NCDRC

NCDRC

RP/517/2013

P. USHA KUMARI - Complainant(s)

Versus

BAJAJ ALLIANZ LIFE INSURANCE CO. LTD. - Opp.Party(s)

MR. C.P. SURESH

14 Feb 2013

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 517 OF 2013
 
(Against the Order dated 23/11/2012 in Appeal No. 95/2011 of the State Commission Andhra Pradesh)
1. P. USHA KUMARI
...........Petitioner(s)
Versus 
1. BAJAJ ALLIANZ LIFE INSURANCE CO. LTD.
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE ASHOK BHAN, PRESIDENT
 HON'BLE MRS. VINEETA RAI, MEMBER

For the Petitioner :MR. C.P. SURESH
For the Respondent :NEMO

Dated : 14 Feb 2013
ORDER

Complainant/petitioner husband Murali Krishna obtained a life insurance policy for Rs.4,50,000/- on 16.2.2008. He died on 21.6.2009 i.e. within two years of the taking of the policy. Petitioner being the nominee lodged the claim with the respondent which was repudiated by the respondent on the ground of suppression of facts that the complainant husband was having nd Stage Renal Failure Condition Petitioner being aggrieved filed the complaint before the District Forum taking the stand that her husband was hale and hearty at the time of taking the policy and there was no suppression of facts. Respondent on being served resisted the claim on the ground that on receiving the claim, it got the matter investigated and found that the deceased Murli Krishna had history of end stage renal transport since March, 2007. The respondent submitted that there was suppression of material facts at the time of taking of the policy. District Forum allowed the complaint and directed the respondent Insurance Company to pay the entire amount of Rs.4,50,000/- to the petitioner alongwith interest @ 7.5% p.a. from the date of filing of the complaint till the date of deposit and Rs. 500/- were awarded by way of cost. Respondent being aggrieved filed an appeal before the State Commission. State Commission relying upon the judgment of the Supreme Court in P.C. Chako vs. LIC III (2008) (SC) 78 and Satwant Kaur Sandhu vs. New India Assurance Co. Ltd. (2009) 8 SCC 319 allowed the appeal, reversed the order of District Forum and dismissed the complaint. State Commission has recorded the following reasons: - ) It is an undisputed fact that the assured Murali Krishna had taken an insurance policy for Rs. 4,50,000/- basing on his declaration in the proposal form submitted by him under Ex. B2. He was a teacher. The complainant, wife of the deceased intimated his death by enclosing Ex. A2 Medical Attendant Certificate issued by one Dr. M. Venkata Ramana wherein he mentioned the primary cause of death epsis, vomiting, loose motions The assured died on 21.6.2009. The doctor had noted the date of first consultation was 19.6.2009 and found that he was having mild fever, followed by vomiting, loose motion. He noted these ailments on the instructions given to him by the attendants. When the complainant had enclosed Ex. A2, the insurance company repudiated the claim under Ex. A1 categorically mentioning hat the deceased life assured had history of end stage of renal transplant since March, 2007. These facts known to the deceased life assured were not disclosed in the proposal form dt. 16.2.2008. Had these facts been disclosed the company would not have covered the risk for the policy. Hence the claim has been repudiated due to non-disclosure of material facts.Assailing the repudiation, she filed the complaint. The complainant did not categorically dispute the said ailment. What all she stated was that the opposite party sent repudiation letter just to evade payment of Rs. 4,50,000/- covered under the policy to the complainant. Since the opposite party did not file any evidence to substantiate the said fact, the Dist. Forum allowed the complaint directing the insurance company to pay the amount covered under the policy. 10) Obviously, after filing of the appeal, coming to know that medical certificate issued by Apollo Hospital to show that the deceased had underwent renal transplant filed the certificate issued by it along with proposal form submitted by the deceased, together with report of the investigator as additional evidence. No doubt, in the petition to receive the documents, it was alleged that its advocate did not file it, the fact remains that the complainant did not dispute the medical record submitted by the insurance company which was already adverted to in the repudiation letter. Therefore, it cannot be said that the insurance company has crated these documents in order to prove that assured underwent renal transplant. The entire record filed herein would disclose that it relates to the assured when he underwent treatment for end stage renal transplant. Sri B. Vinod Kumar, Member of Parliament had issued letter informing that the Chief Minister of Andhra Pradesh had sanctioned an amount of Rs. 35,000/- from his relief fund. Obviously, he underwent renal transplant even before he had taken the insurance policy. This would amount to material suppression of his health condition. 11) The Honle Supreme Court in P. C. Chacko Vs. Chairman, LIC of India reported in III (2008) CPJ 78 (SC) held : he purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bona fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law. 12) Later in the case of Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. reported in (2009) 8 SCC 319 in unequivocal terms has clearly held that when there is a suppression of material fact by the life assured in relation to his health, the insurance company cannot be compelled to pay the insurance amount to the nominee. It is true that the respondent had not produced the medical record before the District Forum showing that the petitioner husband had undergone end stage renal transplant in the year 2007. This record was produced by the respondent in the Appellate Court. The Appellate Court took the material produced on record and relying upon that record and the letter written by Mr. Vinod Kumar, Member of Parliament, informing that an amount of Rs.35,000/- has been sanctioned from the Chief Minister Relief Fund for the treatment of the petitioner late husband for End Stage Renal Failure, came to the conclusion that the husband of the petitioner was indeed suffering from End Stage Renal Failure and had undergone the transplant which he failed to disclose at the time of taking the policy. We agree with the finding recorded by State Commission. From the medical record produced and the letter written by Shri Vinod Kumar, Member of Parliament it is evident that the insured was suffering from renal failure prior to the taking of the policy. Insured suppressed this material fact while taking the policy. Contract of insurance is based on trust and failure to disclose the material fact vitiates the contract. No ground for interference is made out. Dismissed. Keeping in view the peculiar facts and circumstances of the case, we direct the respondent Insurance Company to refund the premium paid by the petitioner within eight weeks from today.

 
......................J
ASHOK BHAN
PRESIDENT
......................
VINEETA RAI
MEMBER

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