National Consumer Disputes Redressal
Life Insurance Corporation Of India vs Smt. Charanjit Kaur on 14 October, 2011
There is a delay of 23 days in filing the present revision petition NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 3653 OF 2006 (From the order dated 19.7.2006 in Appeal No. 91/2000 of Punjab State Consumer Disputes Redressal Commission, Chandigarh) Life Insurance Corporation of India .. Petitioner Divisional Manager Divisional Office Sector 17 Chandigarh Through Assistant Secretary (L&HPF) Northern Zonal Office Jeevan Bharti Connaught Circus New Delhi Vs. Smt. Charanjit Kaur .. Respondent Widow of Sh. Virsa Singh R/o Jhok Mohra P.S. Jhok, Tehal Singh Wala Tehsil & Distt. Firozepur Punjab BEFORE: HONBLE MR.JUSTICE V.B. GUPTA, PRESIDING MEMBER HONBLE MR.SURESH CHANDRA, MEMBER For the Petitioner : Mr. Ashok Kashyap, Advocate For the Respondent : NEMO Pronounced on : 14th October, 2011 ORDER
PER SURESH CHANDRA, MEMBER There is a delay of 23 days in filing the present revision petition. An application has been filed by the petitioner Insurance Co. for condonation of this delay. We have considered the reasons put forth by the petitioner in favour of its application and in consideration thereof, the delay in question is hereby condoned.
2. Challenge in this revision petition is to the order dated 19.7.2006 passed by the Punjab State Consumer Disputes Redressal Commission, Chandigarh (State Commission, for short) by which the appeal of the petitioner Co. filed against the order dated 29.11.1999 of the District Forum, Ferozepur came to be dismissed.
3. Briefly stated, one Virsa Singh, husband of the complainant/petitioner, was insured with the petitioner Insurance Co. vide Policy No.470343848 dated 29.5.1997. The insured, Virsa Singh died on 23.5.1998. The claim filed by the complainant was repudiated on the ground that the deceased was not having good health at the time of insurance. According to the complainant, her husband was keeping good health at the time of taking insurance and his medical examination was also done by the doctor of the LIC and hence the repudiation of the claim was not justified. She, therefore, lodged the complaint before the District Forum, Ferozepur for relief. On being noticed, the Insurance Co. resisted the claim on the ground that the deceased had concealed the material facts that he was suffering from Diabetic Mellitus for the last 10 years and was a chronic alcoholic for one year. According to the Insurance Co., he was also suffering from some other diseases which facts were concealed and hence the contract of insurance which is based on utmost good faith became null and void and nothing was payable under this insurance policy. After appreciating the facts on record, the District Forum allowed the complaint by directing the OP Insurance Co. to pay Rs.2 lacs plus bonus, if any, along with interest @ 12% p.a. from 22.8.1998 (after three months from the date of death) till realization along with cost of Rs.1,000/-. As stated above, the appeal filed by the OP Insurance Co. before the State Commission was dismissed by the impugned order, which is now under challenge through this revision petition.
4. The District Forum in its detailed and well-reasoned order has made the following observations while rejecting the defence of the OP Insurance Co. and accepting the complaint of the respondent/complainant:-
16. The opposite parties have repudiated the claim of the complainant on the ground that husband of the complainant was suffering from Diabetes Mellitus for the last 10 years, he was chronic alcoholic for 1 year; it was a case of NIDDN, ALD and he had suppressed this fact at the time of taking insurance policy. But no evidence has been produced by the opposite parties to establish that prior to taking the policy, husband of the complainant Virsa Singh was suffering from the alleged disease. No evidence has been produced by the opposite parties that deceased Virsa Singh had taken any treatment from any doctor for the alleged disease prior to the policy. No certificate for any doctor in this regard has been placed on record by the opposite parties. There is no sufficient evidence to hold that the insured knowingly and fraudulently concealed the material facts regarding the alleged disease at the time of commencement of policy. The opposite parties have repudiated the claim of the complainant relying upon the Certificate of Hospital Treatment Ex.R-1 which was issued by Dr. Ajay Marwaha; Registrar, D.M.C. Ludhiana. The said Dr. Ajay Marwaha was cross examined at length by the learned counsel for the complainant and during the cross examination he had stated that patient was not under his treatment and history of the patient was not recorded by him. Signature of the patient is not on the history sheet. No test was done by the treating doctor to diagnose the patient of ALD. It is not evident that who narrated the history of the patient/deceased to Dr. A.P.S. Saini.
