MANJINDER KAUR vs LIFE INSURANCE CORPORATION OF INDIA

PETITIONER in this petition is the original complainant and the two respondents herein were OPs No.1 & 2 respectively before the District Forum.

THE factual matrix leading to the filing of this revision petition are that Shri Jagjit Singh, deceased husband of the complainant had purchased two life insurance policies respectively for a sum of Rs.1,05,000/ - for the period from 01.11.2008 to 01.11.2028 and another for a sum of Rs.1,25,000/ - for the period from 17.11.2009 to 17.11.2025 from the respondents/opposite parties. Shri Jagjit Singh complained of chest pain on 7.5.2010 whereupon he was admitted to Arya Hospital, Manimajra, Chandigarh where it was diagnosed that he had suffered Myocardial Infarction (acute cardiac attack) as a result of which he died. The complainant being the nominee of the deceased under both the policies, submitted her claim for the assured amounts to the opposite parties alongwith medical certificate issued by Dr. V.K. Arya of Arya Hospital in support of the cause of death of the life assured. The opposite parties repudiated the claim of the complainant under both the policies on the ground that the deceased/life assured had withheld material information regarding his health at the time of obtaining the two policies and also gave falls answers to the questions contained in the proposal form. According to the complainant, the deceased had no previous history of any heart disease at the time of obtaining the insurance policies and he died after more than one and a half years of obtaining the insurance policies due to Myocardial Infarction which had no nexus with the answers to the questions contained in the proposal form. Treating the repudiation of the claim of the complainant as illegal and arbitrary which amounted to deficiency in service, the complainant knocked the door of the Consumer Forum by lodging a complaint with the District Consumer Forum -I, UT, Chandigarh praying for issuance of direction to the opposite parties to pay a sum of Rs.2,30,000/ - alongwith interest @ 18% p.a. and compensation of Rs.50,000/ - for mental agony and harassment as well as cost of litigation to the tune of Rs.25,000/ -. The complaint was resisted by the opposite parties through a written statement filed by them in which it was stated that since the life assured died within two years from the date of commencement of risk under both the policies, the opposite parties carried out investigation into the matter by obtaining details of the attendance and leave taken by the deceased at the place of his work, certificate of the hospital treatment etc. It was contended by the OPs that the documentary evidence collected by the OPs revealed that the deceased was regularly on sick leave from his office from the year 2007 and was also taking treatment from various hospitals including Arya Hospital and I.V.Y. Hospital for Diabetes Mellitus. It was further stated that the certificates issued by the Arya Hospital confirmed that the primary cause of death of the life assured was Myocardial Infarction and the secondary cause of death was Diabetes Mellitus. It was also submitted that from the medical literature, a person suffering from Diabetes Mellitus disease would be more prone to heart attack and hence the OPs submitted that the life assured had knowingly, willfully and fraudulently suppressed his ailment of Diabetes Mellitus at the time of filling up the proposal form which violated the fundamental principle of ''''UBERRIMA FIDES '''' (utmost good faith) thereby vitiating the contract of insurance. The OPs therefore submitted that the claim of the petitioner/complainant was rightly and validly repudiated by them and there was no deficiency on their part while rendering service to the complainant nor did they indulge into any unfair trade practice while rejecting the claim.

AFTER hearing the parties and going through the evidence adduced by them, the District Forum accepted the complaint in terms of its order dated 29.01.2013 which reads thus: - ''''In view of the foregoing, we are of the opinion that the complainant has fully proved her case. Therefore, the complaint stands allowed. The OPs are directed to pay Rs.2,30,000/ - to the complainant, being the total sum assured amount against both policies of deceased Jagjit Singh, husband of the complainant, along with interest @ 10% p.a. w.e.f. the date of repudiation i.e. 31.3.2011 till its actual payment. The OPs are also directed to pay Rs.15,000/ - towards cost of litigation. This order be complied with by the OPs, within a period of 30 days from the date of receipt of copy of this order, failing which they shall be liable to pay the above awarded amount of Rs.2,30,000/ - along with penal interest @18% per annum from the date of repudiation of claim i.e. 31.3.2011 till its actual payment, besides paying litigation cost of Rs.15,000/ -, as aforesaid ''''

AGGRIEVED of the aforesaid order of the District Forum, the opposite parties challenged the same before the State Consumer Disputes Redressal Commission, UT, Chandigarh by filing First Appeal No.91/2013. The State Commission allowed the appeal of the opposite parties and set aside the order of the District Forum and also dismissed the complaint of the petitioner vide its impugned order dated 15.04.2013 which is now under challenge before us through the present revision petition. Learned Shri Amit Yadav, Advocate who appeared before us on behalf of the petitioner has submitted that the State Commission has wrongly observed that the answers given by the husband of the petitioner while filling up the proposal forms at the time of issuance of policy were incorrect or that the life assured had suppressed any material facts within his knowledge fraudulently. He would argue that the State Commission ought to have considered that in the absence of the affidavit of Dr. V.K. Arya, the certificate of the hospital treatment (Annexure R -6) and medical attendance certificate (Annexure R -7) could not be taken into consideration. He further submitted that the State Commission was wrong in applying the principles laid down by the Apex Court in the cases of Satwant Kaur Sandhu vs. New India Assurance Company Ltd. IV (2009) CPJ 8 (SC) and Pushpa Chauhan vs. Life Insurance Corporation of India II (2011) CPJ 44 (NC) to the present case because the facts and circumstances of the present case are different from those in the citations relied upon. According to learned counsel, the cause of death of the insured had no relation to the questions contained in para -11 of the proposal form and since the insured died due to Myocardial Infarction after more than one and a half year of getting the insurance policy, it cannot be said that the insured had withheld some vital and material information which would ultimately result in his death. Learned counsel summed up his arguments by submitting that the State Commission gravelly erred in not appreciating these aspects properly which has resulted in the setting aside of the well -reasoned order passed by the District Forum thereby causing injustice to the petitioner. He, therefore, pleaded that the impugned order be set aside and the order of the District Forum be restored and the revision petition allowed.

BESIDES hearing learned counsel for the petitioner, we have also perused the record. We may note that the State Commission has dealt with the aspects regarding correctness of the answers given by the life assured at the time of taking policies, treatment taken by the deceased for Diabetes Mellitus, the nexus of the disease with Myocardial Infarction which was admittedly the cause of the death, applicability or otherwise of the provisions of Section 45 of the Insurance Act to the present case where the life assured died within two years of taking of the policies, etc. at great length in the impugned order and after considering the facts and circumstances of the present case in the light of the observations of the Apex Court in the cases of Satwant Kaur Sandhu and Pushpa Chauhan (supra) as also as few other well -known cases referred to by the State Commission in its impugned order, it has accepted the appeal and dismissed the complaint while setting aside the order of the District Forum. We are convinced that the order of the District Forum was not based on correct appreciation of evidence and law and hence suffers from illegality and perversity which warranted interference of the State Commission. Perusal of the impugned order clearly indicates that the State Commission has considered the specific answers given by the life assured in the proposal form before reaching the inevitable conclusion that answers given by the life assured amounted to suppression of material facts which were within the knowledge of the life assured in a fraudulent manner which resulted into vitiating the contract of insurance. We agree with the view taken by the State Commission in its impugned order. The impugned order being a speaking order in which the material aspects have been discussed and examined, we do not wish to indulge in repetition thereof in this order. No new points or aspects have been brought to our notice which would justify our interference with the impugned order while exercising our revisional jurisdiction under Section 21 (b) of the Consumer Protection Act, 1986. Revision petition, therefore, stands dismissed in limine with no order as to cost.