State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India, ... vs Sukhmander Kaur Bhullar, W/O Late Shri ... on 10 September, 2013
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 865 of 2008
Date of institution: 13.08.2008
Date of decision : 10.09.2013
Life Insurance Corporation of India, Branch Fazilka, District Ferozepur,
through its Branch Manager. (Through Life Insurance Corporation of India,
through its Sr. Divisional Manager, Jeevan Parkash Building, Sector 17,
Chandigarh.
.....Appellant
Versus
1. Sukhmander Kaur Bhullar, w/o Late Shri Hardev Singh Bhullar
S/o Kartar Singh r/o Village Rakhala, Tehsil, Gidderbaha, District
Muktsar, Punjab.
....Respondent/complainant
2. Rama Kataria, Agent, Life Insurance Corporation of India,
Fazilka, District Ferozepur, through its Branch Manager.
.........Proforma Respondent
First Appeal against the order dated
04.06.2008 passed by the District Consumer
Disputes Redressal Forum, Ferozepur.
Before:-
Sh. Gurcharan Singh Saran, Presiding Judicial Member
Sh. Piare Lal Garg, Member Sh. Jasbir Singh Gill, Member Present:-
For the appellant : Sh. Varun Chawla, Advocate for Sh. Rajneesh Malhotra, Advocate For respondent No. 1 : Sh. Saurabh Chugh, Advocate with Sh. Navdeep Chhabra, Advocate For respondent No. 2 : Ex-parte PIARE LAL GARG, MEMBER This is an appeal filed by the appellant/O.P. No. 1 (hereinafter called "appellant") under Section 15 of the Consumer Protection Act, 1986 First Appeal No.865 of 2008 2 (hereinafter referred to as "the Act") against the order dated 04.06.2008 passed by the Learned District Consumer Disputes Redressal Forum, Ferozepur (in short the "District Forum") vide which the complaint of the respondent No. 1/complainant (hereinafter called "respondent No. 1) was accepted.
2. Brief facts of the case are that the husband of respondent No.1, namely, Hardev Singh was insured with the appellant for an amount of Rs. 2 lacs vide Policy No. 471504507 commencing from 28.12.2004. The insured suffered a severe heart attack on 2.11.2005 and died on the same day. The claim was submitted by respondent No. 1 being nominee with the appellant and submitted all the requisite documents to respondent No. 2, who was the agent of the appellant. But the claim was not paid by the appellant to respondent No. 1. Legal notice was also served by respondent No. 1 on 8.3.2006 upon the appellant as well as respondent No. 2 but to no effect. First complaint was filed bearing No. 170 of 2006 dated 24.4.2006 before the District Forum but the appellant had taken the objection that the claim is pre-mature as the requisite documents to decide the claim had not been supplied by respondent No. 1 to the appellant and even no intimation regarding the death of the insured was given by respondent No. 1 to the appellant. The complaint was dismissed being premature and not on merits. Respondent No. 1 again supplied all the documents to the appellant and completed all the formalities for the settlement of the claim. It was assured by the appellant that her claim will be settled within seven days but the claim was not settled. Respondent No. 1 again served legal notice dated 26.8.2006 upon the appellant as well as respondent No. 2. The appellant had repudiated the claim of respondent No. 1 on 28.12.2006 on the ground that the life assured was a patient of coronary artery disease and interior wall myocardial infarction and LV Systolic Dysfunction and the same information was withheld by the insured First Appeal No.865 of 2008 3 at the time of filling the proposal form. The complaint was filed by respondent No. 1 that the claim was illegally and wrongly repudiated, which amounts to deficiency in service on the part of the appellant as well as respondent No. 2. It was prayed that the appellant and respondent No. 2 may be directed to pay the insured amount of Rs. 2 lacs alongwith interest @ 2% per month from the death of the life assured till its payment. The appellant and respondent No. 2 may also be directed to pay compensation of Rs. 50,000/- on account of mental tension, agony and harassment and Rs. 5500/- as litigation expenses.
3. Respondent No. 2 had not appeared before the District Forum despite service as such, he was proceeded against ex-parte vide order 11.5.2007.
4. Upon notice reply was filed by appellant by taking preliminary objections that the life assured has concealed material facts regarding his health and previous ailment at the time of filling the proposal form; respondent No. 1 being a nominee is only authorized to receive the amount of the policy; the dispute does not fall within the purview of 'consumer' dispute; there was no deficiency in service on the part of the appellant and the District Forum had no jurisdiction to try and decide the complaint. On merits, the insurance of the assured was not disputed. It was also admitted that respondent No. 1 was nominated as nominee by the assured. It was further averred that on receipt of the claim, the same was investigated by Sh. Jagdish Ram, Branch Manager and he found that the life assured was suffering from CAD prior to taking the insurance policy and also remained admitted in BBC Heart Care Institute, Jalandhar from 8.4.2003 to 9.4.2003 for the treatment of heart disease i.e. CAD. The assured was admitted on 2.11.2005 in Shri Guru Nanak Hospital, Bathinda Road, Mukatsar, where he died on 3.11.2005 due to heart disease. Dr. Sukhwinder Singh of Shri Guru Nanak Hospital, Bathinda Road, Mukatsar First Appeal No.865 of 2008 4 issued Form No. 3816 vide which it was mentioned that the life assured was an old case of ischemic heart disease and was suffering from Tripple Vessel Disease for the last 1½ years i.e. since April, 2003 and was also treated in Pruthi Hospital, Jalandhar but the assured has not disclosed his ailment at the time of filling the proposal form and concealed the material fact, as such, on coming to the knowledge of the appellant from the Investigator, the claim of respondent No. 1 was rightly repudiated. All other averments of the complaint were denied as wrong and for want of knowledge.
