State Consumer Disputes Redressal Commission
M/S Max New York Life Insurance Company ... vs Smt. Gurmeet Kaur on 29 March, 2012
2nd Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No.49 of 2007.
Date of Institution: 08.01.2007.
Date of Decision: 29.03.2012.
1. M/s Max New York Life Insurance Company Limited, SCO 6, 22 Acre
Market, near Midway Hotel, Barnala, through its Branch Manager.
2. M/s Max New York Life Insurance Company Limited, Regd. Office,
Max House, 1 Dr. Jha Marg, Okhla, New Delhi-110020 through its
Managing Director.
.....Appellants.
Versus
Smt. Gurmeet Kaur W/o late Sh. Jalaur Singh, House No.B-V-1306,
Thikriwala Road, Barnala, Tehsil Barnala, District Sangrur.
...Respondent.
First Appeal against the order dated
06.12.2006 of the District Consumer
Disputes Redressal Forum, Sangrur.
Before:-
Shri Inderjit Kaushik, Presiding Member.
Shri Piare Lal Garg, Member.
Present:-
For the appellants : Sh. Rajneesh Malhotra, Advocate. For the respondent : Sh. Tribhuwan Singla, Advocate. INDERJIT KAUSHIK, PRESIDING MEMBER:-
M/s Max New York Life Insurance Company Limited and another, appellants (In short "the appellants") have filed this appeal against the order dated 06.12.2006 passed by the learned District Consumer Disputes Redressal Forum, Sangrur (in short "the District Forum").
2. Facts in brief are that Smt. Gurmeet 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 appellants, pleading that she is the widow of late Sh. Jalaur Singh S/o Daya Singh, who purchased Endow 20, PAB & DD Policies for Rs.1,52,728/-, First Appeal No.49 of 2007 2 Rs.1,00,000/- and Rs.1,00,000/- respectively and paid premium of Rs.10,000/- on 22.03.2004. The respondent was the nominee for insurance amount and the appellants issued policy no.243679834.
3. Sh. Jalaur Singh died on 26.07.2004 at DMC & Hospital due to liver damage. The deceased was not suffering from any disease and was found hale and hearty by the doctors of the appellants before issuing the aforesaid policy. The deceased suffered ailments like fever, cough, lungs problem before being admitted in DMC, Ludhiana on 22.06.2004 where it was declared that his liver was in a damaged condition, though not acutely beyond control and the deceased was treated in the DMC, Ludhiana for a period of one month and ultimately died on 26.07.2004.
4. The respondent intimated the appellants about the death of her husband Sh. Jalaur Singh and supplied all the relevant documents as desired by the appellants from time to time, but the claim was rejected illegally vide letter dated 06.09.2005 on the ground of extending wrong information to question no.11 as 'No'. The deceased was not suffering from hypertension or high blood pressure before admission in DMC & Hospital, Ludhiana.
5. After receiving the claim rejection letter dated 06.09.2005, respondent again supplied the relevant documents to the appellants, but no heed was paid and there is deficiency in service on the part of the appellants. It was prayed that the appellants may be directed to pay Rs.3,52,728/- being the insured amount along with interest from the date of death i.e. 26.07.2004 till realization, Rs.50,000/- as compensation for mental agony and harassment and Rs.5500/- as litigation expenses.
6. In the reply filed on behalf of the appellants, preliminary objections were taken that there is no deficiency in service on the part of the appellants. The claim has been rejected against policy no.243679834 on bonafide grounds of material non-disclosure, concealment, misrepresentation and suppression of material facts by late Jalaur Singh (proposer/policy holder) at the time of taking the policy. The respondent has come to the First Appeal No.49 of 2007 3 Forum without disclosing complete and correct facts of the case. Policy of insurance like any other contract is governed by the provisions of the Indian Contract Act, 1872 and contract of insurance is a contract of uberrimae fidei i.e. utmost good faith. The respondent is not a consumer under the Act.
7. The deceased Jalaur Singh, policy holder proposed for life insurance policy on his life by a proposal signed by him on 22.03.2004. Question no.3(ii) read as follows:-
"Are you now or have your ever been diagnosed with any of the following conditions? If yes, please provide details or attach relevant questionnaire.
ii) Hypertension or high blood pressure".
The proposer life assured answered this question as "NO". Besides this, to each of the 17 specific medical conditions, the proposer life assured had replied as 'NO", conveying that he was not suffering from any of the medical conditions at the time of proposal mentioned therein. The policy holder also gave a declaration in the proposal form, stating that in case of any omissions on his part in disclosing the relevant information, appellants shall have the right to cancel the policy, if issued, and forfeit any payments received.
8. Believing the declaration made by the proposed in proposal form, the appellants issued a 20 Years Endowment Participating Insurance Policy bearing no.243679834 on 23.03.2004 for Rs.1,52,728/- with accrued bonus with Riders (1) Personal Accident Beneift and (2) Dreaded Disease for a sum assured of Rs.1,00,000/- each, as per the terms and conditions of the policy.
