DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.



Complaint no.354 of 19.6.2006. Date of Order 17.3.2009.



Smt. Shukla Jain wife of late Amrit Lal Jain resident of 77, Club Road, Ludhiana.



….Complainant.

Versus



1- Life Corporation of India, Head Office Yogast Seema, Nariman Point, Mumbai through its Manager.

2- Life Corporation of India, Divisional Office, Jiwan Parkash Building, Urban Estate, Dugri, Ludhiana, through its Divisional Manager.

3- Life Corporation of India, Branch Office, LIC Unit-5, Clock Tower, Jawahar Market, Ludhiana through its Branch Manager.

4- Parminder Singh, LIC Agent, H.No.1232, Phase-II, Dugri, Ludhiana.



….Opposite parties.



COMPLAINT UNDER SECTION 12 OF THE CONSUMER PROTECTION ACT, 1986.

Quorum:

Sh. T.N. Vaidya, President.

Sh. Rajesh Kumar, Member.



Present: Sh. Vishal Gupta Adv. for the complainant.

Sh. V.K. Gupta Adv. for opposite parties no.1 to 3.

Sh. Sarwan Sehgal Adv. for opposite party no.4.



O R D E R



T.N. VAIDYA, PRESIDENT:





1- Insurance claim on death of her husband Sh. Amrit Lal Jain, who had obtained insurance policy no.300093894 dated 12.7.2003 from opposite party, was repudiated vide letter dated 24.2.2006 of the opposite party. This repudiation stands assailed to be null, void and illegal, by instituting the present compliant u/s 12 of the Consumer Protection Act, 1986, by complainant being beneficiary as nominee. Complainant claimed that her husband unfortunately died on 14.4.2004, during currency of the policy. While purchasing the policy, her husband had clearly mentioned having undergone Gall Bladder operation on 12.2.2002 and after getting him medically examined from Dr. Harpreet Singh, mentioning that Sh. Amrit Lal had undergone operation of Gall Bladder cancer in February, 2002, the policy was issued after knowing the factual position of his health. The policy was effective upto 12.7.2008 w.e.f. 12.7.2003. Her husband died after falling ill on 11.4.2004, on account of pain in upper abdomen, leading to his death on 14.4.2004. Hence, entitled for policy amount of Rs.20 lacs alongwith compensation of Rs.50,000/- for mental tension and Rs.10000/- as litigation costs.

2- Opposite party no.1 to 3 contested the complaint by justifying repudiation of the claim. It is admitted that husband of complainant had taken insurance policy of Rs.20 lacs. But pleaded allegations of fraud, forgery and tampering of documents from the file maintained in office of the opposite party. So, prayed that this Fora has no jurisdiction to try the complaint in summary manner. Further pleaded that Sh. Amrit Lal fraudulently in connivance with opposite party no.4, the then development officer of the LIC, obtained the policy. Claim was got investigated from Sh. P.K. Kagra Senior Branch Manager, who intimated after investigation that policy ran for 6 months 25 days only. Sh. Amrit Lal was suffering from gall bladder cancer for which, was treated in Oswal Hospital, Ludhiana., before date of proposal. He had not disclosed while purchasing the policy qua such sickness and hospitalization. Subsequently, in the proposal form, in connivance with the agent and development officer of LIC, fabricated entries on the proposal form etc. The originally filled agent’s confidential report was removed from the file. The performa form was printed in 2004, but the same bears date 29.3.2003. When the performa was printed in 2004, how it could have been filled on 29.3.2003. This clearly spells conspiracy between the policy holder, development officer and agent of the LIC, who committed forgery regarding insurance papers of Sh. Amrit Lal Jain. In this way, medical report of Dr. Harpreet Singh dated 29.3.2003 has also been tampered after death of Sh. Amrit Lal. The word “No” stands changed to “Yes” by converting the letter “N” into “Y” and letter “O” into “E” and thereafter, letter “s” has been added underneath the word “Yes” have been written. So, Dr. Harpreet Singh was also fraudulently involved in connivance with the deceased etc. to defraud the LIC of the amount of Rs.20 lacs.Sh. Amrit Lal had remained under treatement in the hospital for Carcinoma gall bladder from 12.2.2002 to 1.3.2002, which ailment he suppressed intentionally while purchasing the policy and committed fraud, So, complainant not entitled for any claim and complaint deserves dismissal.

