Punjab

StateCommission

FA/13/79

LIC of India - Complainant(s)

Versus

Manpreet Singh - Opp.Party(s)

S.K.Mahajan

14 Dec 2016

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL COMMISSION,     PUNJAB

          SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.

                                     

                   First Appeal No.79 of 2013

 

                                                          Date of Institution: 23.01.2013

                                                          Date of Decision: 14.12.2016

 

1.      Life Insurance Corporation of India through its Senior     Divisional Manager, Jeewan Deep Building, Sector 17,         Chandigarh.

2.      Life Insurance Corporation of India, Amritsar Divisional Office,         4-5, District Shopping Centre, Near M.K. Hotel, Ranjit Avenue,          Amritsar through its Authorized Signatory.

3.      Life Insurance Corporation of India, Jeevan Jyoti, Model Town,        Malwal Road, Ferozepur City, through its Authorized Signatory.

 

                                                                   Appellants/Opposite parties    

                 Versus

 

1.      Manpreet Singh aged 25 years, son of Balwinder Singh,

2.      Harpreet Kaur aged 22 years, daughter of Balwinder Singh,    both residents of House No.19, Gali No.15, Basti Tankan Wali,         Ferozepur Cantt.

 

                                                                   Respondents/Complainants

                                                                                                         

First Appeal against order dated 30.10.2012 passed by the District Consumer Disputes Redressal Forum,  Ferozepur

 

Quorum:-

          Shri J. S. Klar, Presiding Judicial Member.

            Shri.J.S Gill, Member

            Shri. H.S. Guram, Member

Present:-

          For the appellants                  : Sh.S.K. Mahajan, Advocate

          For the respondents             : Sh.Sandeep Khungar,  Advocate

          . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

         J.S KLAR, PRESIDING JUDICIAL MEMBER :-

         

          The appellants of this appeal (opposite parties in the complaint) have directed this appeal against order dated 30.10.2012 of District Consumer Disputes Redressal Forum Ferozepur,  accepting the complaint of complainant by directing the appellants to pay Rs.4,00,000/- i.e. Rs.2,50,000/- in respect of policy no. 472294306 and Rs.1,50,000/- in respect of policy no.472264581 along with interest @ 9% per annum from 10.02.2012 i.e. date of repudiation of claim of the complainant till realization, besides Rs.3,000/- as compensation and Rs.2,000/- as litigation expenses. The appellants of this appeal are OPs in the complaint and respondents of this appeal are the complainant in original complaint before District Forum and they be referred as such hereinafter for the sake of convenience.  

2.      The complainant has filed the complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs on the averments that Nasib Kaur (since deceased) mother of the complainants was employed as lady constable no.565/FZR. She was insured with OPs through branch office at Ferozrpur City, vide two separate policies no.472294306 qua LIC's Jeevan Saral with profits and 472264581 qua LIC's New Bima Gold and also paid the premiums of said policies. She was medically examined by the representatives of OPs at Ferozepur, as per policy terms and conditions before accepting policy proposal. After complete satisfaction to the effect that Nasib Kaur was not suffering from any disease and was found fit to be insured, the premium amount of the above said policies was accepted by the OPs.  Nasib Kaur suddenly felt seriously ill in December 2010 and she could not survive despite best treatment and ultimately expired on 23.12.2010 at Kalra Hospital Amritsar. Necessary intimation with regard to her death was given to OP no.2 at Ferozepur. The OPs assured the complainants to make the payment of insurance claim of their mother Smt. Nasib Kaur (since deceased) to them under aforesaid policy. All formalities were completed and claim was lodged, but OPs vide two separate memos dated 10.02.2012 have wrongly repudiated the claim of the complainants merely on the ground that deceased Nasib Kaur withheld the material information regarding her health. The complainants alleged deficiency in service on the part of OPs. The complainant has, thus, filed complaint against OPs directing them to pay Rs.4,00,000/- i.e. Rs.2,50,000/- qua policy no.472294306 and Rs.1,50,000/- qua policy no.472264581 along with interest @ 18% per annum, besides Rs.50,000/- as compensation and Rs.5500/- as litigation expenses.

3.      Upon notice, OPs appeared and filed written reply and contested the claim of the complainant vehemently. It was averred that life assured Nasib Kaur had concealed material facts regarding her health at the time of filling up the proposal forms dated 22.04.2008 in respect of policy no.472264581 and proposal form dated 31.08.2009 in respect of policy no.472294306. The complainant was suffering from GOUT for the last ten years and had been taking poor allopathic medicines (Desi) for the last ten years. Deceased life assured was well within the knowledge of her disease since the year 2000. She deliberately concealed the same at the time of filling up the proposal forms. Repudiation of insurance claim of the complainant by the OPs was justified. Rest of the averments have been denied by OPs and it prayed for dismissal of the complaint.

