Punjab

StateCommission

A/716/2018

LIC of India - Complainant(s)

Versus

Mehar Chand - Opp.Party(s)

S.C Thatai

09 Apr 2019

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB, CHANDIGARH.

 

 

First Appeal No. 716 of 2018                                                     

Date of institution  :  28.12.2018        

Reserved on            :  01.04.2019

Date of decision     :  09.04.2019

 

1. Life Insurance Corporation of India Ltd., Divisional Office Jeevan Parkash, Model Town Road, Jalandhar City-144 001, through Shri Rajeev Malhotra, Manager(L&HPF), Divisional Office, Jeevan Prakash Building, Sector 17-B, Chandigarh.
2. Life Insurance Corporation of India Ltd., Branch Office Unit No.1, Ground Floor, “Jeevan Parkash”, Model Town Road, Jalandhar City-144 001, through Shri Rajeev Malhotra, Manager (L&HPF), Divisional Office, Jeevan Prakash Building, Sector 17-B, Chandigarh.
3. Manager (CRM)/Central Public Information Officer, Life Insurance Corporation of India Ltd., Jalandhar Division, “Jeevan Parkash”, Model Town, Jalandhar City-144 001.

………Appellants-Opposite Parties

                                                Versus

Mehar Chand s/o Sawan Ram, aged 75 years, R/o Nandanpur Colony, P.O. Nagra, Jalandhar.

…….Respondent-Complainant

  

First Appeal against the order dated 20.11.2018 of the District Consumer Disputes Redressal Forum, Jalandhar.   

Quorum:- 

           Hon’ble Mr. Justice Paramjeet Singh Dhaliwal, President

      Mrs. Kiran Sibal, Member.                           

Present:-

          For the appellants       : Shri Nitin Thatai, Advocate.

          For the respondent     : Shri Anshul Jain, Advocate.

         

JUSTICE PARAMJEET SINGH DHALIWAL, PRESIDENT:

 

          The instant appeal has been filed by the appellants/opposite parties against the order dated 20.11.2018 passed by District Consumer Disputes Redressal Forum, Jalandhar (in short, “District Forum”) whereby the complaint filed by respondent/complainant, under Section 12 of the Consumer Protection Act, 1986 (in short, “C.P. Act”) was partly accepted and the appellants/opposite parties were directed to pay the remaining amount of ₹9,00,061/- with interest @ 12% per annum from the date of repudiation of the claim i.e. 28.2.2017 till realization.  They were further directed to pay compensation of ₹20,000/-, on account of mental and physical harassment and litigation expenses of ₹10,000/-.

2. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Forum.

Facts of the complaint:

3. Brief facts, as averred in the complaint, are that the wife of the complainant; namely, Kamlesh Kumari had taken Life Insurance Policy bearing No.133960025 under Plan 'B' LIC's Bima Bachat Table 175 for a term of 9 years for sum assured of ₹40,30,000/- through authorized agents and accordingly single premium of ₹30,00,939/- was paid.  The date of commencement of the policy was 30.11.2013 and the date of maturity was 26.11.2022.  The maturity value on the expiry of term or in the event of contingency of pre-mature death before the term payable was equivalent to the sum assured i.e. ₹40,30,000/-. The complainant for that purpose had filled the proposal form No.300 dated 26.11.2013, which was filled on the dotted lines.  The life assured had perfect health and the insurability with no trace of physical impairment/disease/ill health at the time of proposing for life insurance policy. It is further averred that the policy was issued after due scrutiny and verification by the agent and the Development Officer of the LIC after satisfying about the health and habits, physical condition, insurability and age of the life assured. The risk of the life insurance was accepted without raising any kind of objection as to the details given in Proposal Form. The life assured was all hale and hearty, kept good health, led simple normal active healthy life and participating in day to day activities in family affairs throughout her span of life and was not harbouring and labouring under any disease or sickness when she sought insurance on her life under the policy in question. It is further averred that unfortunately the complainant died on 20.6.2016 due to heart attack.   It is alleged that she had not taken prior treatment.  The death was natural and sudden.  It is further averred that the period of two years had already lapsed from the date of the policy.  The claim was partially settled, vide letter dated 28.2.2017, Ex.C-4, and the full amount of premium amounting to ₹30,00,939/- on ex-gratia basis was refunded towards full and final settlement of the claim.  It was further averred that the amount of ₹9,00,061/- was still pending, which has not been paid by the opposite parties. Non-payment of full amount tantamounts to deficiency in service on the part of the opposite parties and as such, the consumer complaint was filed by the complainant before the District Forum, Jalandhar for payment of remaining claim amount along with interest, compensation and litigation expenses.

