State Consumer Disputes Redressal Commission
Life Insuracne Corpoation Of India & ... vs Smt. Neetu Namdhari on 9 April, 2012
BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SOLAN, H
H.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, SHIMLA.
First
Appeal No: 132/2008
Date
of Decision: 09.04.2012
1. Life Insurance Corporation of India,
Zonal Manager, Northern Zonal Office,
New Delhi.
2. Life Insurance Corporation of India,
Through its Divisional Manager,
L.I.C. Shimla.
3. Branch Manager, LIC, Branch Office,
Mandi, District Mandi.
Appellants
Versus
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar Nagar,
Mandi,
District Mandi, H.P.
Respondent
For the
Appellants: Mr. Navlesh
Verma, Advocate.
For the
Respondent: Mr. Amit K. Vaid,
Advocate.
First
Appeal No: 133/2008
Date
of Decision: 09.04.2012.
1. Life Insurance Corporation of India,
Zonal Manager, Northern Zonal Office,
New Delhi.
2. Life Insurance Corporation of India,
Through its Divisional Manager,
L.I.C. Shimla.
3. Branch Manager, LIC, Branch Office,
Mandi, District Mandi.
Appellants
Versus
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar
Nagar, Mandi,
District Mandi, H.P.
Respondent
For the
Appellants: Mr. Navlesh
Verma, Advocate.
For the
Respondent: Mr. Amit K. Vaid,
Advocate.
First
Appeal No: 134/2008
Date
of Decision: 09.04.2012.
1. Life Insurance Corporation of India,
Zonal Manager, Northern Zonal Office,
New Delhi.
2. Life Insurance Corporation of India,
Through its Divisional Manager,
L.I.C. Shimla.
3. Branch Manager, LIC, Branch Office,
Mandi, District Mandi.
Appellants
Versus
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar Nagar,
Mandi,
District Mandi, H.P.
Respondent
For the
Appellants: Mr. Navlesh
Verma, Advocate.
For the
Respondent: Mr. Amit K. Vaid,
Advocate.
..
First
Appeal No: 135/2008
Date
of Decision: 09.04.2012.
1. Life Insurance Corporation of India,
Zonal
Manager, Northern Zonal Office,
New
Delhi.
2. Life Insurance Corporation of India,
Through its Divisional Manager,
L.I.C. Shimla.
3. Branch Manager, LIC, Branch Office,
Mandi, District Mandi.
Appellants
Versus
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar
Nagar, Mandi,
District Mandi, H.P.
Respondent
For the
Appellants: Mr. Navlesh
Verma, Advocate.
For the
Respondent: Mr. Amit K. Vaid,
Advocate.
..
First
Appeal No: 136/2008
Date
of Decision: 09.04.2012.
1.
Life Insurance
Corporation of India,
Zonal Manager, Northern Zonal Office,
New Delhi.
2. Life Insurance Corporation of India,
Through its Divisional Manager,
L.I.C. Shimla.
3. Branch Manager, LIC, Branch Office,
Mandi, District Mandi.
Appellants
Versus
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar
Nagar, Mandi,
District Mandi, H.P.
Respondent
For the
Appellants: Mr. Navlesh
Verma, Advocate.
For the
Respondent: Mr. Amit K. Vaid,
Advocate.
First
Appeal No: 83/2008
Date
of Decision: 09.04.2012.
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar
Nagar, Mandi,
Himachal Pradesh.
Appellant
Versus
1.
Life Insurance
Corporation of India,
Mandi Branch,
Through its Manager, Post Office Road
Mandi.
2. Life Insurance Corporation of India,
Divisional Officer,
Through its Senior Divisional
Manager,
Block No. No.14-15, S.D.A. Complex, Kasumpti, Shimla-9.
3. Life Insurance Corporation of India,
Zonal Manager, Northern Zonal Office,
Jeeevan Bharti, Connaught Circle, New
Delhi-110001.
Respondents
For the
Appellant: Mr. Amit K.
Vaid, Advocate.
For the
Respondents: Mr. Navlesh Verma,
Advocate.
First
Appeal No: 84/2008
Date
of Decision: 09.04.2012.
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar
Nagar, Mandi,
Himachal Pradesh.
Appellant
Versus
1.
Life Insurance
Corporation of India,
Mandi Branch,
Through its Manager, Post Office Road
Mandi.
2. Life Insurance Corporation of India,
Divisional Officer,
Through its Senior Divisional
Manager,
Block No. No.14-15, S.D.A. Complex, Kasumpti, Shimla-9.
