State Consumer Disputes Redressal Commission
Lic vs Murti Devi on 16 August, 2012
PUNJAB STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 1037 of 2007
Date of institution: 30.07.2007
Date of decision : 16.08.2012
1. Life Insurance Corporation of India, Jeewan Parkash Building, Sector
17-B, Chandigarh - 160017 through its Divisional Manager.
2. Life Insurance Corporation of India, Lal Kothi, Railway Road,
Sangrur through its Branch Manager.
.....Appellants
Versus
Murti Devi aged about 51 years widow of Sh.Raj Kumar r/o Village
Shafipur Kalan, P.O. Kamalpur Via Dirba, Tehsil Sunam, Distt. Sangrur.
.....Respondents
First Appeal against the order dated 04.06.2007
passed by the District Consumer Disputes
Redressal Forum, Sangrur.
Before:-
Sardar Jagroop Singh Mahal,
Presiding Judicial Member
Mr.Vinod Kumar Gupta, Member Argued by:-
For the appellants : Mr.Varun Chawla, Adv. for Sh.Rajneesh Malotra, Advocate For the respondents : Mr.Sanjeev Goyal, Advocate JAGROOP SINGH MAHAL, PRESIDING JUDICIAL MEMBER This is OP's appeal under Section 15 of the Consumer Protection Act, 1986 (hereinafter referred to as the Act) against the order dated 4.6.2007 passed by the learned District Consumer Disputes Redressal Forum, Sangrur (in short the District Forum) vide which the OPs were directed to : -
First Appeal No.1037 of 2007 2
(a) Settle the insurance claim and pay to the complainant a sum of Rs.2,00,000/- alongwith interest @ 9% per annum from the date of repudiation of claim i.e. 16.10.2006 till realization.
(b) pay to the CC a sum of Rs.5000/- as compensation on
account of mental tension and harassment
(c) pay Rs.1000/- as litigation expenses.
2. The present complaint was filed by Murti Devi alleging that her husband Raj Kumar obtained two insurance policies each for Rs.1 lac from the OP; that in March, 2006, he felt pain in the chest and was taken to Sibia Healthcare Private Limited, Sangrur for treatment and was discharged on the same day. He, however, died on 10.4.2006 due to heart attack. It was alleged that prior to the said incident, Raj Kumar had been hale and hearty. After the death of Raj Kumar, she being his nominee lodged a claim with the OP. All the documents needed by the OPs were provided to them but even inspite of that the OPs repudiated the claim vide letter dated 16.12.2006 on frivolous grounds. The complainant filed the present complaint for the claim amount of Rs.2 lacs along with interest @ 18% per annum, Rs.50,000/- for mental agony, pain and suffering and Rs.11,000/- as litigation expenses.
3. The contention of the OP-appellants is that Raj Kumar had obtained two policies each for Rs.1 lac and an intimation was received that he has died on 10.4.2006. It was alleged that Raj Kumar concealed the material information form them and during the investigation, it was found that he was suffering from DM-II and CAD (Coronary Artery Disease) for the last about 2 years but this fact was not disclosed by him in the proposal form. Their contention is that the contract of insurance depends upon utmost good faith and where the policy was procured by concealing the ailment, the First Appeal No.1037 of 2007 3 contract of insurance becomes void. The repudiation of the claim was alleged to be correct and the complaint is liable to be dismissed.
4. Both the parties were given opportunity to adduce evidence in support of their contentions.
5. After hearing the arguments of the learned counsel for the parties and perusing the record, the learned District Forum vide impugned order dated 4.6.2007 allowed the complaint as mentioned above. The OP has challenged the same through the present appeal.
6. We have heard the arguments of the learned Counsel for the parties and have perused the record.
7. The learned counsel for the OP has argued that admittedly, Raj Kumar was taken to Sibia Health Care Private Limited, Sangrur on 1.4.2006 and was discharged on 5.4.2006. Prior to that, he was taken to the said hospital on 10.3.2006 and 25.3.2006 as is clear from Ex.R10 and Ex.R11.
Ex.R14 is the certificate of hospital treatment showing that Raj Kumar was admitted in the said hospital on 1.4.2006 and was discharged on 5.4.2006. Admittedly, all these dates are after the commencement of the policy of insurance which started from 15.10.2005 and 21.10.2005 i.e. the date of proposal. The contention of the OP appellants is that in the proposal form Ex.R1 and Ex.R3, Raj Kumar claimed to be hale and hearty whereas from the certificate of hospital treatment Ex.R14, the doctor has proved that he was an OPD patient for the last two years for DM-II and CAD. The learned counsel argued that these facts having not been disclosed in the proposal form, the entire contract of insurance i.e. the policy of insurance becomes void. We do not find any merit in this argument.
