State Consumer Disputes Redressal Commission
Vivek Gupta Son Of Smt. Veena Gupta, ... vs 1.Life Insurance Corporation Of ... on 26 November, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA Complaint No.21 of 2002 Date of Institution: 12.04.2002 Date of Decision: 26.11.2012 Vivek Gupta son of Smt. Veena Gupta, Resident of House No.7, Sector 11-12, Phase-I, Urban Estate, Panipat. Complainant Versus 1. Life Insurance Corporation of India, Yog Khema Building, Nariman Point, Mumbai through its Chairman. 2. The Zonal Manager, LIC of India, Zonal Office, Jeevan Bharti, Cannaught Circus, New Delhi. Opposite Parties BEFORE: Honble Mr. Justice R.S. Madan, President. Mr. B.M. Bedi, Judicial Member. For the Parties: Shri O.P. Goyal, Advocate for complainant. Shri R.K. Sharma, Advocate Opposite Parties. O R D E R
Justice R.S. Madan, President:
The brief facts of the present complaint are that Smt. Veena Gupta-mother of complainant (since deceased-hereinafter referred to as Life Assured) had purchased six Life Insurance Policies from the Opposite Parties the details of which are given herein below:-
Sr.No. Policy No. Date of Commencement Instalment
1.
170073030 28.0.1998 0.25 lacs
2. 171055060 28.12.1994 1.00 lac
3. 171924366 18.08.2000 10.00 lacs
4. 171067871 28.03.1996 2.00 lacs
5. 171334648 28.08.1997 5.00 lacs
6. 171732911 28.01.1999 10.00 lacs While purchasing the above said policies, the life assured Veena Gupta had nominated her son Vivek Gupta (complainant herein). The policies have been annexed with the complainant as Annexure C-1 to Annexure C-6.
Unfortunately, the life assured Veena Gupta died on 16.10.2000. On being submitted claim with respect to the above said policies, the opposite parties paid the amount with respect to policies mentioned at Sr.No.1,2,3,4 and 5 through cheques of different dates (Annexure C-7 to Annexure C-11), the details of which have been mentioned in para 5 of the complaint. However, the claim with respect to policy mentioned at Sr.No.6 was repudiated by the opposite parties vide letter dated 20.11.2001 on the ground that the life assured had misstated the facts in the proposal form and had not disclosed that she was suffering from Diabetes and had history of piles prior to the date of obtaining the policy. complainant made representation (Annexure C-12) through his lawyer and had requested the opposite party No.2 to sent a Senior Officer of LIC other than Shri M.P. Jain, Branch Manager, LIC (Unit II), Panipat to look into the entire documentary Medical Evidence from August 2, 1989 for satisfying itself that the life assured had neither misstated the facts nor she withheld any material information and moreover she was not suffering from any disease at the time of purchasing the policy in January-March, 1999. For the first time the life assured had little fever and swelling around ankle on 2.8.1999 Dr. P.N. Gandhi, MBBS, M.D. etc of Gandhi Hospital, Panipat had examined the life assured and suggested certain tests which were got conducted from Kashyap Diagnostic Centre, Tehsil Road, Panipat on 4.8.1999 and then further treatment from Dr. Ramesh Jain, MBBS, MD on 6.8.1999 was taken. The life assured developed various other complaints and ailments during the period of one year and two months from August, 1999 untill her death on 16.10.2000. The complainant wrote letters to the opposite parties to pay the insured amount with respect to Policy No. 171732911 dated 28.01.1999 for Rs.10,00,000/- (Rupees Ten Lacs) but to no effect. Forced by these circumstances, the complainant alleging deficiency in service on the part of the opposite parties, filed complaint before this Commission seeking direction to the opposite parties to pay the insured amount of Rs.10 lacs + bonus and interest.
Upon notice, the opposite parties appeared and contested the complaint by filing written statement therein they denied the claim of the complainant. It is stated by the opposite parties that in the proposal form filled on 30.03.1999, the life assured had given answer to Question No.11(e) in negative stating that she was not suffering from diabetes, tuberculosis, high-blood pressure, low blood pressure, cancer, etc diseases and further stated that she was having good health. The life assured had expired on 16.10.2000 and when the claim was investigated into as per the terms and conditions of the Policy, it was revealed that the life assured had made mis-statement in the proposal form dated 30.03.1999 and had concealed the material facts about her health. The life assured had concealed the ailment of diabetes mellitus seven months prior to submitting the proposal form for which she had taken treatment. The life assured was also suffering from piles. Thus, on the basis of concealment, the claim of the complainant was repudiated through letter dated 20.11.2001 (Annexure C-12) on the ground that the life assured had not given correct information regarding her health at the time of effecting the insurance with the opposite parties and she had given wrong answers in her proposal form and withheld material information regarding her health. The Manager (Legal) of LIC, Chandigarh with respect to cause of death as cardiac failure, had made a request to Dr. S. Parbhakar, Prof and Head of Department of Neurology, PGI, Chandigarh who vide his letter dated 13.08.2000 (Annexure R-7) had clarified that scientifically a person dies only when the heart stops or due to respiration failure, whatever may be the ailment but the same can be caused by the ailment suffered by the patient. At the time of purchasing the Policy bearing No. 171732911 dated for Rs.10 lacs on 28.01.1999, the life assured was already suffering from diabetic mellitus and had a history of piles for which she had consulted Doctors and had taken treatment for the same. The representation was filed vide letter dated 24.12.2001 through Shri Promod Goyal, Sr. Advocate which was duly replied by the counsel for the opposite parties vide letter dated 20.02.2002 stating therein that as per the brief history given in the Discharge Summary (Annexure R-2) by the doctor in charge of Sita Ram Bhartla Institute of Sciences and Research Hospital, New Delhi, the life assured had a history of Diabetes Mellituse of an Oral Hypogylycemic and the same was confirmed by Dr. Surjeet Singh, Resident Doctor and Dr. G.S. Gularia, Consultant Doctor of the Institute. The above said document further showed that as per the investigation conducted by the institute showed dissemination of T.B. of liver, thyroid of the patient, which implied that patient was suffering from T.B. since long. But in the proposal form the life assured had given answers to Question No.11(e) and 11(i) as under:-
QUESTIONS ANSWERS 11 (e) Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease?