3. Life Insurance Corporation of India,
Zonal Manager, Northern Zonal Office,
Jeeevan Bharti, Connaught Circle, New
Delhi-110001.
Respondents
For the
Appellant: Mr. Amit K.
Vaid, Advocate.
For the
Respondents: Mr. Navlesh Verma, Advocate.
First
Appeal No: 85/2008
Date
of Decision: 09.04.2012.
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar
Nagar, Mandi,
Himachal Pradesh.
Appellant
Versus
1.
Life Insurance
Corporation of India,
Mandi Branch,
Through its Manager, Post Office Road
Mandi.
2. Life Insurance Corporation of India,
Divisional Officer,
Through its Senior Divisional
Manager,
Block No. No.14-15, S.D.A. Complex, Kasumpti, Shimla-9.
3. Life Insurance Corporation of India,
Zonal Manager, Northern Zonal Office,
Jeeevan Bharti, Connaught Circle, New
Delhi-110001.
Respondents
For the
Appellant: Mr. Amit K.
Vaid, Advocate.
For the
Respondents: Mr. Navlesh Verma,
Advocate.
First
Appeal No: 86/2008
Date
of Decision: 09.04.2012.
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar
Nagar, Mandi,
Himachal Pradesh.
Appellant
Versus
2.
Life Insurance
Corporation of India,
Mandi Branch,
Through its Manager, Post Office Road
Mandi.
2. Life Insurance Corporation of India,
Divisional Officer,
Through its Senior Divisional
Manager,
Block No. No.14-15, S.D.A. Complex, Kasumpti, Shimla-9.
3. Life Insurance Corporation of India,
Zonal Manager, Northern Zonal Office,
Jeeevan Bharti, Connaught Circle, New
Delhi-110001.
Respondents
For the
Appellant: Mr. Amit K.
Vaid, Advocate.
For the
Respondents: Mr. Navlesh Verma,
Advocate.
First Appeal No: 87/2008
Date
of Decision: 09.04.2012.
Smt. Neetu Namdhari Wd/O Shri
Malvinder Singh,
R/O House No.110 (New), Jawahar
Nagar, Mandi,
Himachal Pradesh.
Appellant
Versus
1.
Life Insurance
Corporation of India,
Mandi Branch,
Through its Manager, Post Office Road
Mandi.
2. Life Insurance Corporation of India,
Divisional Officer,
Through its Senior Divisional
Manager,
Block No. No.14-15, S.D.A. Complex, Kasumpti, Shimla-9.
3. Life Insurance Corporation of India,
Zonal Manager, Northern Zonal Office,
Jeeevan Bharti, Connaught Circle, New
Delhi-110001.
Respondents
Coram
Honble
Mr. Justice Surjit Singh, President
Honble
Mr. Chander Shekhar Sharma, Member
Honble
Mrs. Prem Chauhan, Member
Whether
approved for reporting?[1]Yes.
For the
Appellant: Mr. Amit K.
Vaid, Advocate.
For the
Respondents: Mr. Navlesh Verma,
Advocate.
O R D E R:
Justice Surjit Singh, President (Oral) By this common order, we are disposing of ten appeals, particulars whereof, are mentioned in title of this order, as similar questions of law and facts are involved in all appeals and parties to all the appeals are also the same.
2. Facts, relevant for the disposal of appeals, may be noticed. Smt. Neetu Namdhari, appellant in F.A. Nos. 83/2008, 84/2008, 85/2008 86/2008 & 87/2008, hereinafter referred to as complainant, filed five complaints, under section 12 of the Consumer Protection Act, 1986, before learned District Consumer Disputes Redressal Forum, Mandi, seeking issuance of a direction to the Life Insurance Corporation of India, and its functionaries, impleaded as opposite parties, who are appellants in the remaining five appeals, for payment of insurance claims, as lodged by her (complainant) with the opposite parties on account of death of her husband late Shri Malvinder Singh, whose life was insured with the opposite parties for varying amounts of money against five different policies, particulars whereof, are as follows:-
Sr. No. Policy No. Date from which the policy was effective.
Sum assured
1.
