Chandigarh

StateCommission

A/286/2017

Branch Manager, LIC of India - Complainant(s)

Versus

Jaswinder Kaur - Opp.Party(s)

28 Nov 2017

ORDER

   STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

UNION TERRITORY, CHANDIGARH

 

Appeal No.	286 of 2017
Date of Institution	24.11.2017
Date of Decision	28.11.2017

 

1)    LIC Branch Manager, SCO 7-A (First Floor), Sector 7-C, Madhya Marg, through its Branch Manager.

2)   Divisional Manager, LIC Division, Jeevan Parkash, Sector 17-B, Chandigarh.

3)   Claims Disputes Redresssal Committee, LIC of India, Central Office, CRM Department, 5th Floor (Link), Yogakshema Building, Jeevan Bima Marg, Mumbai – 400021, through its Manager.

All through the authorised signatory of Life Insurance Corporation of India, Divisional Office Chandigarh, Jeevan Parkash Building, Sector 17-B, Chandigarh. 

                                        …..Appellants/Opposite Parties

                                Versus

Smt. Jaswinder Kaur wife of Sh.Gurbir Singh resident of House No.1815, Sector 34-D, Chandigarh.                               

                                  …..Respondent/Complainant.

BEFORE:             JUSTICE JASBIR SINGH (RETD.), PRESIDENT

                             MR. DEV RAJ, MEMBER.

                             MRS. PADMA PANDEY, MEMBER

 

Argued by:

 

Sh. S.S.Sidhu, Advocate for the appellants/Opposite Parties.  

 

PER PADMA PANDEY, MEMBER

              This appeal is directed against the order dated 16.10.2017, rendered by District Consumer Disputes Redressal Forum-I, UT, Chandigarh (in short ‘the Forum’ only), vide which, it partly allowed Consumer Complaint bearing No.57 of 2017, with the following directions :-

 “9.     In the light of above observations, the present complaint of the Complainant deserves to succeed against the Opposite Parties, and the same is partly allowed, qua them. The Opposite Parties are, jointly and severally, directed:- 

[a]  To pay Rs.5,00,000/- being the death claim of the deceased to the Complainant;

[b]  To pay Rs.25,000/- as compensation for deficiency in service, unfair trade practice and mental agony suffered by the Complainant; 

[c]  To pay Rs.10,000/- as costs of litigation. 

10.      The above said order shall be complied within 30 days of its receipt by the Opposite Parties; thereafter, they shall be liable for an interest @12% p.a. on the amounts mentioned in sub-paras [a] & [b] above from the date of institution of this complaint, till it is paid, apart from cost of litigation as in sub-para [c].”  

2.           The facts, in brief, are that in the year 2012, husband of the complainant namely Late Sh. Gurbir Singh Riar took a life insurance Jeevan Anand Policy bearing No.165405996 with the death sum assured of Rs.5 lacs and under the aforesaid policy, the complainant was a nominee (Annexure C-1). Unfortunately, due to some unknown fact/ reasons, the husband of the complainant committed suicide on 26.09.2015. Thereafter, the complainant lodged a claim with the Opposite Parties but the same was rejected by Opposite Party No.2 vide letter dated 24.06.2016 (Annexure C-2) on the ground that the deceased concealed the material fact at the time of taking the insurance policy. Against the aforesaid order dated 24.06.2016, the complainant filed appeal before the Zonal Manager, LIC of India, New Delhi but the said Zonal Office upheld the repudiation decision of Divisional Office and  dismissed the appeal vide order/letter dated 09.11.2016 (Annexure C-3). Accordingly, the complainant filed appeal before Opposite Party No.3 (Annexure C-4) but no decision has been taken by Opposite Party No.3. Therefore, the Opposite Parties were deficient, in rendering service, as also indulged into unfair trade practice.  When the grievance of the complainant was not redressed, left with no alternative, a complaint under the Consumer Protection Act, 1986 (hereinafter to be called as the “Act” only), was filed.

3.           In their written statement, the Opposite Parties, admitted the factual matrix of the case. It was  stated that after the death of the deceased life assured (for brevity ‘DLA’), the claim was lodged, which was looked into promptly and it was found that the DLA was suffering from Bipolar Disorder (a mental illness) and had taken treatment from different places for the same and this  material  information  had  deliberately  been

suppressed by him while taking the policy, in question. Hence, the claim of the complainant was rightly repudiated. It was further stated that the replying Opposite Parties were neither deficient, in rendering service nor indulged into unfair trade practice.