Defence of the Opposite Parties:

4.      Upon notice the opposite parties appeared and filed joint reply taking preliminary objections to the effect that the life assured was suffering from various ailments i.e. HTN, DM Type-II and Acute Renal Failure and the said facts were concealed.  The diseases were more than 27 years old.  The life assured had been taking treatment from Dr. Dinesh Dada of Vasal Hospital Private Limited and she had also taken treatment from Ghai Hospital. As such, the complainant is not entitled to any claim.  The complainant is estopped by his own act, conduct and acquiescence and was in knowledge of ailment of his wife Kamlesh Kumari. As such no claim is maintainable. On merits, it is admitted that the insured, Kamlesh Kumari was the wife of the complainant and she got insurance policy in question.  It was categorically denied that the proposal form was taken in routine and got the signature of the insured on dotted line; rather, the life assured did not disclose her ailment at the time of taking the policy.  The opposite parties have paid an amount of ₹30,00,939/-, as per policy condition.  All other allegations made in the complaint have been denied.  A prayer for dismissal of the complaint with costs has been made.

Finding of the District Forum:

5.      Both the sides produced evidence in support of their respective averments before the District Forum, which after going through the same and hearing learned counsel on their behalf, partly accepted the complaint in the terms stated above, vide impugned order. Hence, this appeal.

6.      We have heard learned counsel for the parties and have carefully gone through the records of the case.

Contentions of the Parties:

7.      It was vehemently contended by the learned counsel for the opposite parties that the life assured was suffering from various ailments i.e. HTN, DM Type-II and Acute Renal Failure etc. and the said facts were concealed.  The diseases were more than 27 years old.  The life assured had been taking treatment from Dr. Dinesh Dada of Vasal Hospital Private Limited, Jalandhar and she had also taken treatment from Ghai Hospital, Jalandhar.  The deceased life assured had concealed the material information regarding her health in the proposal form submitted by her.  If the information regarding her health would have been correctly revealed in the proposal/application, the opposite parties would not have accepted the proposal.  The District Forum has wrongly interpreted the ex-gratia payment in its order as part payment of insurance claim.  The claim for the payment of full amount has rightly been repudiated by the opposite parties.  It was prayed that the appeal be accepted and the impugned order passed by the District Forum be set aside.

8.      Per contra, it was vehemently contended by the learned counsel for the opposite parties that the deceased life assured was hale and hearty at the time of submission of the proposal form.  She was not suffering from any disease, as alleged by the opposite parties.  The District Forum has passed a well reasoned order after duly appreciating the pleadings of the parties and the evidence on record in support of those pleadings.  There is no merit in the present appeal and the same is liable to be dismissed with costs.

Consideration of Contentions:

9.      We have given our thoughtful consideration to the contentions raised by the learned counsel for the parties.

10.    The Bima Bachat Policy Table 175 of the LIC of India is a money-back policy, which provides financial security and assurance to the policy holder and his family.  The policy was single premium policy.  The single premium of ₹30,00,939/- was paid and the sum assured was ₹40,30,000/-.  Besides this the other benefits were also available in the policy as mentioned in Ex.C-2 to the effect that on completion of three years 15% of the value of the sum assured was payable and thereafter on the 6^th year of its completion another 15% of the sum assured was payable and thereafter on the completion of 9^th year 15% of the sum assured and the maturity value were payable on completion of the term of the policy.   Under that policy the general investment return rate ranged from 6% to 10% per annum.   Besides this if the policy holder survives for full period loyalty additions was payable at the rate declared by the LIC of India.  Further in the event of the death of the life assured prior to the date of maturity the amount equal to the sum assured (specified in the schedule in the policy) was payable to the nominee or assignees or legal representatives of the proposer immediately on admission of claim. 

