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PUNJAB STATE CONSUMER DISPUTES REDRESSAL COMMISSION
J.S. Klar, Presiding Judicial Member, Vinod Kumar Gupta and Harcharan Singh Guram, Members
KOTAK MAHINDRA OLD MUTUAL LIFE INSURANCE LIMITED AND OTHERS - Appellants
Versus
VEENA RANI - Respondent
First Appeal No. 917 of 2011.
Decided on : 15-05-2015
Consumer Protection Act - Insurance Claim - 12 of the Consumer Protection Act, 1986 - [12 of the Consumer Protection Act, 1986] - The court discussed the controversy of whether the life assured had concealed pre-existing diseases when entering into the insurance contract. The court examined evidence including medical tests, affidavits, and documents submitted by both parties. The court found that the evidence provided by the OPs was not sufficient to prove the pre-existing diseases, and therefore affirmed the District Forum's order in favor of the complainant.
Fact of the Case:
The complainant filed a complaint under the Consumer Protection Act, 1986, alleging that the insurance claim was repudiated by the OPs due to the alleged concealment of pre-existing diseases by the deceased life assured. The District Forum accepted the complaint and directed the OPs to pay the claim amount, leading to the appeal by the OPs.
Finding of the Court:
The court found that the evidence provided by the OPs was not sufficient to prove the pre-existing diseases of the deceased life assured, and therefore affirmed the District Forum's order in favor of the complainant.
Issues: Concealment of pre-existing diseases by the deceased life assured, validity of the insurance claim, sufficiency of evidence provided by the OPs.
Ratio Decidendi: The court relied on the principle that evidence must be legally proved and found that the evidence provided by the OPs, including the investigator's report and affidavits, was not legally admissible. The court also considered the circumstances under which the complainant's signatures were obtained on documents by the OPs.
Final Decision: The appeal filed by the appellants was ordered to be dismissed, affirming the District Forum's order in favor of the complainant. The court also directed the refund of the appeal deposit to the complainant and the payment of the remaining claim amount by the OPs.
ORDER
J. S. Klar, Presiding Judicial Member - The appellants (the opposite parties in the complaint) have directed this appeal against the respondent of this appeal (the complainant in the complaint), challenging order dated 25.03.2011 of District Consumer Disputes Redressal Forum Mansa, accepting the complaint of the complainant by directing the OPs to pay the claim amount of Rs. 1,50,000/- along with interest @ 9% per annum with effect from 12.10.2009 till payment, besides compensation of Rs. 5000/- for mental harassment and Rs. 5000/- as costs of the litigation to the complainant. The instant appeal has been preferred against the same by the OPs now appellants.
2. The complainant Mrs.Veena Rani has filed the complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs on the averments that Sh. Girdhari Lal Arora, since deceased her husband, had taken the insurance policy from the OPs for assured amount of Rs. 1,50,000/- and he paid premium of Rs. 7500/- per month, as premium amount, which would be invested by the OPs in different plans and growth benefits. Being allured by the agent of the OPs, life assured Sh. Girdhari Lal Arora gave his consent for the purchase of the policy and his signatures were taken on blank printed performa on the pretext that they would be filled later on under the supervision of his Sales Manager. The insured had disclosed the facts at the time of signing the proposal form to the agent of the OPs. No terms and conditions were disclosed to him. Sh. Girdhari Lal Arora paid first premium on 18.03.2008 and second instalment was paid by the insured on 13.10.2008. He expired on 13.03.2009. The complainant being his widow lodged the insurance claim with the OPs. OPs repudiated the insurance claim of the complainant, vide letter dated 12.10.2009 on account of concealment of material facts of pre-existing disease by life assured Sh. Girdhari Lal Arora, when he took the insurance policy. The complainant has, thus, filed the complaint directing the OPs to pay the claim amount of Rs. 1,50,000/- along with interest @ 18% p.a and Rs. 1,50,000/- as compensation for mental harassment and agony and Rs. 5,000/- as costs of litigation.
3. Upon notice, OPs appeared and filed written reply raising preliminary objections that the life assured Sh. Girdhari Lal Arora obtained the contract of insurance by suppressing the material information with regard to his pre-existing diseases. Life assured Sh. Girdhari Lal Arora had not disclosed in the proposal form regarding the fact of his pre-existing disease. The complaint was resisted by the OPs even on merits. This fact was admitted that Sh. Girdhari Lal Arora was assured by the OPs and policy no.952006 was issued in this regard. It was denied by the OPs that any medical test of Sh. Girdhari Lal Arora was conducted at the time of insuring him. It was further pleaded that life assured fully knew about his state of health and treatment as undergone by him and he gave false answer in column no.8 and 10 of proposal form with regard to his state of health. The questionnaire was supplied to Sh. Girdhari Lal Arora to be filed by him and he answered them in negative despite the fact that he had already suffered from pre-existing disease of diabetes mellitus, old cardiac arrest, alcoholic liver diseases with pulmonary hypertension with Acute Renal Failure. Lama Summary issued by Dayanand Medical College & Hospital Ludhiana proved that he suffered from the pre-existing diseased, as referred to above. He was suffering from chronic liver disease and malena (blood in stool) due to internal bleeding since 2004. A esophageal banding surgery was also carried out on him to prevent the bleeding recurrence in 2008, which proved the fact that malena was due to an earlier incidence of esophageal varices. The life assured underwent a surgery for bladder stone 15 years old and one his kidney was non-functional. The report of the investigator was obtained by the OPs in
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