- This is a petition filed by one Md. Gulzar Hussain (hereinafter referred to as the petitioner) against the Branch Manager, Reliance Life Insurance Company Limited, Nagaon Branch and one another (hereinafter referred to as the opposite parties) U/S 12 of the consumer Protection Act, 1986 praying for recovery of money, compensation and other relief.
- The fact and circumstances for filing of the aforesaid petition as narrated by the petitioner are as follows:-
The wife of the complainant, namely, deceased Ruhena Muksuda Fardousi Ahmed submitted a proposal form for her life insurance with Reliance Life Insurance Co. Ltd, Nagaon Branch and the opposite parties accepted the said proposal on last 13-03-2012 and issued policy in the name of said Ruhena Muksuda Fardousi vide policy number 19918829 for sum assured Rs.2,00,000/- (Rupees Two Lakh)only along with accident benefit rider for sum assured of Rs.2,00,000.00 and the total installment premium was Rs.17,686.34p(yearly) and the next Premium date was 13-03-2013. Further case of the complainant is that policy holder Ruhena Muksuda Fardousi Ahmed who was the owner of a grocery shop situated at Kadamoni Pathar under Post Office and Police Station Juria, Nagaon, suffered from some minor illness on last 17-07-2012 and he was treated by Doctor Abul Kassem, MBBS, SDM & H.O. of Dagaon P.H.C and during her treatment, she regularly attended her shop but suddenly on last 24-07-2012 at 3:00 P.M., he breathed her last. Further case of the complainant is that he intimated the office of the opposite party No.1 about the death of his wife and placed his claim before opposite party No.1 along with all relevant documents to get the insurance benefit and he was informed by the opposite party No.1 that his claim was sent to the opposite party No.2 and after proper verification of his claim, he would get the claim benefit. He further stated that he visited the office of the opposite parties to get settlement of her claim and every time he was returned by them saying that he will obtain letter from opposite party No.2 in this regard. The complainant stated that he had made approach many a time for settlement of his claim but the opposite parties paid no heed and did not dispose his claim without any sufficient cause which amounts to deficiency of service on their part. Hence, this claim petition is before this Commission praying for the relief.
The opposite party No.1 to 2 filed their written version denying all the allegation of the petitioner leveled against them. By their written version, the opposite party No.1 and 2 pleaded inter- alia that there is no cause of action for the complainant to file the petition and that the petition is unsustainable in law and liable to be dismissed. The opposite party No.1 & 2 further submitted that the law of insurance is governed by the legal doctrine Uberrima Fides meaning almost good faith (literally, most abundant faith) which means all the parties to an insurance contract must deal in good faith, making a full declaration of all material facts in the insurance proposal. The opposite party No.1 to 2 submitted that in the instant case there are inherent misrepresentation and suppression of material facts and intentional false statement was made regarding health condition of the life assured in order to get the insurance coverage. The opposite party No.1 to 2 further stated that since the claim being an early claim, the same was investigated by an independent investigating agency and during investigation it was found that the deceased policyholder at the time of obtaining the policy was suffering from Tuberculosis and she was hospitalized earlier and she suppressed such material facts in the policy form and the insurance policy was obtained by fraud and misrepresentation. The opposite party No.1 & 2 also stated that the instant claim is barred by section 45 of the Insurance Act as because during investigation of the claim it was revealed that the deceased policy holder intentionally suppressed the material facts in the proposal form regarding her health condition and hence, the act of opposite party No. 1 & 2 in repudiation of the claim on the ground of non-disclosure of material fact is squarely within the ambit of section 45 of the Insurance Act as the life assured died within two years from the date of commencement of the policy. Their further version is that even the terms and condition set forth in the policy document itself clearly and specifically prescribed that the policy shall be treated void if there is any inaccurate or false statement made in the policy and the deceased policyholder by signing the policy acknowledged the terms and condition set forth in the policy. The opposite party No.1 & 2 again submitted that the repudiation of the claim in the instant case is as per the terms and condition mentioned in the contract of insurance policy and the claim of the complainant is based on impermissible conjectures, inferences and surmise and the complainant is not entitled to any relief. Under the above premises, the opposite party No.1 and 2 pray for dismissal of the complainant petition.
- Upon pleading of parties the following points are found for discussion and decision in the case.
- Whether the opposite party No.1 and2 illegally denied to extend the benefit to the complainant for the insured policy No. 19918829 for sum assured Rs.2,00,000.00 (Rupees Two Lakhs)only as nominee for the deceased policy holder Ruhena Muksuda Fardousi Ahmed without any justified cause and such act on the part of opposite party No.1 to 2 amounts to deficiency in service?
- Whether the claimant is entitled to any relief as prayed for?
4. The complainant filed evidence in affidavit of one witness and also exhibited several documents in support of his claim. The opposite party No.1 and 2 neither cross-examined the P.W. nor adduced any evidence in support of their written version.
