State Consumer Disputes Redressal Commission
Bahadar Kaur vs Icici Prudential Life Insurance ... on 25 January, 2010
STATE CONSUMER DISPUTES REDRESSAL
COMMISSION,
UNION TERRITORY, CHANDIGARH
APPEAL NO. 474 OF 2009
Bahadar Kaur, w/o Late Sh.Dilbagh Singh, Village
Lakhnaur Post Office Sohana, Near Furniture Market, District Mohali, Punjab
140308.
.Appellant.
Versus
1. ICICI Prudential Life Insurance Company
Limited, ICICI Prolife Towers 1089, Appasaheb Marathe Marg, Pradhadevi, Mumbai
400025 (India) (Through its Branch Head and Managing Director).
Branch
Office
2. ICICI Prudential Life Insurance Company
Limited, SCO No. 9, 10 and 11, Sector 9-D, Chandigarh.
.Respondents.
BEFORE: MAJ. GEN. S. P. KAPOOR (RETD.),
PRESIDING MEMBER.
MRS.
NEENA SANDHU, MEMBER.
Present: Sh.Neeraj Sobti, Advocate for the appellant.
Sh.P.S.Bhangu, Advocate, proxy for Sh.G.S.Walia, Advocate for the respondents No.1 and 2.
MRS. NEENA SANDHU, MEMBER
1. This is an appeal filed by the complainant against order dated 8.7.2009 passed by District Consumer Disputes Redressal Forum-I, UT, Chandigarh (for short hereinafter to be referred as District Forum) passed in complaint case No.1439 of 2008.
2. Briefly stated the facts of the case are that Sh.Dilbagh Singh late husband of the complainant had obtained the insurance policy i.e. Life Time Super Plan from OPs by paying first premium of Rs.24,000/- and on 15.5.2007, a Life Insurance Policy bearing No.05287454 was issued in favour of the husband of the complainant. It was submitted that on 13.1.2008 the husband of the complainant along with his family went to attend the dinner party hosted by a relative on the occasion of Lohri at Mohali, where he took small quantity of alcohol along with his relatives and thereafter in the morning of 14.1.2008, the husband of the complainant was having acute pain in his chest and as such was admitted to Indus Hospital, Mohali but unfortunately on 15.1.2008, the husband of the complainant i.e. Sh.Dilbagh Singh died due to cardiac arrest. After the death of her husband, the complainant being a nominee lodged claim with the OPs but the OPs repudiated the claim vide letter dated 2.9.2008 on the ground that the life assured had history of chronic consumption of alcohol since 20 years. On the above said act of OPs amounts to deficiency in service and unfair trade practice. Hence, the complaint was filed.
3. Reply was filed by the OPs in which the factual matrix of the case was admitted by OPs. It was pleaded that the life assured had deliberately concealed the material information and furnished false replies regarding his health and habits while filling up the proposal form. It is evident from the medical records that the life assured had a long history of sever alcohol abuse and was diagnosed of chronic alcoholism. It was further pleaded that the cause of death was directly related to the facts suppressed by the life assured and the OPs had rightly repudiated the claim on the ground of suppression of material facts, which was duly conveyed to the complainant vide letter dated 2.9.2008. All other material allegations in the complaint were denied and pleaded that there was no deficiency in service on the part of OPs and prayed for dismissal of the complaint.
4. The parties led their evidence in support of their contentions.
5. The District Forum dismissed the complaint on the ground that the complainant had suppressed the material information about his life style details and gave wrong information while filling up the proposal form at the time of taking the policy in question.
6. Aggrieved by the order of District Forum, the present appeal has been filed by the complainant. Sh.Neeraj Sobti, Advocate has appeared on behalf of appellant and Sh.P.S.Bhangu, Advocate has appeared as a proxy for Sh.G.S.Walia, Advocate on behalf of respondents. The main point for consideration before us is whether there was any suppression of material facts at the time of taking the policy.
7. In the grounds of appeal, the appellant has submitted that the learned District Forum failed to appreciate the legal and factual aspects of the complaint and has passed the order on the basis of conjectures and surmises. The learned counsel for appellant submits that the learned District Forum had not considered the citations placed before the learned District Forum at the time of arguments and ignored the law laid down by the Honble State Commission in the case titled as Life Insurance Corporation of India Vs. Smt.Sukhwinder Kaur 2008 (1) CPC 675 wherein it was held that Alcoholic insured only reason for repudiation of claim was given that insured deceased was a chronic alcoholic for the last 20 years which fact was concealed by insured reason of repudiation is unjust and unrealistic as taking of liquor is not a disease. The learned District Forum has ignored the fact that taking of alcohol is not a material fact, as held by the Honble State Commission (Punjab) in the case titled as (LIC Unit No.2 & Anr. Vs. Rahul Sehgal, 2008 (2) CLT 200, wherein it was held that taking of alcohol is not a material fact the suppression of which can entitle the appellant to repudiate the claim. The learned counsel for appellant further submits that the learned District Forum wrongly dismissed the complaint of the appellant/complainant and not appreciated the report of Dr.Isha Sood, CMO in which it has been stated that he had hematemesis, and had severe alcoholic abuse suddenly in morning cardiac arrest happened and patient expired. Copy of the report (C-2) is enclosed as A-2. The findings of the learned District Forum being based on conjectures and surmises and deserves to be set aside. It is prayed by the appellant that the appeal may kindly be allowed and the impugned order passed by the District Forum may kindly be set aside.
