State Consumer Disputes Redressal Commission
Gurdev Singh Son Of Dalip Singh vs Life Insurance Corporation Of India on 28 April, 2011
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB,
S.C.O. NO. 3009-10, SECTOR 22-D, CHANDIGARH.
First Appeal No.1251 of 2006
Date of institution : 3.10.2006
Date of decision :28.4.2011
Gurdev Singh son of Dalip Singh, resident of Village Banbhaura, Terhsil
Malerkotla, District Sangrur.
.......Appellant
Versus
1. Life Insurance Corporation of India, Jiwan Parkash Building, Sector 17-B,
Chandigarh-160017 through its Divisional Manager.
2. Life Insurance Corporation of India, Satta Bazar, Malerkotla through its
Branch Manager.
......Respondents
First Appeal against the order dated 11.8.2006 of
the District Consumer Disputes Redressal Forum,
Sangrur.
Before :-
Hon'ble Mr. Justice S.N. Aggarwal President.
Mrs. Amarpreet Sharma, Member.
Mr. B.S. Sekhon, Member.
Present :-
For the appellant : Shri Tajender Joshi, Advocate. For the respondents : Shri Nitesh Singhi, Advocate for Shri Paramjit Batta, Advocate.
JUSTICE S.N. AGGARWAL, PRESIDENT:
Satwant Kaur wife of Gurdev Singh appellant had taken the life insurance policy from the respondents for an amount of Rs.1,00,000/-. It was valid with effect from 18.2.2004. The life assured died on 10.12.2004. The insurance claim was lodged by the appellant but it was repudiated by the respondents vide letter dated 29.6.2005. Hence the complaint for recovery of the insurance amount. Compensation, interest and costs were also prayed.First Appeal No.1251 of 2006. 2
2. The respondents filed the written reply. It was admitted that the life assured had taken the life insurance policy from the respondents for an amount of Rs.1,00,000/-. The proposal form was filled by her on 10.2.2004 and the life insurance policy was commenced with effect from 15.2.2004. It was not denied that the life assured had died on 10.12.2004 and the insurance claim lodged by the appellant was repudiated.
3. However, it was pleaded that the life assured had concealed material facts while filling the proposal form dated 10.2.2004. She had taken the medical treatment from Acharya Tulsi Cancer Hospital, Bikaner with effect from 25.11.2003 but she had suppressed the material facts while filling the proposal form dated 10.2.2004. Therefore the repudiation was legal and valid. Dismissal of the complaint was prayed.
4. The appellant filed the rejoinder. He also proved documents Ex.C1 to Ex.C10. He also filed his own affidavit as Ex.C-11 and subsequent affidavit as Ex.C12.
5. On the other hand, the respondents proved the documents Ex.R1 to Ex.R3. They also filed the affidavit of Dharam Dev, Agent of the LIC as Ex.R-4. They further proved document Ex.R-5. They also filed the affidavit of Teja Singh, Branch Manager as Ex.R-6. They further proved documents Ex.R-7 to Ex.R-13. They also filed the affidavit of Shiv Om Gupta, Chairman (S.D.K.S.), Aggarsain Charitable Eye and General Hospital, Rajpura Road, Patiala as Ex.R-14.
6. Learned District Forum dismissed the complaint vide impugned order dated 11.8.2006.
7. Hence the appeal.
8. The submission of the learned counsel for the appellant was that the appeal be accepted, the impugned order dated 11.8.2006 be set aside and the respondents be directed to pay the insurance claim with compensation, interest and costs. First Appeal No.1251 of 2006. 3
9. On the other hand, the submission of the learned counsel for the respondents was that there was no merit in the present appeal and the same be dismissed. Written arguments were also filed.
10. Record has been perused. Submissions have been considered.
11. The admitted facts are that Satwant Kaur wife of the appellant had taken the life insurance policy from the respondents for an amount of Rs.1,00,000/-. She had filled the proposal form on 10.2.2004 and the life insurance policy was made effective from 15.2.2004. The life assured had died on 10.12.2004 and the insurance claim lodged by the appellant was repudiated by the respondents.
12. The proposal form dated 10.2.2004 filled by the life assured Satwant Kaur has been proved by the respondents as Ex.R-7. As per clause 11 filled by the life assured, she was not suffering from diabetes, tuberculosis, high blood pressure, low blood pressure, Cancer, Epilepsy, Hemia, Hydrocele, Leprosy or any other disease and she was enjoying good health.
