State Consumer Disputes Redressal Commission
Joginder Kaur vs Life Insurance Corporation on 10 February, 2011
2nd Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB,
SCO NOS.3009-12, SECTOR 22-D, CHANDIGARH.
First Appeal No. 1534 of 2005
Date of institution : 30.11.2005
Date of Decision : 10.2.2011
1. Joginder Kaur alias Mohinder Kaur widow of Gian Singh son of Hazura
Singh, resident of Harindra Nagar, Faridkot.
2. Harjit Singh son of Gian Singh son of Hazura Singh, resident of
Harindra Nagar, Faridkot through his mother Smt. Joginder Kaur alias
Mohinder Kaur widow of Gian Singh.
3. Manjit Kaur d/o Gian Singh son of Hazura Singh, now wife of Iqbal
Singh son of Balwinder Singh, resident of Harindra Nagar, Faridkot.
....Appellants.
Versus
1. Life Insurance Corporation through its Zonal Manager, Northern Zonal
Office, Jiwan Bhartya building, 1124, Connaught Circus, New Delhi
110001.
2. Senior Divisional Manager, Life Insurance Corporation of India, Jiwan
Parkash Model Town Road, Jallandhar.
3. Branch Manager, Branch Office, Life Insurance Corporation, Faridkot.
...Respondents.
First Appeal against the order dated 8.11.2005 of
the District Consumer Disputes Redressal Forum,
Faridkot.
Before:-
Shri Inderjit Kaushik, Presiding Member.
Shri Baldev Singh Sekhon, Member.
Present:-
For the appellants : Sh. Suresh Singla, Advocate
For the respondents : Sh. Rajneesh Malhotra, Advocate
INDERJIT KAUSHIK, PRESIDING MEMBER:
Appellants/complainant(hereinafter called 'the appellants') have filed this appeal against the impugned order dated 8.11.2005 passed by the District Consumer Disputes Redressal Forum, Faridkot(in short, 'the District Forum').
2. Appellants filed the complaint under Section 14 of the Consumer Protection Act, 1986(hereinafter called 'the Act'). Facts in brief are that Sh. Gian Singh s/o Hazura Singh got a policy for life insurance through respondent No. 3 bearing No. 131484028 and the date of its First Appeal No. 1534 of 2005 2 commencement was 28.2.2002 and the sum insured was Rs. 1 lac. Annual premium of Rs. 11,210/- was deposited with the respondents and the proposal form was duly accepted and the policy was issued. 2nd installment of the premium was deposited on 12.3.2003.
3. At the time of obtaining insurance policy Gian Singh was hale and hearty and was not suffering from any ailment and in September, 2003 Gian Singh all of a sudden suffered heart ailment and he consulted Dr. Bimal Garg on 20.9.2003, who told him that he was suffering from heart problem and advised him to get treatment from some renowned medical institution. Gian Singh got admitted in Hero DMC, Ludhiana where he was treated for heart treatment till 26.9.2003. He was again admitted in the said hospital on 29.9.2003 and remained their till 4.10.2003. Thereafter he was admitted in Fortis Heart Institute, Mohali where he died on 13.10.2003. Appellant No. 1 was nominee and after the death of Sh. Gian Singh submitted the claim alongwith necessary documents. Respondent No. 2 did not make any payment and vide letter dated 15.10.2004 informed that the claim has been repudiated. The reason for the repudiation given was that deceased Gian Singh suffered from hyper-tension.
4. The deceased Gian Singh never suffered any type of ailment and he was not suffering from hyper tension nor he was aware of it prior to September, 2003. At the time of admission in the hospital Gian Singh was not in sound state of his health and he was not conscious so as to give the accurate detail about his health and treatment. Deceased Gian Singh did not conceal any fact in the proposal form about his health and he was duly examined by the doctors appointed by the respondents. There is deficiency in service on the part of the respondents and the appellants suffered great mental tension, harassment and prayed that the respondents be directed to pay Rs. 1 lac i.e. the sum insured, Rs. 1 lac by First Appeal No. 1534 of 2005 3 way of compensation and interest @ 18% per annum alongwith litigation expenses.
5. In the written statement filed on behalf of the respondents, preliminary objections were taken that the appellant/complainants has no locus-standi to file the present complaint. No succession certificate has been produced. Complaint is time barred. The appellants are not 'consumers' and the Civil Court only can decide the dispute. The husband of the appellant, namely, Gian Singh deceased got his life insured by fraud and mis-representation and by concealing the material facts intentionally and knowingly regarding his old disease of hyper tension, which he was suffering four years prior to the commencement of the present policy. As per the certificate issued by Dr. Bishav Mohan on 13.10.2004 the answering deceased was suffering from hyper tension for the last four years. At the time of admission in D.M.C., Ludhiana he was diagnosed as suffering from CAD, HT, AWMI, LVF (Left Verticle Failure), Cervical Spondyloses etc..
6. The claim was rightly repudiated. On merits, it was admitted that Gian Singh got a policy for his life insured from the respondent which commenced from 28.2.2002 for a sum of Rs. 1 lac at the rate of annual premium of Rs. 11,210/- and the premium was deposited. Gian Singh made wrong declaration and the complaint is liable to be dismissed. Other pleas were repeated and prayed that the complaint be dismissed.
7. Learned District Forum after considering the evidence and material placed on file by the parties and after hearing the learned counsel for the parties, observed that Dr. Naveen Kumar, who recorded the history of Gian Singh in Hero DMC Heart Institute, Ludhiana had no motive or enmity to note down wrong history of Gian Singh and there is no reason to discard the evidence of Dr. Naveen Kumar. Gian Singh was suffering from hyper tension for the last four years and dismissed the complaint. First Appeal No. 1534 of 2005 4
8. Aggrieved by the impugned order dated 8.11.2005, the appellants have filed this appeal.
9. We have heard the learned counsel for the parties and have gone through the file and documents placed on record with the assistance of the learned counsel for the parties.
