Maya Devi vs Life Insurance Corporation of India

-THIS appeal has been directed by opposite parties 1 and 2 i. e. Life Insurance Corporation of India against order dated 10. 10. 2007 passed by Consumer Disputes Redressal Forum-II, U. T. Chandigarh (hereinafter to be referred as District Consumer Forum), vide which complaint of respondent Smt. Sarabjit Kaur was accepted with costs of Rs. 2,500 and appellants were directed to pay Rs. 1,30,000 along with interest @ 9% p. a. from the date of repudiation of the claim i. e. 27. 9. 2000 till the date of payment and further to pay Rs. 10,000 as compensation for harassment and mental agony.

BRIEFLY stated the facts are that Sh. Chattar Singh was husband of Smt. Sarabjit Kaur respondent (complainant ). He was employed as XEN, MC, PH Division No. 3, Chandigarh. He got his life assured by taking LIC policy dated 28. 3. 1999 (Pension scheme) for the sum assured of Rs. 1,30,000 under Table 122-13. 13 Schedule PNGS-G102. The premium of Rs. 10,368 which was payable on yearly basis was paid by him. The date of annuity was 28. 3. 2012 with the last premium payable upto 28. 3. 2011. The copy of the insurance policy is Annexure C-1. It was next averred that Sh. Chattar Singh suddenly fell ill on 23. 12. 1999 and was got admitted in medical emergency of PGI where he breathed his last on 25. 12. 1999.

It was further averred that after his death, respondent being his wife and nominee under the policy submitted her claim on 5. 5. 2000 with the appellant along with all other relevant documents but Life Insurance Corporation of India rejected the claim on the ground that Sh. Chattar Singh withheld material information regarding his health at the time of effecting the insurance and gave false answers to the questions mentioned at serial No. 11 (b) (c) (e) of the proposal form dated 31. 3. 1999 as he had been a diabetic (type 2 diabetes mellitus) for the last 10 years and suffered a stroke (CEREBRO- Vascular Accident) in 1993. The copy of the repudiation letter dated 27. 9. 2000 is Annexure C-2.

IT was next averred that respondent has requested the Zonal Manager vide letter dated 10. 11. 2000 to reconsider her claim as the pleas taken in the repudiation letter dated 27. 9. 2000 were not correct. The copy of the letter is Annexure C-4. Thereupon, Zonal Office asked the Senior Divisional Manager, LIC, Chandigarh to send the file for reviewing the claim by Zonal Office, New Dehli vide letter nnexure C-5 dated 16. 11. 2000. Thereafter, several letters were written Annexures C-9 to C-15. Ultimately it was revealed when she had written letter to the Central Public Information Officer of LIC, Divisional Office, Chandigarh under Right to Information Act, 2006 that her review application had been rejected on 25. 6. 2001 and the copy of the letter dated 5. 2. 2007 is annexure C-19. Alleging deficiency in service, the complaint was filed on 23. 2. 2007.

LIFE Insurance Corporation of India contested the complaint and filed written reply. It is stated that the policy in question was issued on the basis of proposal form and personal statement dated 31. 3. 1999 and believing averments made therein to be true. However, later on information was received that Sh. Chattar Singh was admitted in PGI on 23. 12. 1999 where he expired on 25. 12. 1999. It next stated that the claim of respondent had been rightly repudiated after considering all the relevant facts including medical certificate issued by PGI, Chandigarh. It further stated that Chattar Singh had made material concealment of information about his previous bad health and the repudiation made by it was legal as it had been made on the basis of medical record of life assured. Parties adduced their evidence by way of affidavits. After hearing Counsel for the parties, District Consumer Forum vide order dated 10. 10. 2007 accepted the complaint with costs as stated in the earlier part of the judgment.

WE have heard Mr. B. S. Walia, Advocate for appellants, Sh. Dayal Singh, father of respondent in person and carefully gone through written arguments submitted by him.

