State Consumer Disputes Redressal Commission
Lic vs Sukhwinder Kaur on 17 January, 2008
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
SCO NO.3009-10, SECTOR 22-D, CHANDIGARH
First Appeal No.475 of 2007
Date of Institution : 3.4.2007
Date of Decision : 17.1.2008
Life Insurance Corporation of India, Jeevan Udyog Building, City Centre Scheme,
Amritsar through its Sr. Divisional Manager through Life Insurance Corporation of
India through its Sr. Divisional Manager, Jeevan Deep Building, Sector 17,
Chandigarh
.........Appellant
Versus
Smt.Sukhwinder Kaur wd/o S.Kulwant Singh, r/o 34-A, Sandhu Colony, Chheharta
Road, Amritsar.
.........Respondent
Appeal against the order dated 29.1.2007
of District Consumer Forum, Amritsar.
BEFORE
Hon'ble Mr.Justice S.N.Aggarwal, President
Mr.C.P.Budhiraja, Member
PRESENT For the appellant : Sh.Rajneesh Malhotra, Advocate For the respondent : Sh.K.M.S.Bedi, Advocate JUSTICE S.N.AGGARWAL, PRESIDENT Kulwant Singh, husband of Sukhwinder Kaur, respondent had obtained three life insurance policies with following particulars:-
Policy No. Date Amount Nominee
470890967 28.12.2001 Rs.1,50,000/- Sukhwinder Kaur
470893860 28.12.2001 Rs. 30,000/- Gurleen Kaur through
her mother
470893859 28.12.2001 Rs. 30,000/- Harleen Kaur through
her mother
2. The first Insurance Policy was under the scheme 'Ashadeep' while the remaining two insurance policies were under the scheme of 'Jeevan Chhaya'. Said Kulwant Singh died on 20.12.2004. The respondent lodged the claim. It was repudiated by the appellants vide letter dated 30.9.2005. Hence she filed the complaint in the learned District Consumer Disputes Redressal Forum, Amritsar (in short 'the District Forum').
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3. The appellants filed the written reply and contested the complaint. Their main objection was that Kulwant Singh, insured was Chronic Alcoholic for the last 20 years but he had suppressed this fact while filling the proposal form and defrauded the appellants. Therefore, the repudiation of the insurance policy was legal and valid. Hence the dismissal of the complaint was prayed.
4. The parties placed on file certain documents.
5. The learned District Forum considered the matter and vide judgement dated 29.1.2007 accepted the complaint and directed the appellants to make the payment of amount of insurance policy with interest @ 8% per annum from the date of repudiation till the date of payment. Costs were also imposed.
6. Hence this appeal.
7. The submission of the learned counsel for the appellants was that since Kulwant Singh has suppressed the factum of being a Chronic Alcoholic while filling the proposal form, therefore, the beneficiaries of insurance policies were not entitled to any claim under these insurance policies. It was also submitted that Kulwant Singh has died because of his alcoholism. Reliance was placed on the judgements of Hon'ble National Commission rendered in Revision Petition No.1935 of 1999 titled as Life Insurance Corporation of India Versus Krishan Chander Sharma decided on 23.1.2006 and judgement reported as 'Ajay Prakash Mittal Versus LIC of India 1997(2) CPR 233 (NC)' and 'Prema & ors. Versus Life Insurance Corporation of India 2007(1) CPC 58'.
8. The learned counsel for the appellants made reference to the proposal form, Ex.R-3, in which the answers to sr.no.11(a), (d), (e), (h) and (i) were given as under:-
Q.no. Question Answer given 11(a) During the last 5 years did you consult a Medical Practitioner No
for any ailment requiring treatment for more than a week? 11(d) Are you suffering from any disease pertaining to liver, stomach, No Heart, Lungs, Kidney, Brain or Nervous system?
11(e) Are you suffering or have you ever suffered from Diabetes, No 3 Appeal 475/2007 Tuberculosis, High B/Pressure, Low B/P, Cancer, Epilepsy, Hernia or any other disease?
11(h) Do you use or have you ever used (i) alcoholic drinks No
(ii) narcotics (iii) any other drugs (iv) Tobacco in any form? 11(i) What has been your usual state of health? Good
9. In order to prove that Kulwant Singh was Chronic Alcoholic for the last 20 years, the learned counsel for the appellants drew the attention of this Commission towards Death Summary report of the Escorts Heart and Super Speciality Institute, Amritsar (undated) (Ex.R-6) signed by Dr.Puneet K.Verma, Cardiologist Consultant. It reads as under:-
"Resume of History:
Patient S.Kulwant Singh, 43 yrs old male S/o S.Vil Singh was admitted on 18-12-04 at 4.30am. He is a known Chronic Alcoholic for last 20 yrs. He was admitted at Guru Nanak Dev Hospital in congestive heart failure and managed with dopamine & dobutamine from where he was shifted to EHSSIL for further management."
