BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, REWARI.
Consumer Complaint No: 404 of 2012.
Date of Institution: 24.09.2012.
Date of Decision: 31.03.2015.
Kanta Rani w/o Shri Gopi Chand resident of house no. 202, M/3 A, Krishna Nagar, Rewari ( Tehsil and Distt. Rewari).
…….Complainant.
Versus
- Aviva Life insurance company India Ltd. Through its Chief Managing Director, Regd. Office, 2nd floor, Prakashdeep Building, 7 Tolstoy Marg, New Delhi-110001,
- Branch Manager, Aviva Life Insurance company India Ltd. Aviva Tower, Sector Road, Opp. Golf Course, DLF-Phase V, Sector-43, Gurgaon, 122003 ( Haryana),
- Surendra Singh Tomar, Deputy Branch Manager, Sourcing (DSF) Aviva Life Insurance Company India Ltd. Aviva Tower, Sector Road, opp. Golf Course, DLF Phase V, Sector 43, Gurgaon, 122003.
- Bhagwant Rai, Advisor code Y0515613 Aviva Life Insurance company India Ltd. 119, Lok Nayak Apartments, Delhi .
…...Opposite Parties.
Complaint Under Section 12 of Consumer Protection Act
Before: Shri Raj Kumar ………. …..………..PRESIDENT
Shri Kapil Dev Sharma…………………MEMBER
Present : Shri H.C.Madan, Advocate for the complainant.
Shri S.K.Gautam, Advocate for the opposite parties
No.1 to 3.
Opposite party no.4 given up.
ORDER
Per Raj Kumar President
Factual matrix comprising the case of the complainant, shorn of details, is that the complainant Kanta Rani’s brother late Shri Lal Chand had taken a life insurance policy no. ALA3062472 from the opposite parties for an amount of Rs. 10,00,000/- but unfortunately he died on 6.6.2011 and the complainant being the nominee took steps for taking the insurance benefits but the claim was repudiated by the opposite parties vide its letter dated 2.12.2011 wrongly and illegally; hence this complaint.
2) In reply, opposite parties no.1 to 3 averred that the life assured has suppressed the material facts in the proposal form regarding health and activity and also regarding previous life insurance policy with other insurance companies and did not disclose the same in the proposal form. While in the death claim form, she has mentioned the details of other policy no.115398633 of LIC of the life assured. The life assured concealed the factum of taking treatment by the deceased form Safdargang Hospital Delhi from 5.1.2011 to 7.5.2011 for chest pain and CAG (Cardio Angiography) and he was a known case of CAG Anterolateral MR with HTN. Thus, the claim of the complainant was rightly repudiated and she is not entitled to any claim.
3) We have heard both the counsel for the parties and gone through the record of the case available on the file thoroughly.
4) The claim was repudiated by the insurance company vide repudiation letter Ex. OP-2 on the ground that policy holder has concealed and has suppressed the material facts as the medical records pertaining to the insured revealed that the deceased was a known case of CAD and hypertension since January 2011 and was under treatment for the same. The pre existing medical ailment was not mentioned in the proposal form and the same was considered a serious non disclosure of facts and violation of the contract of the insurance. The observation in the repudiation letter Ex. OP-2 is based on investigation report Ex. OP-10. The investigation report is supported by documentary evidence of the reputed hospital to establish the disease. Our attention was drawn towards Ex. OP-9 which is the discharge summary of the patient from department of Cardiology Safdarjang Hospital. This discharge report is dated 7.1.2011. It clearly shows that the patient was already suffering from heart disease. He got Cardio Angiography performed and he has been reported to be a known case of CAG Anterolateral MR with HTN. It is also surprising that the deceased got himself insured as per policy Ex. C-7 on 10.3.2011 and he died after about three months i.e. on 6.6.2011. Thus, it is clear that on the date of executing policy, material facts pertaining to pre existing disease were suppressed. It has been held in catena of authorities that the contract of insurance is based upon good faith and suppression of material information or fact will amount to breach of contract resulting in repudiation of claim. Reliance in this context can be placed on LIC of India Vs. Smt. G.M. Channabasamma ( 1991) 1 SCC 357 and Life Insurance Corporation of India & Ors. Vs. Smt. Asha Goel & ANr.(2001) ACJ 806.
5) In view of the above discussion and for the foregoing reasons, we find no merit in the complaint and the same is hereby dismissed leaving the parties to bear their own costs.
File after needful be consigned to the record room.
Announced
31.3.2015.
President,
Distt. Consumer Disputes
Redressal Forum, Rewari.
Member,
DCDRF,Rewari.
