State Consumer Disputes Redressal Commission
Pardeep Kumar Son Of Shri Hardwari Lal vs Life Insurance Corporation Of India, on 10 May, 2013
2nd Addl. Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 1289 of 2009
Date of institution: 10.9.2009
Date of decision : 10.5.2013
Pardeep Kumar son of Shri Hardwari Lal, Arya Nagar, Kartarpur, Tehsil
and District Jalandhar.
.....Appellant
Versus
1. Life Insurance Corporation of India, Divisional Office, Model Town
Road, Jalandhar - 144001 through its Senior Divisional Manager.
2. Life Insurance Corporation of India, Branch Office, Kartarpur
through its Branch Manager.
.....Respondents
First Appeal against the order dated 3.6.2009
passed by the District Consumer Disputes
Redressal Forum, Jalandhar.
Before:-
Shri Piare Lal Garg, Presiding Member
Shri Jasbir Singh Gill, Member Present:-
For the appellant : Sh. K.C. Malhotra, Advocate
For the respondents : Sh. B.J. Singh, Advocate
PIARE LAL GARG, PRESIDING MEMBER
This is an appeal filed by the appellant/complainant-Pardeep Kumar(hereinafter called 'the appellant') against the order dated 3.6.2009 of the District Consumer Disputes Redressal Forum, Jalandhar(hereinafter called the 'District Forum') vide which the complaint of the appellant was dismissed by the District Forum.
2. Brief facts of the case are that the mother of the appellant Smt. Rama Rani since deceased (hereinafter called 'the LA') was insured vide policies bearing Nos. 131569357, 131569358, 131569359, 131569362 each for Rs. 25,000/- under accidental benefit i.e. Table No. 14 First Appeal No. 1289 of 2009 2 for term of 11 years by the respondents. The policies commenced from 28.3.2002 and the premiums of the same was Rs. 2701/- per year of each policy. The LA was also medically examined by the Doctor on the panel of the respondents at the time of acceptance of the proposal form. The insured was hale and hearty at the time of taking the insurance policies. The LA suffered suddenly a heart attack and expired on 12.4.2004. The appellant as a nominee lodged the claim with the respondents but the claim was not settled by the respondents despite repeated requests by the appellant. No intimation regarding the repudiation of the claim was given to the appellant. Registered notice was also served by the appellant upon the respondents on 6.9.2007 but the same was not replied by the respondents. Complaint was filed by the appellant with the prayer that the respondents may be directed to settle the claim amount and to pay the same alongwith interest @ 18% per annum from the date of death till its payment. It was also prayed that Rs. 50,000/- as compensation and Rs. 10,000/- as litigation expenses may also be awarded to the appellant.
3. Upon notice, reply was filed by the respondents/opposite parties taking preliminary objections that the complaint was time barred, the complaint was not maintainable, the claim of the appellant was repudiated on 22.11.2004 and the complaint was filed on 24.9.2007 i.e. not within two years from the repudiation of the claim, the LA was not having good health at the time of taking the policy, she was patient of diabetic, hyper tension, kidney problem and facial paralysis and gall bladder stones, Form No. 3816 was issued by Patel Hospital, Jalandhar and as per the same she had taken the treatment from the above hospital as Out-door Patient for the above diseases from October, 2001 till March, 2004 but she deliberately concealed this information at the time of filling the proposal form. The concerned agent also joined hands with the LA. The repudiation letter was sent to Sh. Hardwari Lal husband of the LA. On merits, the First Appeal No. 1289 of 2009 3 issuance of the policies as well as medical check up by the Doctor was not denied but it was pleaded that only routine check up was made until the life assured disclosed regarding the ailments for which various tests and examination are needed. As the life assured had not disclosed the ailments from which she was suffering, no test or examination was conducted by the Doctor. The other averments of the complaint were denied as incorrect and dismissal of the complaint was prayed.
4. The District Forum, after hearing the learned counsel for the parties and going through the record, dismissed the complaint.
5. Aggrieved against the order of the District Forum, the present appeal was filed on the grounds that the order of the District Forum is against the evidence produced by the appellant, the District Forum committed material and serious illegalities at the time of passing the order, as such, the order of the District Forum is liable to be set-aside.
6. We have gone through the pleadings of the parties, grounds of appeal, perused the record of the learned District Forum and heard the arguments of the learned counsel for the parties.
