State Consumer Disputes Redressal Commission
Smt. Balwinder Kaur vs Life Insurance Corporation Of India on 24 October, 2013
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB
SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No.750 of 2010.
Date of Institution: 06.05.2010.
Date of Decision: 24.10.2013.
Smt. Balwinder Kaur, Mother of Sh. Narinjan Singh and wife of Sh.
Surjan Singh, R/o House No.BX/187, Village Chhote Aulakh, Tehsil
Batala, District Gurdaspur.
.....Appellant.
Versus
1. Life Insurance Corporation of India, through Branch Manager,
Batala.
2. The Zonal Manager, Life Insurance Corporation of India, Zonal
Office, Jeevan Bharti, 124, Connaught Circus, P.B.No.630, New
Delhi-110001.
...Respondents.
First Appeal against the order dated
28.01.2010 passed by the District
Consumer Disputes Redressal Forum,
Gurdaspur.
Before:-
Shri Inderjit Kaushik, Presiding Judicial Member.
Shri Vinod Kumar Gupta, Member.
...................................
Present:- Sh. Varun Baanth, Advocate, counsel for the appellant.
Sh.Rajneesh Malhotra, Advocate, counsel for the respondents.
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INDERJIT KAUSHIK, PRESIDING JUDICIAL MEMBER:-
Smt. Balwinder Kaur, appellant/complainant (In short "the appellant") has filed this appeal against the order dated 28.01.2010 First Appeal No.750 of 2010 2 passed by the learned District Consumer Disputes Redressal Forum, Gurdaspur (in short "the District Forum").
2. Facts in brief are that the appellant filed a complaint under section 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the respondents/opposite parties (hereinafter called as "the respondents"), making the averments that her son namely Narinjan Singh was insured with the respondents vide policy No.471192571 dated 28.11.2002 and he was depositing the premiums regularly with the respondents till 29.11.2005. He was insured for a sum of Rs.1.50 lacs. The son of the appellant died on 01.12.2005 due to the injuries suffered in an accident. Prior to his death, he was hale and hearty. He did not take any medical treatment from any doctor or hospital, nor remained admitted anywhere. The respondents were duly intimated regarding the death of the son of the appellant and the appellant, being the nominee, is entitled to the claim. The respondents refused to accept the claim and the same is illegal, null and void.
3. The appellant sent the correct information regarding the death of her son to the respondents, but the respondents have not paid the claim and harassed her which amounts to deficiency in service and the act of the respondents caused mental tension and harassment to the appellant.
4. The appellant filed a complaint bearing no.750/2006 and the District Forum directed the appellant to submit the claim for payment of the insured amount of Rs.1.50 lacs along with other profits plus accidental benefits regarding the policy in question vide order dated 10.01.2008. The claim was submitted vide application dated 16.01.2008, but the respondents intentionally and willfully First Appeal No.750 of 2010 3 repudiated the same vide letter dated 14.02.2008 on the false and baseless observations. That complaint was withdrawn with the permission to file a fresh complaint on the same cause of action vide order dated 25.09.2008.
5. It was prayed that the respondents may be directed to make payment of the claim along with interest @ 18% p.a. and to pay Rs.25,000/- as compensation and Rs.3,000/- as litigation expenses.
6. In the written version filed on behalf of the respondents, preliminary objections were raised that the policy was allowed to lapse by non-payment of premium due from 28.05.2005 to 28.11.2005 and the policy was revived on 29.11.2005 by paying three quarterly installments of premiums due from 28.05.2005 to 28.11.2005. Deceased Life Assured (in short "DLA") was not keeping good health at the time of revival of the policy on 29.11.2005 and while giving the answers to the questions of the personal statement regarding health dated 27.11.2005, concealed the material facts and mis-represented the facts regarding his having met with an accident on 26.11.2005 and having suffering head injuries and undergone Frontal Craniectomy with removal of Epidural Haematoma (EDH) done on 26.11.2005 at Military Hospital, Jalandhar where he remained admitted from 26.11.2005 to 30.11.2005. On 30.11.2005, the DLA was referred to Command Hospital, Chandi Mandir where he remained admitted from 30.11.2005 to 01.12.2005, the date on which he expired. FIR No.146 dated 25.11.2005 u/s 304-A, 279 and 338 IPC was lodged with Police Station, Qadian regarding the road accident of Niranjin Singh on 26.11.2005.
7. In the declaration of good health dated 27.11.2005, the DLA declared that he has not suffered from any illness or disease, did First Appeal No.750 of 2010 4 not have any operation, accident or injury and was enjoying good health, which was absolutely false and against the true facts as the DLA met with an accident on 26.11.2005 and was admitted in the hospital and died consequently. The DLA was not in good health and was not in a position to revive the policy and the said policy was revived in absentia with the intention, to play fraud and to grab the public money and the contract of insurance is null and void and the complaint is liable to be dismissed. The claim was thoroughly investigated and repudiation was legally made. The contract of insurance is a contract of utmost good faith, but the DLA gave false information and the contract is null and void.
8. On merits, similar pleas as taken in preliminary objections were repeated and denying allegations of the complaint, it was prayed that the complaint may be dismissed with costs.
