Haryana

Karnal

CC/71/2019

Khushboo - Complainant(s)

Versus

Manager, LIC Of India - Opp.Party(s)

Manoj Jain

21 Nov 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                          Complaint No. 71 of 2019

                                                          Date of instt.11.02.2019

                                                          Date of Decision 21.11.2019

 

Khushboo d/o late Smt. Pushpoa wife Shri Satpal resident of House no.710/20 Gandhi Colony, Panipat.

Now

Khushboo wife of Sandeep resident of ward no.5, Amar Colony, Nisshing District Karnal, age 28 years.

                                                 …….Complainant.

                                              Versus

 

1.Manager, LIC of India, 489, Post Box no.106 Jeevan Parkash, Model Town, Karnal.

2. Manager, LIC of India, Jeevan Bharti, Cannought Circus, New Delhi.

 

                                                                         …..Opposite Parties.

 

           Complaint u/s 12 of the Consumer Protection Act. 

 

Before    Sh. Jaswant Singh……President. 

      Sh.Vineet Kaushik ………..Member

                Dr. Rekha Chaudhary…….Member

 

 Present:  Shri Manoj Jani Advocate for complainant.

                   Shri Shakuntla Dagar Advocate for opposite parties.

                 

                   (Jaswant Singh President)

ORDER:                    

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986 on the averments that Smt. Pushpa mother of complainant had got insured from OPs, vide policy no.178170510 dated 28.05.2017 for sum assured Rs.2,65,000/- for 16 years under LIC New Endowment Plan (with profits) and paid regular premium against the said policy. At the time of taking said policy the mother of complainant was not suffering from Cancer disease. The mother of the complainant died on 03.06.2018 at house due to heart attack. Thereafter, complainant being nominee requested the OPs so many times to release the claim as per policy and submit the required documents as per demand of the OPs but OPs did not pay any heed to the request of complainant and postponed the matter on one pretext or the other. Lastly, OP flatly refused to release the claim of the complainant. OPs sent a letter bearing no.Claims/Rep./M/18-19/38 dated 31.10.2018 and same has been duly replied in the shape of reply-cum-registered legal notice dated 5.1.2018 but till today OPs did not release the claim. In this way there was deficiency in service on the part of the OPs. Hence complainant filed the present complaint.

2.             Notice of the complaint was given to the OPs, who appeared and filed written version raising preliminary objections with regard to cause of action; maintainability and concealment of true and material facts. On merits, it is pleaded that Smt. Pushpa wife of Shri Satpal has proposed for insurance under table and term 814-16 for a sum assured of Rs.2,65,000/-, vide proposal form dated 31.07.2017. The policy no.178170510 was issued on the basis of this proposal form and was dated back from 28.05.2017. The premium of Rs.4800/- was payable quarterly under the policy i.e. every three months. In the proposal form at the bottom contains a declaration by the proposer which was duly signed by the deceased life assured. The declaration is as follows:

        “I, Pushpa, the person whose life is herein being proposed to be assured, do hereby declare that foregoing statements and answers have been given by me after fully understanding the questions and the same are true and complete in every particulars and I have not withheld any information and I do hereby agree that these statements and this declaration shall be the basis of the contract of assurance between me and the Life Insurance Corporation of India and if any untrue averment be contained herein the said contract shall be absolutely null and void and all moneys which shall have been paid in respect thereof shall stand forfeited to the corporation.”

        Whereas, deceased life assured was suffering from cancer before filling in the proposal form and for which she had consulted a medical man and had taken treatment in a hospital. However, life assured did not disclose these facts in her proposal form. Instead she gave false answers therein. The life assured had answered the following question as follows:

Questions

11(d) Are you suffering from or have you ever suffered from ailments, pertaining to liver, stomach, Heart, Lungs, Kidney, Brain or Nervious system?

Answer      No

11(e) Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Eiplepsy, Hernia, Hydrocele, Leprosy or any other disease?

Answer      No

Ii(i) What has been your usual state of health

Answer      Good

It is further pleaded that the life assured died on 03.06.2018 as per information received from the complainant who is the nominee under the policy. The date of commencement of risk was 31.07.2017, so the duration of policy was only 10 months and 2 days from the date of commencement of risk. It is further pleaded that complainant has applied for the death claim under the policy in question on 10.09.2018. Since the policy in question has not completed three years from the date of commencement of the risk i.e. 31.07.2017, the claim was examined keeping in view the provisions of section 45 of the Insurance Act, 1938. During investigation it was found that the deceased life assured had not answered the questions relating to her health, correctly and gave false answers to the question in the proposal form dated 31.07.2017. It is further pleaded that the life assured suffering from Cancer before proposing for this policy and got treatment for the same in Madaan Hosital, Assandh Road, Model Town, Panipat on 23.06.2017 to 27.06.2017 (where she was diagnosed-Huge lump in abdomen-Multiple Malignant ovaries from left side) and this information has been concealed by Smt. Pushpa in her proposal form dated 31.07.2017.  Hence, the claim of the complainant has been rightly repudiated by the OPs due to suppression of material facts with holding the correct information about her health by the deceased life assured in the proposal form. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Complainant tendered into evidence her affidavit Ex.CW1/A and documents Ex.C1 to Ex.C5 and closed the evidence on 04.07.2019.