7. There is no dispute between the parties that the LA was assured with the respondents for an amount of Rs. 1 lac through four policies of Rs. 25,000/- each under Endowment Assurance Policies with Profits plus Acc. Benefits. i.e. under Table 14-11 (for 11 years). The maturity date of the policies was 28.3.2013.
8. There is also no dispute between the parties that the LA died on 12.4.2004. It is also admitted by the respondents that the claim was lodged by the appellant - Pardeep Kumar nominee. The version of the respondents is that the information regarding the repudiation of claim was sent to Hardwari Lal husband of the LA on 16.12.2004. Copy of the dispatch register Ex. O-14 also tendered into evidence by the respondents. First Appeal No. 1289 of 2009 4
9. So from the version of the respondents, it is proved beyond doubt that no information regarding the repudiation of the claim was sent to the appellant till the filing of the complaint. It is settled law that the limitation for filing of the complaint starts from the date of knowledge of the repudiation of the claim to the person, who submit the claim as held by the Hon'ble State Consumer Disputes Redressal Commission, Panchkula in case "HUDA through its Administrator and Anr. Versus Raj Pal Singh", 2010 (1) CLT 567 and discussed the point of limitation and observed in para No. 10 as follows:-
"10. It is further contended by the learned counsel for the appellants-opposite parties that allotment of the plot to the complainant was made in the year 1998 whereas the present complaint was filed before the District Forum in the year 2004 and as such the complaint was beyond the period of limitation of two years as provided in Section 24-A of the Consumer Protection Act.
On this point learned counsel relied upon the decision of the Hon'ble Supreme Court in case State Bank of India vs. M/s B.S. Agricultural Industries (I), vol. CLIV-(2009-2) The Punjab Law Reporter 496 (S.C.), wherein the Hon'ble Apex Court has held that:
"Limitation - Expression 'shall not admit a complaint' occurring in Section 24-A is sort of a legislative command to the Consumer Forum to examine on its own whether the complaint has been filed within limitation period prescribed thereunder - As a matter of law, the Consumer Forum must deal with the complaint on merits only if the complaint has been filed within two years from the date of accrual of cause of action and if beyond the said period the sufficient cause has been recorded in writing."
After examining the facts and circumstances of the case, we do not find it a fit case to the observations made in the above cited case of the Hon'ble Apex Court. In the above cited case the possession of the booth was delivered to the allottee in the year 1987. Furthermore, the bhatties which were alleged to hae caused loss and damage to the complainant, as stated in the complaint, had been installed before 1989 and removed in 1994 whereas the complainant had filed complaint before the State Commission in 1997 i.e. ten years after obtaining possession and eight years after the cause of alleged damage commenced and three years after that cause ceased.
But in the instant case though the cause of action had arisen in the year 1998 when the complainant was allotted plot No. 608 in Sector-12, Sonepat but this cause of action did not cease as admittedly the possession nof the plot was not delivered to the complainant till the filing of the complaint before the District Forum in the year 2004 and the possession was delivered to the complainant on 30.05.2005 i.e. during the pendency of the complaint before the District Forum First Appeal No. 1289 of 2009 5 and as such the case law of the Hon'ble Apex Court is not attracted to the present case and no case of time barred is made out.
For the reasons recorded above, we do not see any infirmity in the impugned order and deficiency in service on the part of the opposite parties in not delivering possession to the complainant for a long period of seven years from the date of allotment has been amply proved.
Finding no merit in this appeal, it is dismissed."
10. In view of the above discussion, the findings of the District Forum that the complaint was not filed within limitation are not correct.
11. The claim of the appellant was repudiated by the respondents vide letter Ex. O-2 dated 22.11.2004. The relevant part of the same is reproduced:-
"With reference to your claim under the above policy on the life of your deceased wife, we have to inform you that we have decided to repudiate all liability under the policy on account of deceased having with-held material information regarding her health at the time of effecting the assurance with us. In this connection, we have to inform you that in the proposal for assurance dated 30.03.2002, signed by the deceased assured on 30-03-2002, the risk under this proposal was accepted on 30-03-2012. At the time of submission of her proposal, she had answered the following questions as under noted:-
QUESTIONS ANSWERS
11.(a) During the last five years did you consult a Medical NO
Practitioner for any ailment requiring treatment for more than a week?
(d) Are you suffering from or have you ever suffered NO from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System?