11.    In the case in hand unfortunately the life assured died on 20.6.2016 after about two and a half years from the date of commencement of the policy and before completion of the three years allegedly due to heart attack.  There is dispute regarding the date of death of the life assured.  In para no.5 of the complaint the date of death of the life assured is mentioned as 26.11.2016.  However in para no.19 of the complaint the date of death of the life assured is mentioned as 20.6.2016.  However, we have come to the conclusion that the death of the life assured took place on 20.6.2016 because in the letter dated 8.3.2017, Ex.C-5, it is mentioned that the claim was received on 26.10.2016.  It is pertinent to mention here that vide letters dated 28.2.2017 and 8.3.2017, Ex.C-4 and Ex.C-5, the opposite parties paid the insurance claim to the tune of ₹30,00,939/-, which is alleged to be the ex-gratia and the same is not in dispute. The only issue is whether the total sum assured was required to be paid or the balance as per the terms of the policy, Ex.C-2, was required to be paid and to what extent?

12.    If we take into consideration the terms and conditions of the insurance policy, Ex.C-2, since the policy was for 9 years and apparently death is before three years and thereafter investigation was carried out by the opposite parties to ascertain the cause of death.  During the investigation the opposite parties came to know that the complainant was suffering from following ailments for the last 27 years:-

          “1. Diabetes Mellitus-II,

           2. Hypertension and

3. ARF (Acute Rental Failure)”

The opposite parties produced on record Discharge Summary of Vasal Hospital Private Limited dated 11.6.2014, Ex.O-3, in which the life assured was diagnosed as HTN, DM Type II and ARF with Sepsis.  The life assured was treated by Dr. Dinesh Dada in that Hospital.  The opposite parties also filed affidavit of Sunil Sethi, Administrator of the Vasal Hospital Private Limited dated 5.2.2018 in which he deposed that Smt. Kamlesh Kumari was admitted in that Hospital on 4.6.2014 and was discharged on 11.6.2014.  The information provided to Dr. Dinesh Dada that she was suffering from Diabetes Mellitus Type-II and other diseases for the last 27 years had been so recorded in the Discharge Summary which is correct.  The opposite parties also filed Certificate of Dr. H.S. Bhutani, M. Ch. Urologist of Ghai Hospital, Neuro Surgery, Trauma and Kidney Care Centre, Jalandhar, in which it is mentioned that the life assured Kamlesh Kumari was brought to that Hospital for first time on 19.7.2014 for A.V. fistula formation and she was discharged on the same day after surgery.  As per the life assured/patient she was on Haemo Dialysis for short time and had already been diagnosed as a case of ESRD.  She was on Haemo Dialysis in that Hospital.  Her first dialysis was done on 26.8.2014 and last Haemo dialysis was done in that Hospital on 6.6.2016.  However, this history of the life assured is not relevant so far as the policy in question is concerned, as the policy was an investment policy and it has no nexus with the cause of death of the life assured.  It is not a medical insurance policy.  It is a pure and simple investment i.e. with a purpose for financial security.  If the life assured would have survived, she would have got other benefits besides the total amount of premium.  Moreover, the District Forum in its order while dealing with the above mentioned ailments of the life assured has observed in para no.11 as under:-