10. Reference was made to another report dated 5.10.2005 (Ex.R-5) given by Doctor Yash P.Mehra as under:-
"To The Manager (Claims) LIC of India, ASR Sub: Medical opinion for Policy No.470890967 &470893859 &470893860 Dear Sir, From the available records it is evident that the deceased died of Dilated Cardiomyopathy (Alcoholic). Alcoholic Dilated Cardiomyopathy develops after many years of heavy alcohol intake. 4 Appeal 475/2007 As mentioned in the records, the deceased was a known alcoholic for the past twenty years."
11. These submissions have been considered and record has been perused.
12. So far as the report of Dr.Yash P.Mehra, Ex.R-5, is concerned, no reliance can be placed on it as it is virtually based on the report of Dr.Puneet K.Verma, Ex.R-6. Moreover, Dr.Yash P.Mehra has never dealt with this patient nor he had medically examined or treated him.
13. So far as the report of Dr.Puneet K.Verma, Ex.R-6, is concerned (reproduced above), it only states that Kulwant Singh had died of Dilated Cardiomyopathy which could be caused by alcoholism. Dr.Puneet K.Verma has not given the source of his opinion that Kulwant Singh was a Chronic Alcoholic for the last 20 years. It appears, therefore, that this information given by Dr.Puneet K.Verma was imaginary. Certainly he has not stated if Kulwant Singh was a heavy drunkard which was necessary for the growth of the disease which proved fatal for Kulwant Singh. Therefore, this opinion of Dr.Puneet K.Verma cannot be relied upon.
14. Moreover, consumption of liquor is not a disease. It has become a sort of luxury for every type of society. Even a poor person who may not be able to afford his livelihood would like to take a peg of liquor on the festive occasion. It is consumed by the rich as an enjoyment. It is consumed frequently not only on festive occasions but also to celebrate the ceremonious occasions in the family. It was held by this Commission in First Appeal No.1585 of 2006 titled as 'Branch Manager, LIC, Unit No.2, Hall Bazar, Amritsar and another Versus Rahul Sehgal' decided on 20.12.2007 as under:-
"11. The learned counsel for the appellants submit that this medical record has proved that Rohit Sehgal was alcoholic for the last 15 years, and therefore, this habit of the insured led to the disease and had become a cause of his death.5
Appeal 475/2007
12. This submission has been considered. It is a far fetched argument. Taking liquor is not a material fact. Moreover, taking liquor is not a disease. Almost everybody takes liquor with few exceptions. Again, it varies whether one takes liquor in larger quantity or takes only small dose like medicine; whether one takes regularly or occasionally. This report does not clarify these details. If consumption of liquor was a disease, the insured would not have survived for 15 years. He would have died even prior to filling of revival form. Therefore, taking alcohol was not a material fact the suppression of which can entitle the appellants to repudiate the claim."
15. It cannot be believed if heavy intake of liquor needs 20 years for a person to die. Heavy intake of alcohol could have consumed a person in a short time and if Kulwant Singh had been taking heavy alcohol as opined by Dr.Yash P.Mehra in his report, Ex.R-5, he could not have survived for 20 years and would have died before filling the proposal form.
16. So far as the judgements relied upon by the learned counsel for the appellants are concerned, in Krishan Chander Sharma's case (supra), the insured was suffering from Asthma and Allergic Bronchitis etc. and he had suppressed these diseases which were considered sufficient by the Hon'ble National Commission for repudiation of the insurance claim. Therefore, this judgement is not applicable to the facts of this case.
17. In Ajay Prakash Mittal's case (supra), the insured was pregnant but she had concealed her pregnancy while filling the proposal form and the Hon'ble National Commission was pleased to hold that if the information of pregnancy had been disclosed, it would have enabled the L.I.C. whether to insure or not to insure her. Therefore, this judgement is not applicable to the facts of this case.
18. So far as the third judgement relating to Prema & others (supra) is concerned, the facts were entirely different. In this case, the insured remained admitted in the hospital for 6 days for fever, loss of appetite, burning sensations in 6 Appeal 475/2007 hands and feet but he concealed these facts while filling the proposal form. Therefore, this judgement is also not applicable to the facts of this case.
19. In view of the discussion held above, the appellants had not only failed to lead reliable evidence to prove if Kulwant Singh was taking alcohol for the last 20 years prior to his death but even the law has not been produced that if the factum of taking alcohol was suppressed while filling the proposal form, it was a good ground for the appellants to repudiate the insurance claim.
20. For the reasons stated above, we find no illegality in the impugned order dated 29.1.2007 passed by the learned District Forum.
21. We find no merit in the appeal which is dismissed with costs of Rs.10,000/-.
22. The appellants have deposited a sum of Rs.25,000/- with this Commission while filing the appeal. This amount be remitted to the respondent by way of crossed bank draft/cheque after 45 days under intimation to the District Forum. The remaining amount be paid by the appellants to the respondent within 45 days.
( JUSTICE S.N.AGGARWAL ) PRESIDENT ( C.P.BUDHIRAJA ) MEMBER January 17, 2008 vr/-
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