151411894 28.10.2003 `5.00 lacs
2. 151417896 28.04.2005 `5.00 lacs
3. 151684187 15.03.2005 `5.00 lacs
4. 151686089 28.04.2005 `4.00 lacs
5. 151414550 28.05.2003 `5.00 lacs
3. It was alleged in the complaints that Malvinder Singh, husband of the complainant had purchased five policies on his life from the opposite parties. Printed proposal forms were filled in by an agent of the opposite party, who obtained Malvinder Singhs signatures on the said form, when the same were blank. It was alleged that Malvinder Singh, himself was only 5th standard pass and hence unable to read the forms, leave alone capable to fill-in the same. It was stated that Malvinder Singh had been having a mild problem of indigestion and when he visited a doctor at Mandi, where he used to reside, with the problem of indigestion, he referred him to Sir Ganga Ram Hospital, at New Delhi, where it was detected that he was suffering from liver cirrhosis, which required transplantation of liver. Complainant offered a portion of her own liver for transplantation, but the operation was not successful. There had been internal bleeding, which resulted in the death of Malvinder Singh. Complainant informed the opposite parties of the death of her husband and submitted five claims, one in respect of each policy to the opposite parties. Claim was repudiated by the opposite parties on the pretext that the deceased was not enjoying good health, had been suffering from diabetes mellitus and had several other ailments which he had concealed/suppressed while answering various parts of question No.11.
4. Notice of the complaint was issued to the opposite parties, who filed reply and contested the claim of the complainant, on the same ground on which the claims were repudiated.
5. Learned District Forum, vide five separate orders (each dated 29.02.2008) passed in the five complaints held that the deceased had suppressed material facts with respect to his ailments and state of health, which mislead the opposite parties to enter into the contracts of insurance and because of this, the complainant was not entitled to the insurance claims. With these findings, the learned District Forum, disposed of the complaints with a direction to the opposite parties, to refund premium charged from the deceased, with interest at the rate of 9% per annum, from the dates of receipt of premium.
6. Both the complainant and the opposite parties are aggrieved by the orders of learned District Forum. So, they have filed separate appeals against each of the five orders. Opposite parties seek the dismissal of the complaints in their entirety, while the complainants seek a direction to the opposite parties to pay the sums assured with interest. Complainant has challenged the findings of the learned District Forum that the deceased had suppressed material information relating to the state of his health, as also the finding that the opposite parties are not guilty of any deficiency in service.
7. We have heard learned counsel for the parties and gone through the record.
8. Opposite parties have placed on record the proposal forms, filled in for obtaining each of the five policies. Forms are marked Annexure RW-2 in all the five complaints. Answers to questions No.10 & 11 appearing in these forms are as follows:-
Q:10
Family history LIVING DEAD Present age State of health If dead, age of death Cause of death Father 61 Illness Mother 56 Good Brother living No.1 Dead No. Nil 32 Good Sister living No.1 Dead No. Nil 36 Good Wife/husband 28 Good Children living No.2 Dead No.nil 8, 2 Both good Q:11
(a) During the last five years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week.
No.
(b) Have you ever been admitted to any hospital or nursing home for general check up observation treatment or operation?
No.
(c) Have you remained absent from place of work on grounds of health during the last 5 years?
No.
(d) Are you suffering from or have you ever suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, kidney, Brain or Nervous system?
No.
e) Are you suffering from or have you ever suffered from diabetes, Tuberculoses, High Blood Pressure, Lower Blood Pressure, Cancer, Epilepsy, Hemia, Hydrocele, Leprosy or any other disease?
No.
f) Do you have any bodily defects or deformity?
No.
g) Do you ever have any accident or injury?
No.
h) Do you use or have you ever used?
No. (1) Alcoholic Drinks No. (2) Narcotics No. (3) Any other drug No. (4) Tobacco in any form No.
(i) What has been your usual state of health?
Good
(j) Have you ever received or at present availing/undergoing medical advice, treatment or test in connection with Hepatitis B or on AIDS related condition?
No.
9. It has been submitted on behalf of the complainant that deceased Malvinder Singh, himself was only 5th standard pass and hence unable to fill-in the proposal forms. He also submits that signatures of Malvinder Singh, had been obtained on all these forms, when same were blank and later on, the agent of the opposite parties, at whose instance the policies were purchased, filled-in those forms. Learned counsel submits that the contention stands established from the fact that in the forms against column No.5, his qualification is written as matriculate, while actually he was only 5th standard pass. It is submitted that since forms were filled-in by the agent of the opposite parties without consulting Malvinder Singh, the plea of suppression of material information by the life assured, cannot be accepted.
