State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Rajwant Kaur on 2 December, 2013
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB
SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No.676 of 2010.
Date of Institution: 27.04.2010.
Date of Decision: 02.12.2013.
Life Insurance Corporation of India, having its Divisional Office at
Jeevan Parkash Building, 4-5, District Shopping Centre, Ranjit Avenue,
Amritsar, through is Sr. Divn. Manager.
.....Appellant.
Versus
Rajwant Kaur wd/o Sh. Parminder Singh, R/o VPO Naushera Pannuan,
Tehsil and District Tarn Taran.
...Respondent.
First Appeal against the order dated
17.02.2010 passed by the District
Consumer Disputes Redressal Forum,
Tarn Taran.
Before:-
Shri Inderjit Kaushik, Presiding Judicial Member.
Shri Vinod Kumar Gupta, Member.
...................................
Present:- Sh. Ravi Kumar, Advocate for Sh. Puneet Sharma, Advocate, counsel for the appellant.
Respondent Exparte.
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INDERJIT KAUSHIK, PRESIDING JUDICIAL MEMBER:-
Life Insurance Corporation of India, appellant/opposite party (In short "the appellant") has filed this appeal against the order dated 17.02.2010 passed by the learned District Consumer Disputes Redressal Forum, Tarn Taran (in short "the District Forum"). First Appeal No.676 of 2010 2
2. Facts in brief are that Smt. Rajwant Kaur, respondent/ complainant (hereinafter called as "the respondent") filed a complaint under section 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the appellant, on the grounds that her husband namely Sh. Parminder Singh was serving in the army in the rank of DFR and he obtained an insurance policy No.471378290 from the appellant for a sum of Rs.1.00 lac along with family benefit of Rs.50,000/- and he was paying the premium regularly. The husband of the respondent died on 21.02.2007. In November, 2006, the arteries of the husband of the respondent blocked and his heart surgery was conducted.
3. Before effecting the insurance, husband of the respondent received a telephonic call from the officials of the appellant that he is winner of a lucky draw and he was called in the office and by trapping him, the insurance in question was effected in the name of the husband of the respondent. After the death of her husband, the respondent lodged her claim with the appellant for disbursement of the sum assured along with family benefits and other benefits and supplied all the documents for settlement of the claim, but the appellant vide letter dated 29.12.2008, repudiated the genuine claim on flimsy grounds that the husband of the respondent withheld the correct information regarding his health at the time of effecting the insurance. The fact remains that at the time of taking the insurance policy, husband of the respondent was not, at all, suffering from any disease. He was medically examined by the paneled doctors of the appellant and after thorough examination, the insurance was effected. The heart surgery was conducted in the year 1992-93 and he died after 16-17 years and the said surgery has no nexus with cause of death. The proposal form was filled by the agent of the appellant and only the signatures were First Appeal No.676 of 2010 3 obtained. No information was withheld. The respondent visited the office of the appellant, but the claim was refused. The act and conduct of the appellant caused a lot of mental tension and harassment and the respondent is entitled to compensation.
4. It was prayed that the appellant may be directed to pay the sum assured of Rs.1.00 lac besides family benefit of Rs.50,000/- along with interest @ 18% p.a. from the date of lodging the claim till payment and to Rs.50,000/- as compensation and litigation expenses.
5. In the written version filed on behalf of the appellant, preliminary objections were taken that the deceased Sh. Parminderjit Singh willfully and fraudulently concealed the material facts regarding his health at the time of taking the policy for Rs.1.00 lac, commencing from 08.03.2006 and gave wrong answers to the questions of the proposal for insurance signed by him, knowing very well that the same were incorrect and he was not in good health. Life assured died immediately after one year from the date of proposal i.e. on 21.01.2006. The claim was got investigated and it was revealed that the insured had concealed the information regarding his health at the time of proposal. He had undergone bypass surgery at Army Hospital, New Delhi and he was kept under category BEE (P) by the army as per the record provided by the hospital. He also remained on sick leave from 31.12.2003 to 27.12.2004 before the proposal as per certificate provided by the employer. Decease Life Assured (hereinafter called "DLA") breached the insurance contract and violated the principle of good faith. The claim was rightly repudiated. The complaint is not maintainable and the respondent is estoped to file the present complaint under the provisions of the Act. Para-5 of the policy deals with forfeiture in certain events and the same is applicable as the DLA First Appeal No.676 of 2010 4 concealed material facts. He was not keeping good health at the time of filing the proposal and replied in negative to the questions and also gave false declaration. Elaborate evidence is required and civil court can decide the matter in dispute. Provisions of Insurance Act, 1938 are applicable and not of the Act.
6. On merits, taking of the policy was admitted. The appellant is a Govt. body and has no such scheme for effecting insurance of the proposer on the basis of lucky draws, but the insurance is effected as per Insurance Act, based on proposal form and willingness of the proposer. Other similar pleas as taken in preliminary objections were repeated and denying allegations of the complaint, it was prayed that the complaint may be dismissed with costs.