17. The cause of death has been given Jaundice but the opposite parties are not sure whether jaundice was due to infective hepatitis or other illnesses like stones or cancer. The various other conditions can produce Jaundice and the Jaundice is also seen in children and neonates where the case may be heamolytic. In the present case no such evidence has been produced to the effect that cause of death had any connection with the taking of liquor. No material has been produced by the opposite parties to prove that Jaundice was due to taking of liquor by the deceased during his life time. The opposite parties have not produced the doctor of Hakim Kishori Lal Hospital Pvt. Ltd., Guruharsahai who referred the deceased Virsa Singh to D.M.C. Ludhiana and how he diagnosed that the deceased was patient of NIDDM, ALD. Even no test was done by the doctor to come to the conclusion that the deceased was patient of above mentioned diseases. In para No.5 of Ex.R-1, it was not mentioned that whether the patient reported history to the Doctor at the time of his admission regarding his ailment and whether history was reported by any one else. Even signature of the patient or any of his relation was not obtained by the doctor. The opposite parties have not produced Dr. A.P.S. Saini to whom the alleged history was reported. In para No.5 of Ex.R-1, the present address of the doctor who recorded the history is not given. It was also mentioned in para 9 of Ex.R-1 that when the patient was discharged from the hospital his condition was satisfactory, from it seems that the patient died afterward due to some other illness rather than the disease for which he was admitted in the D.M.C. Ludhiana. The original history sheet and Bed Head Ticket of the deceased have not been produced by the opposite parties in the Forum to prove that the deceased died due to diseases for which he was admitted in D.M.C. Ludhiana.
18. The patient was admitted in the hospital on 30.11.97, discharged on 8.12.97 and died on 22.5.98, after five months from the admission which means he may have contacted some other illnesses as mentioned above in the meantime and may be died due to that. The opposite parties have repudiated the claim vide Ex.C-4. In Ex. C-4 the opposite parties have mentioned that they hold indisputable poof to show that life assured Virsa Singh was suffering from diabetes for the last 10 years. He was in the habit of taking alcohol for the last one year and he was suffering from ALD and PH as a result of which he was not keeping good health but the opposite parties have not produced any evidence except Ex. R-1 Form No.3816. No reason has been given by the opposite parties that why they have concealed the alleged indisputable proof from this Forum. Only history sheet is not sufficient to hold that the deceased Virsa Singh was suffering from diabetes and other diseases and he was under any treatment prior to taking the policy. The proposal form Ex.R-4 was filled by the official of the opposite parties and the deceased Virsa Singh only put its signatures on it. The opposite parties have not produced the official who filled the said proposal form to prove whether the life assured/deceased replied the questions of proposal form in his presence or he filled the said form at his own will. Moreover, the proposal form has been printed and filled in English whereas the signature of life assured/deceased is in Punjabi, from which it seems that the deceased was not able to read, write and understand English.
5. As stated above, the State Commission has dismissed the appeal of the Insurance Co. and upheld the order of the District Forum. Thus there are concurrent orders of the two fora below based on finding of facts accepting the complaint and unsuiting the defence of the petitioner Insurance Co. We do not find any material irregularity or illegality in the concurrent findings of the fora below. Learned counsel for the petitioner Co. during the course of hearing has relied on the order of the Apex Court in the case of Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. [IV (2009) CPJ 8 (SC)] wherein repudiation of the claim of the complainant by the insurer on the ground of suppression of material facts was upheld by the Apex Court. However, we find that the facts and circumstances of this case are quite different and the petitioner Insurance Co. has not been able to prove the allegation of fraudulent concealment/suppression of material facts pertaining to the health of the deceased. In view of this, we are unable to apply the ratio of Satwant Kaurs case to the present case. Under the circumstances, there is no case for our interference with the concurrent orders of the fora below while exercising our revisional jurisdiction. The revision petition of the Insurance Co. is, therefore, dismissed with cost which is quantified at Rs.15,000/-. The cost shall be deposited with the Consumer Legal Aid Account of N.C.D.R.C. within a period of one month by the petitioner failing which the petitioner shall also be liable to pay interest @ 9% p.a. till actual payment of the cost. The matter be listed for compliance on 1.12.2011.
(V.B. GUPTA, J) PRESIDING MEMBER (SURESH CHANDRA) MEMBER SS/