State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt. Daya Renu Alias Dayawati on 24 February, 2023
Appeal No. Life Insurance Corporation of India 24.02.2023
02 of 2018 Vs.
Smt. Daya Renu and Anr.
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND, DEHRADUN
Date of Institution: 10.01.2018
Date of Final Hearing: 19.01.2023
Date of Pronouncement: 24.02.2023
First Appeal No. 02 / 2018
Life Insurance Corporation of India
Divisional Office, Haridwar Road, Dehradun
Through Manager
(Through: Smt. Anjali Gusain, Advocate)
.....Appellant
VERSUS
1. Smt. Daya Renu @ Dayawanti W/o Late Sh. Dharmendra Kumar
R/o Karakpur, Devipura Kashipura,
Tehsil Kashipur, Udham Singh Nagar
(Through: Sh. Rajesh Kumar Devliyal, Advocate)
.....Respondent No. 1
2. Kendriye Jan Soochna Adhikari
Manager (Customer Care Officer) LIC Haldwani, Nainital
.....None for Respondent No. 2
Coram:
Ms. Kumkum Rani, Judicial Member II
Mr. B.S. Manral, Member
ORDER
(Per: Ms. Kumkum Rani, Judicial Member II):
This appeal under Section 15 of Consumer Protection Act, 1986 has been directed against the judgment and order dated 21.11.2017 passed by the District Consumer Disputes Redressal Forum, Udham Singh Nagar (hereinafter to be referred as the District Commission) in consumer 1 Appeal No. Life Insurance Corporation of India 24.02.2023
02 of 2018 Vs. Smt. Daya Renu and Anr.
complaint No. 88 of 2015 styled as Smt. Daya Renu Vs. Life Insurance Corporation of India and Anr., wherein and whereby the District Commission has allowed the consumer complaint.
2. The facts giving rise to the appeal in hand, in brief, are as such that the complainant's husband Sh. Dharmendra Kumar had purchased a Life Insurance policy in question from the opposite party No. 1 / insurance company after due enquiry and medical examination. Husband of the complainant suddenly expired on 28.02.2014. The complainant filed her claim before the opposite party No. 1 - insurance company claiming insured amount from the opposite party No. 1 - insurance company. The insured amount of the some policies was paid to the complainant, but the claim of the life insurance policy Nos. 243007942 and 243312360 was rejected by the opposite party No. 1 - insurance company. The complainant has got the information under RTI from the opposite party No. 1 - insurance company, then the complainant was informed vide letter dated 22.04.2015 that the claim of the above mentioned two policies was rejected on 09.03.2015 alleging that the insured was a Chronic Alcoholic and Smoker and was suffering from the disease COPD; he was under regular medication, therefore, her claim was rejected. It is further averred in the claim petition that her husband was not suffering from any pre-existing disease. The deceased was fit & fine and a healthy person but the claim of the above mentioned two insurance policies was illegally rejected by the opposite party No. 1 - insurance company. Hence, the opposite party No. 1 - insurance company be directed to pay the insured amount of Rs. 9,50,000/- alongwith interest @ 10% per annum from the date of filing of the petition till its actual realization alongwith compensation of Rs. 5,00,000/- for mental and physical agony and financial loss of Rs. 2,00,000/- for deficiency in service on the part of the opposite party No. 1
- insurance company.
2Appeal No. Life Insurance Corporation of India 24.02.2023 02 of 2018 Vs. Smt. Daya Renu and Anr.
3. Opposite party No. 1 - insurance company has submitted its written statement before the District Commission pleading that the respondent No. 1 - complainant has concealed the true facts from the opposite party No. 1
- insurance company. The true facts are as such that the other life insurance policies were taken by the insured several years ago when he was fit & fine and healthy person, therefore, the payment of those previous polices was done by the opposite party No. 1 - insurance company, but in the policy in dispute, the insured was chronic smoker, alcoholic and was suffering from COPD disease; he was under regular medication. The fact of pre-existing disease was concealed by the inured from the opposite party No. 1 - insurance company, therefore, the claim of the above mentioned two policies Nos. 243007942 and 243312360 was rejected. It is further averred that in the proposal form the insured had left the column blank regarding the question pre-existing disease and has not given any answer. It is further averred that the respondent No. 1 - complainant is not entitled to get any relief in the complaint case. Therefore, the complaint is liable to be dismissed.