9. Intimation about death of the policy holder was received by appellants on 06.09.2004 and respondent was asked vide letter dated 10.09.2004 to submit the relevant claim documents as mentioned in the said letter. Appellants received some of the documents, including Attending Physician's statement in Form-C and hospital treatment certificate in Form-D First Appeal No.49 of 2007 4 completed by Dr. Gagan Deep of DMCH, Ludhiana and as per those documents, the deceased was hypertensive for the last one year. Thereafter, the appellants further requested the respondent to provide the remaining documents as demanded earlier. Vide letter dated 19.02.2005, the respondent informed that her husband policy holder never took any treatment for the last five years, except for 'Bwaseer' operation in April, 2004 at Guru Teg Bahadur Hospital, Ludhiana. Thereafter, the appellants again requested the respondent to send all the records pertaining to the treatment rendered to the policy holder at Guru Teg Bahadur Hospital as well as pertaining to hypertension, but no document was supplied.
10. It was further established that the policy holder was a known case of chronic alcoholism. As per claim documents, policy holder was suffering from ALD cirrhosis i.e. alcoholic liver disease and the appellants vide letter dated 06.09.2005 informed the respondent regarding its inclination to repudiate the claim and repudiated the claim finally vide its letter dated 20.10.2005.
11. On merits, similar pleas as taken in the preliminary objections were repeated and denying allegations of the complaint, it was prayed that the complaint may be dismissed with costs.
12. Parties led evidence in support of their respective contentions by way of affidavits and documents.
13. 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 to support the documents i.e. proposal form Ex.R-1, copy of attending physician's statement for death claim Ex.R-4, hospital treatment certificate Ex.R-5, relied upon by the appellants to support their contention that life assured gave wrong answer to question no.3(ii), are not sufficient enough to prove this fact. Record or death certificate issued by DMC Hospital Ex.C-4 shows that deceased died due to cardio respiratory arrest which indicates that the deceased died due to other ailment than mere First Appeal No.49 of 2007 5 hypertension. Life assured cannot be expected to know about his disease on 22.03.2004 when he filled the proposal form nor he can be held liable to be guilty of deliberate concealment of the disease and relying upon "LIC of India Vs Joginder Kaur & Ors.", 2005(2) CLT-229, allowed the complaint, directing the appellants to pay Rs.3,52,728/- along interest @ 9% p.a. from the date of death of deceased i.e. 26.07.2004 and Rs.3000/- as compensation and Rs.1000/- as litigation expenses.
14. Aggrieved by the impugned order dated 06.12.2006, the appellants have come up in appeal.
15. 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 parties.
16. Proposal form is Ex.R-1 placed on the file by the appellants and under Sub-head of the 'Diagnosis of different diseases', the insurer gave the answer as 'NO'. The proposal form is dated 22.03.2004. First time, deceased Jalaur Singh, as per Ex.R-4, was admitted on 26.07.2004 in Dayanand Medical College & Hospital, Ludhiana and in column no.11 of this document, it is mentioned that the deceased was also suffering from Hypertension and was a Chronic Alcoholic. Document Ex.R-4, which is Attendant Physician's statement for death claim, is signed by Sh. Gagan Deep, P.G. Registrar of Dayanand Medical College & Hospital, Ludhiana, but no affidavit of said Registrar Gagan Deep has been placed on file, nor there is any other prescription slip or any certificate of the doctor, to prove that earlier the deceased was suffering from Hypertension and mere mentioning of 'Chronic Alcoholic' is not sufficient, without there being any evidence to support the same. Ex.R-5 is the Hospital Treatment Certificate signed by Dr. Ajit Sood of Dayanand Medical College & Hospital, Ludhiana and in column no.5, exact history of illness reported at the time of admission, is given, wherein it is mentioned, "Fever 4 days, Jaundice" and Hypertension and Chronic Alcoholic etc. are also mentioned. This diagnosis was made on 22.06.2004. Again, First Appeal No.49 of 2007 6 there is no affidavit of Dr. Ajit Sood to corroborate the facts mentioned, nor there is any medical record to support the said history. Prior to 22.06.2004, what type of ailment, the deceased Jalaur Singh was suffering, it not on record. The proposal form was filled on 22.03.2004 and at that time, the doctor of the appellants must have examined the insured, but that certificate has also been withheld. At the time of medical examination, the first thing to be checked is blood pressure and had the insured been suffering from Hypertension, then the appellants must have come to know then and there. As stated above, there is no evidence on record to show and prove that at the time of filling the proposal form, the insured was suffering from any such ailment and mere writing 'Chronic Alcoholic', is not sufficient, without there being any corroborative evidence. The documents Ex.R-4 and Ex.R-5 are the documents of the appellants and it appears that the appellants have procured these documents. The deceased Jalour Singh was admitted with the ailments of fever and jaundice and he died of Cardiac Arrest and that has no nexus with the cause of death.
17. In view of above discussion, the order passed by the District Forum is legal and valid and there is no ground to interfere with the same.
18. Accordingly, the appeal is dismissed and the impugned order under appeal dated 06.12.2006 passed by the District Forum is affirmed and upheld. No order as to costs.
19. The appellants had deposited an amount of Rs.25,000/- with this Commission on 10.01.2007. This amount with interest accrued thereon, if any, be remitted by the registry to the 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 appellants.
20. The remaining amount as per order of the District Forum shall be paid by the appellants to the respondent/complainant within two months of the receipt of copy of the order.
First Appeal No.49 of 2007 7
21. The arguments in this appeal were heard on 19.03.2012 and the order was reserved. Now the order be communicated to the parties.
22. The appeal could not be decided within the stipulated timeframe due to heavy pendency of court cases.
(Inderjit Kaushik) Presiding Member (Piare Lal Garg) Member March 29, 2012.
(Gurmeet S)