5. Written argument filed by the complainant side and perused the same.
6. Decision and reasons thereof:-
7. For the sake of brevity both the Point (i) & (ii) are taken jointly for discussion and decision:-
The claim of the complainant is that his wife deceased Ruhena Muksuda Fardousi Ahmed during her life time opened a policy with the opposite parties, namely, Reliance Life Insurance Company Limited and on her death, the complainant being her husband and nominee filed his claim to get the insurance benefit of the policy of his wife but the opposite parties, namely, Reliance Life Insurance Company Limited, without any justified cause hold that his wife suppressed the material facts regarding her health condition that she was suffering from Tuberculosis at the time of opening the policy and refused to provide him with the insurance benefit. In support of his claim, he as P.W.1 adduced evidence to the effect that his wife namely, deceased Ruhena Muksuda Fardousi Ahmed submitted a proposal form for her life insurance with Reliance Life Insurance Company Limited, Nagaon Branch and opposite parties accepted the said proposal on last 13-03-2013 and issued policy in the name of said Ruhena Muksuda Fardousi Ahmed vide policy number 19918829 for sum assured Rs.2,00,000/- (Rupees Two Lakhs)only along with accident benefit rider for sum assured of Rs.2,00,000.00 and the total installment premium was Rs.17,686.34p(yearly) and the next Premium date was 13-03-2013. Further evidence of the P.W.1 is that Ruhena Muksuda Fardousi Ahmed who was the owner of a grocery shop situated at Kadamoni Pathar under Post Office and Police Station Juria, Nagaon, suffered from some minor illness on last 17-02-202 and she was treated by Doctor Abul Kassem, MBBS, SDM & H.O. of Dagaon P.H.C and during her treatment, she regularly attended her shop but suddenly on last 24-07-2012 at 3:00 P.M., she breathed her last. P.W.1 also deposed that he intimated the office of the opposite party No.1 about the death of his wife and placed his claim before the opposite party No.1 along with all relevant documents to get the insurance benefit and he was informed by the opposite party No.1 that his claim was sent to the opposite party No.2 and after proper verification of his claim, he would get the claim benefit. His further evidence is that he visited the office of the opposite party No.1 to get settlement of his claim and every time he was returned by them saying that he will obtain letter from opposite party No.2 in this regard. The complainant as P.W.1 also deposed that he had made approach many a time for settlement of his claim but the opposite parties paid no heed and did not dispose his claim without any sufficient cause and thus, the opposite parties violated the term of the contract between the policyholder and the insurer company and such act on the part of the opposite parties amount to deficiency in service.
The opposite party No.1 and 2 while filing their written version submitted that the policy was obtained by fraud and at the time of opening the policy, the policy holder had suppressed the material facts regarding her health condition and she was diagnosed with Tuberculosis and was hospitalized prior to the date of her application for the policy and thus she having concealed the material facts at the time of application, the act of opposite party No. 1 and 2 in repudiation of the claim on the ground of non-disclosure of material fact is squarely within the ambit of section 45 of the Insurance Act as the life assured died within two years from the date of commencement of the policy and such act on their part does not amount to deficiency in service. However, the opposite party No.1 and 2 neither cross-examined the P.W.1 nor adduced any evidence in support of their written version. Honourable Apex Court in many judicial pronouncement specifically stated that mere filing of written statement is not sufficient unless supported by evidence. The same Court further in Life Insurance Corporation of India-Vs-Komalavalli Kamba & others Reported in (1984) AIR, 1014, 1984 SCR (3) 350 has held that the general rule is that the contract of Insurance will be complete only when the party to whom an offer has been made accepts unconditionally and communicates the acceptance to the person making the offer. The duty of the insurer is to verify the correctness of the information supplied by the person whose life is assured regarding his health condition. In the instant case the opposite party No.1 and 2 failed to adduce any evidence in support of their written version that they verified regarding the information supplied by the policy holder regarding her health condition and that she was suffering Tuberculosis and was hospitalized prior to the date of her application and the given policy bearing number 50749187 was obtained by fraud and misrepresentation by the deceased policy holder Ruhena Muksuda Fardousi Ahmed for reasons best known to them. In view of above observation we are of the opinion that the complainant has successfully established that there is a deficiency of service on the part of the opposite party No.1 and 2.
In result both the points for discussion and decision are answered in affirmative and go in favour of the complainant.
O R D E R
8. In view of the above discussion, it is found that the petitioner has succeeded to prove that there was a deficiency of service on the part of opposite party No.1 and 2.
Accordingly, the prayer made by the petitioner U/S 12 of the Consumer protection is allowed on contest. Issue direction to the opposite party No.1 and 2 to pay the complainant the insurance benefit for the insured policy No.19918829 of deceased Ruhena Muksuda Fardousi Ahmed as per terms and condition of the policy with interest @ 12 per annum from today till realization.
Inform all the parties concern.
Given under the hand and seal of this Commission, we signed and delivered this Judgment on this 19th Day of April, 2022.
