- This is a petition filed by one Mrs. Banesha Begum (hereinafter referred 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 husband of the complainant, namely, deceased Sirajuddin Ahmed submitted a proposal form for his life insurance with Reliance Life Insurance Co. Ltd, Nagaon Branch on last 31/01/2013 and the opposite party No.1 accepted the said proposal on last 13-02-2013 and issued policy in the name of said Sirajuddin Ahmed vide policy number 50749187 for sum assured Rs.2,25,000/- (Rupees Two Lakh and Twenty-five Thousands)only along with accident benefit rider for sum assured of Rs.2,25,000/- and the total installment premium was Rs.21,245.02p(yearly) and the next Premium date was 13-02-2014. Further case of the complainant is that policy holder Sirajuddin Ahmed who was an employee in the Divisional Forest Office, Nagaon, suffered from some minor illness on last 12-03-2013 and he was treated by Doctor of Sillongoni, Amtola P.H.C. and he regularly attended office till 10-04-2013 but on last 11-04-2013 at 8:40 P.M., he expired suddenly. Further case of the complainant is that she intimated the office of the opposite party No.1 about the death of her husband and placed her claim before opposite party No.1 along with all relevant documents to get the insurance benefit and she was informed by the opposite party No.1 that her claim was sent to the opposite party No.2 and after proper verification of her claim, she would get the claim benefit. She further stated that she visited the office of the opposite parties to get settlement of her claim and every time she was returned by them saying that she will obtain letter from opposite party No.2 in this regard. The complainant stated that she had made approach many a time for settlement of her claim but the opposite parties paid no heed and did not dispose her 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, namely, Zenith Surveillance and during investigation it was found that the deceased policyholder at the time of obtaining the policy was suffering from Diabetes Mellitus, Respiratory Tract infection, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease and he 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 his 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 under the Heading “Forfeiture in certain events” 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 and illegally denied to extend the benefit to the complainant for the insured policy No. 50749187 for sum assured Rs.2,25,000/- (Rupees Two Lakh and Twenty-five Thousands)only as nominee for the deceased policy holder Sirajuddin 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 her claim. The opposite party No.1 and 2 cross-examined the P.W. but did not adduce any evidence in support of their written version.
5. Written argument filed by both the contesting parties 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 her husband deceased Sirajuddin Ahmed during his life time opened a policy with the opposite parties, namely, Reliance Life Insurance Company Limited and on his death, the complainant being his wife and nominee filed her claim for getting the insurance benefit of the policy of her husband but the opposite parties, namely, Reliance Life Insurance Company Limited, without any justified cause hold that her husband suppressed the material facts regarding his health condition at the time of opening the policy and refused to provide her with the insurance benefit. In support of her claim, she as P.W.1 adduced evidence to the effect that her husband namely, deceased Sirajuddin Ahmed submitted a proposal form for his life insurance with Reliance Life Insurance Co. Ltd, Nagaon Branch on last 31/01/2013 and opposite party No.1 accepted the said proposal on last 13-02-2013 and issued policy in the name of said Sirajuddin Ahmed vide policy number 50749187 for sum assured Rs.2,25,000/- (Rupees Two Lakh and Twenty-five Thousands) along with accident benefit rider for sum assured of Rs.2,25,000/- and the total installment premium was Rs.21,245.02p(yearly) and the next Premium date was 13-02-2014. Further evidence of the P.W.1 is that policyholder Sirajuddin Ahmed who was an employee in the Divisional Forest Office, Nagaon, suffered from some minor illness on last12-03-2013 and he was treated by Doctor of Sillongoni, Amtola P.H.C. and he regularly attended office till 10-04-2013 but on last 11-04-2013 at 8:40 P.M., he expired suddenly. P.W.1 also deposed that she intimated the office of the opposite party No.1 about the death of her husband and placed her claim before the opposite party No.1 along with all relevant documents to get the insurance benefit and she was informed by the opposite party No.1 that her claim was sent to the opposite party No.2 and after proper verification of her claim, she would get the claim benefit. Her further evidence is that she visited the office of the opposite party No.1 to get settlement of her claim and every time she was returned by them saying that she will obtain letter from opposite party No.2 in this regard. The complainant as P.W.1 also deposed that she had made approach many a time for settlement of her claim but the opposite parties paid no heed and did not dispose her 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 his health condition and he was diagnosed with Diabetes Mellitus, Respiratory Tract infection, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease and was taking treatment prior to the date of his application for his policy and thus he 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 though cross-examined the P.W.1 but nothing revealed from her cross examination that her husband was suffering from Diabetes Mellitus, Respiratory Tract infection, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease and was taking treatment prior to the date of his application for his policy. The opposite party No1 and 2 also did not adduce any evidence in support of their written version. Hon’ble 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 & Ors. 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 his health condition and that he was suffering from Diabetes Mellitus, Respiratory Tract infection, Chronic Liver Disease, Chronic Obstructive Pulmonary Disease and was taking treatment prior to the date of his application for his policy for reasons best known to them while from cross examination of P.W.1 also reveals nothing that policy bearing number 50749187 was obtained by fraud and misrepresentation by the deceased policy holder Sirajuddin Ahmed. In view of above observation we are of the opinion that the 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.50749187 of deceased Sirajuddin 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 20th Day of December 2021.