3- Opposite party no.4 in separate reply, claimed that he has been unnecessarily dragged in this litigation and complaint is bad for misjoinder of parties. Complainant has wrongly shown him as agent of LIC, whereas he is development officer. Complaint is barred by limitation. He has denied allegations of the complainant for want of knowledge. He denied his any involvement in fabricating the record, to help husband of the complainant.

4- Parties adduced evidence in support of their claims and stood heard through their respective counsels.

5- Sh. Amrit Lal submitted proposal for insurance vide proposal form Ex.C2 on 29.3.2003 and subsequently, died on 14.4.2004. While filling the proposal form Ex.C2(Ex.R2), had given answer to questionnaire no.11 as under:-



Personal History


Answer ‘Yes’ or ‘No’


If ‘Yes’ please give details

a)During last five years did you consult a medical practioner for any ailment requiring treatement for more than a week?


No


Except in Feb. 02

b) Have you even been admitted to any hospital or nursing home for general check-up observation, treatement or operation ?


No


Except in Feb.02 for G.bladder opeation

c)Have you remained absent from place of work on grounds of health during the last 5 years?


No


Except Feb. 02.

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, tuberculosis, high blood pressure, low blood pressure, cancer, epilepsy, hernia, hydrocele, leprosy or any other disease?


No


Except for cancer of G.bladder in Feb.02

f)Have you any bodily defect or deformity?


No




g)Do you ever have any accident or injury?


No




h)Do you use or have you ever used?







(i)Alcoholic drinks


No




(ii)Narcotics


No




(iii)any other drugs


No




(iv)Tobacco in any form


No




i)What has been your usual state of health?


Good




i)Have you ever received or at present availing/undergoing medical advice, treatement or tests in connection with Hepatitis B or a AIDs related condtion?


No






6- Now plea and defence of opposite party is that 2nd column of questionnaire no.11 was answered in negative by Sh. Amrit Lal Jain and stated his health to be good. But last column of questionnaire no.11, was forged by him or somebody else on his behalf in connivance with agent and development officer of the LIC. It was done after mentioning that had not consulted any medical practitioner nor hospitalized. But in last column, subsequently made entry “except in Feb.02” for G.Bladder operation in February, 2002. Against column no.11(e), after mentioning not suffering from TB, diabetes, BP, cancer etc., in last column, forged entries “except for cancer of G. Bladder in February, 2002”. It is contended on behalf of opposite party that had last column of entry no.11 of proposal form filled the time of proposal, as is suggested now, proposal of Amrit Lal Jain would never have been accepted. Or if accepted, it would have been with certain stipulations and conditions. Because, had mentioned having been operated for cancer of Gall Bladder in February, 2002, which was in near proximity of submitting proposal form. Neither he says such was practice to answer the query. Because he would have first answer 2nd question of questionnaire of the proposal form in affirmative, then in last column, was required to give details. But 2nd column was answered in negative, so last column was left vacant which later on was converted in connivance with agent and development officer of the LIC.

7- Similar was contention of opposite party qua form Ex.C3 pertaining to medical examination report of Sh. Amrit Lal Jain. In that report, columns no.5 to 9 were answered in negative. But against column no.6, after answering the same in negative, some words have been written. This is apparent from bare look of Ex.C3 which reads as follows:-

Question


Answer

5. Is there any abnormality of the Cardiovascular system?


No

6. Is there any swelling of joints, enlargement of thyroid, lymphatic glandc or scars(of earlier surgery)?


No except scar of G.Bladder surgery on front of abdomen.