4.             On the other hand, OPs tendered into evidence affidavit of Puneet Kumar Manager Ex.OP1/A and documents Ex.OP1 to Ex.OP21 and closed the evidence on 09.10.2019.

5.             We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

6.             The case of the complainant is that Smt. Pushpa mother of complainant had got insured herself from OPs, vide policy no.178170510 dated 28.05.2017 for sum assured Rs.2,65,000/- for 16 years under LIC New Endowment Plan (with profits) and paid regular premium against the said policy. At the time of taking said policy the mother of complainant was not suffering from Cancer disease. The mother of the complainant died on 03.06.2018 at house due to heart attack. Thereafter, complainant being nominee requested the OPs so many times to release the claim as per policy and submit the required documents as per demand of the OPs but OPs did not pay any heed to the request of complainant and postponed the matter on one pretext or the other. Lastly, OP flatly refused to release the claim of the complainant.

7.             On the other hand, the case of the OPs is that the claim of the complainant has been rightly repudiated by the OPs due to suppression of material facts with holding the correct information about her health by the deceased life assured in the proposal form as she was suffering from Cancer at the time of taking the policy.

8.             The policy in question was issued on the basis of proposal form Ex.OP4 dated 31.07.2017 and was dated back from 28.05.2017. The premium of Rs.4800/- was payable quarterly under the policy i.e. every three months. As per the version of the OPs, deceased life assured was suffering from Cancer before filing the proposal and for which she had consulted a medical man and had taken treatment in a hospital. Life Assured did not disclose these facts in her proposal form and suppression of material facts. Thus, all the money received by the OPs under the policy stand forfeited in the terms and conditions as stated in column no.6 of the policy  bond Ex.OP20 which read as under:-

        “In case of any condition herein contained or enclosed herewith shall be contravened in case it is found that any untrue or incorrect statement is contained in proposal, personal statement, declaration and connected documents or any material information is withheld, then and in every such case this policy shall be void and all claims to any benefits in virtue of this policy shall be subject to the provisions of Section 45 of the Insurance Act, 1938, as amended from time to time.”

9.             Admittedly, life assured died on 03.06.2018 and the complainant is the nominee under the policy. The date of commencement of risk was 31.07.2017, so the duration of the policy was only 10 months 2 days from the date of commencement of risk. The contract of insurance is based on the principal of ‘Uberrima fide” i.e. utmost good faiths, where a legal obligation cast upon the party seeking insurance to disclose all the facts and material information truly to the OPs. But in the present case, the correct information of the life assured suffering from Cancer and got treatment for the same in Madaan Hospital, Assandh Road, Model Town, Panipat on 23.06.2017 to 27.06.2017 (where she was diagnosed-Huge lump in abdomen-Multiple Malignant ovaries from left side) has been concealed and withheld by Smt. Pushpa in her proposal form dated 31.07.2017 which makes this contract of insurance null and void, ab-initio.

10.            As per treatment record Ex.OP21 deceased life assured under treatment before commencement of risk date. It is settled principle of insurance law that contract of insurance is a contract uberrima fides and utmost faith must be observed by the contracting parties. Every material fact must be disclosed, otherwise there is good ground for rescission of contract. If, there are misstatements or suppression of material facts, the policy can be called into question. In this regard reference may be made to the judgment of the Hon’ble Supreme Court in case titled Satwant Kaur Sandhu Versus New India Assurance Co. IV( 2009) CPJ 8 (SC) and judgment of Hon’ble National Commission in case Life Insurance Corporation of India and another Versus Bimla Devi Revision Petition no.3806 of 2009 decided on 12.8.2015.

11.            Thus, as a sequel to abovesaid discussion and in view of law cited above, we do not find any merits in the complaint and the same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:21.11.2019                                                                       

                                                                      President,

                                                              District Consumer Disputes

                                                               Redressal Forum, Karnal.      

 

 

                (Vineet Kaushik)          (Dr. Rekha Chaudhary)

                 Member                            Member