State Consumer Disputes Redressal Commission
Smt. Swaran Chopra vs Life Insurance Corporation Of India on 15 July, 2011
2nd Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
SCO NO.3009-12, SECTOR 22-D, CHANDIGARH.
First Appeal No.274 of 2007.
Date of Institution: 20.02.2007.
Date of Decision: 15.07.2011.
Smt. Swaran Chopra Wd/o Sh. Vinod Kumar Chopra, 326/7, Central Town,
Jalandhar City.
.....Appellant.
Versus
Life Insurance Corporation of India, Divisional Office, Jeevan Parkash,
Model Town Road, Jalandhar City, through its Senior Divisional Manager.
...Respondent.
First Appeal against the order dated
22.12.2006 of the District Consumer
Disputes Redressal Forum, Jalandhar.
Before:-
Shri Inderjit Kaushik, Presiding Member.
Shri Piare Lal Garg, Member.
Present:-
For the appellant : Sh. Munish Goel, Advocate.
For the respondent : Sh. K.C. Bhatia, Advocate.
INDERJIT KAUSHIK, PRESIDING MEMBER:-
Smt. Swaran Chopra, appellant/complainant (In short "the appellant") has filed this appeal against the order dated 22.12.2006 passed by the learned District Consumer Disputes Redressal Forum, Jalandhar (in short "the District Forum").
2. Facts in brief are that the appellant filed a complaint under section 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the respondent, pleading that Sh. Vinod Kumar Chopra (since deceased) was husband of the appellant and he got insured his life vide policy bearing no.131364854 for a sum of Rs.1.00 lac under Table-106 for 15 years. The premium was to be paid yearly and the risk of insurance commenced on First Appeal No.274 of 2007 2 28.08.2000. At the time of filling the proposal form for insurance, the life assured underwent complete medical check-up by a penal of medical examiners of the respondent and he was in perfect health and nothing adverse was noticed by the medical examiners. The policy was taken from Branch Office, Unit no.2, Jalandhar which is a policy service branch.
3. The life assured had another policy bearing no.0230035371 for Rs.50,000/- and death claim of the same was paid. The life assured died on 14.10.2001 due to Cardio Respiratory Arrest prior to the date of maturity of the policy and the appellant lodged the death claim with the respondent for payment of the sum assured along with other benefits and complied with all the requirements for quick settlement of the claim, but the claim was repudiated vide letter dated 26.03.2002, delivered to the appellant on 04.05.2002. The repudiation of the claim by the respondent is wrong and unwarranted and amounts to deficiency in service and unfair trade practice.
4. The appellant was nominee and is beneficiary and is entitled to the amount of insurance policy and, as such, is a consumer as defined under the Act, and prayed that the respondent be directed to pay Rs.1.00 lac as sum assured along with bonus and other benefits with interest @ 18% p.a., compensation to the tune of Rs.25,000/- and Rs.5500/- as costs of litigation.
5. In the reply filed on behalf of the respondent, preliminary objections were taken that the complaint is not maintainable as the life assured suppressed the material facts at the time of taking the policy. The life assured was 50 years old when he took the policy for Rs.1.00 lac vide proposal dated 27.08.2000 and died on 14.10.2001 after one year and one month. The life assured was admitted in D.M.C. & Hospital, Ludhiana in June, 2001 and October, 2001 and Portal Hypertension with Verices were diagnosed and was a patient of Type-II Diabetes Mellitus Cirrhosis Oesophagenal Verices, U.G.I. bleed. The attending doctor observed in Form No.3816 that deceased was a chronic alcoholic for the last 20 years First Appeal No.274 of 2007 3 and known case of Type-II Diabetes Mellitus and Alcoholic Liver disease and he died because of these diseases, but he suppressed all these facts and the appellant has not come to the Forum with clean hands. Life assured got the policy with malafide intention in order to get wrongful gain, by suppressing the material facts and no relief can be granted. The claim is time barred. On merits, it was admitted that life assured got the insurance policy no.131364854 for Rs.1.00 lac. The proposer affirmed that he does not suffer from any disease but the life assured gave wrong information/answers to the questions, as such, no claim is maintainable. The appellant submitted her claim on 22.01.2002 and the claim was decided on 26.03.2002 and the information was duly given. The repudiation is legal and valid and was given under valid reasons. Form No.3816 issued by the D.M.C. & Hospital, Ludhiana has been submitted by the appellant herself and she being nominee is not a consumer. The claim was rejected two years ago and in the repudiation letter, the appellant was advised to approach Zonal Office, New Delhi and the claim is clearly time barred. All other allegations were denied and it was prayed that the complaint may be dismissed with special costs.
6. Parties led evidence in support of their respective versions by way of affidavits and documents.
7. After going through the documents and material placed on file and after hearing the learned counsel for the parties, the learned District Forum observed that it is proved that the insured had taken the policy by concealing material facts in the proposal form and the claim was rightly repudiated, and dismissed the complaint.
8. Aggrieved by the impugned order dated 22.12.2006, the appellant has come up in appeal.
9. We have gone through the pleadings of the parties, perused the record of the learned District Forum and have heard the arguments advanced by the learned counsel for the parties.
