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PUNJAB STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHANDIGARH
S.N. Aggarwal, President and Baldev Singh Sekhon, Member
Life Insurance Corporation of India —Appellant
versus
Resam Singh —Respondent
First Appeal No. 1606 of 2007
Decided on 13.9.2012
Counsel for the Parties:
For the Appellant:Mr. Rakesh Verma, Advocate.
For the Respondent:Mr. K.C. Malhotra, Advocate.
IMPORTANT POINT
Concealment of every fact does not empower Insurance Company to repudiate claim.
Headnote:Consumer Protection Act, 1986—Sections 15 and 17—Insurance—Repudiation of death claim for suppression of material facts—Death due to heart attack—District Forum accepted complaint with costs of Rs.2,000 and directed appellants to make payment of Rs. 50,000 at the rate of 12% per annum—No reliance can be placed on affidavit for determining if life assured was suffering from material disease or if she had concealed material facts—Deceased was patient of Asthma—It is not concealment of every fact which empowers Insurance Company to repudiate claim—It is only a material fact which is concealed and that too with fraudulent intention—Appellants failed to prove if life assured was suffering from serious disease and if that disease proved to be a cause of death of life assured—Appeal partly allowed and rate of interest reduced from 12% per annum to 6% per annum. (Paras 6, 12, 18 to 23)
Version of the respondent
S.N. Aggarwal, President—Miss Preet Kaur (now deceased) (in short “the life assured”) daughter of Resham Singh respondent had purchased the life insurance policy from the appellants for an amount of Rs.50,000. The policy commenced with effect from 28.5.2002. The life assured died by heart attack on 1.7.2003. The insurance claim was lodged with the appellants, which was repudiated by the appellants vide order dated 28.11.2004. Hence the complaint for insurance claim of Rs.50,000. Compensation, interest and costs were also prayed.
Version of the appellants
2. The appellants filed written reply. It was admitted that Miss Preet Kaur had taken the life insurance policy by filling the proposal form on 28.5.2002. It was accepted on 3.6.2002. It was for an amount of Rs.50,000. It was also admitted that life assured died on 1.7.2003 i.e. only after a period of about 11 months 25 days.
3. It was further pleaded that the life assured had suppressed the material facts while filling the proposal form. The life assured Miss Preet Kaur was suffering from Asthmatic problem for the last 3/4 years before her death, but this fact was kept concealed by her, while filling the proposal form. Therefore, repudiation was legal and valid. Dismissal of the complaint was prayed.
Proceedings before the district Forum:
4. The respondent filed his affidavit Ex. C1 and additional affidavit Ex. C2. The respondent also filed affidavit of Jagir Kaur Ex. C3 and affidavit of Dr. Ashutosh Gupta, MD as Ex. C4. The respondent also prove documents Ex. C5 to Ex. C15.
5. On the other hand, the appellants file affidavit of S.L. Dhupar, Manager as Ex. O1 affidavit of Satya Badhan, Manager (Claims) as Ex. O2, affidavit of R.K. Toofan, Branch Manager as Ex. O3, affidavit of Dr. Rishi Kumar Arya as Ex. O4, Dr. Ashwani Rai, Medical Officer as Ex. O5 and affidavit of Ms. Sandeep as Ex. O6. The appellants also proved documents Ex. O7 to Ex. O13.
6. After considering the pleadings of the parties and evidence placed on file by them, the District Forum accepted the complaint vide impugned order dated 1.11.2007 with costs of Rs.2,000 and directed the appellants to make the payment of Rs. 50,000 at the rate of 12% per annum.
7. Hence the appeal.
Discussion:
8. The submission of learned Counsel for the appellants was that appeal be accepted and impugned order dated 1.11.2007 be set aside.
9. On the other hand, submission of learned Counsel for the respondent was that there was no merit in the present appeal and same be dismissed with costs.
10. Record has been perused. Submissions have been considered.
11. Admittedly Miss Preet Kaur had filled the proposal form for taking the life insurance policy from the appellants. The copy of proposal form has been proved as Ex. C9. It has also been proved by the appellants as Ex. O7. The answers given to question 11A, D, E and I read as under:
First Appeal No. 1606 of 2007
Question Answers
(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 ever suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System? No
(c) Are you suffering from or have ever suffered from ailments pertaining to Liver, Stomach, Heart, Lungs, Kidney, Brain or Nervous System? No
(i) What has been your usual state of health? Good
12. In order to prove that reply given by the life assured was false and material facts were concealed, the appellants have filed affidavit of S.L Dhupar, Manager as Ex. O1, affidavit of Satya Badhan, Manager as Ex. O2, affidavit of R.K. Toofan, Branch Manager as Ex. O3. All these officers are employees of the appellant corporation and, therefore, they are supposed to support the case of the appellants whether it is right or wrong. Therefore, no reliance can be placed on their affidavit for determining if the life assured was suffering from materia