(e) Are you suffering from or have ever suffered from NO diabetes, tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, hernia hydrocele, leprosy or any other disease.
(i) What has been your usual state of health? GOOD We may, however, state that all these answers were false as we hold indisputable proof to show that before he submitted the proposal for the above policy she had suffered from Diabetes, Hypertension, kidney problem, facial paralysis and gall stone. She did not, however, disclose these facts in her proposal. Instead she gave false answers therein as stated above.
It is, therefore, evident that she had made deliberate mis-statement and with - held material information from us regarding her health at the time of effecting the assurance and hence in terms of the policy contract and the declarations First Appeal No. 1289 of 2009 6 contained in the forms of proposal for assurance and personal statement, we hereby repudiate the claim and accordingly we are not liable for any payment under the above policy and all moneys that have been paid in consequence thereof belong to us.
In case, you are not satisfied with our above decision and fee that we have not considered any particular fact and circumstances in support of your claim, you may send your representation within a month for re consideration of your claim to our Zonal Office at the following address:
"THE ZONAL MANAGER, L.I.C. OF INDIA, NORTHERN ZONAL OFFICE, "JEEVAN BHARTI BUILDING, 124, CONNAUGHT CIRCUS, NEW DELHI - 110 001"
12. To prove that the LA was taking the treatment from Patel Hospital Pvt. Ltd., Jalandhar as Out-door Patient, the respondents tendered into evidence affidavit Ex. OW-A of Dr. B.S. Chopra, M.D. Patel Hospital and Ex. OW-5 Form No. 3816 to prove its version that the LA was taking the treatment before filling of the proposal forms i.e. after taking the policies and she had intentionally not disclosed her ailment.
13. We have perused the affidavit of Dr. B.S. Chopra but no specific date is mentioned in the affidavit on which the LA had taken the treatment from his hospital as outdoor patient. Dr. B.S. Chopra has also not stated on Oath in his affidavit that LA had taken any treatment from him or she remained under his treatment. It is not possible for a human being to remember the name as well as the period of the patient, who had taken treatment as out-door patient from the hospital. It is proved beyond doubt that the respondents had procured the above false affidavit of Dr. B.S. Chopra only to repudiate the claim of the appellant.
14. The respondents had also not produced the out-door patient register of the hospital for the period from October, 2001 till March, 2004 to prove that the LA had ever taken treatment from the above mentioned hospital as 'Out-door Patient'. It was held by the Hon'ble National First Appeal No. 1289 of 2009 7 Commission in case "Life Insurance Corporation of India & Anr. Versus Naseem Bano", 2013 (1) CPC 491 that heart attack has no nexus with ailment of diabetes and hypertension and observed in para No. 3 as under:-
"3. To our mind, the evidence adduced by the LIC is exiguous. They should have produced some more material before the Court to prove that the deceased was suffering from these ailments, secondly he was aware of the same and thirdly, he got the treatment for these diseases. It is difficult to say as to who had made statement before the above-said hospital. The 'Bed-Head Ticket' does not mention the name of any person. Moreover, the 'Bed-Head Ticket' cannot be the conclusive proof. There is no piece of evidence which may go to show that prior to filling-up of the policy form, record of any hospital, slips of doctors, any prescriptions showing the name of medicines which the deceased must be taking, saw the light of the day. In the absence of those important documents, the position does not begin to jell. Their absence goes to enervate the petitioners case. Secondly, the deceased expired due to heart attack. Heart attack has no nexus with the ailments like Diabetic Mellitus and Hypertension."
15. The version of the respondents is that the LA was suffering from sided facial paralysis before the filling of the proposal form. It is also not disputed that at the time of filling the proposal form, the LA was medically examined by the Doctor, who was on the panel of the respondents. If she was suffering from facial paralysis then it could be noted by the Doctor that she was suffering from such disease. Facial paralysis was not internal disease and that could be looked by the Doctor with the naked eye. It is also not the version of the respondents that its Doctor had neither medically examined the LA nor that the certificate regarding the fitness of LA to insure was issued by the Doctor with the connivance of the LA.