7. Is any abnormality found on examination of mouth, ear, nose, throat or eyes?


No

8. Is there partial/total blindness or deafness or any other physical impairment?


No

9. Are there any symptoms or signs suggesting abnormality or disease of the respiratory system?


No



8- Hence, contended by opposite party that when Sh. Amrit Lal had undergone Gall Bladder operation in February, 2002, answer to question no.6 could not have been in ‘no’. So, it means and suggests that wording pertaining to operation of Gall Bladder against column no.6, were entered subsequently.

9- Further, he pointed out that in Ex.C3(Ex.R7) against column no.4(i), whether has been hospitalized initially, was mentioned “No”. That “No” was converted into “Yes” by way of overwriting. Bare look suggests that attempt was made to change letter “N” to “Y” and then with that “Y”, “es” words were added to complete “Yes in February, 02”. Similarly, appears to be case against entry at column no.14(a) of this form Ex.C3, where initially against year or operation, word “No” was written and the same was changed to “Yes” and below that “Yes”, is written “February,2002”.

10- Also in this way, it was claimed that personal statement, copy of which is Ex.R3, entries therein were also forged subsequently. Having mentioned not suffering with any disease or illness, complainant in column no.7( a to d) also mentioned not taking treatement for illness for more than a week. But in the last column subsequently, forged entries “except G.Bladder operation in February,02, 12.02.02 to 28.02.02, Dr. Satish Jain except G. Bladder operation in Feb.02, except during F-84 admission M-79 old OPC”. It is claimed that these lines in last column of Ex.R3, were added subsequently. Otherwise, answer to the questionnaire would have been in “Yes”. But answer was in negative and the factum of Gall Bladder operation in February, 2002 was added later on.

11- To stress and bring home the point, again attention was drawn to form Ex.R4 and Ex.R5. According to ld. counsel for opposite party, both these forms Ex.R4 and Ex.R5 as per print on the form, were printed in 2003-04. On top of these forms, mentioned “Print Master/200 Pad/03-2004”. So, it is claimed that these forms were printed in March, 2004. Policy holder or any other person on his behalf while committing forgery, forgot that the form being filled by them purportedly on 29.3.2003, were not printed in that year, but subsequently in March, 2004. In Ex.R4, against column no.2(ii) (c) pertaining to having suffered from any illness or injury, or undertaking any operation, answer given is “No, except Gall Bladder operation in February, 02”. According to ld. counsel for opposite party, when this form itself was printed in March, 2004, so could not have been filled by opposite party on 29.3.2003. So, this shows that this form was forged subsequently, but forgot that the forged form was not even printed on the day, it being purportedly to be prepared. Same thing will hold good qua form Ex.R5 in respect of confidential report of Sh. Amrit Lal Jain. Form Ex.R5 was filled purportedly on 1.9.2003. Though, form itself was printed in 2003-04, as mentioned on the top of the form.

12- In order to draw home the point that record qua Amrit Lal Jain was forged and fabricated later on, attention was referred to Ex.R6, medical examiner’s diary of Sh. Amrit Lal Jain, maintained by Dr. Harpreet Singh. In column no.6 pertaining to operation, reason nature of operation mentioned is ‘nil’. So, it means the diary maintained by the doctor shows that on 29.3.2003, when medical examination was conducted, no operation marks on the person of Sh. Amrit Lal, were noticed, neither any operation was mentioned.

13- It is again pertinent to note that opposite party no.4, development officer was proceeded departmentally for fabricating the record qua Sh. Amrit Lal, and action taken against him, as apparent from order Ex.R16 dated 22.1.2008. For such reason, vide communication Ex.R17 dated 29.2.2008, services of Dr. Harpreet Singh, as medical examiner on behalf of the LIC, were terminated. Disciplinary proceedings against Ms Anu Garg, agent of LIC, were also initiated vide show cause notice Ex.R18, leading to termination of her agency vide order Ex.R19.

