Complaint No.211 of 2021.

       Date of Institution:22.09.2021.

               Date of order:03.10.2023.

Maninder Kaur wd/o Sukhbir Singh, resident of Village Sandhwan, P.O. Ladha Munda, Tehsil Batala District Gurdaspur at present residing at Near Vishal Mart, G.T.Road, Gurdaspur.

                                                                                                                                 ….................Complainant.

                                                                            VERSUS

1.       Life Insurance Corporation of India, 24, Shastri Nagar, Jalandhar Road, Batala Tehsil Batala District Gurdaspur Pin-143505 through its Branch Manager.

2.       Life Insurance Corporation of India, Zonal Office at Connaught Circus, Jeevan Bharti Building New Delhi-110001 through its Zonal Manager.

                                                                                                                                                     ….Respondents.

                                           Complaint U/S 35 of the Consumer Protection Act.

Present: For the complainants: Sh.Rajiv Bhatia, Advocate.

    For the opposite party: Sh.A.K.Joshi, Advocate.

Quorum: Sh.Lalit Mohan Dogra, President, Sh.Bhagwan Singh Matharu, Member.  

ORDER

Lalit Mohan  Dogra, President.   

          Complainant Maninder Kaur had filed the present complaint U/S 35 of the Consumer Protection Act against the opposite parties and praying that the opposite parties be directed to pay the full claim of Rs.10,00,000/- of the policy in question alongwith interest @ 18% P.A. from the date of due till its realization and Rs.50,000/- as compensation for causing mental as well as physical harassment to her by allowing the complaint and she may also be granted any other relief which she may be found entitled to.

2.       The case of the complainant in brief is that she had taken life insurance policy bearing No.474085091 dated 28.03.2017 at the name of her son namely Shehrajpreet Singh Sandhu who was born on 06.04.2004 and regularly paid the premium to the opposite parties. It was pleaded that in the year 2018 son of the complainant was effected from Collar Bone Cancer due to which he had gone through various tests and MRI and after that it was found that he was effected from above cancer and as such he was taken to DMC Ludhiana where huge amount was spent on his treatment as well as various test and duing that time officials of the opposite parties were informed by the complainant regarding the disease and expenses on the treatment of her son and she was assured by the officials of the opposite parties that all the expenses will be covered under the above said policy but the son of the complainant did not recover from his disease from DMC Ludhiana and he was taken to Medanta Hospital, Gurgaon where also huge amount was spent by the complainant on the treatment and other medical expenses as well as travelling and other related expenses for treatment/curing the disease of his son. It was further pleaded that regular installments were paid by the complainant during that period with the hope that whole expenditure incurred on her son will be reimbursed to her by the opposite parties under policy in question but unfortunately her son was died on 14.08.2020 despite many efforts and huge expenditure to get him cured from the disease. It was also pleaded that complainant approached the officials of the opposite parties alongwith medical bills and other related documents for the reimbursement of the medical claim but initially complainant was assured by the opposite parties that her case will be sent to the head office and as and when they got the approval, the amount will be reimbursed to her but uptill now no positive response was given by the officials of the opposite parties despite making many visits to the office of the opposite parties by the complainant and they intentionally and willfully did not show any interest for the release of claim amount in her favour which is clear cut mal practice and deficiency in service at the end of the opposite parties. It was next pleaded that complainant was also served upon opposite party No.1 with a legal notice dated 30.03.2021 to pay the  claim amount alongwith interest @ 18% P.A. from the date of due till its realization which was acknowledged by the opposite party No.1 and sent the letter dated 06.04.2021 in which it was stated that policy in question was repudiated by the competent authority and whatever due had been paid towards final settlement and amount of Rs.2,35,340/- paid to the complainant through NEFT in her bank account but this amount was not sufficient as per the actual claim and her right as she was entitled for more amount against the medical expenses and death of her son for which many requests were made by her to the opposite party but they refused to hear her request and she had left no option to file this complaint to get the full claim of the policy alongwith interest, hence this complaint.