5. The learned District Forum after hearing the learned counsel for the parties and going through the evidence and documents on record, accepted the complainant and directed the appellant as well as respondent No. 2 to pay Rs. 2 lacs within one month from the receipt of the copy of the order, failing which respondent No. 1 shall be entitled to recover the above amount with interest @ 12% per annum from the date of filing the complaint dated 26.3.2007 till its payment.
. 6. Aggrieved from the order of the learned District Forum, the appellant has filed the present appeal on the grounds that the order of the District Forum is against the evidence and record produced by the appellant, as such, the same is liable to be set-aside.
7. 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 counsel for the parties.
8. There is no dispute that the assured was insured with the appellant through respondent No. 2 for an amount of Rs. 2 lacs w.e.f. 28.12.2004, who died on 3.11.2005 in Shri Guru Nanak Hospital, Bathinda Road, Mukatsar due to heart attack. The claim of respondent No. 1 was repudiated only on the ground by the appellant that at the time of taking First Appeal No.865 of 2008 5 the policy, the assured was suffering with heart disease but he intentionally concealed this fact at the time of filling the proposal form.
9. The appellant to prove that the assured was suffering from CAD/ heart problem at the time of filling the proposal form tendered into evidence case file Ex. R-15 of Dr. Sukhwinder's Hospital & Heart Care Centre, Muktsar and indoor patient case file Ex. R-14 of Guru Nanak Hospital, Bathinda Road, Muktsar. The appellant also examined Dr. Sukhwinder Singh and Dr. Madan Mohan Bansal of Guru Nanak Hospital, Muktsar as witnesses before the District Forum to prove the fact that the assured was suffering from heart disease.
10. Dr. Sukhwinder Singh stated in his statement that as per medical file Ex. R-15 of his hospital, assured Hardev Singh was admitted in his hospital on 29.9.2005 and he was discharged on 2.10.2005, who was suffering from Ischemic heart disease with left heart failure.
11. We have perused the patient case file Ex. R-15 but nowhere it is mentioned in the said file that from which date/period the assured was suffering from heart disease. Even no period was also disclosed regarding the disease by Dr. Sukhwinder Singh in his statement before the District Forum.
12. Dr. Madan Mohan Bansal of Guru Nanak Hospital, Muktsar in his statement before the District Forum stated that assured was admitted in his hospital on 2.11.2005 and died on 3.11.2005 as per his record. It was further stated by Dr. Madan Mohan Bansal that assured Hardev Singh was suffering from heart disease (CAD) since 2003 as per Angiography report of BBC Heart Care Centre, Pruthi Hospital dated 8.4.2003.
13. We have perused the Indoor Patient Case file of Shri Guru Nanak Hospital Ex. R-14. In the said file, the record of BBC Heart Care Pruthi Hospital, Lajpat Nagar, Jalandhar is enclosed. We have perused - Cardiac Catheterization and Angiography Report made by Dr. Amritpal First Appeal No.865 of 2008 6 Singh which is at page No. 163 of the District Forum file. As per the record, one Hardev Singh resident of Village Bhullar, P.O. Muktsar was admitted in Pruthi hospital, Jalandhar on 8.4.2003 and Dr. Amrit Pal Singh of Cardiology Department had treated said Hardev Singh. As per his report, the relevant entry of the same is reproduced:-
Summary : CAD. Single Vessel disease. LAD 100% block In the said record, the father name of the patient was not mentioned and the address of the patient was entered as V-Bhullar PO Muktsar referred by Dr. Sukhwinder Singh".
14. We have also perused Form No. 3816 Ex. R-10 issued by Dr. Amrit Pal Singh of BBC Heart Care & Pruthi Hospital, Lajpat Nagar, Jalandhar. In the said form, the address of the patient mentioned by him in said form is reproduced:-
"Name Hardev Singh
Age 45 years
Address Village Bhullar PO Muktsar
Occupation Data not available
Father's name Kartar Singh"
So from the record of Pruthi Hospital as well as Form No. 3816, Dr. Amritpal Singh had examined the patient, namely, Hardev Singh resident of Village Bhullar,, P.O. Muktsar, when the assured was resident of village Rakhala, Tehsil Gidderbaha and not of Village Bhullar, PO Muktsar. The appellant also neither examined Dr. Amritpal Singh nor tendered into evidence his affidavit to prove that the assured Hardev Singh was the same patient, who was treated by Dr. Amritpal Singh in Pruthi Hospital on 8.4.2003.