10. May be that the forms were filled-in by an agent of opposite parties, as is alleged in the complaint and is being canvassed by the learned counsel representing the complainant, but it is also the complainants own case that Malvinder Singh, had been examined by a Medical Officer on the panel of the opposite parties, who on the basis of the information disclosed by life assured, recommended the acceptance of the proposals. Doctor who examined the life assured obtained his signatures below proposal forms. As per these forms, the answers to question No.10 onwards were admitted to be correct by the proposer and thereafter, he put his signature in his presence. Signature of the proposer appears on the form opposite the signature and stamp of the doctor. In view of this certification by the doctor, complainant cannot be heard to say that answers to question No.10 onwards were filled-in by the agent, on his own.
11. Learned District Forum had appointed Dr. Jiwa Nand Chauhan, Medical Officer, Zonal Hospital, Mandi as Local Commissioner to visit Sir Ganga Ram Hospital, New Delhi, where the life assured was operated upon for liver ailment and where he died because of the operation being not successful and to question the doctor, who had treated the deceased. Said doctor visited hospital on 06.02.2008 and recorded the answers to the interrogatories given by Dr. A.S. Soin, who treated the deceased. The said Doctor in answer to question No. 3 (d) stated that history of the case was reported to a team of resident doctors. In answer to interrogatory No. (4), doctor stated the deceased was diagnosed to be a patient of cirrhosis liver. In reply to interrogatory No.5, he stated that besides the aforesaid cirrhosis liver, he was suffering from diabetic mellitus. Said local commissioner submitted with his report various documents, including his report dated 12.02.2008. This report is available at page 76. As per this report, it was revealed by the resident doctor of Sir Ganga Ram Hospital, Delhi, that the deceased was a case of diabetic mellitus and had been under treatment since 1996. Said resident doctor had also informed that the patient had episode of upper gastro inteshnal bleeding in 1999 and was admitted to PGI Chandigarh, where endoscopy and EST were done.
12. With his aforesaid report Dr. Jiwa Nand Chauhan, submitted photostat copies of the history recorded at the time of the admission of the deceased to Sir Ganga Ram Hospital, New Delhi. History sheet corroborates the aforesaid report regarding the deceased having informed that he had been a patient of diabetes mellitus since 1996 and in the year 1999, he had been admitted in PGI, Chandigarh, where endoscopy and EST were done. However, in the proposal form RW-2, while answering question Nos.10 & 11 the deceased stated that his health was good. He also stated that during last 5 years, he had not been suffering from any ailment requiring medical treatment for more-than a week, he had not been admitted to any hospital for treatment or operation etc. and he had not been suffering from diabetes. These answers were apparently incorrect because he had been a known patient of diabetes mellitus since 1996 and had also remained admitted in PGI in 1999 for upper gastro inteshnal bleeding, where he was subjected to endoscopy and EST.
13. Honble Supreme Court in Satwant Kaur Sandhu versus New India Assurance Company Ltd.,2009 CTJ 956 (Supreme Court) (CP), has held that contract of insurance is based on utmost good faith and if the proposer suppresses material information asked for, in the form of questions in the proposal form, insurer is entitled to repudiate the claim. It has also been held that it is not for the courts to hold as to what is material information and that this depends upon the information asked of the proposer in the proposal form.
14. In view of the above discussion, we uphold the findings of the learned District Forum that the proposer had suppressed material facts disentitling his LRs/nominee to claim the insured sums. However, we find ourselves unable to endorse the final order of the learned District Forum, directing the opposite parties to refund the amounts of money charged from the deceased by way of premium. Reason is that neither the complainant claimed the refund of the premium amount nor are the legal heirs of the life assured entitled to the refund of the premium money, where the claim is liable to repudiation or rejection because of suppression of material facts and information. Consequently, all the five appeals filed by the Life Insurance Corporation of India, are accepted. Impugned orders passed by the learned District Forum, in each of the five complaints are set aside and the complaints dismissed. As a sequel to the dismissal of the complaints, appeals filed by the complainant become infructous and are therefore dismissed.
15. This order shall be placed on the record of F.A. No. 132/2008, titled Life Insurance Corporation of India & others versus Neetu Namdhari and its one authenticated copy, shall be placed on the record of the each of the remaining nine appeals.
16. One copy of this order be sent to each of the parties, free of cost, as per Rules.
(Justice Surjit Singh) President (Chander Shekhar Sharma) Member (Prem Chauhan) Member April 09, 2012.
N Mehta) [1] Whether reporters of the local papers may be allowed to see the order?