9. Parties led evidence in support of their respective contentions by way of affidavits and documents.
10. 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 the DLA was admitted in Military Hospital, Jalandhar and was operated upon for Frontal Craniectomy with removal of Epidural Haematoma (EDH) on 26.11.2005 and remained there till 30.11.2005 and was shifted to Command Hospital, Chandi Mandir, but all these facts were not disclosed in the personal statement of health made by the DLA while getting the policy revived on 29.11.2005. He was lying unconscious and was not in a position to sign which is evident from the certificate issued by the Military Hospital Ex.R-4. The appellant has not rebutted the same. The life assured by making wrong and false declaration breached the contract First Appeal No.750 of 2010 5 of insurance which forced the Corporation to repudiate the claim. The complaint was dismissed.
11. Aggrieved by the impugned order dated 28.01.2010, the appellant has come up in appeal.
12. 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.
13. Learned counsel for the appellant vehemently argued that the policy was purchased way back in 2002 and the DLA was paying the premiums regularly. The policy lapsed due to non-payment of the premiums of 28.05.2005 to 28.11.2005 and the same was revived on 29.11.2005, by paying all the installments of the premiums due from 28.05.2005 to 28.11.2005. It has been argued that the revival relates back to the commencement of the policy. Section-45 of the Insurance Act, 1988 was not applicable and the repudiation was not, at all, justified. It has been argued that no material fact was suppressed and the claim was to be paid. The order passed by the District Forum is illegal and the appeal may be allowed.
14. On the other hand, learned counsel for the respondents has argued that the deceased met with an accident on 26.11.2005 and he remained admitted in Military Hospital from 26.11.2005 to 30.11.2005 and was operated upon for Frontal Craniectomy with removal of Epidural Haematoma (EDH) and he was shifted to Command Hospital, Chandi Mandir where he died on 01.12.2005. The declaration of good health Ex.R-3 was made on 27.11.2006 when the DLA was in unconscious state and it was certified vide the certificate of hospital treatment Ex.R-4. Intentionally, the material facts were concealed just to claim the public money fraudulently. The order First Appeal No.750 of 2010 6 passed by the District Forum is legal and valid and there is no ground to interfere with the same and the appeal may be dismissed.
15. We have considered the respective submissions advanced on behalf of the parties and have thoroughly scanned the entire record and other material placed on the file.
16. Sh. Narinjan Singh son of the appellant was insured vide policy in question dated 28.11.2012 and the premium was paid, except the premium due from 28.05.2005 to 28.11.2005. It is also admitted that the policy was revived on 29.11.2005, by paying the premium from 28.05.2005 to 28.11.2005. At the time of revival of the policy, the life assured filled the personal statement regarding health Ex.R-3 and replied in negative to the questions regarding illness, operation, accident or injuries. This declaration was made on 27th November, 2006, whereas as per the certificate of hospital treatment Ex.R-4, life assured Narinjan Singh was admitted in the Military Hospital, Jalandhar Cantt. and the date of admission was 30th November, 2005 and he was admitted for the head injury he suffered, for removal of Epidural Haematoma (EDH). As per the history, the life assured was operated upon for Frontal Craniectomy with removal of Epidural Haematoma (EDH) on 26.11.2005. As per certificate, the life assured suffered close head injury and even could not give the history which was given by the attendants, as the life assured was semi- conscious and confused. Ex.R-5 is the FIR dated 25.12.2005 which further prove that Sh. Narinjan Singh received head injury in the accident. Ex.R-6 is the postmortem report and as per this report, cause of death was head injury and the injuries were anti-mortem in nature and were sufficient to cause death in the ordinary course of nature.
First Appeal No.750 of 2010 7
17. Thus, from the above medical record and the evidence, it is clear that the life assured was not in a position to even fulfill the personal statement regarding health on 27.11.2006 and he was in semi-conscious state and was confused. Personal Statement regarding health and the declaration Ex.R-3 has been filled by some employee of respondent no.1 insurance company in order to cause wrongful loss to the respondents and to cause wrongful gain to the appellant. The person, who was in a semi-conscious state and was not even able to tell the history as to how he received head injury, cannot sign the personal statement regarding health as well as declaration of good health. Inspite of that, the policy was revived and this has been done by some employee of respondent no.1 insurance company. It is clear that a thorough inquiry is required to be conducted and the employee, who has done this act, should be punished in accordance with law.
18. Thus, the declaration made was false by someone on behalf of the life assured and this is no declaration regarding health in the eyes of law. The order passed by the District Forum is legal and valid and speaking and there is no ground to interfere with the same. The appeal filed by the appellant is false and frivolous and is required to be dismissed with special costs.
19. Accordingly, the appeal is dismissed with special costs of Rs.10,000/- and the impugned order under appeal dated 28.01.2010 passed by the District Forum is affirmed and upheld. Payment of costs shall be made by the appellant to the respondents within 45 days after the receipt of copy of the order.
20. Copy of this order be sent to the Zonal Manager, Life Insurance Corporation of India, Zonal Office, Jeevan Bharti, 124, First Appeal No.750 of 2010 8 Connaught Circus, P.B.No.630, New Delhi-110001, with the direction to depute some competent authority to conduct the inquiry and fix the responsibility and thereafter, the action shall be taken in accordance with law by the competent authority against the guilty official. Copy of the inquiry report be sent to this Commission within three months after the receipt of copy of the order.
21. The arguments in this appeal were heard on 11.10.2013 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 Judicial Member (Vinod Kumar Gupta) Member October 24, 2013.
(Gurmeet S)