15. The patient Hardev Singh was admitted in Pruthi Hospital on 08.04.2003 who was referred by Dr. Sukhwinder Singh as per the record of the Pruthi Hospital. But Dr. Sukhwinder Singh in his statement nowhere stated that assured Hardev Singh was examined or remained admitted First Appeal No.865 of 2008 7 before 29.9.2005 in his Hospital or he referred him to Pruthi Hospital for further treatment on 08.04.2003.
16. As per the record of Hospitals of Dr. Sukwhinder Singh and Dr. Madan Mohan Bansal, the assured remained in their hospital on 29.9.2005 to 2.10.2005 and on 2.11.2005 to 3.11.2005. The appellant had not produced any cogent evidence to prove that assured had taken any treatment regarding heart disease before taking the insurance policy or filling the proposal form dated 20.1.2005.
17. As per the proposal form Ex. R-2 the assured was also examined by Dr. Ajay Kumar Dhawan, Medical Examiner, LIC of India before the issuance of the policy and he did not find that the assured was suffering from any ailment.
18. In view of the above discussion, the appellant has badly failed to prove that the assured was suffering from Heart Disease at the time of taking the insurance policy and it was in his knowledge but he had intentionally concealed this fact at the time of filling the proposal form.
19. The appellant had also neither examined Shiv Maini Development Officer, who filled the proposal form nor examined Dr. Ajay Kumar Dhawan, who medically examined the assured before issuance of the policy. Their affidavits were also not tendered into evidence by the appellant.
20. The appellant also neither examined Jagdish Ram, Branch Manager, who investigated the claim of the assured nor his affidavit was tendered into evidence to prove his inquiry report as well as the statements of Pawan Kumar and Gursewak Singh, which were annexed with his claim inquiry report. The Inquiry Officer was their own officer then what was the difficulty to withhold his evidence, which shows that the version of the Inquiry Officer regarding the treatment allegedly taken by the assured from Pruthi Hospital, Jalandhar was not correct.
First Appeal No.865 of 2008 8
21. The appellant had not produced any evidence that the insured had taken any treatment for heart disease from any hospital before filling the proposal form. The appellant had also not produced any evidence that it was in the knowledge of the assured that he was suffering from heart disease at the time of filling the proposal form. It was held by the Hon'ble National Consumer Disputes Redressal Commission in Revision Petition No. 982 of 2011 titled as "Bajaj Allianz Life Insurance Company Ltd and another Vs. Mrs. Nasi Ban Begum" that if the insurance company failed to prove that the assured had deliberately concealed the material facts regarding his ailment then the assured will be entitled for the claim. The relevant portion of the judgment is reproduced:-
11. A similar matter had come up for consideration in Civil Appeal No. 7437 of 2011 decided by Hon'ble Supreme Court of India on 26.8.2011 (P. Venkat Naidu Branch Manager, LIC Kurnool and Anr.). A life insure policy of Rs. 10 lakhs was taken by the insured with effect from 28.04.2002. In the proposal form for insurance, the insured had not indicated whether during the last five years he had consulted any medical practitioner for any ailment. The insured died on 19.12.2003 due to cardio respiratory failure. The claim under the policy was contested by the insurance company on the ground that the insured had suppressed facts relating to his illness at the time of taking the policy.
12. The Supreme Court has held that "Since the respondents had come out with the case that the deceased did not disclose correct facts relating to his illness, it was for them to produce cogent evidence to prove the allegation." The respondents were found to have failed to produce any tangible evidence to prove that the deceased had withheld information about First Appeal No.865 of 2008 9 his hospitalization and treatment. Therefore, the claim under the policy was allowed.
21. In view of the above discussion, the appeal of the appellant is meritless and the same is dismissed with no order as to costs. There is no infirmity in the order of the District Forum, as such, the same is affirmed.
22. The appellant had deposited an amount of Rs. 25,000/- in this Commission at the time of filing of the appeal on 13.08.2008. This amount of Rs. 25,000/- alongwith interest accrued thereon, if any, be paid by the registry to the respondent No. 1/ complainant by way of crossed cheque/bank draft after the expiry of 45 days under intimation to the learned District Forum. Remaining amount will be paid by the appellant and respondent No. 2 to respondent No. 1/complainant within one month from the receipt of copy of the order.
23. The arguments in this appeal were heard on 04.09.2013 and the order was reserved. Now the order be communicated to the parties.
24. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(Gurcharan Singh Saran) Presiding Judicial Member (Piare Lal Garg) Member (Jasbir Singh Gill) Member September 10, 2013.
RK First Appeal No.865 of 2008 10 First Appeal No.865 of 2008 11