3.       Upon notice opposite parties appeared through their counsel and filed written reply by taking the preliminary objections that policy bearing No.474085091  for a sum assured:10,00,000, Table Term: 814-15-15, with date of commencement 28.03.2017 from Branch Office: Batala-II with mode of payment half yearly was purchased by Smt.Maninder Kaur on the life of her minor son Master Shehrajpreet Singh whose date of death as per death certificate was 14.08.2020 and death  claim was also filed by the complainant which was repudiated vide letter dated 22.01.2021, Ref.No.Claims/Repd. No.2091/2081 as the complainant Smt.Maninder Kaur did not disclose all the material facts regarding the health of her son at the time of revival of policy on 16.01.2020; that complainant approached this Hon'ble Commission without exhausting the other remedies available under the law for redressal of her complaint. She should have approached the high power 'Zonal Office Claims Review Committee", New Delhi, where a retired High Court Judge is also one of the member; that complainant should have approached the office of "Insurance Ombudsman", Chandigarh for redressal of her grievance, if any; that complaint of the complainant is bad for mis-joinder or non-joinder for all the necessary parties and that there is no deficiency in service on the part of the opposite parties and claim under the policy in question had been rejected on legal and valid grounds of concealment of material facts. On merits, it was admitted complainant had taken the Life Insurance Policy under policy No.474085091 in the name of her minor son namely Shehrajpreet Singh. It was stated that the policy was in lapsed condition for the due dates 03/2019 to 09/2019 which was revived by Smt.Maninder Kaur (Mother of deceased Master Shehrajpreet Singh, minor aged 15 years) on 16.01.2020 by submitting the personal statement regarding health i.e. Form No.700  in which complainant and life assured had answered the relevant Q.Nos. 5(a)v, 5(a)Vii, 5(c) and Q. No.9 as "NO" whereas, prior to revival of the policy on 16.01.2020 above named deceased life assured took treatment from Medanta Hospital, Gurgaon on various dates vide admissions in the said hospital on 13.05.2019, 14.05.2019, 24.05.2019, 01.06.2019 and 20.06.2019 for 'Chemotherapy' as he was diagnosed as a case of "Metastatic Ewing Sercoma" i.e. a type of cancer that most often occurs in and around the bones which mostly affecting children and young adults but later on, the minor life assured died on 14.08.2020 and complainant did not mention the details of her son's admission in the hospital and disease from which he was suffering from prior to revival of the policy in the personal statement i.e. Form No.700 whereas she herself admitted these facts in her complaint that her son was suffering from Collar Bone Cancer in the year 2018 due to which he had gone through various tests and MRI and after that it was found that he was suffering from above cancer and she admitted him at DMC Ludhiana and when he did not recover from his disease was taken to Medanta Hospital, Gurgaon from which it becomes evident that complainant deliberately did not disclose these material facts at the time of revival of policy and this conduct of the complainant on behalf life assured was prejudicial to the concept of "Uberrima Fides" which is the basis of all Insurance Contracts. Moreover the facts of ill health and medical treatment of the son was well within the knowledge of the complainant and it was willful suppression to revive a lapsed policy fraudulently and a revival of the lapsed policy is also a De Novo Contract i.e. a fresh contract. Had the correct details regarding the extreme ill health of the minor life assured been mentioned at the time of revival, the policy would not have revived at all. As the deliberate mis-statement was made in this case, so the claim was referred to the Standing Committee and on the recommendations of the same, the competent authority had rightly been repudiated the claim of the complainant under the terms and conditions of the policy and the premiums paid under the policy i.e. an amount of Rs.2,35,340/-  had already been refunded to the3 complainant on 20.01.2021 through NEFT in her bank account No.50298138720 with Allahabad Bank, VPO Ghoman, Tehsil Batala. It was further stated that the life insurance policies do not cover the mediclaim benefits i.e. expenditures incurred on medical treatment and hospitalization etc. as such the question of reimbursement of expenditure of medical bills etc. does not arise at all. It was also stated that the legal notice dated 30.03.2021 was promptly and suitably replied vide letter dated 06.04.2021 and complainant was duly informed about the decision of the Corporation vide Speed Post letter dated 22.01.2021 by stating the details of appellate authority at New Delhi and had paid Rs.2,35,340/- as full and final payment to the complainant and nothing remains due and had rightly repudiated the claim of the complainant under the terms and conditions of the policy. All other averments made in the complaint have been denied and lastly prayed for dismissal of complaint along with litigation costs and any other relief, which the opposite parties are found entitled under the law.

4.       To Prove the case, counsel for the complainant had filed duly sworn affidavit of complainant Ex.CW-1/A alongwith copies of documents Ex.C1 to Ex.C13.

5.       On the other hand counsel for the opposite parties had tendered into evidence affidavit of Anand Gupta Manager Legal Ex.OP-1/A alongwith copies of documents Ex.OP-1 to Ex.OP-12 alongwith written statement.  

6.       Rejoinder not filed by the complainant.

7.       Written arguments filed by both the parties

8.       Counsel for the complainant has argued that complainant had purchased one life insurance policy in the name of her son namely Shehrajpreet Singh Sandhu. It is further argued that in the year 2018, son of the complainant suffered from cancer and had under gone treatment at DMC and later on Medanta Hospita,l Gurgaon. It is further argued that opposite parties have not paid the total sum assured of Rs.10,00,000/- inspite of the fact that son of the complainant expired on 14.08.2020 and all the up to date premiums had been paid to the opposite parties. It is further argued that only Rs.2,35,340/- has been paid to the complainant.

