LIFE INSURANCE CORPORATION OF INDIA vs KUSUM LATA

THIS appeal has been directed by the respondent against order dated 20.5.2005 passed by the District Consumer Disputes Redressal Forum -II, U.T. Chandigarh, vide which complaint filed by Mrs. Kusum Lata, complainant, (respondent in the present appeal) was accepted and the appellant was directed to pay to the respondent (complainant) a sum of Rs. one lac along with interest @ 6% p.a. after the expiry of the period of three months from the date of submission of claim papers by the respondent till payment. She was also awarded Rs. 5,000 on account of deficiency in service and for mental agony and harassment etc. Costs of litigation were quantified at Rs. 1,500 which were also to be paid by the appellant to the respondent. Further directions were given to the appellant for complying with the order within two months from the date of receipt of its certified copy.

BRIEFLY stated the facts are that Mr. Hukam Chand (now deceased) was an agriculturist and an illiterate person. He got himself insured with the appellant for a sum of Rs. one lac vide plan and term No. 14 -10, on 8.12.2002. He paid premium of Rs. 5,679 in cash to the appellant on 8.12.2002. He also filled the proposal form on that date. Before the acceptance of the proposal, he was examined by Dr. Anil Kumar, Divya Clinic, Sector -45, Chandigarh, who was on the approved panel of the appellant. After it, insurace policy was issued and copy of the insurance policy is Annexure C -3. Unfortunately, Hukam Chand died on 7.1.2003 at about 4.00 a.m. due to heart failure and a copy of the death certificate is Annexure C -4. Intimation with regard to death of Hukum Chand was given to the appellant vide letter Annexure C -5. It was next averred that the Senior Divisional Manager of Life Insurance Corporation of India (respondent No. 2 in the complaint) vide letter dated 31.3/17.5.2004 informed Mrs. Kusum Lata complainant that the Competent Authority had repudiated the claim as her husband had misled the Life Insurance Corporation by misrepresenting facts at the time of the proposal form. However, respondent asserted that the appellant had no reason to repudiate her claim in such a manner and it was done just to deny her claim. It was also averred that Hukam Chand was not suffering from any problem relating to heart disease. Alleging deficiency in service, she claimed an amount of Rs. one lac along with interest from the date when the claim was due, till the date of actual payment. Compensation for pain and suffering was also claimed.

THE appellant and the Senior Divional Manager (respondent No. 2 in the complaint) filed reply. They took certain preliminary objections; that the nominee was not a consumer under Section 2(1)(d) of the Consumer Protection Act, 1986; that the Fora under the Consumer Protection Act had no jurisdiction to enforce a security for payment of money when liability was denied or repudiated and only Civil Court had jurisdiction; that the dispute involved contentious issues on points of fact and question of law and as such could not be decided by the Consumer Court. On merits, they denied the allegations and stated that Hukam Chand was a literate person as he had signed the proposal papers. It was admitted that the proposal on behalf of Hukam Chand was received for getting insurance for Rs. one lac along with deposit of Rs. 5,679 and FPR was issued on 30.12.2002. They also admitted that the medical examination of Hukam Chand by their panel doctor was conducted, but the same was conducted on the basis of information received on the proposal form and believing the averments made therein to be correct. They further stated that since the death had taken place within ten days of the acceptance of the proposal, so, the matter was got investigated and it was found that Hukam Chand was not maintaining good health, as prior to the submission of proposal dated 8.12.2002, he was under treatment of Government Medical College and Hospital, Sector 32, Chandigarh, since 20.11.2002 and this relevant information was fraudulently concealed by him while submitting the proposal form and due to concealment of facts, the claim was rightly repudiated.

PARTIES adduced their evidence by way of affidavits. After hearing the Counsel for the parties, the District Consumer Disputes Redressal Forum -II, U.T., Chandigarh, vide its order dated 20.5.2005 accepted the complaint and awarded the amount of insurance policy to the respondent along with other benefits, as stated in the earlier part of the judgment.

AGGRIEVED by the said order, the respondent No. 1 has filed the present appeal.

WE have heard Counsel for the appellant Mr. B.J. Singh, Counsel for the respondent Mr. N.P. Singh and carefully gone through the file. It is an admitted fact that Mr. Hukam Chand, husband of Mrs. Kusum Lata had got himself insured under the insurance policy with the appellant for a sum of Rs. one lac vide plan and term No. 14 -10, on 8.12.2002. He had also paid premium of Rs. 5,679 in cash against receipt on 8.12.2002 and has further filled proposal form Annexure C -2. After the acceptance of the proposal, the appellant had issued insurance policy Annexure C -3. Annexure C -4 is copy of the death certificate issued by the Additional District Registrar (B&D) -cum -District Health Officer, Yamuna Nagar, showing that Mr. Hukam Chand died on 7.1.2003. Annexure C -5 is copy of the letter written by the respondent intimating that her husband had died on 7.1.2003 and claim under the insurance policy be paid to her. Annexure C -6 is copy of the letter dated 31.3/17.5.2004 written by the Senior Divisonal Manager, informing the respondent that her claim had been repudiated.

