State Consumer Disputes Redressal Commission
The Sbi Life Insurance Company Limited vs Harvinder Kaur on 14 December, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH.
First Appeal No.55 of 2009
Date of institution : 15.1.2009
Date of decision : 14 .12.2012
The SBI Life Insurance Company Limited, Unit No.1 & 2, 3rd Floor, First
Mall, Mall Road, Ludhiana through its Manager (through Shri V.
Srinivas, Head-Legal, SBI Life Insurance Co. Ltd., Central Processing
Centre, Kapas Bhavan, Sector 10, CBD-BELAPUR, Navi Mumbai.
....Appellant
Versus
1. Harvinder Kaur w/o Late Shri Sukhvinder Singh son of Gurjeet
Singh, resident of Village Kasba Bhural, Tehsil Malerkotla,
District Sangrur, Punjab.
.....Respondent
2. Gurdeep Singh Kehal (Insurance Agent of SBI Life Insurance Co.
Ltd.), resident of Village Sandaur, Tehsil Malerkotla, District
Sangrur, Punjab.
.....Performa Respondent.
First Appeal against the order dated
15.12.2008 of the District Consumer Disputes
Redressal Forum, Sangrur.
Before :-
Sardar Jagroop Singh Mahal, Presiding Judicial Member.
Shri Vinod Kumar Gupta, Member.
Present :-
For the appellant : Ms. Jaimni Tewari, Advocate for Shri Rajneesh Malhotra, Advocate. For respondent No.1 : None.
For respondent No.2 : Shri Manpreet Singh Sidhu, Advocate for Shri TPS Makkar, Advocate.First Appeal No.55 of 2009. 2
JAGROOP SINGH MAHAL, PRESIDING JUDICIAL MEMBER:
This is OP's appeal against the order dated 15.12.2008 vide which the complaint was allowed and the OP-appellant was directed to pay to the complainant a sum of Rs.1,00,000/- along with interest at the rate of 9% per annum since the date of repudiation till realization and also to pay Rs.3,000/- as compensation.
2. The present complaint was filed by Harvinder Kaur alleging that her husband Sukhwinder Singh had obtained a life insurance policy in his name from the OP-appellant for a sum of Rs.2,00,000/- and she was appointed as nominee under the said policy. On 17.11.2007 Sukhwinder Singh complained of breathlessness which persisted for two-three days. He was, therefore, shifted to Tagore Hospital, Jalandhar City where various tests were conducted and he was found suffering from chest infection and pulmonary hypertension. He remained admitted in the hospital from 20.11.2007 to 7.12.2007 but he died soonafter on 8.12.2007. The OP appellant was informed about the death and a claim application was submitted. It was alleged by the complainant that the insured did not have any knowledge about the prior ailment nor he concealed any material facts. The complainant submitted all the documents needed by the OP and requested them to pay the insured amount but they did not. She, therefore, filed the present complaint to direct the OPs to pay the amount of Rs.2,00,000/- along with bonus and interest at the rate of 18% per annum and also to pay Rs.50,000/- as compensation for mental tension, agony, pain, physical harassment and Rs.25,000/- as litigation expenses.
First Appeal No.55 of 2009. 3
3. The complaint was opposed by the OPs admitting that Sukhwinder Singh had obtained insurance policy from them and she is the legal heir and wife of Sukhwinder Singh aforesaid. It was, however, alleged that there are other legal heirs of Sukhwinder Singh who should have been joined as party to the present complaint. The contention of the OPs is that Sukhwinder Singh was already suffering from hypertension but the same was not mentioned by him while filling up the proposal form and due to this concealment the contract of insurance cannot be enforced. It was alleged that the complainant is not entitled to any compensation.
4. The complainant filed a rejoinder alleging that Sukhwinder Singh was not suffering from any disease prior to the filling up of the proposal form nor he knew about it. The allegations mentioned in the written reply were denied and those mentioned in the complaint were reiterated.
5. Both the parties were given opportunity to produce evidence in support of their contentions.
6. After hearing arguments of the learned counsel for the parties and perusing the record, learned District Forum allowed the complaint in terms as mentioned in the opening para of this order. The OPs have challenged the same through this appeal.
7. We have heard arguments of the learned counsel for the parties and have perused the record.
8. Learned counsel for the OP-appellant has referred to the proposal form Ex.R-2 which was filled up by the deceased insured on 3.8.2007 in which he mentioned in para no.7 that he was not suffering from any disease nor was admitted in any hospital nor he took any medical treatment earlier to that. The contention of the learned counsel is that First Appeal No.55 of 2009. 4 these assertions are found to be false because Ex.R-4 is the record from the Tagore Hospital showing that the insured was admitted in the Tagore Hospital on 14.6.2007 and was discharged on 21.6.2007. It is mentioned in the history and findings that he was suffering from Primary Pulmonary Hypertension for 2 years and was discharged from the hospital on 21.6.2007. Learned counsel argued that in view of Ex.R-4 the insured did not disclose the previous ailment while filling up the proposal form and this concealment disentitles the complainant of any benefit under the insurance policy. This contention was not accepted by the learned District Forum.