First Appeal No.274 of 2007 4
10. Learned counsel for the appellant has contended that the District Forum has failed to appreciate the facts and evidence on record. The life assured was thoroughly examined at the time of filling up the proposal form and he was physically fit and all the questions were answered correctly as the deceased was not suffering from any major disease. The cause of death was Cardiac Respiratory Arrest which was not related to any disease. The insurance company could not repudiate the claim. The provisions of Section-45 of the Insurance Act, 1938 were not correctly applied and the findings of the District Forum are erroneous and are liable to be set aside. No evidence has been led to prove that the deceased life assured husband of the appellant was suffering from any pre-existing disease and prayed that the appeal may be accepted.
11. On the other hand, it was contended on behalf of the respondent that the insured concealed the material facts regarding his illness at the time of filling up the proposal form and the insurance contract is vitiated. The document Ex.C10 of D.M.C. & Hospital, Ludhiana shows that the deceased was suffering from Alcoholic Liver Disease, Cirrhosis and the deceased was admitted in the hospital and died in the hospital. The medical evidence led by the respondent clearly proves that the deceased was suffering from pre-existing disease and the District Forum has rightly dismissed the complaint.
12. We have considered this submission of the learned counsel for the parties.
13. As per case summary and discharge slip of D.M.C. & Hospital, Ludhiana Ex.OC, the deceased Vinod Chopra was diagnosed as Alcoholic Liver Disease Cirrhosis PHT with Verices and acute Gastroenteritis. As per past history, no H/O Diabetes Mellitus/Ischaemic Heart Disease/ Tuberculosis/ Hypertension and the patient improved with the treatment. Deceased Vinod Chopra died of Cardiac Respiratory Arrest on 14.10.2001. Respondent-Insurance Company has not examined any doctor to prove that First Appeal No.274 of 2007 5 the above mentioned Alcoholic Liver Disease Cirrhosis PHT Verices, acute Gastroenteritis has any nexus with the cause of death i.e. Cardiac Respiratory Arrest. The deceased was thoroughly medically examined at the time of filling up the proposal form, but the doctors did not notice any such disease which could have any link with Cardiac Respiratory Arrest. In case, "Birla Sun Life Insurance Co. Ltd. Versus Keshav Lal", 2008(3) R.C.R. (Civil) 637, the Hon'ble Punjab & Haryana High Court in para 5 observed that the disease of bronchitis had no nexus with the cause of death and further observed as follows:-
"The death of the insured is not related to any such disease which he was expected to disclose in response to questions addressed and that being the position, the Insurance Company is totally unreasonable and unjustified in repudiating the claim. This is only a farce on the part of the Insurance Company to deny a genuine claim and is aimed at escaping the liability, which would arise on account of having sold this policy to deceased."
14. In other case "New India Assurance Company Limited Versus Smt. Usha Yadav & others", 2008(3) R.C.R. (Civil) 111, the Hon'ble Punjab & Haryana High Court expressed its anguish and observed as follows:-
"It seems that the Insurance Companies are only interested in earning the premiums, which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance Companies make the effected people to fight for getting their genuine claims. The insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus, pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy."First Appeal No.274 of 2007 6
15. In a very recent judgment, the Hon'ble Delhi State Consumer Disputes Redressal Commission, New Delhi in case "Mamta Versus Life Insurance Corporation of India", III (2010) CPJ 292; in para 6 observed as follows:-
"On the other hand it will be seen that at the time of insurance the deceased was examined by the insurance doctor and it was found that he was not suffering from any disease and made a note of NAD which means that nothing abnormal was detected."
16. It was further observed in para 7 as follows:-
"We have therefore to notice that we have the report of the Vice- Principal in support of the version of the Insurance Doctor that at the time of insurance the deceased was not suffering from any disease, and we must therefore lean in favour of the version that at the time of insurance the deceased was not suffering from any disease and that he did not conceal any illness. It cannot also be ignored whether it is diabetes or tuberculosis, any disease can strike any person and any time. The possibility of the deceased getting diabetest and tuberculosis subsequent to the obtainment of the insurance policy is not unlikely and we should not therefore deprive her of the insurance benefit on this ground."
17. Hon'ble National Commission in in case "National Insurance Company Ltd. vs. B.L. Sharma", 2009 CTJ 873 (CP) (NCDRC) observed as follows:-
"Most people are not familiar with medical knowledge and cannot diagnose their own disease. If they were expected to be aware of their medical condition at all times, there would be no use of insurance policies."
18. In view of above discussion and the ratio of the law laid down above, the disease of the husband of the appellant had no nexus with the cause of death in the present case and the respondent insurance company has failed to bring on record any evidence to prove that the husband of the appellant Sh. Vinod Kumar Chopra deceased was suffering from any First Appeal No.274 of 2007 7 disease at the time of filling up the proposal form. The doctor of the respondent insurance company itself declared the deceased fit and found no abnormalities. In these circumstances, the view taken by the District Forum is not correct and is not sustainable.
19. Accordingly, the appeal filed by the appellant/complainant is accepted and the impugned order dated 22.12.2006 under appeal passed by the District Forum is set aside. Consequently, the complaint filed by the appellant/complainant is accepted and the respondent insurance company is directed to pay Rs.1,00,000/-(Rupees One Lac) which was the sum insured along with interest @ 9% p.a. from the date of repudiation of the claim till realization and Rs.5,000/- (Rupees Five Thousand) as litigation expenses, within two months from the receipt of copy of the order.
20. The arguments in this appeal were heard on 07.07.2011 and the order was reserved. Now the order be communicated to the parties.
21. The appeal could not be decided within the stipulated timeframe due to heavy pendency of court cases.
(Inderjit Kaushik) Presiding Member (Piare Lal Garg) Member July 15, 2011.
(Gurmeet S)