No. 11(i) What has been your usual state of health?
Good Since cardiac arrest is triggered off due to other factors, therefore, the complainants claim was rightly repudiated as the life assured was having pre-existing disease. Thus, denying any kind of deficiency in service on their part, the opposite parties prayed for dismissal of the complaint.
Both the parties have tendered documents as well as affidavits in support of their respective claims alongwith the complaint as well as written statement.
We have heard learned counsel for the parties and perused the case file.
It is contended on behalf of the complainant that the opposite parties have already paid the insurable benefits to the complainant in respect of five policies and wrongly repudiated claim with respect to sixth Policy bearing No. 171732911 dated 28.01.1999 for Rs.10,00,000/- (Rupees Ten Lacs). It is further argued that at the time of obtaining the said policy, the life assured was having good health and the disease stated by the opposite parties in their repudiation letter had developed during the period of one year i.e. after obtaining the policy in question. Shri O.P. Goyal, learned counsel for the complainant has vehemently argued that the diabetes and piles diseases have no nexus with the cause of death of the life assured as the death had occurred due to cardiac arrest. More so, the life assured was medically examined by the Doctor of the Life Insurance Corporation at the time of issuing the Insurance Policy and therefore the question of concealing the ailment and other material facts by the life assured with respect to her state of health does not arise. In support of his argument Shri O.P, Goyal, learned counsel for the complainant has referred to case law cited as Life Insurance Corporation of India v. Narmada Agarwalla and others, AIR 1993 ORISSA 103.
On the other hand learned counsel appearing on behalf of the opposite parties opposing the contention raised on behalf of the complainant has reiterated the facts detailed in the written statement which are supported with medical record with respect to the treatment taken by the life assured. In support of his argument Shri R.K. Sharma, learned counsel for the opposite parties has referred to judgment cited as SATWANT KAUR SANDHU versus NEW India ASSURANCE COMPANY LIMITED, (2009)8 Supreme Court Cases 316.
We do not find force in the contention raised on behalf of the opposite parties. Admittedly, the Insurance Policy bearing No. 171732911 for Rs.10 lacs was issued by the opposite parties w.e.f. 28.01.1999 on the basis of proposal No.6770 dated 30.03.1999. Meaning thereby it was as back dated policy. As per Treatment Record of SITARAM BHARTIA INSTITUE OF SCIENCE & RESEARCH, NEW DELHI the life assured was a known case of Diabetes Mellitus on oral hypoglycemic agents and was also on ATT (minus Ruifampicin) as she was diagnosed to have TB in October, 1999. was suffering from of T.B. since October, 1999. There is no evidence on the record to prove that there was any concealment on the part of the life assured- Veena Gupta. The opposite parties have miserably failed to produce even an iota of evidence to the effect that on the date of proposal i.e. on 30.03.1999 the life assured was suffering from any disease and also that she was having knowledge about the said disease on the date of submitting the proposal form. Thus, from the record it is established that the opposite parties wrongly repudiated complainants claim with respect to Insurance Policy bearing No. 171732911 dated 28.01,1999 for Rs.10 lacs and therefore the opposite parties have been proved deficient in service. The complainants are entitled to the insurable benefits in respect of the policy in question.
It is a matter of common knowledge that a person may have suffered of some disease and at the initial stage of the disease in his/her body, one may not be having knowledge unless he/she fell ill or diagnosed by Medical Practitioner/Doctor. No such evidence has been led by the opposite parties in the instant case that the life assured was having knowledge of the disease suffered by her on the date of obtaining the policy in March, 1999, which was diagnosed in October, 1999. The opposite parties have erred in repudiating complainants claim with respect to the Insurance Policy obtained by life assured Smt. Veena Gupta on flimsy ground and therefore the ground taken by the opposite parties in the repudiation letter is not sustainable.
Before parting with the order we express our great concern that the genuine claim of the complainant has been denied by the Life Insurance Corporation and the complainant has been unnecessarily harassed. Therefore the opposite parties are responsible for this lapse on their part and they are liable to pay the entire insured amount to the complainant alongwith interest. So far as awarding of interest on the insured amount, the complainant has sought interest @ 18% per annum. But from the record it is established that the complainant himself has delayed the early decision of this complaint because of applications moved by him from time tome. The complainant had moved an application under Order 1 Rule 10 C.P.C. for impleading Shri M.P. Jain, Branch Manager as one of the opposite party but lateron the said application was dismissed as withdrawn. Another application seeking permission to lead additional evidence was moved by the complainant which was allowed vide order dated 19.05.2006. The record of the case further reflects that the complainant has himself delayed the disposal of this complaint. Thus, under these circumstances we feel that the ends of justice would be met suitably if the complainant is awarded interest not more than @ 6% per annum from the date of repudiation of complainants claim till its realization.
As a sequel to our aforesaid discussions this complaint is accepted with direction to the opposite parties to pay the entire insurable benefits to the complainants with respect to Insurance Policy bearing No. 171732911 dated 28.01.1999 alongwith interest @ 6% per annum from the date of repudiation till its realization. The cost of litigation is quantified at Rs.11,000/-.
Announced: Justice R.S. Madan 26.11.2012 President B.M. Bedi Judicial Member