Nursing & Maternity Home Mansa further corroborated this fact that he was a patient of CAS, (SVD-16-5-17). It is not possible that the above referred medical records of DLA could be fabricated one. The PGI is the government institute and one of the prestigious institute in India and it also found him to be a patient of heart ailment since 2012. It is not believable that DLA was not aware of pre- existing disease, when he went to PGI Chandigarh, DMC Ludhiana and Jindal Nursing Home Mansa. The policy in this case was taken by DLA on 19.06.2017, whereas he suffered from the cardiac ailment on 16.05.2017 for single vessel disease, which is a type of CAD, as per history of clinical details of DMC and Hospital record on the file. It is, thus, clear that he was even struck with cardiac problem i.e. single vessel disease on 16.05.2017, as per DMC and Hospital record on the file, whereas he took the life term policy subsequently by filling the proposal form on 12.06.2017 of the policy. He died within few months from the commencement of the policy on 23.01.2018 vide Ex.C-2. The inference is clear that he was already suffering from single vessel disease i.e. cardiac artery disease and had not disclosed this material fact to OPs in proposal form and inveigled it to issue the insurance policy to him by keeping insurer in darkness about correct facts. The OPs are justified in repudiating the Consumer Complaint No.601 of 2018 10 contract of insurance on the basis of law laid down by the Apex Court in "P.C. Chacko and another Vs. Chairman, Life Insurance Corporation of India & others" AIR2008 (SC)-424 and "Satwant Kaur Sandhu Vs. New India Assurance Company Limited"
2006(SCC)-2776. The repudiation of the insurance claim of complainants by OPs is, thus, justified on account of breach of principle of good faith by him, which is bed-rock of the contract of insurance.
7. As a result of our above discussion, there is no merit in the complaint and the same is hereby dismissed.
8. Arguments in this complaint were heard on 26.02.2019 and the order was reserved. The certified copies of the order be communicated to the parties, as per rules.
9. The complaint could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR) PRESIDING JUDICIAL MEMBER (RAJINDER KUMAR GOYAL) MEMBER March 06, 2019.
(MM)