Darshna Devi Widow Of Bhagwan Dass vs LIFE INSURANCE CORPORATION OF INDIA

LATE Shri Bhagwan Dass husband of complainant No. 1 Darshna Devi and father of complainant no. 2 Ashwani Kumar, took two insurance policies from the respondent Life Insurance Corporation of India (hereinafter referred to as ''LIC''), one for a sum of Rs.5 lakh and the other for a sum of Rs. 3 lakh. Bhagwan Dass expired on 07.02.2007. After his death, the complainants submitted claims seeking payment of the insurance amount in terms of the aforesaid two policies. The claim, however, was repudiated by the LIC, vide their letter dated 19.03.2008. The said letter, to the extent it is relevant, reads as under: - "In this connection, we have to inform you that in the Proposal for Assurance dated 22.03.2005 / personal statement signed by the deceased assured on 30.3.05, at the time of his medical examination he had answered the following questions, as under noted:

11(a) During the last five years did you consult a Medical Practitioner for any ailment requiring treatment for more than a week?

No

(b) Are you suffering from or have you even suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocele, Leprosy or any other disease?

No

(c) What has been your usual state of health

Good

We may, however, state that all these answers were false as we have evidence and reasons to believe that just before he proposed for the above policy he had suffered from CVA Rt. Side Hemiparsis and had also suffered from hypertension X 8 -9 years. He did not, however, disclose these facts in his proposal/personal statement instead he gave false answers therein as stated above.

It is, therefore, evident that he had made deliberate mis -statements and withheld material information from us regarding his health at the time of effecting the assurance and hence in terms of the policy contract and the declaration contained in the forms of proposal for Assurance and Personal Statement, we hereby repudiate the claim and accordingly, we are not liable for any payment under the above policy and all moneys that have been paid in consequence therefore belong to us."

BEING aggrieved from the repudiation of the claim, the complainants approached the concerned District Forum, seeking the amount of Rs. 8 lakh alongwith interest @12% p.a. They also sought Rs.50,000/ - as compensation, Rs.22,000/ - towards litigation expenses.

THE complaint was resisted by the respondents on several grounds. One of the grounds taken in the written statement was that the deceased had played fraud in connivance with the concerned agent, who signed the medical related documents in the name of the insured. Reliance was placed upon the report of the Document Expert examined by the LIC. The District Forum vide its order dated 4.12.2009, directed the LIC to pay a sum of Rs.8 lakh to the complainants along with interest @9% p.a. from the date of repudiation of the claim till the date of payment. The respondent was also directed to pay Rs.5,000/ - towards litigation expenses.

AGGRIEVED from the order passed by the District Forum, the LIC approached the Punjab State Consumer Disputes Redressal Commission by way of filing an appeal. The said Commission vide impugned order dated 20.12.2013, allowed the appeal and dismissed the complaint. Being aggrieved from the dismissal of the complaint, the complainants are before this Commission by way of present revision petition.

THE contentions of the learned counsel for the petitioner are that: - (i) The deceased at the time he filled -up the proposal form was not aware that he was suffering from hypertension;

(ii) The deceased was not suffering from CVA at the time he filled -up the proposal form.

A perusal of the certificate of hospital treatment which the claimants submitted after getting it countersigned from concerned hospital would show that late Shri Bhagwan Dass was admitted in the hospital on 17.01.2007 and at that time, he informed that he had hypertension from 8 9 years. He also informed that he had CVA about two years ago. The contention of the learned counsel of the respondent is that CVA occurred two years before the date of admission in the hospital, i.e., around 17.01.2005. Admittedly, the proposal form was submitted by the insured on 30.03.2005. thus, as per the complainants own showing he already had CVA before the said proposal form was filled -up by him. It is thus, quite evident that the deceased had suppressed, while seeking the insurance policy, that he had suffered from CVA, in or around Jan. 2005. Thus, a material fact with respect to the state of his health was concealed by the insured. A perusal of the proposal form submitted by the insured would show that while responding to the question as to whether he had suffered from any disease, he answered in the negative, though, in fact, he had already suffered from CVA before the said answer was given by him. Even if it is presumed that the deceased at the time he filled -up the proposal form, was not aware of his having hypertension, it cannot be accepted that he was unaware of CVA which had struck him some time around January 2005. Had the insured disclosed to the LIC that he had suffered from CVA, either the LIC would not have accepted his proposal or it might have asked for further investigation and/or a higher premium. Therefore, the LIC was entitled to repudiate the claim on account of the aforesaid material concealment made by the deceased.

ANOTHER reason which disentitle the complainants/petitioners from seeking any payment from the LIC is that the medical examiner''s report dated 30.03.2005 does not bear genuine signature of the insured. The opinion of hand -writing expert engaged by LIC would show that the signature on the Q -8 on the aforesaid documents are not of the deceased. No hand -writing expert was examined by the complainants before the District Forum to prove that the document was actually signed by Bhagwan Dass at Q -8. It is thus, obvious that some person other than the insured Bhagwan Dass had appeared before the Doctor who prepared the report dated 30.03.2005 after examining that person. Had Bhagwan Dass himself been examined by the Doctor on that date, the signature at Q -8 would have been of Bhagwan Dass and not of his agent or some other person. Thus, a fraud was played by the deceased upon the LIC, by asking some other person to impersonate as Bhagwan Dass in his place. Since the policies were obtained by playing the said fraud, the claim has rightly been repudiated by the LIC of India.

FOR the reasons stated above, I find no merit in the revision petition, the same is dismissed.