4. After hearing both the parties and after taking into consideration the material available on record, learned District Commission passed the impugned judgment and order dated 21.11.2017, wherein it is held as under:-
"ifjoknuh dk ifjokn i= foi{khx.k ds fo:) Lohdkj fd;k tkrk gS ,oa foi{khx.k dks funsZ"k fn;k tkrk gS fd os fu.kZ; dh frfFk ls ,d ekg ds vUnj nksuksa ikWfyfl;ksa dh chfer /kujkf"k (7,50,000+2,00,000) dqy 9]50]000:0 e; 8 çfr"kr lk/kkj.k okf'kZd C;kt lfgr] tks okn nk;j dh frfFk ls okLrfod Hkqxrku dh frfFk rd ns; gksxh] ifjoknuh dks vnk djs]a lkFk gh 10]000:0 3 Appeal No. Life Insurance Corporation of India 24.02.2023 02 of 2018 Vs. Smt. Daya Renu and Anr.
ekufld ,oa vkfFkZd {kfr ds rFkk 5]000:0 okn O;; ds vnk djsAa "
5. Aggrieved by the aforesaid order of the District Commission, the appellant - insurance company has preferred the present appeal contending that the District Commission, Udham Singh Nagar has given an arbitrary and biased order; the respondent No. 1- complainant did not come with clean hands, therefore, the claim was repudiated because of suppression of health related facts. As per the doctors certificate B and B-1 the insured was suffering from COPD. The BHT received from COSMOS Hospital that the insured was the chronic, alcoholic and smoker. The policy of insurance is a contract made in utmost good faith and the insured obtained the same by concealment of fact of his pre-existing disease, therefore, the District Commission has committed manifest error of law in wrongly appreciating the evidence contrary to the facts, hence the liability of the appellant - insurance company is not covered by the condition and provisions of the policy. Therefore, the appeal is liable to be allowed and the impugned judgment should be set aside.
6. Learned counsel for respondent No. 1 - complainant has contended that the insured (deceased) was not suffering from any pre-existing disease at the time of purchasing of the above mentioned two insurance policies. He was fit & fine. The appellant - insurance company has not submitted any such documentary evidence which has proved that the deceased was suffering from any pre-existing disease on or before the date of purchasing the above mentioned two insurance policies.
4Appeal No. Life Insurance Corporation of India 24.02.2023 02 of 2018 Vs. Smt. Daya Renu and Anr.
7. The main question arisen for consideration before us is whether as per doctor's certificate the insured has concealed or suppressed his health related fact from the appellant - insurance company or not.
8. During courser of the arguments learned counsel for the appellant - insurance company has drawn our attention to paper No. 18 of the appeal file, which is a prescription note of Dr. K. Kumar of COSMOS Hospital, Moradabad prepared on dated 27.02.2014 whereas the death of insured took place on 28.02.2014. It means that the above-said certificate was prepared just one day before from the date of death of insured. This paper is marked as BHT. In this certificate, it is written that the patient / insured is the chronic smoker and alcoholic and COPD under regular medication. Paper Nos. 19 & 20 (certificate B) are also available on record, wherein in the column 7 it is written as under:-
¼v½ e`rd dh vfUre chekjh ds le; vkidks fn[kykus ls iwoZ D;k fdlh vU; fpfdRld }kjk fdlh vU; fpfdRlky; esa ¼e`rd dk½ mipkj fd;k x;k Fkk\ The answer of this question is as under:-
"Was treated elsewhere not known to me."
9. As per the above observation of Dr. Rakesh Kumar, COSMOS Hospital, it is proved that the deceased was not treated and medically examined elsewhere. Thus, this medical evidence does not indicate that the deceased was suffering from any pre-existing disease at the time of purchase of above mentioned two insurance policy Nos. 243007942 for Rs. 7,50,000/- and 243312360 of Rs. 2,00,000/- Lacs.
5Appeal No. Life Insurance Corporation of India 24.02.2023 02 of 2018 Vs. Smt. Daya Renu and Anr.
10. The burden of proof that the deceased was suffering from any pre- existing disease lies on the shoulder of the appellant - insurance company. The appellant - insurance company has submitted BHT certificate dated 27.02.2014 wherein the deceased has shown as chronic smoker & alcoholic and was under regular medication, but this fact does not prove that the deceased was suffering from any pre-existing disease on or before the purchase of the above mentioned two policies in question.
11. The appellant - insurance company has not submitted any documents, i.e. medical certificate in regard to the fact that the deceased was suffering from any pre-existing disease, i.e. chronic smoker & alcoholic and under regular medication of any other doctor who examined the insured on or before such dates, i.e. date of purchase of life insurance policies in question.
12. Learned counsel for the appellant has submitted the following case laws, which are as under:-
1. Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., Civil Appeal No. 2776 of 2002 decided by the Hon'ble Supreme Court of India on 10.07.2009
2. P.C. Chako and Another Vs. Chairman, Life Insurance Corporation of India decided by the Hon'ble Supreme Court of India on 20.11.2007
3. Branch Manager, Bajaj Alllianz Life Insurance Company and Others Vs. 6 Appeal No. Life Insurance Corporation of India 24.02.2023 02 of 2018 Vs. Smt. Daya Renu and Anr.
