State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Rajesh Kumar on 30 October, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH.
First Appeal No.186 of 2008
Date of institution : 27.2.2008
Date of decision : 30 .10.2012
Life Insurance Corporation of India, Patiala Branch-1, Chhoti Baradari, Patiala
through its Sr. Divisional Manager, Jeevan Parkash Building, Sector 17-B,
Chandigarh.
.......Appellant
Versus
Rajesh Kumar s/o Shri Baisakhi Ram, H.No.18, St. No.27, Anand Nagar B,
Patiala, Punjab.
...Respondent
First Appeal against the order dated 18.1.2008
of the District Consumer Disputes Redressal
Forum, Patiala.
Before :-
Shri Piare Lal Garg, Presiding Member.
Shri Jasbir Singh Gill, Member.
Present :-
For the appellant : Ms. Jaimini Tewari, Advocate for Shri Rajneesh Malhotra, Advocate.
For the respondent : Shri Vishal Sodhi, Advocate.
PIARE LAL GARG, PRESIDING MEMBER:
This is an appeal filed by the opposite party/appellant (hereinafter called 'the appellant') against the order dated 18.1.2008 of District Consumer Disputes Redressal Forum, Patiala (hereinafter called 'District Forum') vide which the complaint of the respondent was allowed by the District Forum.
2. The brief facts of the complaint are that the mother of respondent, namely, Kala Devi wife of Shri Baisakhi Ram had taken Life Insurance Policy for an amount of Rs.62,500/- on 28.3.2004 after the payment of Rs.1561/- as First Appeal No.186 of 2008. 2 premium. As per complaint, said Kala Devi was admitted in Rajindra Hospital, Patiala due to heart attack on 28.9.2005 and died on the same day at 3.00 P.M. It was the first heart attack suffered by his mother after taking the policy.
3. It was further pleaded that the mother of the respondent was medically examined by Dr. Anju Gupta authorized doctor of the appellant and it was found by the doctor that the deceased/insured was not suffering from any disease. The respondent was appointed as nominee in the policy in dispute. The claim was submitted to the appellant which was repudiated on the ground that she was suffering from coronary artery disease and was also suffering from D.M. Type-II as well as with hypertension at the time of filling the proposal form for taking the policy. The respondent pleaded that the repudiation of the claim was illegal as his mother was not suffering from any disease at the time of filling the proposal form. The complaint was filed with the prayer that the appellant may be directed to release the death benefit along with compensation due to mental agony and harassment with litigation expenses.
4. Upon notice the appellant appeared through counsel and filed reply taking preliminary objections that the District Forum has no jurisdiction to try and decide the complaint under the life insurance policy. On merits it was pleaded that the insured had taken the policy fraudulently and concealed the material facts regarding her ailment as she was suffering from diabetic mellitus type-II on irregular treatment and uncontrolled diabetes and was a known case of hypertension for 5 years on regular treatment and was also known case of coronary artery disease for the last one and a half years at the time of filling the proposal form i.e. on 31.3.2004.
5. It was admitted that policy No.162650151 for an amount of Rs.62,500/- under Table 165-15 was issued in favour of deceased Kala Devi with the date First Appeal No.186 of 2008. 3 of commencement as 28.3.2004 by the Branch Office, Patiala-1 of the appellant. The nomination of Rajesh Kumar was also not disputed. It was denied that the true facts regarding her health were disclosed by the insured at the time of filling of the proposal. The submission of the documents by the respondent was also not denied. The assured died only after 1 year 5 months and 27 days from the issuance of the policy. Form No.3784 got completed by the appellants from Senior Resident Doctor of Rajindra Hospital, Patiala and as per the opinion of the doctor, deceased Kala Devi was a case of diabetes and hypertension for the last five years and was also suffering from heart disease for the last one and a half years at the time of her admission in Rajindra Hospital, Patiala on 28.2.2005 for treatment and she died on the same day in the hospital. But the facts regarding previous ailment were not disclosed by the deceased/insured at the time of filling the proposal form. The medical examination of the deceased on 30.3.2004 by Dr. Anju Gupta, Panel Doctor of the LIC was not denied and it was pleaded that this fact was not disclosed by the deceased even to the doctor. As such the policy was void ab initio and the claim was rightly and legally repudiated by the appellant. Dismissal of the complaint was prayed.
6. The parties led their evidence by way of affidavits/documents in support of their respective versions.
7. The District Forum after hearing the counsel for the parties and going through the pleadings and evidence on record, accepted the complaint vide impugned order dated 18.1.2008 and directed the appellant to pay Rs.62,500/- with interest at the rate of 9% per annum till realization. The appellants were also directed to pay Rs.10,000/- as compensation for harassment and mental agony as well as Rs.500/- as litigation expenses.
8. Aggrieved from the order of the District Forum the present appeal was filed by the appellant on the grounds that the order of the District Forum is First Appeal No.186 of 2008. 4 against medical record and case history of the deceased/insured and District Forum overlooked the evidence brought on record by the appellant in support of its version, the District Forum also failed to appreciate the provisions of Section 45 of the Insurance Act, 1938, District Forum has overlooked the specific terms and conditions of the policy and given wrong finding on the medical examination of deceased/insured by Dr. Anju Gupta. The order of the District Forum suffers from material irregularity and is based upon conjectures and surmises and is not sustainable in the eyes of law.
9. On the other hand, the submission of the learned counsel for the respondent was that there is no merit in the present appeal and the same be dismissed.