8. After hearing the learned counsel for the parties and perused the record, we have come to the conclusion that the husband of the complainant had obtained the insurance policy Life Time Super Plan which includes life insurance cover of Rs.1,20,000/- for 10 years, i.e. (The premium amount paid by the complainant is invested in the market under 100% Flexi Growth, as mentioned in Clause 27A (c) of the proposal form at page No. 3, and units were allotted to the complainant as per the market rates) from OPs by paying first premium of Rs.24,000/- and on 15.5.2007, a Life Insurance Policy No.05287454 was issued in favour of the husband of the complainant and on the occasion of Lohri i.e. on 13.1.2008, the husband of the complainant took small quantity of alcohol and thereafter on 14.1.2008, the complainant had acute pain in his chest, was admitted to Indus Hospital, Mohali where he died on 15.1.2008 due to cardiac arrest. The nominee of the complainant lodged claim with the OPs but the OPs have repudiated the claim on the ground of suppression of material facts by alleging that the life assured had history of chronic consumption of alcohol since 20 years and the District Forum dismissed the complaint with the observations that there is a concealment of material facts.
9. After going through the facts of the case, we have come to the conclusion that the sole reason of repudiation of claim by the OPs was that insured had a history of chronic consumption of alcohol since 20 years. This fact was concealed by the life assured at the time of taking the insurance policy. In our view, the reason of repudiation is unjust and unrealistic as taking of liquor is not a disease. Moreover, mere by not disclosing that the complainant is taking alcohol is not a material fact, the suppression of which can entitle the OP to repudiate the claim. Although, the copy of the certificate/report of the M.O of the concerned hospital which is placed on the record as A-2 but the OPs have not placed or rendered any evidence to establish that the disease Hematemesis (vide which the husband of the complainant was suffering) occurred to a person who is a chronic alcoholic. From the available record it is evident as per annexure A-2 it is nowhere mentioined that the patient was suffering from Hematemesis for the last many years or the patient was getting treatment for the said disease since long. Neither the affidavit of the M.O was placed on the file nor any corroborated evidence was placed on the file by the OPs. Therefore, we are of the considered view that there is no suppression of material facts. In our view the right of repudiation cannot be exercised on flimsy grounds or sketchy evidence. The insurer must prove it by cogent and convincing evidence. On the other hand a contrary view had been taken by learned District Forum holding that there is a suppression of material facts. In this set of circumstances, we are of the view that the appeal is liable to be allowed and the impugned order passed by the learned District Forum is to be set aside. With these observations as mentioned above, we set aside the order passed by the District Forum and allow the appeal with the following directions to the OPs :-
1. The OPs are directed to release the claim of Rs.1,20,000/- (insurance amount) to the complainant along with interest @ 9% from 2.9.2009 (from date of repudiation) to its actual realization.
2. The OPs are further directed to release the amount if any earned by the OPs out of the investment/units allotted to the complainant as per clause 27A (c) of the proposal form at page No. 3 (under 100% Flexi Growth).
The relief granted by us will meet the ends of justice. Hence, the rest of the prayers made by the appellant/complainant are denied. This order be complied with by the respondents/OPs within one month from the date of receipt of copy of this order failing which interest @ 12% p.a. will be charged.
10. Copies of this order be sent to the parties, free of charge.
Pronounced.
25th January, 2010. Sd/-
[MAJ. GEN. S. P. KAPOOR(RETD.)] PESIDING MEMBER Sd/-
[MRS. NEENA
SANDHU]
Rb/- MEMBER
APPEAL NO. 474 OF 2009
Present: Sh.Neeraj
Sobti, Advocate for the appellant.
Sh.P.S.Bhangu, Advocate, proxy for
Sh.G.S.Walia, Advocate for the
respondents No.1 and 2.
-.-
Vide our detailed order of even
date recorded separately, the appeal filed by the appellant is allowed.
25.1.2010 (PRESIDING MEMBER) (MEMBER) Rb/-
10.12.2009 (PRESIDENT) (MEMBER) (MRS.NEENA SANDHU) Rb/-