PUNJAB STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, CHANDIGARH
Hon’ble Mr. Justice A.L. Bahri, President & Mrs. Davinder Kaur Bhamrah, Member
LIFE INSURANCE CORPORATION OF INDIA—Appellant
versus
JASVINDER KAUR—Respondent
Appeal No. 720 of 1998—Decided on 27.5.1999
Counsel for the Parties :
For the Appellant :Mr. B.J. Singh, Advocate.
For the Respondent:Mr. Satwant Waraich, Advocate.
Headnote:(i) Consumer Protection Act, 1986 - Section 15 - Appeal- Life Insurance Claim - Repudiation Alleging suppression of material facts as to the state of health by Insured at the time of submission of proposal form on 10-10-1993 - Died on 18-7-1995 due to renal failure Burden of proof - Evidence - No evidence produced by insurer that deceased was taking treatment prior to 10-10-1993 for renal problems The repudiation by insurer is held, to be arbitrary.
Held: The question for consideration is as to whether the insured has given wrong information regarding his health to the Corporation on the date of submission of the proposal i.e. October 10. 1993. From the evidence collected by the Corporation, at the most, it can be said that it was after October 1993 that the treatment by the deceased relating to renal failure was taken. The contention of B.J. Singh, Advocate that the renal failure does not take place suddenly, but is a graduate process and the insured must have been suffering from renal problem prior to the submission of the Proposal Form. This contention as such cannot be accepted. The question for consideration is as to whether the insured knew about his ailment and suppressed it while submitting the Proposal Form. This can only be proved on production of evidence that he had been taking treatment for such an ailment before submission of the Proposal Form. Since the Corporation could not collect any evidence of any such treatment taken prior to October 1993 regarding renal problem, the repudiation of the claim is held to be arbitrary. (Para 3)
(ii) Interest - Insurance claim lodged - Repudiated by Insurer after 2 years - Submission that interest be allowed after 2-3 months of the date of repudiation held, submission -cannot be accepted, as the Forum has rightly allowed interest by way of compensation allowing 4 months time from lodging of the claim on the insured amount. (Para 5)
(iii) Interest - Forum awarded 18% interest on the compensation awarded - Contention that interest more than 12% is not permissible in view of Supreme Court decision in United India Insurance Company Ltd. (1996 (3) CPJ 8 (SC) - Plea not accepted.
Held: It is not a case of grant of interest on the amount but it is the grant of compensation for the loss suffered by the complainant on account of deficiency in rendering, service on the part of the Corporation and generally 18% interest on the money value is considered just compensation. (Para 6)
(iv) Double compensation - Forum awarded 18% interest on the amount of compensation awarded Forum also awarded consolidated amount of Rs. 5,000/- as special compensation - Commission held that double compensation cannot be allowed in this; one by grant of interest on money value and the consolidated amount of Rs. 5,000/- award to that extent modified. (Para 7)
Result : Appeal partly allowed.
Mr. Justice A.L. Bahri, President—This appeal is by the Life Insurance Corporation and challenge is to the order of District Forum, Jalandhar dated May 19,1998 whereby complaint filed by Jasvinder Kaur was allowed with the direction to the Corporation to pay Rs. 70,000/- alongwith 18% p.a. interest starting from a date four months after the submission of the claim. Special compensation of Rs. 5,000/- and costs of Rs. 2,000/- were also ordered to be paid. Gurmit Singh, husband of Jasvinder Kaur aged about 43 years had taken life insurance policy (Asha Deep Policy) w.e.f. October 28,1992 against a proposal dated October 10, 1993. Gurmit Singh having died on July 18,1995 on account of renal failure, claim was lodged by the complainant with the Corporation with regard to the insured amount of Rs. 70,000/- under the policy aforesaid. The claim was repudiated on October 22,1997 by the Corporation on the ground that the deceased/ insured had concealed material facts relating to his health while submitting the proposal for taking the policy. This led the complainant to approach the District Forum. The Corporation took up the plea as briefly stated above and repudiated the claim.
2. Mrs B.J. Singh, learned Counsel for the Corporation has argued the appeal on the following points :
3. Firstly, the repudiation was bona fide made on the material collected. The death in the present case of the insured had taken place within three years which required thorough investigation. Secondly, in the alternative, it is argued that the grant of interest, if any, should have been after the date of repudiation and not from the date of claim. Thirdly, it is argued that grant of 18% interest on the insured amount is not justified as the Supreme Court has held that in the case of Insurance Companies which are nationalised, grant of compensation by way of interest should not be more than 12% and finally it has been argued that double compensation could not be allowed; one in the form of interest and secondly consolidated amount of Rs. 5,000/-. Quantum of cost awarded is also challenged.
4. The first question for consideration is as to whether repudiation of the claim by the Corporation is arbitrary or not. The burden is on the Corporation to prove that on the cogent material collected, bona fide such a decision was taken. The case depends upon the documentary evidence collected by the Corporation in support of the repudiation. Copy of the repudiation letter is dated October 22,1997 which is at page 109 of the District Forum record. Questions from the Proposal Form are repeated therein, answers to which were given in respect of three questions in the negative which related to the ailments suffered more than a week or hospitalisation or suffered from ailments of Diabetes, Tuberculosis, Blood Pressure etc. With respect to the general state of health, the answer was “good”. Thus, answers were stated to be wrong as on investigation it was found that at the time of effecting the assurance, material information was concealed relating to his health by the deceased. Further details were not given in this letter about the type of information which was concealed. For that the Insurance Company relied upon other documents produced on the record Ex. O-l is medical attendant certificate as issued by Registrar, D.M.C., Ludhiana. The cause of death was stated to be Primary Cause - Renal Failure, Secondary Cause - Cardaic Respiratory Arrest. It is reported that the patient was suffering from Hypertension for 15 years. It is for Hypertension and Renal Failure that the treatment was given by the hospital aforesaid. Under Column No. 6, it was stated regarding his habits that he was occasional alcoholic. Ex. O-3 is Form No. 3816 as issued by Registrar, D.M.C., Ludhiana. At the time of admission, on June 30,1995, the nature of complaint recorded is Calculus D8 operated in 1987, C.F.R. on H.D. since October 5,1994, patient presented for transplant. It may be observed that aga