4.           The complainant filed replication to the written statement of the Opposite Parties, wherein she reiterated all the averments, contained in the complaint, and refuted those, contained in the written versions of the Opposite Parties. 

5.           The parties led evidence, in support of their case.

6.           After hearing Counsel for both the parties and, on going through the evidence, and record of the case, the Forum, partly allowed the complaint, as stated above. 

7.           Feeling aggrieved, the instant appeal, has been filed by the appellants/Opposite Parties.

8.           We have heard the Counsel for the appellants/Opposite Parties, and have gone through the evidence and record of the case, carefully. 

9.           After going through the evidence and record of the case, we are of the considered opinion, that the appeal is liable to be dismissed, at the preliminary stage, for the reasons to be recorded, hereinafter.

10.          Counsel for the appellants/Opposite Parties has submitted that the deceased life assured had given wrong information of his personal history in column No.11 of the proposal form and suppressed the material fact, while taking the policy.  He further stated that the suicide committed by the deceased life assured has proved the fact that he was suffering from the disorder/syndrome, which has resulted into committing of suicide by him. He further submitted that the Forum while passing the impugned order did not examine the latest position of law. It was argued that Section 45 of Insurance Act, 1938, as amended came into effect w.e.f. 26.12.2014, whereas, the deceased life assured died subsequently i.e. on 26.09.2015 and, as such, the claim was rightly repudiated by the insurance Company. He prayed for allowing the appeal and setting aside the impugned order. 

11.          Annexure C-1 is a copy of Insurance Policy. From this document, it is proved that the respondent/complainant took Jeevan Anand policy bearing No.165405996 from the appellants/Opposite Parties and the date of commencement is shown as 04.12.2012. It is also evident from the aforesaid policy that the sum assured is Rs.5 lacs. It is proved from the Death Certificate (Annexure A-4) annexed by the complainant, before the Forum, that Sh.Gurbir Singh Riar, husband of the complainant died on 26^th September, 2015. After his death, the claim was lodged, which was repudiated vide repudiation letter dated 24.06.2016 (Annexure C-2) with the observation that before the husband of the complainant proposed for the policy, he had suffered from Bipolar disorder and Alcoholic Dependance Syndrome, for which, he had consulted a medical man and had taken treatment in Neuropsychiatry and Drug Deaddiction Cum Rehabilitation Centre, Chandigarh in the year 2008 & 2009. It was further observed that he did not, however, disclose these facts in his proposal/personal statement.

12.          At the time of arguments, Counsel for the appellants argued that Section 45 of Insurance Act, 1938, as amended came into effect w.e.f. 26.12.2014, whereas, the deceased life assured died subsequently i.e. on 26.09.2015 and, as such, the claim was rightly repudiated by the insurance Company.  This plea taken by the appellants is of no use at this stage and seems to be an afterthought. It was for the appellants to intimate any such amendment to the respondent/complainant at that point in time and now they cannot be heard to say that the claim is not payable at this stage on account of such an amendment. So, we are of the view that the Forum has rightly observed in para No.8 while passing the impugned order, which reads thus :-

“8. It is important to mention here that Section 45 of the Insurance Act, 1938, which deals with policy not to be called in question on the ground of mis-statement after two years. The said Section reads as under: -

 “45. Policy not to be called in question on ground of mis-statement after two years.- No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy holder and that the policy holder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose. Provided that nothing in this Section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.” 

           In the present case, the husband of the Complainant took the life insurance policy on 04.12.2012; whereas the husband of the Complainant died on 26.09.2015 i.e. after a period of more than 2½ years from the date of commencement of the policy in question. In this view of the matter, a conjoint reading of Section 45 reproduced ibid along with the material placed before us, shows that no policy of insurance can be repudiated after the expiry of two years by stating that statement of fact was concealed and suppression and it was fraudulent on the part of the policy holder. Hence, we are of the concerted view that the Opposite Parties are bound to pay the insurance claim to the Complainant, which they failed to pay and are thus, guilty of deficiency in service and unfair trade practice.”

 Hence, the order passed by the Forum, being based on the correct appreciation of evidence and law, on the point, does not suffer from any illegality or perversity.

13.          For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same stands dismissed, at the preliminary stage, with no order as to costs. The order of the Forum is upheld.

14.          Certified Copies of this order be sent to the parties, free of charge.

15.          The file be consigned to Record Room, after completion.

Pronounced.                                     Sd/-

28.11.2017             [JUSTICE JASBIR SINGH (RETD.)]

PRESIDENT

                                                                     Sd/-

(DEV RAJ)

MEMBER

 

Sd/-

(PADMA PANDEY)

        MEMBER

 

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