Dalbir Kaur decided by the Hon'ble Supreme Court of India on 09.10.2020
4. Life Insurance Corporation of India Vs. Raj Vilas Dongre & Anr., Revision Petition No. 1949 of 2018 decided on 03.03.2020 by the Hon'ble National Consumer Commission
13. We have perused the above cited case laws. The principles as laid down in the above mentioned case laws with due respect are not applicable to the case in hand because in the present case the appellant - insurance company has not submitted any documentary evidence regarding the pre- existing disease of the deceased (insured). The medical evidence / prescription note (paper No. 18 of the appeal file Annexure -C) is prepared just one day before the date of death of the insured, hence such certificate does not indicate that the deceased was suffering from any pre-existing disease and thereby he suppressed the material facts about his illness from the appellant - insurance company.
14. Learned counsel for respondent No. 1 - complainant has submitted the following case laws, which are as under:-
1. Future Generali India Insurance Co. Ltd.
Vs. Inderjit Singh, 2019(2) CPR 623 (NC)
2. Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. and Anr. Vs. Yenkamma, 2019 (2) CPR 817 (NC) 7 Appeal No. Life Insurance Corporation of India 24.02.2023 02 of 2018 Vs. Smt. Daya Renu and Anr.
15. We have perused the above cited case laws.
16. In the case of Future Generali India Insurance Co. Ltd. (supra) the Hon'ble National Commission has held that the diagnosis was after the date of filing the proposal form. There is no concealment. Hence, the order of District Forum, as maintained by the State Commission, upheld.
17. In the case of Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. and Anr. (supra) the Hon'ble National Commission has held that the burden of proving the suppression of material facts lies on insurer.
18. In the present case, the burden of proving the fact that the insured (deceased) was suffering from any pre-existing disease lies on the shoulder of the appellant - insurance company but this burden has not discharged by the appellant - insurance company because the appellant - insurance company has not submitted any documentary evidence on record that the deceased (insured) was suffering from pre-existing disease much before the date of purchase of insurance policies in question. The appellant - insurance company has not submitted any documentary evidence regarding the admission and discharge slip of the insured of any hospital wherein the insured (deceased) got the treatment for chronic smoking, alcoholic and had been under regular medical examination.
19. The appellant - insurance company has submitted only one single document Annexure-C (paper No. 18 of the appeal file) prepared on 27.02.2014 (one day before the date of death of insured (deceased), i.e. 28.02.2014).
8Appeal No. Life Insurance Corporation of India 24.02.2023 02 of 2018 Vs. Smt. Daya Renu and Anr.
20. In the light of the above cited case law and as per the principle as laid down in the Future Generali India Insurance Co. Ltd. (supra) if the diagnosis is after the date of filing the proposal form, then that cannot be treated as concealment / suppression of the material fact regarding the previous illness. The appellant - insurance company has relied only one diagnose / prescription note of COSMOS Hospital which is after the date of the proposal form, hence it cannot be considered as suppression and concealment of material facts regarding the previous illness of the insured.
21. Thus, we are of the view that the respondent No. 1 - complainant has not suppressed any fact regarding his health and his previous disease from the appellant - insurance company.
22. Thus, learned counsel for the appellant - insurance company has not succeeded to establish the fact on record that the insured (deceased) was suffering from any pre-existing disease or he was a smoker and alcoholic patient, who had been under regular medication till the date of purchase of insurance policies in question.
23. Thus, after appreciation of the evidence and the documents available on record, we are of the opinion that the insured (deceased) has not concealed any material fact from the appellant - insurance company. It is admitted by both the party that the insured (deceased) purchased several insurance policies, out of which payment of some policies has been made to the family of the insured (deceased).
24. We have also of the considered opinion that the District Commission has not committed any manifest error of law while appreciating the evidence and has not disregarded any defence plea.
9Appeal No. Life Insurance Corporation of India 24.02.2023 02 of 2018 Vs. Smt. Daya Renu and Anr.
25. We are of the view that the impugned judgment is passed according to law, hence it is liable to be affirmed. We hold that the appeal is liable to be dismissed.
26 Appeal is dismissed. Impugned judgment passed by the District Commission, Udham Singh Nagar is hereby affirmed. No order as to costs.
27. A copy of this Order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986 /2019. The Order be uploaded forthwith on the website of the Commission for the perusal of the parties. The copy of the Order be sent to the concerned District Commission for record and necessary information.
28. File be consigned to record room along with a copy of this Order.
(Ms. Kumkum Rani) Judicial Member II (Mr. B.S. Manral) Member Pronounced on: 24.02.2023 10