10. Learned counsel for the appellants has contended that the insured Gian Singh was hale and hearty and he had no pre-existing disease and all of a sudden on 20.9.2003 he was admitted in D.M.C. Heart Institute, Ludhiana and he came to know that he was heart patient. For repudiation of the claim hyper-tension is the only reason given by the respondents. There is no evidence of pre-existing disease. It was further contended that the proposal form has not been produced and the application filed to produce the same was dismissed but against that no revision was filed and in the absence of the proposal form the claim cannot be declined. It was further contended that as per indoor patient admission record of Hero D.M.C. Heart Institute Ex. R-1, only one day prior to admission there was chest pain and there was no history of dyspnoea, palpitations, cough, fever or syncope and all the investigation conducted were normal. As per Ex. R-3(Annexure R-B), the hyper tension was the only reason given but the plea that Gian Singh was suffering from hyper- tension for the last four years is not supported by any medical record and there is no evidence to prove that earlier also Gian Singh was suffering from any hyper tension or any other ailment. Blood Pressure of Gian Singh was normal. The District Forum has not considered these facts and the order is liable to be set-aside.
11. On behalf of the respondents, it was argued that the history was recorded by the doctor at the time of admission of Gian Singh in the said Heart Institute and he was suffering from hyper-tension and many other ailments and the same were not disclosed at the time of filling the First Appeal No. 1534 of 2005 5 proposal form. Ex. R-4 shows that deceased Gian Singh was suffering from hyper-tension, cervical spondylosis, acute gastroenteritis, LVF(recovered). Dr. Bishav Mohan tendered his affidavit Ex. R-7. He has also depose so. Respondents Insurance co. has proved that deceased Gian Singh was suffering from hyper-tension and other ailments which he never disclosed and the claim was rightly repudiated and there is no illegality in the impugned order under appeal and the appeal may be dismissed.
12. We have considered the submissions made by the learned counsel for the parties.
13. The claim of the appellants was repudiated on the ground that Gian Singh deceased was suffering from hyper tension and this fact was not disclosed by the insured. Ex. A-4 is the letter dated 15.10.2004 vide which the claim was repudiated. The respondent Insurance Co. has relied upon the statement of Dr. Naveen Kumar, who proved the documents Ex. R-1 to R-4. In his examination-in-chief itself he has deposed that hyper- tension increases the risk of heart disease(CAD Coronary Artery Disease) but it has no direct link with Cardiac arrest. In his cross-examination he deposed that as per record produced by him today, the patient was not taking any medicine for hyper-tension before his admission in the hospital. The blood pressure was 130/70 at the time of admission. The blood pressure according to the age of the patient should have been 130/80 and it cannot be said that at the time of admission blood pressure was normal.
14. From the statement of expert Cardiologist, it is clear that even at the time of admission in the Dayanand Medical College & Hospital, Ludhiana deceased Gian Singh was not suffering from high blood pressure and his blood pressure was normal. Dr. Bishav Mohan vide affidavit Ex. R-7 has also stated that the patient was having the history of hyper tension, cervical, spondylosis, CAD, AWMI, LVF, AV dissociation. But as First Appeal No. 1534 of 2005 6 stated by Dr. Naveen Kumar, CAD has no direct link with the cardiac arrest. Cervical spondylosis is also not at all linked with cardiac arrest. One of the diagnose was acute gastroenteritis. In the present age the way of life has changed and hyper tension, cervical spondylosis or such type of ailments are very common and are curable diseases but as stated by Dr. Naveen Kumar the deceased Gian Singh was not taking any medicine of hyper tension before his admission in the D.M.C. Hospital, Ludhiana. The patient was admitted due to chest pain and his blood pressure was normal and he cannot be stated to be patient of hyper tension for the last four years before admission. There is no evidence regarding the said contention nor any Doctor, who treated the deceased Gian Singh has been examined and the respondent Insurance co. has repudiated the claim solely on the basis of the hyper-tension as the same was not disclosed at the time of proposal form but no proposal form was produced. Deceased Gian Singh was found not to be taking any medicine of hyper tension before admission. As such, he was not aware of any such disease and there was no question of disclosing the same. The Hon'ble National Commission in case "National Insurance Company Ltd. v. B.L. Sharma", 2009 CTJ 873 (CP) (NCDRC) observed as follows:-
"Most people are not familiar with medical knowledge and cannot diagnose their own disease. If they were expected to be aware of their medical condition at all times, there would be no use of insurance policies."
15. The District Forum has not considered the material evidence on file and agreed with the respondent Insurance Co. that the deceased Gian Singh was suffering from hyper tension and he did not disclose the same in the proposal form. This finding of the District Forum is against the facts and evidence on record and cannot be sustained in the eyes of law. Accordingly, the impugned order being erroneous, is set-aside. First Appeal No. 1534 of 2005 7
16. The appeal is accepted. Consequently, the complaint filed by the appellants is allowed and the respondents are directed to pay to the appellants Rs. 1,00,000/- i.e. the sum insured vide policy No. 131484028 and to pay interest @ 7.5% per annum from the date of the repudiation of the claim i.e. 15.10.2004 till realization. Rs. 5,000/- awarded as costs of the litigation.
17. The arguments in this appeal were heard on 2.2.2011 and the orders were reserved. Now the order be communicated to the parties.
18. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Inderjit Kaushik)
Presiding Member
February 10, 2011. (B.S. Sekhon)
as Member