State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Lillu Ram on 11 August, 2010
STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA PANCHKULA First Appeal No.2550 of 2007 Date of Institution: 19.09.2007 Date of Decision: 11.08.2010 Life Insurance Corporation of India through, Sector-17, Chandigarh through its Manager (L and HPF). Appellant/Opp. Parties Versus Lillu Ram son of Shri Inder Singh c/o Ram Niwas Malik, village Agawanpur, permanent resident of village Deeg, Tehsil and District Kaithal. ......Respondent/Complainant BEFORE: Honble Mr.Justice R.S.Madan, President. Dr.Rekha Sharma, Member. Sh.Diwan Singh Chauhan, Member. For the Parties: Mr.Deepak Arora Advocate for the appellant. Mr.R.K.Malik Advocate for the respondent. ORDER
JUSTICE R.S.MADAN PRESIDENT:
This appeal is preferred against the order dated 26.07.2007 passed by District Consumer Disputes Redressal Forum, Kaithal in complaint No.19/2006 which relates to insurance benefits in respect of the insurance policy obtained by Raj Kumar brother of the respondent-complainant.
The brief facts of the present case are that Raj Kumar (hereinafter referred to as Life Assured) has got insured his life from the opposite parties vide policy No.172681453 for a sum of Rs.3,00,000/- which commenced from 28.3.2001. The policy lapsed due to non-payment of premium which was due in March, 2003 and thereafter in September, 2003. The Life Assured got revival his policy on 06.11.2003. Unfortunately the Life Assured died on 12.2.2005. The complainant being the nominee of the Life Assured submitted his claim to the appellant-opposite party but the same was repudiated vide letter dated 20.12.2005 on the ground that at the time of revival of the policy the Life Assured had not disclosed that he was suffering from HIV positive and T.B. since 21.8.2003 for which he was taking treatment from AIMS, New Delhi.
Taking it a case of deficiency of service the complainant invoked the jurisdiction of the District Forum with the averment that at the time of revival of the policy the Life Assured was got medically examined and for that reason the opposite parties cannot take the plea that the Life Assured had concealed any material facts from the insurance company.
Upon notice, the opposite parties appeared and contested the claim of the complainant on the ground stated above. It was pleaded by the opposite parties that the Life Assured was getting treatment from AIMS New Delhi as per OPD Card dated 27.11.2003 but this fact was not disclosed by him in DGH and in medical examination while getting the policy revived on 6.11.2003. Thus, denying it a case of any kind of deficiency of service they prayed for dismissal of complaint.
Both the parties led evidence in support of their respective claims.
On appraisal of the pleadings of the parties and evidence adduced on record, the District Forum accepted the complaint and granted following relief:-
.The ends of justice will be met if the claim of complainant is accepted. So, the respondents are directed to pay the insured amount to the complainant along with interest @ 12% p.a. and all other benefits from the date of repudiation of claim till its realization. Complaint is accepted. No order as to costs.
We have heard learned counsel for the parties and perused the case file.
The controversy involved between the parties is that at the time of revival of the policy on 06.11.2003 the Life Assured had not disclosed true and material facts with respect to his state of health in the proposal form while giving wrong answers to the following questions:-
Learned counsel for the appellant-opposite parties further referred to the personal statement of the Life Assured with respect to his health in form No.680 dated 5.11.2003 when the Life Assured had revived the above policy wherein the Life Assured had made the following statement:-
I, Raj Kumar do hereby declare that the foregoing statements and answers are true in every particulars and agree and declare that these statements and this declaration along with any proposal for insurance under the lapsed policy, shall be the basis of the contract of the revival of the lapsed policy, between me and the Life Insurance Corporation of India, and that if any untrue averment be contained therein the said contract shall be absolutely null and void and all moneys which shall have been paid in respect of there of shall stand forfeited to the Corporation.
In view of the above stated documents it is contended by learned counsel for the appellant-opposite parties that the action of the Insurance Corporation was justified while repudiated the claim of complainant in view of the conditions and privileges of the policy which is reproduced as under:-
Forfeiture in certain events:- In case the premium shall not be duly paid or in case any condition herein contained or endorsed hereon shall be contravened or in case it is found that any untrue or incorrect statements is contained in the Proposal, Personal Statement, declaration and connected documents or any material information is withheld then and in every case, but subject to the provisions of Section 45 of the Insurance Act, 1938, wherever applicable, this policy shall be void and all claims to any benefit in virtue hereof shall cease and determine and all money that have been paid in consequence hereof shall belong to the Corporation, excepting always in so far as relief is provided in terms of the Privileges herein contained or may lawfully granted by the Corporation.
We find force in the contention raised by the learned counsel for the appellant-opposite parties. The documents mentioned above leave no manner of doubt that the Life Assured had concealed the true facts with respect to his state of health when he got the policy revived on 6.11.2003. It is well settled principle of law that contract of insurance is an agreement and both the parties are governed by the terms and conditions of the policy.
In the present case from the evidence adduced on record, it is established that at the time of revival of the policy, the Life Assured was suffering from HIV positive and T.B. but this fact was not disclosed by him in his Personal Statement/Proposal Form, therefore, the complainant is not entitled for any compensation from the appellant-opposite parties in respect of the policy obtained by the deceased. The District Forum has not appreciated the cogent and convincing evidence and committed great error in allowing the complaint and as such the impugned order under challenge is not sustainable in the eyes of law.
Accordingly this appeal is accepted, the impugned order is set aside and the complaint is dismissed.
The statutory amount of Rs.25,000/- deposited by the appellant at the time of filing of the appeal is ordered to be refunded to the appellant on expiry of period of limitation for filing revision/appeal if any before the Honble National Commission, with proper receipt, identification and verification.
11th Aug., 2010 Justice R.S.Madan President Dr.Rekha Sharma, Member.
Diwan Singh Chauhan, Member.