7. Parties led evidence in support of their respective contentions by way of affidavits and documents.
8. After going through the documents and material placed on file and after hearing the learned counsel for the parties, the learned District Forum observed that in the present case, the appellant has not produced the insurance policy to prove whether the questions mentioned in the reply, appeared in the policy or not. Affidavit of the concerned investigator has not been filed. Inquiry Report Ex.R-14 is having no supporting documents to prove its credibility. The deceased was admitted in the hospital for heart operation in November, 2006 but due to failure of the operation, died on 21.02.2007. The deceased was not suffering from any ailment at the time of taking the policy. The version of the appellant that the deceased had undergone some operation somewhere in 1996-1997 cannot be believed as it has not placed any hospital record to prove this contention. Even if the deceased has undergone some treatment, he might have become fit for First Appeal No.676 of 2010 5 performing his army duty where he served for about 17 years. The appellant has placed on file one copy of the proposal, but the policy has not been brought on record. There is no evidence regarding the supply of terms and conditions of the policy to the deceased. The complaint was allowed and the appellant was directed to pay Rs.1.00 lac as insurance amount and Rs.50,000/- as family benefit along with interest @ 9% p.a. from the date of death of the insured Parminder Singh till payment and Rs.10,000/- as compensation and Rs.5,000/- as litigation expenses.
9. Aggrieved by the impugned order dated 17.02.2010, the appellant has come up in appeal.
10. We have gone through the pleadings of the parties, perused the record of the learned District Forum and have heard the arguments advanced by the learned counsel for the appellant.
11. The respondent has not contested the appeal and was proceeded against exparte.
12. The appeal was filed on the grounds that the life assured died within one year of taking the policy i.e. on 21.02.2007 while taking treatment for heart ailment. The District Forum has totally ignored the evidence collected during the course of investigation and exhibited on the record of the District Forum. The investigator has categorically stated that the deceased had undergone bypass surgery at RR Military (Military Hospital) at Delhi in the year 1995. The life assured was kept initially in BEE (T) category for 6/12 years by the Board of the Military Authorities on 05.03.1995 and subsequently, the category was changed from Temporary BEE category to Permanent BEE category which proves that the life assured was not in good state of health. Life assured remained on sick leave from 31.12.2003 to 27.12.2004 and the First Appeal No.676 of 2010 6 certificate of the employer Ex.R-2 was not considered. The DLA did not disclose true facts regarding his pre-existing ailment at the time of taking the policy and the claim was rightly repudiated and the affidavit of the Manager Legal was filed in support of the version. The District Forum has not considered the medical evidence brought on record. The order passed by the District Forum is liable to be set aside and the appeal may be accepted.
13. We have considered the version of the appellant as given in the appeal and have minutely scrutinized the entire record.
14. The DLA was insured under the policy for a sum of Rs.1.00 lac along with family benefit of Rs.50,000/- and the claim of the respondent was not paid and vide Ex.C-2, the policy was declared void abnitio and appellant repudiated the claim on the grounds that questions were answered in negative and material information was withheld. The appellant has also relied upon the same letter dated 29.12.2008 Ex.R-1. Certificate Ex.R-2 was issued by the employer of the DLA and as per this certificate, the DLA took casual leave, earned leave, medical leave and other leave on different dates and the medical leave was only for 28 days. Ex.R-3 and Ex.R-4 was the medical case sheet of deceased and as per them, the deceased remained admitted from 01.12.2006 to 01.02.2007 and took treatment. Vide letters Ex.R-5 to Ex.R-9, documents were demanded from the respondent. Ex.R-10 to Ex.R-12 are the Medical Board proceedings of the year 1993 and the insured was kept under category BEE (T) after the CABG was done. Ex.R-13 is another letter vide which the documents were demanded. Ex.R-14 is the claim inquiry report. Ex.R-15 is the postmortem report and the cause of death was hemorrhage shock as a result of rupture of abdominal aorta, which was sufficient to cause death in the normal First Appeal No.676 of 2010 7 course of events. Ex.R-16 and Ex.R-17 are the status reports of policy. Ex.R-18 is the claimant's statement as per which the DLA died on 21.02.2007 due to sudden heart attack. Ex.R-19 is again the certified of employer, showing some number of days of medical leave. Ex.R-20 is the intimation of death claim. Ex.R-21 is the proposal for insurance which was filled on 08.03.2006 and the questions regarding consulting any medical practitioner during the last five years and other related questions were answered in negative and declaration of good health was made. Ex.R-22 is the affidavit of Sh.Makhan Lal, Manager, Legal of the appellant, which is nothing, but the attested copy of the written version. There is no affidavit of any investigator or any other document to prove that prior to filling of the proposal form, the DLA was not fit. Heart surgery which he has undergone in the year 1993 was not even the cause of death as per postmortem report. Mere category BEE (P) given by the medical authorities of the army, itself is not sufficient to prove that the DLA was suffering from any ailment which he was required to disclose. The DLA had not suppressed any material information at the time of filling the proposal form and the treatment taken about 13 years back, which has no nexus with the cause of death, cannot be said to be material information withheld. The order passed by the District forum is detailed and speaking there is no ground to interfere with the same.
15. Sequel to the above discussion, the appeal is dismissed and the impugned order under appeal dated 17.02.2010 passed by the District Forum is affirmed and upheld. No order as to costs.
16. The appellant had deposited an amount of Rs.25,000/- with this Commission at the time of filing of the appeal. This amount with interest accrued thereon, if any, be remitted by the registry to the First Appeal No.676 of 2010 8 respondent/complainant by way of a crossed cheque/demand draft after the expiry of 45 days under intimation to the learned District Forum and to the appellant.
17. Remaining amount as per the order of the District Forum shall be paid by the appellant to the respondent/complainant within 45 days of the receipt of copy of the order.
18. The arguments in this appeal were heard on 26.11.2013 and the order was reserved. Now the order be communicated to the parties.
19. The appeal could not be decided within the stipulated timeframe due to heavy pendency of court cases.
(Inderjit Kaushik) Presiding Judicial Member (Vinod Kumar Gupta) Member December 02, 2013.
(Gurmeet S)