State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Sh. Gurpreet Singh Son Of Hakam Singh on 31 October, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB,
SECTOR 37-A, DAKSHIN MARG, CHANDIGARH
First Appeal No. 1385 of 2008
Date of institution : 2.12.2008
Date of Decision : 31.10.2012
1. Life Insurance Corporation of India, Sangrur Northern Zone Chandigarh
Division, Branch Office, Post Box No. 11, Jeevan Jyoti Railway Road, Sangrur
through its Branch / Divisional Manager.
2. Life Insurance Corporation of India, Divisional Office, Sector 17,
Chandigarh.
....Appellants.
Versus
Sh. Gurpreet Singh son of Hakam Singh, Resident of Ward No. 6, Cheema
Mandi, District Sangrur.
...Respondent.
First Appeal against the order dated 24.10.2008 of
the District Consumer Disputes Redressal Forum,
Sangrur.
Before:-
Shri Piare Lal Garg, Presiding Member.
Shri Jasbir Singh Gill, Member.
Present:-
For the appellants : Sh. Rajesh K. Sharma, Advocate For the respondent : Sh. Tejinder Pal Singh, Advocate PIARE LAL GARG, PRESIDING MEMBER:
This is an appeal filed by the appellants/Life Insurance Corp.
of India (hereinafter called 'the appellants') against the order dated 24.10.2008 of the District Consumer Disputes Redressal Forum, Sangrur(hereinafter called the 'District Forum') by which the complaint of the respondent/complainant (hereinafter called 'the respondent') was allowed by the District Forum.
2. Brief facts of the case are that the father of the respondent Sh. Hakam Singh took a policy No. 163232212 for an amount of Rs. 3,00,000/- on 7.6.2006 and the respondent was appointed as nominee by the insured- deceased in the said policy. The insured died on 9.6.2006 and after the First Appeal No. 1385 of 2008 2 death of insured, the respondent had submitted the claim to the appellants, which was repudiated vide letter dated 21.12.2006 on the ground that the deceased/insured had concealed material facts regarding his earlier ailment. The complaint was filed by the respondent with the prayer that the appellants may be directed to pay Rs. 3,00,000/- as insurance claim alongwith interest @ 18% per annum from the date of death till realization and a compensation of Rs. 20,000/- on account of mental tension, pain, agony and harassment with Rs. 5,500/- as litigation expenses may also be awarded in favour of the respondent.
3. Upon notice, reply was filed by the appellants by taking preliminary objections that the respondent has not come to the District Forum with clean hands, respondent has no locus-standi to file the complaint, respondent not comes under the definition of 'consumer' as such, the complaint was liable to be dismissed. On merits, the version of the respondent regarding the insurance policy taken by the deceased was not denied as well as his death on 9.6.2006. It was also admitted that the claim was submitted by the respondent as nominee appointed by deceased Hakam Singh in the policy. It was replied that the claim was rightly repudiated on the ground that the deceased/insured had not given correct answers of the questions regarding his ailment at the time of filling the proposal form. The form No. 3816 issued by Dayanand Hospital, Ludhiana from where deceased Hakam Singh took the treatment had proved beyond doubt that the deceased had not disclosed his previous ailment as well as regarding the treatment which he had taken from Dayanand Hospital, Ludhiana from 11.5.2005 to 22.5.2005 and again on 10.4.2006 to 17.4.2006. All other allegations were denied and dismissal of the complaint was prayed.
4. Learned District Forum after hearing the learned counsel for the parties and going through the record, allowed the complaint and directed First Appeal No. 1385 of 2008 3 the appellant to pay Rs. 3,00,000/- to the respondent alongwith interest @ 9% per annum from the date of repudiation i.e. 21.12.2006 till realization and pay Rs. 2,000/- as compensation.
5. Hence, the appeal.
6. We have gone through the pleadings of the parties, grounds of appeal, perused the record of the learned District Forum and heard the arguments of the learned counsel for the parties.
7. The present appeal is filed by the appellants on the ground that the order of the District Forum is against the terms and conditions of the policy, as such, the same is liable to be set-aside.
8. There is no dispute between the parties that the deceased/insured was insured for an amount of Rs. 3,00,000/- on 7.6.2006 and died on 9.6.2006 i.e. after two days from the commencement of the policy.
9. There is also no dispute that the claim was lodged by the respondent with the appellants and the claim of the respondent was repudiated by the appellants vide letter Ex. R-4 dated 21.12.2006 on the ground that the insured did not disclose the facts at the time of filling the proposal form that he was suffering from Liver SOL c lungs metastasis c ascites IVC thrombosis and he remained on medical leave for 26 days from 3.1.1998 to 28.1.1998.
