RESERVED
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
UTTAR PRADESH, LUCKNOW
APPEAL NO. 587/2015
(Against the order dated 10-02-2015 in Complaint Case
No. 48/2009 of the District Consumer Forum, Kanpur Nagar)
Ramesh Dutta Sharma
S/o Late B L Sharma
R/o Plot No.5, Bhaseen Bhawan
Meerpur, Cantt., Kanpur Nagar
...Appellant
V/s
- M/s. Bajaj Allianz Life Insurance Co. Ltd.
Through Principal Officer
Regd. Head Office G. E. Plaza
Airport Road, Yarvada, Pune
02.M/s. Bajaj Allianz Life Insurance Co. Ltd.
11/9, Silvar House
Opposite Align Mills, Civil Line
Kanpur Nagar
Through Manager
...Respondents
BEFORE:
HON'BLE MR. JUSTICE AKHTAR HUSAIN KHAN, PRESIDENT
For the Appellant : Sri R K Gupta, Advocate.
For the Respondent : Sri Sajeev Bahadur Srivastava, Advocate.
Dated : 10-10-2017
JUDGMENT
PER MR. JUSTICE AKHTAR HUSAIN KHAN, PRESIDENT
This is an appeal filed under Section 15 of the Consumer Protection Act 1986 against judgment and order dated 10-02-2015 passed by the District Consumer Forum, Kanpur Nagar in Complaint Case No. 48 of 2009 Ramesh Dutta Sharma V/s M/s. Bajaj Allianz Life Insurance Company Limited and another whereby the District Consumer Forum has dismissed complaint.
Feeling aggrieved complainant Ramesh Dutta Sharma has filed this appeal.
Learned Counsel for the appellant Mr. R K Gupta appeared.
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Learned Counsel for the respondents Mr. Sanjeev Bahadur Srivastava appeared.
I have heard learned Counsel for the parties and perused impugned judgment and order passed by the District Consumer Forum as well as records.
Relevant facts for determination of appeal are that the appellant has filed complaint before District Consumer Forum, Kanpur Nagar for getting claim arising out of following insurance policies of his deceased wife Smt. Maya Sharma who died on 07-03-2008.
Sl.No. | Policy No. | Sum Assured | Medical or Non Medical | Period | Scheme | Payment of Instalments |
|---|
01. | 0011695313 | 1,00,000 | Non Medical | 04-10-2005 to 04-10-2008 | Unit Gain | Rs.10,000/-per year. 3 instalments Rs.30,000/- paid by policy holder |
|---|
02. | 0018196603 | 1,00,000 | Medical | 28-03-2006 to 28-03-2018 | Unit Gain | Single premium of Rs.50,000/- paid |
|---|
03. | 0024360635 | 1,00,000 | Medical | 09-06-2006 to 09-09-2009 | Unit Gain Premier | Single premium of Rs.50,000/- paid |
|---|
04. | 0024304512 | 1,50,000 | Non Medical | 09-09-2006 to 09-09-2009 | Unit Gain Plus AC | Rs.30,000/- per year Two instalments of Rs.30,000/- and Rs.30,000/- have been paid in 2007-2008 |
|---|
05. | 0067257577 | 1,00,000 | Medical | 07-11-2007 to 07-11-2017 | Capital Gain Unit | Rs/10,000/- per year Only one premium of Rs.10,000/- paid |
|---|
It has been contended in complaint by appellant that the respondents/opposite parties have wrongly repudiated claim of appellant on the ground that the insured wife of appellant had obtained above policies by suppression of material fact regarding past disease.
Respondents/opposite parties have filed written statement before
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District Consumer Forum wherein it has been stated that Smt. Maya Devi wife of appellant had a history of past heart disease and she had undergone a serious operation in year 1989.She was admitted in Regional Hospital, Kanpur and L.P.S. Institute of Cardiology G.S.V.M. Medical College, Kanpur prior to her death.
In written statement it has been further stated that the insured Smt. Maya Devi has also concealed her previous policies in proposal forms.
In written statement it has been stated that claim of appellant has been rightly repudiated.
After having gone through pleadings of parties and evidence on record the District Consumer Forum is of the view that insured Smt. Maya Devi has obtained policy by concealment of past disease of heart which is cause of her death. Repudiation of claim is justified. Consequently the District Consumer Forum has dismissed complaint.
Learned Counsel for the appellant has contended that the impugned judgment and order passed by District Consumer Forum is erroneous. Smt. Maya Devi had undergone operation in year 1989 and she was perfectly well at the time of taking policies. She has given correct information in proposal forms. She had faced medical examination conducted by authorized doctor of respondents and was declared fit. Repudiation of claim of appellant by respondents is unjustified.
Learned Counsel for the respondent has supported judgment and order passed by District Consumer Forum and contended that the insured has obtained policies by concealment of past disease fraudulently. Respondents have rightly repudiated claim.
I have considered the submissions made on behalf of parties.
Relevant column 14 of proposal form of policies in question is reproduced below:-
14. Have you ever been treated or currently under treatment for any of the following conditions:
a) ………..
b) ………..
c) ………..
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d) Any diseases and disorders of the Cardiovascular system such as but not limited to chest pain, heart disease, high/low blood pressure, artery or blood disease?
Above question 14(d) of proposal form has been answered in negative by insured whereby she has concealed her past disease of heart for which she had undergone operation in year 1989.
The death of insured has occurred due to Cardiac Respiratory Arrest as is evident from the death certificate of insured Smt. Maya Devi.
At this juncture, reference of Section-45 of the Insurance Act 1938 appears relevant. Section-45 of the Insurance Act is reproduced below:-
“45. Policy not to be called in question on ground of mis-statement after two years. – No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement [was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made] by the policy-holder and that the policy-holder knew at the time of making it that the statement was false [or that it suppressed facts which it was material to disclose]:
[provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.]”
In view of discussion made above it is fully clear that the insured Smt. Maya Devi had past history of heart disease and she had undergone operation for such disease in year 1989. As such she had given false information in this respect in proposal form in question no. 14(d). It is thus
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clear that she has concealed material fact to obtain policies in question. She has concealed material fact knowingly. Therefore it is absolutely clear that she has obtained policies in question fraudulently through misrepresentation. As such Insurance Company is entitled to make repudiation of insurance policy obtained fraudulently by making misrepresentation of material fact.
In view of discussion made above I am of the view that the respondent Insurance Company has sufficient ground to repudiate insurance claim of appellant/complainant for his wife’s policies in question. As such respondent Insurance Company has not committed deficiency in service by repudiating claim of appellant/complainant.
In view of above I am of the view that the impugned judgment and order passed by District Consumer Forum is in accordance with law and no interference in it is justified.
In view of above appeal is dismissed.
Parties shall bear their own costs.
Let copy of this order be made available to the parties within 15 days positively as per rules.
( JUSTICE A H KHAN )
PRESIDENT
Pnt.