4.      The complainant tendered in evidence his affidavit Ex.C-1 along with copies of documents Ex.C-2 to Ex.C-6.  As against it; OPs tendered in evidence affidavit of Makhan Lal Manager (Legal) Divisional Office LIC Ex.R-7 along with copies of documents Ex.R-1 to Ex.R-6. On conclusion of evidence and arguments, the District Forum Ferozepur accepted the complaint of the complainant by virtue of order dated 30.10.2012. Dissatisfied with the order of the District Forum Ferozepur dated 30.10.2012, the opposite parties now appellants, carried this appeal against the same.

5.      We have heard learned counsel for the parties at considerable length and have also examined the record of the case.

6.      There is no dispute about this fact that Nasib Kaur was insured with OPs for two policies and advertence to evidence on the record is also required in this case for adjudication of the matter. The complainant Manpreet Singh as legal heir of life assured Nasib Kaur (since deceased) has filed affidavit Ex.C-1 on oath in support of the case of the complainant. He has stated that Nasib Kaur was not suffering from any disease and was found fit at the time of accepting her proposal forms by OPs. OP no.2 obtained her signatures on blank papers under the garb of completing certain formalities of the insurance company. They gave policy numbers to Nasib Kaur, but did not provide complete particulars thereof to her. Ex.C-2 is death certificate of Nasib Kaur proving her death on dated 23.12.2010. Ex.C-3 is repudiation letter of claim under policy no.472294306 dated 10.02.2012 addressed to complainant. Ex.C-4 is repudiation letter dated 10.02.2012 under policy no.472264581 addressed to complainant. Ex.C-5 is affidavit of  Manpreet Singh in support of his averments as contained in the complaint. Copy of certificate issued by Kalra Hospital Ex.C-6. This is the entire evidence relied upon by the complainant in this case.

7.      In rebuttal of this evidence, OPs relied upon the terms and conditions of policy no.472264581  dated 22.04.2008 Ex.R-1. Ex.R-2 is proposal for insurance, the date is recorded as 22.08.2008. Ex.R-3 are the terms and conditions of Jeevan Saral Policy. Ex.R-4 is proposal form dated 31.08.2009. Ex.R-5 is the Bed Heat Ticket of Nasib Kaur life assured by Guru Gobind Singh Medical College Hospital Faridkot, vide CR No.16321 dated 14.12.2010. It contained the treatment record of Nasib Kaur. Ex.R-6 is the history issued by Tarlok Hospital Ferozepur Cantt. Ex.R-7 is affidavit of Makhan Lal Manager (Legal) Divisional Office LIC of India.

8.      The District Forum accepted the complaint of the complainant by directing the OPs to pay the amount of Rs.4,00,000/-  and Rs.1,50,000/- with regard to above referred two policies with interest @ 9% p.a. The District Forum has recorded the  reason on the Bed Head Ticket Ex.R-5 of Guru Gobind Medical College & Hospital Faridkot, which was much later after the date of the proposal. This document remained unproved as it has not been proved nor there is any affidavit to support it. The first proposal form Ex.R-2 was made by life assured on 22.04.2008 and second proposal for insurance policy Ex.R-4 was made on 31.08.2009, whereas the date of admission of Nasib Kaur has been mentioned as 14.12.2010 and bed head ticket Ex.R-5 has been issued much later after date of proposal as observed by District Forum. The District Forum relied upon law laid down by National Commission in "Life Insurance Corporation of India and others versus Ram Murti", reported in 2010(1) CPC 143. The Apex Court has held in "P.Vankut Naidu versus Life Insurance Corporation of India and another," reported in 2011(3) CPC 350 that no cogent evidence was produced by the insured to prove that insured had concealed any fact about her illness or hospitalization before submitting the proposal form. Resultantly, it was held by District Forum that claim under the policy was to be granted in the cited authority. There was no cogent evidence produced by OPs to prove that insured/deceased had concealed any fact regarding her illness and hospitalization. This specific finding was recorded in view of peculiar facts of the case, as appeared before their Lordship in the cited authority. The National Commission has held in Life Insurance Corporation of India versus Ram Murti (supra) that claim was repudiated on the ground that insured concealed the fact of earlier treatment. Insured is illiterate and could not understand contents of proposal form. No affidavit of earlier problem was filed. The District Forum directed to refund the amount.

9.      From evidence on record as referred to above, it is evident that Nasib Kaur was a Constable in the Police Department. It cannot be presumed that she was illiterate or did not understand the implication of the documents. She filled in the proposal forms and duly signed them. Vide proposal form Ex.R-2, she gave answers in negative to specific questions put to her with regard to her health. She also signed declaration for insurance claim in one policy at Zira on 22.04.2008, it is signed by her in Punjabi. In another proposal form Ex.R-4, she gave the answers in negative with regard to questions regarding her state of health and declaration is part of this proposal form, which is signed by her. Ex.R-5 is Bed Heat Ticket record of Nasib Kaur, vide CR No.16321 dated 14.12.2010.