THE allegation of the appellant is that Mr. Hukam Chand was having some serious disease and was getting regular treatment from Government Medical College and Hospital, Sector 32, Chandigarh and had made a number of visits to that hospital for that purpose and further Hukam Chand had concealed this fact while filling the proposal form on 8.12.2004 and Hukam Chand died within a few days of the acceptance of the proposal. In order to prove the allegation, the appellant has examined R.W. 1 Mr. Tarlok Nath, File Restorer of Government Medical College and Hospital, Sector 32, Chandigarh. He stated that he had brought copy of the noting of the Government Medical College and Hospital, Sector -32, Chandigarh and as per computer record, the patient visited Government Medical College and Hospital, Sector -32, Chandigarh on the dates mentioned in R.W. 1/A. In cross -examination he could not tell as to from which disease the patient was suffering and for what purpose he had visited the hospital. No suggestion was put to him that son of Mr. Hukam Chand had got the record of the computer tamped with. The affidavit of Smt. Kusum Lata had been filed by way of evidence. No effort was made on behalf of the appellant to call her in the witness box by making an application to the District Forum to cross -examine her about the fact of visits of her husband to the Government Medical College and Hospital, Sector 32, Chandigarh for treatment and further to elicit from her about the disease from which he was suffering and got treatment. A perusal of the computer data RW1/A shows that Mr. Hukam Chand visited the said hospital on five different dates i.e., 20.11.2002, 30.11.2002, 3.12.2002, 7.12.2002 and 20.2.2003. He had visited the medicine department but nothing had been brought on record as to from which disease he was suffering. From the mere fact that he had visited the medicine department of the Hospital five times within a span of three months, it cannot be said that he was suffering from some serious disease which had nexus with his heart failure. Moreover, the name of father of Mr. Hukam Chand had not been mentioned. No evidence has been led that Hukam Chand, husband of the respondent had got treatment from the medicine department of the Hospital as OPD patient five times. He was unable to tell that the said record related to Hukam Chand s/o Mr. Badri Parshad, r/o Village Bhagwant Pur, P.O. Dayalgarh, District Yamunanagar, Haryana. He frankly admitted that Card No. 021104305 related to one Hukum Chand whose fathers name and address had not been mentioned. It is also not mentioned as to from which disease he was suffering. His last visit to the hospital is reported to be on 20.2.2003. But according to admitted case, Hukam Chand had died on 7.1.2003. Certainly, this record does not pertain to Hukum Chand husband of the complainant. It appears that the appellant had tried to create evidence in order to repuditate the claim of the respondent on some flimsy grounds, simply because Hukam Chand died after a short time of the acceptance of the insurance proposal. Admittedly, Hukam Chand was examined by the doctor on the panel of the appellant before acceptance of the proposal and he, apparantely did not find that Hukam Chand was suffering from any serious disease. Shri Hukam Chand was not examined by any doctor at the time of his death, so at best, it can be presumed that it was his natural death. No body has control over death.

COUNSEL for the appellant contended that there are serious allegations of fraud and cheating and as such serious allegations should not be decided by the Commission and should be left to be decided by the Civil Court. For this contention, he has placed reliance on two authorities -N Shivaji Rao v. M/s. Daman Motor Company & Ors., I (1993) CPJ 88 (NC) and M/s. Special Machines v. Punjab National Bank & Ors., I (1991) CPJ 78 (NC). In our opinion, the contention of learned Counsel is not tenable and the above said authorities are not applicable to the facts of the present case because in the present case, it is not prima facie proved that Hukam Chand had committed any fraud or had mis -stated the facts at the time of filling the proposal form. On the other hand, it is not proved on file by cogent evidence that Hukam Chand ever visited Govt. Medical College and Hospital, Sector 32, Chandigarh for treatment. The authorities Ajay Parkash Mittal v. Life Insurance Corporation of India, I (1998) CPJ 2 (NC)=1997 (2) CPR 233 (NC) and Sr. Divisional Manager, LIC of India v. Mrs. Gangama and Anr., III (2002) CPJ 56 (NC) regarding repudiation of claim on the basis of suppression of material facts are not applicable to the facts of the present case because it is not proved on file that Hukam Chand had suppressed any material facts relating to his disease. Section 45 of the Insurance Act, 1938 is not applicable to the facts of the present case because at the cost of repetition it may be stated that it is not proved on record that Hukam Chand on a material fact had made a false or inaccurate statement or had suppressed the facts which he was duty bound to disclose. We concur with the reasoning given by the District Forum in accepting the claim of the respondent (complainant).

IN view of the discussion above, we hold that there is no force in the appeal and as such the same is dismissed with costs, which are quantified at Rs. 3,000. Copies of the order be communicated to the parties, free of charge. Appeal dismissed.