“11.   So for the concern of other objection raised by the OP in the  letter that the insured had concealed for previous ailment is also not established in this case because the OP has examined one Sunil Sethi, Administrator of M/s Vasal Hospital, Kapurthala Chowk, Jalandhar and Mr. Amit Jangra, Administrator of M/s Ghai Hospital and both the affidavits are Ex.OW2/B and Ex.OW3/C and both the administrators also proved on the file Discharge Summary Ex.O-3 of Vasal Hospital Private Limited and certificate issued by Vasal Hospital is Ex.O-6 and an other certificate issued by Ghai Hospital is Ex.O-5. These documents are produced by the OPs to establish the previous ailment to the insured Kamlesh Kumari, but if we go through the Discharge Summary Ex.O-3, wherein no doubt, the diagnosis have been mentioned HTN, DM Type-II, but we are concerned on which date these diseases were liquidated to the doctor, the crucial date is 04.06.2014, when the insured was admitted in the hospital and discharge there from on -6- 11.06.2014, whereas the commencement of the insurance policy was 30.11.2013, much prior to the admission of the insured in the Vasal Hospital. Similarly, the certificate issued by the Vasal Hospital Ex.O-6 is also relating to the disease discovered in the month of May, 2014. Similarly, an other certificate produced on the file by the OP, issued by Ghai Hospital Ex.O-5 is also related to the year July, 2014, but there is no documentary evidence on the file to establish that the insured was having any disease prior to 30.11.2013 i.e. the date of the commencement of the insurance policy, simply stating or alleging that it is mentioned in the discharge summary that insured was having 27 years old Hypertension disease, is not sufficient rather it is duty of the OP to bring on the file any documentary evidence to establish that the insured was taking medicine of that disease, then it can be considered that the insured was having any problem for a such long time, but without any medical evidence, we cannot accept this version of the OP and further find that the rulings referred by learned counsel for the OP, decided by Hon'ble National Commission, in Revision Petition No.2996 of 2015, titled as “Smt. Sangeeta Halwe Vs. Life Insurance Corporation of India & Anr”, Revision Petition No.3322 of 2016, titled as “Sunita Rani Vs. PNB Metlife India Insurance Company Limited”, Revision Petition No.3223 of 2010, titled as “LIC of India Vs. Ms. Mamta”, Revision Petition No.1161 of 2014, titled as “LIC of India Vs. Rekha Heda” and relied upon an other judgment of Hon'ble Supreme Court, in Civil Appeal No.5322 of 2007, titled as “P.C. Chacko and another Vs. Chairman, Life Insurance Corporation of India and others”, are not helpful and applicable in the present case being not having identical facts of the case in hand.” 

We do not find anything wrong in the above finding recorded by the District Forum.  Therefore, it is held that the District Forum has rightly directed the opposite parties to pay the remaining amount of ₹9,00,061/- to the complainant.  However, the rate of interest awarded by the District Forum at the rate of 12% per annum is on the higher side and the same is reduced to 7.5% per annum. 

13.    In view of our above discussion, this appeal is partly accepted and the impugned order passed by the District Forum is modified to the extent that the rate of interest shall be 7.5% per annum instead of 12% per annum.  Rest of the impugned order is upheld. 

 14.   The appellants/opposite parties had deposited a sum of ₹25,000/- at the time of filing of the appeal. They deposited another sum of ₹11,10,932/-, vide receipt dated 30.1.2019  in compliance of the order dated 21.1.2019.  Both these sums, along with interest which has accrued thereon, if any, be remitted by the registry to the District Forum forthwith. The complainant may approach the District Forum for the release of the above amount and the District Forum may pass the appropriate order in this regard after the expiry of limitation period in accordance with law.   

15.    Before parting with the judgment we want to notice that since the single premium was more than ₹30,00,000/-, so as per the judgment of Hon’ble National Commission in AMBRISH KUMAR SHUKLA & 21 ORS. v. FERROUS INFRASTRUCTURE PVT. LTD) (NC) reported in I (2017) CPJ 1 (NC) this was not within the pecuniary jurisdiction of the District Forum to entertain such a complaint.  It appears that the District Forum as well as its registry has not taken into consideration the above said judgment and the law on the subject as on date.  The objection to this effect has not been taken in the reply by the opposite parties before the District Forum and the same cannot be raised in the appeal before this Commission.  For that reason we have not returned the complaint for filing the same before appropriate Fora having pecuniary jurisdiction.  The District Forum and its registry are warned to be careful in such cases in future.  Before admitting complaint they must examine the issues of limitation, territorial and pecuniary jurisdiction.                                                                                              

 

(JUSTICE PARAMJEET SINGH DHALIWAL)

                                                            PRESIDENT

 

         

 

                                                          (KIRAN SIBAL)                    

                                                             MEMBER

April 09, 2019

Bansal