9. Ex.R-4 is purported to be discharge card pertaining to the insured. The OP-appellant has not produced the medical treatment record of the insured from the Tagore Hospital nor the affidavit of Dr. Vijay Mahajan who is alleged to have been Consulting Incharge has been produced. As regards the history and finding that the insured was suffering from pulmonary hypertension for 2 years, apart from the history recorded in the discharge record, there is no evidence to prove the same and even this much is not mentioned as to at whose instance the history was recorded. Neither the affidavit of the doctor to whom the history was narrated was filed nor the affidavit of the doctor who treated the insured has been produced. In such circumstances we are of the opinion that Ex.R-4 cannot be relied upon to hold that the insured was ever treated in the Tagore Hospital prior to his taking the insurance policy. In this respect, we may refer to a decision of this Commission in the case Life Insurance Corporation of India v. Charanjit Kaur, I (2001) CPJ 53. In that case also, as in the present case, no evidence was produced by the OP that the First Appeal No.55 of 2009. 5 deceased had taken any treatment from any doctor for the alleged disease prior to the policy. There was no evidence to hold that the insured knowingly and fraudulently concealed the material facts regarding the alleged disease. The findings recorded by this Commission in Life Insurance Corporation of India v. Charanjit Kaur's case (supra) that only history sheet is not sufficient to hold that the deceased was suffering from the disease was upheld by the Hon'ble National Commission in Revision Petition No.3653 of 2006 (Life Insurance Corporation of India v. Charanjit Kaur) decided on 14.10.2011. In that case also, as in the present case, it was not mentioned whether the patient gave history to the doctor at the time of his admission regarding his ailment or whether the history was given by anyone else. Even the signatures of the patient or any of his relative were not obtained by the doctor.
10. We may also refer to the cases "Life Insurance Corporation of India v. Dr.P.S.Aggarwal, I (2005) CPJ 41 (NC)" and "LIC of India v. Joginder Kaur and others II (2005) CPJ 78 (NC)". In the latter case, the OP tried to prove concealment of disease on the basis of the past history recorded by the doctor. The Hon'ble National Commission in para 11 held as follows : -
"11. No affidavit of any doctor who had treated him earlier was produced nor any other material piece of evidence had been produced to support the contention of the petitioner except opinions and inferences based on surmises. Even the investigation report has not been produced though the matter was not First Appeal No.55 of 2009. 6 investigated. It is contended that record of Dayanand Medical Hospital wherefrom the deceased got the treatment and O.P.NO.1 had collected death certificate, etc. has allegedly proved that the deceased was admitted on 16.8.1998 in Dayanand Medical Hospital. In this light, in absence of any evidence except filing the proposal form, etc. in the face of affidavits of Surinder Kaur, Inderjeet Kaur and Swaran Singh it is not possible to hold that the deceased was alcoholic. He got study award in his education. Simple allegations made by the petitioner that the deceased was alcoholic; was suffering from diabetes mellitus, and jaundice, etc. would not be sufficient. The unproved case history recorded by some person on the date of admission of Sh.Bachan Singh, the deceased, would not be cogent and convincing evidence to repudiate the claim unless it was coupled with medical report for the treatment prior to submission of the proposal form."
11. Needless to mention that Sukhwinder Singh was admitted in the Tagore Hospital on 20.11.2007 and was discharged on 7.12.2007 as is clear from Ex.R-5. This fact is admitted even by the complainant. This admission and treatment relates to the period after the insurance policy had already been taken by him.
First Appeal No.55 of 2009. 7
12. In view of the above discussion we are of the opinion that the OP- appellant has failed to prove if Sukhwinder Singh was treated in the Tagore Hospital for any such disease prior to his taking the insurance policy. He, therefore, cannot be said to have concealed material information from the OP-appellant before taking the insurance policy. Learned District Forum, therefore, rightly allowed the complaint.
13. There is no merit in this appeal and the same is accordingly dismissed. Parties are left to bear their own costs.
14. The appellant had deposited an amount of Rs.25,000/- with this Commission at the time of filing of the appeal on 15.1.2009. The appellant had also deposited another amount of Rs.83,000/- with this Commission on 11.2.2009 in pursuance of order dated 30.1.2009. These amounts of Rs.25,000/- and Rs.83,000/- along with interest, if any, be remitted by the registry to respondent No.1- Harvinder Kaur 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.
Copies of the orders be sent to the parties free of cost.
(JAGROOP SINGH MAHAL)
PRESIDING JUDICIAL MEMBER
December 14, 2012 (VINOD KUMAR GUPTA)
Bansal MEMBER
First Appeal No.55 of 2009. 8