10.    The District Forum observed that this record is not sufficient to prove the fact in dispute. We disagree with the reasoning of the District Forum on the premise that Guru Gobind Singh Medical College Hospital Faridkot is a recognized Medical College in the State of Punjab by the Punjab Government. Even students are taught in MBBS and in PG Classes and Research Degrees are provided to the candidates, who received training therefrom. It is a Government Institution and it is not possible that record was prepared in a false manner. Even record is prepared by the government doctors, who are public servants in the discharge of their official duties and this record can be duly considered by us. We find no ground to discard it out of consideration, as lightly done by District Forum. This record contained the brief history of Nasib Kaur of joint pain for one month. History was narrated by Nasib Kaur DLA herself to the doctor attending on her. It is recorded therein that she complained from Gout allopathy and indigenous medication were taken by her for the last ten years. Why the government doctors of recognized institute would, record false history, remained unexplained to us.  We cannot exclude this evidence Ex.R-5 out of consideration in this case, because it is by the recognized Government College of the State of Punjab and can be relied being relevant under Section 35 of Evidence Act. It has, thus, proved that Nasib Kaur was taking allopathy medication, as well as, indigenous medicines (Desi) for the last ten years for disorder of Gout. This history was recorded by doctors, as per narration of life assured herself. This record is dated 14.12.2010, when she was admitted and was discharged on 21.12.2010 from Guru Gobind Singh Medical College Hospital Faridkot, as per Ex.R-5 on the record. The cited authorities are distinguishable from the peculiar facts situation of the case, because recognized government institute has issued the record, where she remained admitted under treatment and it cannot be said to be a false one nor lacking in any credibility. We have, thus, no option but to rely upon this record of medical college and history as recorded atf Guru Gobind Singh Medical College Hospital Faridkot Ex.R-5 as produced on record, where she remained admitted for treatment of this disorder. There is, thus, admission of life assured contained in this record because of her Gout disease and taking medication therefor for the last ten years even before the date of taking the proposal form. The government doctors of the government institutions generally did not file their affidavits even at the asking of the concerned persons. They are busy fellows in their own pursuits or treating the hordes of patients. The OPs, thus, remained successful in proving that life assured has been suffering from disease of 'Gout'  for the last more than ten years before taking the policy. She was suffering from this disorder even prior to filling up the proposal form. Ex.C-6 is certificate issued by some Khushbir Kalra of Memorial Hospital Amritsar, which is unable to rebut the record prepared by the Government Institute of Medical Science at Faridkot (supra).

11.    We, thus, conclude that life assured was a patient of 'Gout' before taking the policy, as per the proposal form Ex.R-2 and Ex.R-4 on the record. She was well within knowledge of her disease and she deliberately withheld this material information, when she entered into contract with OPs. It could have changed the mind of OPs whether to accept the contract or not with complainant. The Contract of Insurance is based on principle of UMBERRIMA FIDES. On this point, we rely upon law laid down by Apex Court in Satwant Kaur Sandhu vs. New India Assurance Company Ltd, reported in (2009) SCC 316 and P.C Chacko and another versus  Chairman Life Insurance Corporation of India and others reported in (2008) 1 SCC 321. The information suppressed in this case was material in nature and it was within the knowledge of life assured that she was a patient of 'Gout' before entering into the Contract of Insurance with OPs. The order of District Forum is, thus, erroneous, which cannot be sustained in the appeal and is order to be reversed.

12.    As a result of our above discussion, we accept the appeal of the appellants and by setting aside, the order of the District Forum Ferozepur dated 30.10.2012, the complaint of the complainant now respondent in this appeal is ordered to be dismissed.

13.    The appellants had deposited an amount of Rs.25,000/- with this Commission at the time of filing the appeal. This amount with interest, if any, accrued thereon, be refunded by the registry to the appellants by way of crossed cheque/demand draft after the expiry of 45 days.

14.    As a result of our above discussion, finding no merit in the appeal, the same is hereby dismissed.

15.    Arguments in this appeal were heard on 13.12.2016 and the order was reserved. Copies of the order be communicated to the parties as per rules.

15.    The appeal could not be decided within the statutory period due to heavy pendency of court cases.

 

                                                                          (J. S. KLAR)

                                                          PRESIDING JUDICIAL MEMBER

                    

                                                                             (J.S GILL)

                                                                              MEMBER

 

 

                                                                             (H.S.GURAM)

                                                                               MEMBER

December 14, 2016                                                            

(ravi)