10. We have also perused the proposal form Ex. R-5, which was filled on 8.6.2006, the relevant para of the same is reproduced:-
11. Personal History Answer 'Yes If 'Yes, Please or No' give full details
(a) During the last five years did you consult a No Medical Practitioner for any ailment requiring treatment for more than a week
(b) Have you ever been admitted to any hospital or No nursing home for general check-up, observation, treatment or operation?
(c) Have you remained absent from place of work No on grounds of health during the last 5 years?
(d) Are you suffering from or have you ever No suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or First Appeal No. 1385 of 2008 4 Nervous system?
(e) Are you suffering from or have you ever No suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Eplipsy, Hernia, Hydrocele, Leprosy or any other disease?
11. We have also perused Form No. 3816 filled by Dr. Preeti Singla of Dayanand Medical Hospital, Ludhiana. The relevant entries of the same are reproduced:-
6. What was the diagnosis arrived at 6. Liver SOL with Lung Metastasis ĉ the Hospital? ascites ĉ IVC theombosis
7. Was there any other disease illness 7. Pain in Lumbar region 4 yrs back which Preceded or co-existed with the ailment at the time of the Patient's admission into the Hospital? If so, what was it? Please, give details.
(a) History reported (a) Weakness of Lower Limbs x 6 Bowel in continuance x 1mnt
(b) Date when first observed by the (b) As above patient
(c) By whom treated? (c) Treated by Medicine and Neurosurgery consults
(d) By whom history was reported? (If (d) Not in record not by the patient himself, please indicate if it was in his presence and to his knowledge).
(e) By whom the history was noted and (e) Dr. Kusum recorded? (If the doctor is not with the hospital at present. Please give his present address)
10. Was he treated in the hospital on 10. Yes the previous occasion? If so please state.
(a) Date of admission (a) 11.5.2005
(b) Date of discharge and condition on (b) 22.5.2005 Satisfactory Gen. discharge. spondylytic changes in the form of Osteophitis and disc dessico at L4-L5 & L5 - S1 min post disc bulge at L1- L4 B/C compression of descending L5 at L5-S1 ĉ disc protrusion Lumbar laminectomy doc.
13. History of illness as per records (Case summery) Pt. came with abd. Distension, breathlessness which was increasing progressively. It was associated with pedal oedema, loss of appelite attend bowel liabits. Pt. was evaluated and found to be suffering from liver SOL with lung metastasis ĉ ascites ĉ IVC theombosis.
12. From the above evidence, it is proved beyond any doubt that at the time of filling the proposal form and taking the insurance policy, the insured/deceased was suffering from Liver SOL c lungs metastasis c ascites IVC thrombosis, which was very much in his knowledge but he deliberately and knowingly not disclosed the same at the time of filling the First Appeal No. 1385 of 2008 5 proposal form and concealed the real facts regarding his ailment. It is held by the Hon'ble Supreme Court in case "P.C. Chacko and another Vs. Chairman, Life Insurance Corporation of India and others", 2008 3 CLT-380(SC) in para No. 16 (relevant portion) as follows:-
"The proposer must show that his intention was bona fide. It must appear from the fact of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may be lead to the policy being vitiated in law."
13. The Hon'ble National Commission in case "LIC of India & Ors. Vs. K.A. Chandrakala", 2009 (3) CLT-278(NC) observed in para No. 11(relevant portion) as follows:-
"As we have stated above, insofar as the insurance policy especially the Life Insurance Policy is concerned, the person has to act in 'utmost good faith'. Cancer is a serious disease and in good faith, life assured should have disclosed the information regarding the disease from which he was suffering. To the contrary, the deceased withheld the fact regarding his state of health on the date of taking of the policy in answering the questions contained in the proposal form (reproduced in the earlier paragraph) in the negative, which were evidently false."
14. It is proved that the insured had concealed the material information regarding status of his health from the appellants at the time of filling the proposal form and obtained the insurance policy by concealing the real facts.
15. In view of the above discussion, we are of the opinion that the appellants rightly repudiate the claim of the respondent.
16. Accordingly, the appeal is accepted and the order dated 24.10.2008 under appeal is set-aside. Consequently, the complaint filed by the complainant is dismissed. No order as to costs.
17. The arguments in this appeal were heard on 26.10.2012 and the order was reserved. Now the order be communicated to the parties. First Appeal No. 1385 of 2008 6
18. The appellants had deposited an amount of Rs. 25,000/- with this Commission at the time of filing the appeal. This amount of Rs. 25,000/- with interest accrued thereon, if any, be remitted by the registry to appellant No. 2 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.
19. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Piare Lal Garg)
Presiding Member
October 31, 2012. (Jasbir Singh Gill)
as Member
First Appeal No. 1385 of 2008 7