8. The sole question to be determined in this complaint is whether in the absence of any medical treatment before the date of proposal, the First Appeal No.1037 of 2007 4 contract of insurance can be repudiated on the basis of the history of patient recorded by the treating doctor. Our answer to this question is in the negative. In this respect, we may refer to a decision of this Commission in the case Life Insurance Corporation of India v. Charanjit Kaur, I (2001) CPJ 53. In that case also, as in the present case, no evidence was produced by the OP that the deceased had taken any treatment from any doctor for the alleged disease prior to the policy. There was no evidence to hold that the insured knowingly and fraudulently concealed the material facts regarding the alleged disease. The findings recorded by this Commission in Life Insurance Corporation of India v. Charanjit Kaur's case (supra) that only history sheet is not sufficient to hold that the deceased was suffering from the disease was upheld by the Hon'ble National Commission in Revision Petition No.3653 of 2006 (Life Insurance Corporation of India v. Charanjit Kaur) decided on 14.10.2011. In that case also, as in the present case, it was not mentioned whether the patient gave history to the doctor at the time of his admission regarding his ailment or whether the history was given by anyone else. Even the signatures of the patient or any of his relative were not obtained by the doctor.
6. The contention of the learned counsel for the OP that the deceased was suffering from DM-II and CAD for the last two years. He, however, could not point out to any evidence showing if he ever got himself treated for the said disease from any doctor or hospital. It was held by the Hon'ble National Commission in case "Life Insurance Corporation of India v. Joginder Kaur 2005 (1) CPC 52 that because no evidence was adduced to prove that any doctor had treated the deceased for these diseases, therefore, simple allegation is not sufficient to prove the case of concealment.
First Appeal No.1037 of 2007 5
7. We are, therefore, of the opinion that simply on the basis of history recorded by the doctor during the policy of insurance cannot be a ground to presume the concealment unless the OP has produced the record about the treatment taken by the insured from any hospital or doctor before filling up the proposal form.
8. Apart from that, the proposal form is in English whereas the signatures of the insured were in Punjabi. There is no evidence to suggest if the contents of the proposal form were ever read over and explained to him in his own language. The learned District Forum has examined this point in detail in para 6 of the judgment as follows : -
"To start with, a look at the proposal form dated 20.10.2005, Ex.R-3 show that late Raj Kumar was an illiterate person, he put his signatures on the same in Punjabi. In neither of these documents, there is any endorsement, which are printed in English and Hindi languages were ever read over and explained to him in life assured's own dialect in Punjabi. It is no doubt true that Sohan Lal agent has put his signature on the endorsement, which is printed and which is a certificate on the back of both the documents to the effect that he fully explained the above questions and contents to the proposer, but what is significant to notice is that in between the words "proposer and "language" the space is left blank. In such a situation, therefore, Sohan Lal agent's mere affidavit-statement Ex.R-22, on that aspect of the matter, to our mind, does not carry any weight. It pales into insignificance. M.P. State Consumer Commission in Life Insurance Corporation of India Vs. Amritram 2002 (3) CLT 697 held that in case of an illiterate person, the contents of the proposal form must be read over and explained to the policy holder in his own language. As seen above, that having not been done in the present case, we are First Appeal No.1037 of 2007 6 afraid, opposite parties cannot take advantage of the entry of the contents of the proposal form, which are made the basis of the repudiation.
9. The proposal form Ex.R1 and Ex.R3 show that the insured was examined by Dr.Amandeep Agarwal and the policy of insurance was issued by the OP basing their decision not on the answers given by the insured in the proposal form but on the medical examination conducted by Dr.Amandeep Agarwal. When the OPs have already got the insured medically examined, it cannot be said if the insured was suffering from any disease prior to the submission of the proposal form or there was any concealment of any such disease as alleged by them.
10. In view of the above discussion, we are of the opinion that the learned District Forum rightly allowed the complaint and the impugned order is perfectly legal and valid and does not call for interference. There is, therefore, no merit in this appeal and the same is, accordingly, dismissed.
11. The appellants had deposited an amount of Rs.25,000/- with this Commission at the time of filing of the appeal on 30.7.2007. This amount of Rs.25,000/- with interest, if any, accrued thereon be remitted by the registry to the complainant-respondent by way of a crossed cheque/demand draft after the expiry of 45 days.
12. Copies of the orders be supplied to the parties free of costs.
(JAGROOP SINGH MAHAL) PRESIDING JUDICIAL MEMBER (VINOD KUMAR GUPTA) MEMBER August 16, 2012.
Paritosh