10. Record has been perused. Submissions have been considered.
11. There is no dispute between the parties that deceased insured Kala Devi i.e. mother of the respondent had taken the policy from the appellants on 28.3.2004 for an amount of Rs.62,500/- against the payment of premium. There is also no dispute that respondent Shri Rajesh Kumar was nominated as a nominee by the assured. There is also no dispute between the parties that on 28.9.2005 assured suffered a heart attack and she was admitted in Rajindera Hospital, Patiala where she had died on the same day.
12. The claim was submitted by the respondent with the appellants which was repudiated by the appellants vide letter dated 31.3.2006 (Ex.C-11) on the following ground:-
" It is, therefore, evident that she had made deliberate mis- statements and withheld material information from us regarding her health at the time of effecting the assurance and hence in terms of the policy contract and the declaration contained in the forms of proposal of Assurance and Personal Statement, we hereby repudiate the claim and accordingly, we are not liable for First Appeal No.186 of 2008. 5 any payment under the above policy and all moneys that have been paid in consequence thereof belong to us."
13. The appellants to prove this version tendered into evidence the affidavit of Dr. Sunil Singla (Ex.R-3). Relevant para 2 of the affidavit of Dr. Sunil Singla is reproduced hereunder:-
"2. I state on oath that patient Smt. Kala Devi aged about 50 years, resident of H.No.18, Street No.27, Anand Nagar, 'B' Patiala, was admitted in Emergency Ward of Rajindera Hospital, Patiala in the evening of 28.9.2005, with a Case History of 'Known case of Diabetes Mellitus 2nd Stage on Irregular Treatment and Un-controlled Diabetes and with a known case of Hypertension for five years on regular treatment and as a known case of Coronary Artery Disease (CAD) for 1.1/2 years on regular treatment' and with a sudden chest pain since 6-00 P.M. and was transferred to Medicine Unit-II, for treatment after admission with Admission No.22537 dated 28.9.2005."
14. We have also perused form No.3784 Ex.R-8 which was issued by Dr. Sunil Singla who treated the patient. In column no.6(2)(c) it is mentioned that history of ailment was explained/told by the patient herself. We have also perused the copy of bed head ticket Ex.R-9 as well as the details of treatment mentioned in the bed head ticket Ex.R-9(6). It is stated in the said document that the patient was received at 7.15 PM in the hospital and the detail of the treatment is mentioned on page No. Ex.R-9(8) but no document is produced by the appellants where history of the patient was recorded. It is mentioned in page No.R-9(6) that the patient had suffered sudden chest pain at 6.00 P.M. and she was brought to Rajindera Hospital, Patiala at 7.15 P.M. So how it was possible that when the patient was suffering from a severe heart attack, had narrated the history of her ailment to the doctor. The doctor in Form No.3784 First Appeal No.186 of 2008. 6 mentioned that the history of ailment was narrated by the patient herself. A person can speak lie but documents never speak lie. From the documents it is proved beyond doubt that the patient i.e. Kala Devi was not in a position to narrate the history of her ailment to doctor when she was under severe heart attack. Dr. Sunil Singla had given a wrong affidavit to favour the appellant when it was very much in his notice that the patient was not in a position even to talk.
15. We have also perused the affidavit of Dr. Anju Gupta (Ex.R-2) and her Medical Examiner's Confidential Report (Ex.C-3) vide which she had found the assured fit for to be insured as she was not suffering from any ailment when she had medically examined the assured. However she had also nowhere in her affidavit Ex.R-2 mentioned that the assured was suffering from any ailment when she was medically examined by her.
16. The appellants also not produced any document or evidence to prove that the assured/deceased had taken any treatment from any hospital/doctor before filling the proposal form or before the heart attack which she had suffered on 28.9.2005. The repudiation of the claim by the appellants on the ground that the assured had not disclosed her previous ailment was illegal and the order of the District Forum is speaking one and there is no infirmity in the same.
17. In view of the above discussion, the appeal of the appellant is dismissed with costs of Rs.5000/- with modification that interest will be paid by the appellant after three months of death of Kala Devi assured.
18. Dr. Sunil Singla son of Shri R.D. Singla, R/o 60-B, Ranbir Marg, Model Town, Patiala had given a wrong affidavit to help the Insurance Company which is not as per the ethics of the medical practice. A letter be sent to the Medical Council of India as well as a copy of the order to enquire under what circumstances Dr. Sunil Singla had made a false affidavit in favour of the First Appeal No.186 of 2008. 7 Insurance Company to help it. The people in India believe the doctor as a God and if it happened in future the confidence of the people will be shaken. A copy of the report be sent to this Commission within three months from the receipt of copy of the letter regarding the action taken against Dr. Sunil Singla.
19. The appellant had deposited an amount of Rs.25,000/- with this Commission at the time of filing of the appeal on 27.2.2008.
20. The interest on the amount of Rs.25,000/- shall stop running with effect from the date the appellants had deposited the same in this Commission. Interest on this amount of Rs.25,000/- shall be what has accrued on this amount when it remained deposited by this Commission in the Bank.
21. 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.
22. Remaining amount shall be paid by the appellant to the respondent within one month after the receipt of order.
23. The arguments in this case were heard on 17.10.2012 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.
(PIARE LAL GARG)
PRESIDING MEMBER
October 30 , 2012 (JASBIR SINGH GILL)
Bansal MEMBER
First Appeal No.186 of 2008. 8