COUNSEL for appellants contended that the complaint is time barred inasmuch as the claim was repudiated by the LIC vide letter dated 27. 9. 2000, whose copy is Annexure C-2 and complaint was filed much later on and not within two years from repudiation of claim. It is true that claim was repudiated vide letter dated 27. 9. 2000 and the present complaint was filed on 23. 2. 2007. However, it is mentioned in para-7 of the complaint that the respondent (complainant) had moved the Zonal Manager, Northern Zonal Office vide letter dated 11. 10. 2000 to reconsider her claim as the pleas taken in the repudiation letter dated 27. 9. 2000 were not correct and the repudiation was illegal. The copy of the letter dated 10. 11. 2000 is Annexure C-4. It is further stated in para-8 of the complaint that thereupon the Zonal Office vide letter No. 5893 dated 16. 11. 2000 asked the Senior Divisional Manager, LIC, Chandigarh to send the file for reviewing the claim of respondent by the Claim Review Committee, Zonal Office, New Delhi. A copy of the letter dated 16. 11. 2000 is Annexure C-5. It has been further stated in para-11 that thereafter respondent made repeated visits to the office of appellants and wrote several letters, whose copies are annexures C-9 to C-15 and even sent registered letter Annexure C-16 dated 14. 4. 2006 but there was no reply to her review petition. It is next stated that thereafter she wrote to the Central Public Information Officer of LIC, Divisional Office, Chandigarh under Right to Information Act, 2006 to furnish information regarding the action taken on the review petition pending before the Zonal office. The copy of the letter dated 20. 1. 2007 is Annexure C-18. Thereupon vide letter dated 5. 2. 2007, the Central Public Information Office informed that the Review Committee of Zonal Office, New Delhi had upheld the decision of repudiation on 25. 6. 2001. The copy of the letter dated 5. 2. 2007 is Annexure C-19. It is not the case of LIC of India that it had informed Mrs. Sarabjit Kaur earlier. No plea had been taken either in the written reply or in the memorandum of appeal that the claim of Smt. Sarabjit Kaur was time-barred. It was only stated in the written reply that the repudiation had been rightly made on the basis of medical record. It is further stated in para-11 of the written reply that the claim of complainant was duly considered by the Competent Authority as well as by the Claims Review Committee and found not admissible but no assertion was made that it had ever conveyed the decision of Review Committee. It was conveyed to her only on 5. 2. 2007 Annexure C-19. In the memorandum of appeal no plea of limitation was taken. Earlier in the written reply also no such plea was taken. In the circumstances a period of two years has to be considered under Section 24a of the Consumer Protection Act from the letter dated 5. 2. 2007 and the present complaint had been filed on 23. 2. 2007, so, it is within time. There is no dispute about it that Sh. Chattar Singh, husband of respondent had taken LIC policy dated 28. 3. 1999 for a sum of Rs. 1,30,000 and he suddenly fell ill on 23. 12. 1999 and was got admitted in medical emergency of PGI and he died on 25. 12. 1999. The claim was repudiated on the ground that life assured had made incorrect statement and withheld material information from LIC regarding his health at the time of filing proposal and gave false answers to the questions mentioned at serial No. 11 (b) (c) (e) of the proposal form dated 31. 3. 1999 as he had been a diabetic (Type-2 Mellitus) for the last 10 years and also suffered stroke (CEREBRO-Vascular accident) in 1993.

The photocopy of the certificate Annexure OP/5 issued by Post-Graduate Institute of Medical Education and Research (Nehru Hospital), Chandigarh has been placed on file. It shows under the heading ''antecedent causes'' as under: type 2 Diabetes mellitus essential hypertension cerebro vascular accident aspiration pneumonia

IN the proposal form Annexure OP/2 the state of health is stated to be good and he was not suffering from any kind of disease like diabetes, tuberculosis and cancer, etc. There is no evidence that Sh. Chattar Singh was ever treated for Type 2 diabetes mellitus or for hypertension, etc. There is no further evidence that he had suffered stroke in the year 1993 and was got admitted in the hospital. The history which was alleged to be mentioned in the certificate was not given by Chattar Singh but by some third person. The doctor who had recorded history has not been examined. There is no affidavit of the treating doctor to the effect that he had recorded history and such person had told the history. Leave record Annexure C-3 of Chattar Singh shows that although, Chattar Singh remained on leave, yet he had not taken medical leave in the year 1993 or earlier. Counsel for appellants contended that document OP/5 was produced by respondent, so, it is binding upon her. In our opinion, it is not binding upon respondent especially as far as history recorded therein is concerned. The ultimate cause of death according to the document issued by PGI, Chandigarh had been mentioned as aspiration pneumonia. There is no mention that diabetes has direct nexus with ultimate cause of death. The PGI had treated the deceased for Cerebro Vascular Accident and Aspiration Pneumonia. Type-2 diabetes mellitus and hypertension had been only a part of the history reported by the attendant whose name and address are not known. There is no evidence (at the cost of repetition) that Shri Chattar Singh had been taking medicine for diabetes for the last 10 years or he had taken treatment for the stroke suffered in 1993. Even otherwise diabetes which is under control and hypertension are not serious diseases and are part of ordinary strain and stress of life. Otherwise also insurance company must have examined the insured before giving policy and such diseases could have been easily detected. There is no evidence that assured had knowledge of these diseases and had not voluntarily disclosed the same.

IT has been held by the Hon''ble Apex Court in a number of cases that statement must be on material matter or must suppress facts which were material to be disclosed and further the suppression must be fraudulently made by the policy holder and he/she must have known at the time of making the statement that it was false or that the facts which were suppressed were material to be disclosed. None of these facts have been proved in the present case. It has been further observed by the Hon''ble Apex Court in Life Insurance Corporation of India and Ors. v. Asha Goel and Anr. , I (2001) SLT 89=air 2001 SC 549 that repudiation of the claim by the insurer should not be merely on the ground that deceased had withheld correct information regarding his health at the time of effecting insurance with the Corporation and further it should not be dealt with in a mechanical and routine matter and should be taken with extreme care and caution. The Authority Narinder Kaur v. Zonal Manager, Life Insurance Corporation of India and Another, I (2004) CPJ 584=2004 (2) Con. LT 348, is not applicable to the facts of the present case as in that case there was death certificate issued on the basis of information issued by PGI ,chandigarh. Since, admission of the deceased to PGI was an admitted fact by the complainant, so, record of PGI, Chandigarh had become relevant and did not require any formal proof as far as death was concerned but here we are dealing with the certificate issued by the PGI, Chandigarh, where history was got recorded by a third person and not by the deceased and further treating/recording doctor has not been examined or his affidavit has not been filed. We concur with the reasoning given by the District Consumer Forum and hold that there is no force in the appeal. Consequently, it is dismissed with costs of Rs. 10,000.

COPIES of this order be communicated to the parties, free of charge. Appeal dismissed.