9.       Counsel for the opposite parties has argued that the policy of insurance commenced on 28.03.2017 and the death of life assured took placed on 14.08.2020. However, proposer Smt.Maninder Kaur has not disclosed material facts regarding health of her son at the time of revival of the policy. The policy of insurance was in lapsed condition by due dated 03/2019 to 09/2019, as such claim was rightly repudiated by the opposite parties and premium of Rs.2,35,34/- was refunded to the complainant through NEFT transaction.

10.     We have heard the Ld. counsels for the parties and gone through the record. It is admitted fact that complainant had purchased a life insurance policy in the name of her son on 28.03.2017. It is further admitted fact that life assured died due to cancer on 14.08.2020. It is further admitted fact in the year 2019, the policy was in lapsed condition due to non payment of some installments of premiums. It is admitted that clam lodged by the complainant has been repudiated by the opposite parties vide letter dated 06.04.2021 Ex.C4 on ground of concealment of material facts at the time of revival of the policy. The only disputed question for adjudication before this Commission is whether repudiation of claim by the opposite parties due to concealment of material facts at the time of revival was justified or not.

11.     To prove her case complainant has placed on record her duly sworn affidavit, copy of received notice, copy of letter of repudiation Ex.C4, copies of treatment record and copies of receipts regarding payment of premiums to the opposite parties. It is further admitted fact that when the policy of insurance was sold to the complainant on 28.03.2017 at that time Shehrajpreet Singh Sandhu i.e. son of complainant was not suffering from any disease and disease came to the knowledge of the complainant in the year 2018.

12.     Perusal of record and pleading shows that the policy in question was commenced on 28.03.2017 and thereafter was in a lapsed condition for due date 03/2019 to 09/2019 and the same was revived by the proposer Smt.Maninder Kaur on 16.01.2020 by submitting personal statement regarding health in Form No.700 containing details regarding health and assured Master Shehrajpreet Singh Sandhu. Since the complainant herself admitted in para No.2 of her sworn affidavit that her son was found to be suffered from cancer in 2018. As such it is material concealment of facts. We are of the view that since the complainant came to know about the disease from which her son was suffering the complainant in connivance with the Mr.Thakr Singh agent manipulated the fact in the revival form and deposited the premium by concealing the serious disease i.e. cancer from which Master Shehrajpreet Singh Sandhu suffering.

13.     We have placed reliance upon the judgment of Hon'ble Supreme Court of India reported in 2008 ACJ 456 in C.A. No.5322 of 2007 arising out of S.L.P. (C) No.23951 of 2005; decided on 20.11.2007 in case titled as P.C. Chacko and another Vs. Chairman L.I.C. of India and others wherein it is held as under:-

          "Insurance Act, 1938, section 45 - Life insurance  -        Fraudulent suppression of material facts - Repudiation of           claim - Death of assured within six months of taking policy -        L.I.C. repudiated the claim as assured suppressed material    fact of his undergoing an operation within 4 years prior to       filing the proposal form - Answers given by the  assured in the     proposal form were found incorrect but trial court decreed the          suit - Single Judge in appeal held that non-disclosure of a previous operation did not justify repudiation of claim by           L.I.C. as it might not have declined to insure or insisted on a   higher premium - Division Bench opined that parties were          bound by the warranty clause and non-disclosure related to a        material fact which was required to be answered correctly and          allowed the appeal of L.I.C. - Apex Court observed that      assured had          undergone a major operation, he did not disclose           it prior to obtaining the policy, assured was aware of the        consequences of making a misstatement of fact and such a    person would ordinarily be stopped from pleading that even if this fact had been disclosed it would not have made any          material difference - Whether L.I.C. was justified in           repudiating the claim - Held:   yes; a deliberate wrong           answer which has a bearing on         contract of insurance, if discovered may lead to the policy being vitiated in law".    (Paras 10, 15, 21, 26).

14.     From the evidence on record and by relying upon the judgment of the Hon'ble Supreme Court of India it is very much evident that policy of insurance was got revived by the complainant in connivance with Mr.Thakr Singh agent by mentioning wrong facts regarding health of the assured. Moreover, it is nowhere case of the complainant that she is not aware about the contents of the revival form and answers given by her. Even she has nowhere stated that she never gave said answers or that her signatures were obtained on blank form.

15.     Accordingly, by relying upon the judgment of Hon'ble Supreme Court of India and from the facts as stated above we do not find any merit in the present complaint and is dismissed.

16.      The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases.

17.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record room. 

                               (Lalit Mohan Dogra)

                                                                        President   

Announced:                                          (B.S.Matharu)

Oct. 03, 2023                                                Member

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