13. On the other hand, the respondents have also proved the ultra-sonography and eco-cardiography report dated 29.1.2004 relating to Satwant Kaur life assured issued by Vikas Utrasound & Echo, Bikaner as Ex.R-1. As per this document the life assured was having solid gall bladder mass with multiple lymphnodes at porta hepatis & peri pancreatic-region. The respondents also proved the prescription slip dated 20.11.2003 issued to the life assured by Aggarsain Charitable Eye & General Hospital, Rajpura Road, Patiala as Ex.R-2. In this report also it is mentioned that the life assured was having G.B. Mass.
14. The respondents also filed the discharge and follow-up card issued to the life assured by Acharya Tulsi Cancer Clinic and Research Centre dated 25.11.2003 as Ex.R-11. As per this document also the life assured was suffering from cancerous disease. The respondents have also filed the affidavit of Shiv Om Gupta (S.D.K.S.), Aggarsain Eye and General Hospital, Rajpura Road, Patiala as Ex.R-14. As per this document, Satwant Kaur (life assured) wife of Gurdev Singh (appellant) had come to the hospital on 20.11.2003 with OPD ticket First Appeal No.1251 of 2006. 4 No.19604. After medical examination the life assured was diagnosed on 20.11.2003 as a case of gall bladder mass (i.e. cancer of gall bladder).
15. Therefore it is clearly proved that the life assured was suffering from cancerous disease much before filling the proposal form on 10.2.2004 (Ex.R-7).
16. The law has been settled by the Hon'ble Supreme Court in a number of judgments that the contract of insurance is a contract of Uberrima fides and the parties are bound to disclose the material facts to each other. This law was settled by the Hon'ble Supreme Court in the judgment reported as Mithoolal Nayak v. Life Insurance Corporation of India, AIR 1962 Supreme Court 814. It was held in this judgment that if the life insured suppressed the material facts with fraudulent intention then the insurer would be at liberty to repudiate the insurance claim.
17. This dictum of law was reiterated by the Hon'ble Supreme Court in the subsequent judgment reported as "Life Insurance Corpn. Of India & Ors. v. Asha Goel (Smt.) & Anr., I (2001) SLT 89 = (2001) 2 SCC 160" in which it was observed as under : -
"The contracts of insurance including the contract of life assurance are contracts uberimma fides and every fact of material (sic material fact) must be disclosed, otherwise, there is good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract and also implies any material alteration in the character of the risk which may take place between the proposal and its acceptance. If there are any misstatements or suppression of material facts, the policy can be called into question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the First Appeal No.1251 of 2006. 5 suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person."
18. This view of law has been approvably reiterated by the Hon'ble Supreme Court in the judgment reported as "P.C.Chacko & Anr v. Chairman, Life Insurance Corporation of India & Ors. III (2008) CPJ 78 (SC).
19. The Hon'ble Supreme Court in the judgment reported as "Satwant Kaur Sandhu v. New India Assurance Company Ltd." 2009 CTJ 956 (Supreme Court) (CP) was pleased to observe as under:-
"17. The terms "material fact" is not defined in the Act and, therefore, it has been understood and explained by the Courts in general terms to mean as any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether he would like to accept the risk. Any fact which goes to the root of the Contract of Insurance and has a bearing on the risk involved would be "material'.
20. The Hon'ble Supreme Court was further pleased to observe in Satwant Kaur's case (supra) as under : -
".................We do not find any substance in the contention of learned counsel for the appellant that reliance could not be placed on the certificate obtained by the respondent from the hospital, where the insured was treated. Apart from the fact that at no stage the appellant had pleaded that the insured was not treated at Vijaya Health Centre at Chennai, where he ultimately died. It is more than clear from the said certificate that information about the medical history First Appeal No.1251 of 2006. 6 of the deceased must have been supplied by his family members at the time of admission in the hospital, a normal practice in any hospital. Significantly, even the declaration in the proposal form by the proposer authorizes the insurer to seek information from any hospital he had attended or may attend concerning any disease or illness which may affect his health."
21. Therefore, it is clearly proved that the life assured was suffering from cancerous disease much prior to filling of proposal form but this fact was fraudulently concealed by her while filling the proposal form.
22. In view of the discussion held above, we do not find any merit in the present appeal and the same is dismissed.
23. The arguments in this case were heard on 20.4.2011 and the order was reserved. Now, the order be communicated to the parties.
24. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(JUSTICE S.N. AGGARWAL)
PRESIDENT
(MRS. AMARPREET SHARMA)
MEMBER
April 28 , 2011 (BALDEV SINGH SEKHON)
Bansal MEMBER