National Consumer Disputes Redressal
Life Insurance Corporation Of India vs Smt. Baljit Kaur on 15 January, 2013
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO.1548 OF 2012 (Against the order dated 22.12.2011 in First Appeal No.707/2007 of the State Commission, Punjab) Life Insurance Corporation of India (A Body Corporate Constituted under the Life Insurance Corporation Act) H-39, Connaught Place, New Delhi- 110001 .Petitioner Versus Smt. Baljit Kaur W/o Late Joginder Singh S/o Sh. Chuhar Singh R/o Kaki Pind Road, Suryaran Da Khoo, Dakoha, District Jalandhar, Through Sh. Tarsem Lal Wahi, S/o Sh. F.S. Wahi C/o Punjab National Bank, Rama Mandi, Jalandhar, Her Lawful Attorney .........Respondent BEFORE HONBLE MR. JUSTICE J. M. MALIK, PRESIDING MEMBER HONBLE MR. VINAY KUMAR, MEMBER For the Petitioner : Mr.Neeraj Gupta, Advocate For the Respondent : Mr. Anish Verma, Advocate PRONOUNCED ON: 15.01.2013. ORDER
PER MR.VINAY KUMAR, MEMBER The Life Insurance Corporation of India has filed this revision petition against the order of Punjab State Consumer Disputes Redressal Commission in FA No.707 of 2007. The matter arose out of a life insurance policy taken by one Shri Joginder Singh on 15.6.2003. Over one year later, the insured died on 16.8.2004. Therefore, a claim under the policy was made by his wife/Complainant Smt. Baljt Kaur. The claim was repudiated by the OP/Life Insurance Corporation of India on 26.3.2005, on the ground that the deceased had withheld information regarding his health condition at the time of effecting the insurance. The letter of repudiation referred to information supplied by the insured in the proposal form to five specific questions in parts (a), (c),
(d), (e) & (i) of column 11. At 11(i), the answer to the question on the usual state of health was good. In other 4 parts i.e. (a), (c), (d) and (e) it was No. The letter gave it as the reasons for repudiation of the claim stating that:-
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 he had suffered from PUO and remained admitted in Hopital from 12-09-2002 to 11-10-2002, taken many medical leaves before taking this insurance due to ill health. He did not, however, disclose these facts in his proposal. Instead he gave false answers therein as stated above.
It is, therefore, evident that he had made deliberate mis-statement and with- held material information from us regarding his health at the time of effecting the assurance and hence in terms of the policy contract and the declarations 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.
2. District Consumer Redressal Forum, Jallandhar held it to be a case where the insured had made false statements regarding his health and therefore, dismissed the complaint. The appeal filed by the Complainant against this order was allowed by the State Commission, holding that the claim of the appellant did not come within the ambit of suppression of material facts or fraud by the insured, which could have justified repudiation of the claim.
3. Life Insurance Corporation of India has challenged this order, mainly on the ground that the State Commission was wrong in allowing the claim under the policy on the ground that the cause of death had no nexus with the pre-existing diseases which was suppressed from the Insurance Co, at the time of taking the policy.
It is also contended that it is not the cause of death, but the pre-existing disease of the insured which is material for deciding the liability under the policy.
4. In the present proceedings, the revision petitioner has been represented by Shri Neeraj Gupta, Advocate and the respondent/Complainant by Shri Anish Verma, Advocate. The delay of 18 days in filing the revision petition has been condoned, considering the explanation offered by the petitioner. We have also perused the records with care and heard the two counsels.
5. Learned counsel for the Life Insurance Corporation of India referred to the contents of the proposal form of 12.6.2003 submitted by the insured, late Joginder Singh with reference to the letter of repudiation of 26.3.2005. He argued that nearly eight months before submitting the proposal for insurance, late Joginder Singh had been admitted in a hospital for a month during September-October 2002. But, this was not disclosed in the proposal.
In turn, the counsel for the respondent/Complainant drew our attention to a clear finding to the contrary given by the State Commission in para 11 of its order to the effect that:-
The appellant has not denied the fact that the insured had taken the treatment from 12.09.2002 to 11.10.2002 from the Railway Hospital, Jallandhar Cantt. as he was suffering from Pyrexia (fever of unknown origin) as a outdoor patient.
On this point, we find that the District Forum has also referred to documents marked Ext. C-6 and C-7, according to which the deceased was only an out-door patient and had been declared fit on 11.02.2002. We must therefore, observe that the claim made in the letter of repudiation that the insured remained admitted in hospital from 12-9-2002 to 11-10-20002 turns out to be factually incorrect.
6. The State Commission has examined medical literature in the context of the allegation that the Complainant was suffering from PUO, which stands for Pyrexia of Unknown Origin. Therefore, the State Commission has observed that:-
So from the above medical reference, the pyrexia fever of unknown origin was not a disease, which was not disclosed by the deceased/insured to the respondent at the time of filling of the proposal form. So the questions asked to the insured and replied by him as referred by the respondent are also not having any material significance which points out towards material suppression of facts on the part of the insured.
7. What comes out from the medical literature referred to by the State Commission is that fever cannot be considered a disease, by itself. It is just a symptom and can be due to several causes. In the preset case, the cause remained unidentified. Hence, the record of treatment shows it as PUO i.e. Pyrexia of Unknown Origin. We have also examined it. Blacks Medical Dictionary, 41st Edition shows that pyrexia i.e. fever generally accompanies a disease. In the case before us, the disease or the cause behind the fever, which lasted a month, remained unidentified. Therefore, the question of late Jogindar Singh, having known the disease he suffered from and having deliberately not disclosed it in the proposal form, would not arise at all.
8. We therefore find no basis to disturb the well-considered finding of fact given by the State Commission. The revision petition filed by the Life Insurance Corporation of India is held to be devoid of any merit and is dismissed as such. No orders as to costs.
.Sd/-
(J. M. MALIK, J.) PRESIDING MEMBER Sd/-.
(VINAY KUMAR) MEMBER S./-