State Consumer Disputes Redressal Commission
M/S Icici Prudential Life Insurance ... vs 1. Mrs. Veena Sharma Wife Of Late Shri ... on 3 February, 2014
STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA First Appeal No.636 of 2013 Date of Institution: 13.09.2013 Date of Decision: 03.02.2014 M/s ICICI Prudential Life Insurance Company Ltd. having its Branch Office at 2nd Floor, Sheela Shopee Complex, Near IDBI Bank, Sanjay Chowk, G.T. Road Panipat, through its Manager/Sub Divisional Manager/Health Assurance Manager. Appellant (Opposite Party) Versus 1. Mrs. Veena Sharma wife of late Shri Deepak Sharma 2. Prince Sharma (minor) son of Sh. Deepak Sharma Both Residents of H.No.686, HUDA Phase-1, Sector-11, Panipat (respondent-complainant No.2 being minor through his mother Smt. Veena Sharma, respondent-Complainant No.1, being the natural guardian and next friend of minor. Respondents (Complainants) CORAM: Honble Mr. Justice Nawab Singh, President. Mr. B.M. Bedi, Judicial Member. Mrs. Urvashi Agnihotri, Member. For the Parties: Shri Hitender Kansal, Advocate for appellant. Shri Sukhdeep Parmar, Advocate for respondents. O R D E R
B.M. Bedi, Judicial Member:
Whether the insured was suffering from diabetes at the time of submitting the proposal form for obtaining the Insurance Policy of which he was having knowledge at that time? This indeed is the significant question in this appeal.
2. Deepak Sharma (since deceased)-husband of complainant No.1Mrs.Veena Sharma and father of complainant No.2-Prince Sharma (respondents herein) had purchased a Life Insurance Policy from M/s ICICI Prudential Life Insurance Company Ltd.-opposite party (appellant herein), known as SmartKid Policy for his son Prince Sharma for a sum of Rs.2,00,000/-. The annual premium of Rs.15,000/- was to be paid for sixteen years. Deepak Sharma deposited three instalments on dated November 21st, 2008, November 17th, 2009 and November 18th, 2010. Deepak Sharma died on 8th of August, 2011.
3. Respondent No.1 submitted claim with the opposite party but the same was repudiated vide letter dated October 28th, 2011 (Exhibit R-4) on the ground that the Life Assured was suffering from Diabetes Mellitus for the last eight years and was obtaining treatment for the same but this fact was not disclosed by him in the proposal form Exhibit R-1 and thus gave false answers to Question Nos.22 (a), 23(c), (f) and (h) (i).
4. The respondents filed the complaint under Section 12 of the Consumer Protection Act 1986 before District Consumer Disputes Redressal Forum, (for short District Forum), Panipat.
5. The appellant-opposite party filed written statement denying the averments made by the respondent.
6. On evaluating the pleadings of the parties and the evidence brought on the record, District Forum accepted complaint vide order dated July 9th, 2013 whereby direction was given to the appellant to pay Rs.2,00,000/- to the respondents with interest at the rate of 8% per annum from the date of filing the complaint till its realization besides other death benefits. Cost of litigation was quantified at Rs.2200/-.
7. Aggrieved by the order of the District Forum, M/s ICICI Prudential Life Insurance Company Ltd.-appellant has come up in appeal.
8. Learned counsel for the appellant has argued that the Life Assured was suffering from Diabetes Mellitus for the last eight years and was taking treatment for the same but while filling up the proposal form for obtaining the policy, he did not disclose this fact and therefore the contract of insurance became ab initio. Support was sought to be drawn from Discharge Card of G.C. GUPTA HOSPITAL (Ex.R-3).
9. There is no merit in the stand of the learned counsel for the appellant. The Proposal Form (Exhibit R-1) was submitted by the insured on 20th of November, 2008. Discharge Card (Exhibit R-3) reflects that the patient-Deepak remained admitted in the hospital from April 12th, 2010 to April 24th, 2010. This document nowhere reflects that the patient was suffering from diabetes for the last eight years, that is, prior to the date of obtaining the insurance policy.
10. The appellant has miserably failed to produce any cogent and convincing evidence to prove that on the date of submitting the proposal form (Exhibit R-1), that is, on 20th of November, 2008 the life assured was suffering from diabetes and was having knowledge of the same. Support can be had from the judgment rendered by Honble National Commission in L.I.C. of India versus Joginder Kaur and Another, 2005(1) C.P.C. 52 (N.C.), wherein it has been held that:-
.Simple allegations were made by the petitioner that the deceased was alcoholic; was suffering from diabetes mellitus, and jaundice etc would not be sufficient. The unproved case history recorded by some person on the date of admission of Sh. Bachan Singh, the deceased, would not be cogent and convincing evidence to repudiate the claim unless it was coupled with medical report for the treatment prior to submission of the proposal form.
11. In the instant case only photo copy of the Discharge Card placed on the record cannot be termed as authenticated document to prove appellants version. Onus was upon the appellant to prove that the deceased was suffering from a pre-existing disease. Reliance can be placed on the observation made by Honble National Commission in Tarlok Chand Khanna vs. United India Insurance Company Ltd. I(2012) CPJ 84 (NC) wherein it has been held that:-
The onus to prove that the Petitioner was suffering from a pre-existing disease as per settled law is on the respondent. We note that the respondent has not produced any credible documentary evidence/expert medical opinion in support of its case
12. In view of the above, the document, that is, Discharge Summary Exhibit R-3 does not inspire confidence about life assured having suppressed material facts while submitting his proposal.
13. As a sequel to the aforesaid discussion, it has not been established by the appellant that the insured had any pre-existing disease which would justify repudiation of the claim.
14. For the reasons recorded above and particularly in the absence of any credible documentary or other evidence on behalf of the appellant-opposite party, upon whom was the onus to prove the reason for repudiation, this appeal fails and is hereby dismissed.
15. The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the respondents-complainants against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any filed in this case.
Announced:
03.02.2014 (Urvashi Agnihotri) Member (B.M. Bedi) Judicial Member (Nawab Singh) President CL