16. We have also perused Form No. 3816 Ex. O-5. No age of Rama Rani is mentioned in the said form. It is also reported that the LA was never admitted in the hospital. No name of any Doctor is mentioned in the form from whom she had taken the treatment. No specific date or entry of the out-door patient register is mentioned in Form No. 3816. The form is First Appeal No. 1289 of 2009 8 also signed by Mr. B.S. Chopra and from the perusal of Form No. 3816, it is proved beyond doubt that this form is also issued by Dr. B.S. Chopra only to frustrate the claim of the appellant as column No. 7 of Form No. 3816 was cancelled/crossed, which relates to the history of the patient regarding the ailments which she was allegedly suffering.
17. The version of the appellant is that the LA died due to heart attack but the version of the respondents that there is no evidence that the LA died due to heart attack.
18. We have perused the Claim Inquiry Report Ex. O-17 and as per column No. 18-A(iii) the cause of death is reported "heart attack". The Inquiry was made by Sh. R.S. Walia, Branch Manager, Kapurthala - Investigator of the respondents and his affidavit is also tendered into evidence by the respondents as Ex. OW/B.
19. So from the Investigation Report, it is also proved beyond doubt that the cause of death of LA was heart attack and the version of the respondents that there is no evidence that the LA died due to heart attack is not correct. It is also correct from Medical Examiner's Confidential Report Ex. C-6 that the life assured was not a very much literate person as she signed in Hindi and the answers given to the questions put to her are written in English on the form and it is not clear that how these questions were interpreted/explained to her. As per Dr. Sunita Arora, the general appearance of the LA was healthy and also certified that she was not related to LA or the Agent or the Development Officer. Hon'ble Madras High Court in case "Athayee (died) and another v. Life Insurance Corporation of India", AIR 2003 Madras 382 held in para No. 11.20 as follows:-
"11.20 In this case, we have no evidence whatsoever from any person as to who put the questions to this assured, how they were interpreted to him or who wrote the answers. There is also a certificate issued under Ex. B-15, whereby Dr. R. Swaminathan of R. Thiruchengode had, after mentioning about the health of the First Appeal No. 1289 of 2009 9 deceased Muthu Gounder, specifically contended that the health by then was in first class condition. This Doctor Swaminathan had not been examined by the Insurance Company. If he was subjected to cross-examination, it would have been made known as to whether the health condition of Muthu Gounder was first class or not. It is in this circumstance, the mere signature of Muthu Gounder found in the proposal where the contents have been filled in by someone else and more particularly Kulandaivel as evidenced by P.W. 1 will not go to clothe an element of fraud upon Muthu Gounder."
20. It is also the version of the respondents that the policies were taken by the LA with the connivance of their Agent but the respondents had not brought any iota of evidence what action was taken by the respondents against the agent for his mischief as alleged by the respondents that the LA was not having the good health at the time of filling the proposal form. It was also held by the Hon'ble National Commission in its recent judgment "Life insurance Corporation of India and Anr. Versus Chaitanya Das, Advocate and Anr.", 2013(1) CPR 199(NC) that the insurance companies are responsible for the act of its Agent and held in para No. 6 as follows in this regard:-
"6. This contention is at best a very feeble attempt to find an explanation for what has happened. We have already quoted from the written response of the Ops before the District Forum. It comes very close to admitting the allegation of the Complainant that the proposal form was filled by the agent himself. Even before the District Forum, the revision petitioners confined themselves to merely arguing that:-
"The complainant is an educated and legal expert person. If he had appended his signatures on the simple papers on the directions of the Opposite Party No. 3 Agent, in that event the complainant himself is liable for this lapse."
This again is an indirect admission of the allegation of the OP-3 before the District Forum, not did it lead any other evidence to show that the proposal form was not filled up by OP-3. Therefore, this contention of the revision petitioner has no leg to stand."
21. In view of the above discussion, it is clear that the respondent has wrongly repudiated the claim of the appellant. The appeal of the appellant is accepted and the respondents are directed to pay to the First Appeal No. 1289 of 2009 10 appellant the insurance claim of policies bearing Nos. 131569357, 131569358, 131569359, 131569362 with all benefits accrued thereon with 9% per annum interest after three months from the date of filing of the claim till payment within one month from the receipt of copy of the order. Consequently, the complaint filed by the appellant/complainant is accepted. No order as to costs.
22. The arguments in this appeal were heard on 3.5.2013 and the order was reserved. Now the order be communicated to the parties.
23. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Piare Lal Garg)
Presiding Member
May 10, 2013. (Jasbir Singh Gill)
as Member