14- In these circumstances, it appears that there appears some force in plea and defence of opposite party that record qua proposal form of health conditions of Sh. Amrit Lal, was subsequently forged and fabricated. So, Sh. Amrit Lal was suffering from Gall Bladder Cancer, for which had undergone operation in February, 2002 and had suppressed that information from opposite party. But subsequently, fabricated entries to show that he had shown such ailment.

15- Therefore, appears that there was deliberate concealment of facts by the proposer qua his health. So, for such reason, policy stands vitiated. Reference made to a case reported as Mithoolal Nayak Vs LIC AIR 1962 Supreme Court 814(SC) and P.C. Chacko & Anr. Vs Chairman, LIC & Ors. III(2008)CPJ-78(SC).

16- Hon’ble Punjab State Commission has gone to the extent that if policy holder concealed serious disease while purchasing the policy and such concealed diseases might not have nexus with cause of death, still it would amount to suppression of material facts, sufficient to repudiate the claim. Reliance is placed to Life Insurance Corp. of India Vs Piari Devi II(2008)CPJ-156(Punjab State Commision).

17- Hon’ble National Commission in LIC Vs Roshan Lal Gupta II(2007)CPJ-194(NC), has held that principle of utmost good faith, if not adhered to by the policy holder, insurance claim deserves to be dismissed.

18- Husband of complainant as such, is proved having suffering Gall Bladder Cancer in February, 2002, prior to purchasing the policy in 2003, but suppressed such factum. Complainant simply states that Sh. Amrit Lal was having upper abdomen pain due to which, he died. But Gall Bladder Cancer is a chronic disease. Stone in the bladder may lead to malignancy and cancer may cause tenderness in right upper abdomen. So, it means he suppressed the ailment.

19- According to ld. counsel for complainant, in case of fraud, even there is no necessity to go to civil court, as this Fora is competent to decide the question. In support, he referred us to a case reported as P.K. Transport Corp. Vs Bhilwara Synthetic Ltd. III(2006)CPJ-445(NC).

20- But with due respect, we venture to record that this authority will have no bearing to the case in hand. As in this case, not only fraud, but forgery as well, is also alleged.

21- Whereas Hon’ble Supreme Court in Oriental Insurance Co. Ltd. Vs Munimahesh Patel 2006(4)Civil Court Cases-203(SC), has held that proceedings under the Consumer Protection Act, are summary in nature and adjudication of issues involved disputed questions, should not be adjudicated and complex questions required to be examined by Court of Law and not by the Consumer Court.

22- Hon’ble National Commission in Appeal No.1 of 2004 titled as LIC Vs Meena Mahalawat decided on 9.9.2008, has held that tampering with critical entry visible to the naked eye, means that person has not come with clean hands and would amount to breach of contract. So, such questions of fraud and forgery can not be decided by the Fora in summary inquiry.

23- Next contention of the complainant is that evidence prepared by opposite party during pendency of proceedings required to be ignored. Reliance is placed to a case reported as Jai Singh Vs Shakuntala 2002(2)RCR(Civil)-482(SC). But there is nothing to show that evidence was prepared by opposite party during pendency of the proceedings. Hence, authority would be of no help to the complainant.

24- As allegations of forgery and fraud or fabrication of the documents have been alleged by opposite party, which appears to have some strength in them. It is settled that where allegations of forgery or fraud are alleged, Consumer Fora is not competent to entertain and decide the complaint. As the matter is complicated and of complex nature, it can be decided on the basis of oral as well as documentary evidence at length, offering chance to parties to cross examine witnesses of each other. Therefore, in these circumstances, we dismiss the complaint and the complainant, if so wish, may get the matter settled by approaching the civil court of competent jurisdiction. Copy of order be made available to the parties free of charge. File be consigned to record room.



Announced on 17.3.2009 T.N. Vaidya, President.