PBEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, ERNAKULAM.
Dated this the 26th day of September 2012
Filed on : 31/07/2010
Present :
Shri. A Rajesh, President.
Shri. Paul Gomez, Member.
Smt. C.K. Lekhamma, Member
C.C. No. 428/2010
Between
Jayarajam M.R., : Complainant
W/o. Late M.S. Ramanan, (By Adv. M.R. Jayaprasad,
Mattapurath house, H. No. 43/716, ‘Maathalil, PHE
Eramalloor P.O., Road, Kochi-682 018)
Alappuzha-688 537.
And
1. Bajaj Allianz Life Insurance : Opposite parties
Company Ltd., GE Plaza, (1st o.p absent)
Airport road, Yerwada,
Pune-411 006.
2. The Branch Manager, :(2ndOPBy Adv. S. Sibha, 41/4262/D
Bajaj Allianz Life Inurance 2/B/, Metro Plaza, 2nd floor,
Co. Ltd, Kochi Branch, Market road, (North)
Ernakulam. Cochin-14)
O R D E R
A Rajesh, President.
The case of the complainant is as follows:
The complainant’s husband late Ramanan had availed a Bajaj Allianz New Family Gain policy with effect from 17-12-2007. The premium payable was Rs. 12,000/- annually. The sum assured was Rs. 1,80,000/- and the death benefit was Rs. 1,80,000/- plus fund value as shown in the policy. The insured expired on 21-05-2009. The complainant, nominee of the policy holder submitted claim application before the opposite parties on 29-07-2009. The insurance claim was repudiated by the opposite party stating that there was non disclosure of material facts. There is deficiency in service on the part of the opposite party in repudiating the claim of the complainant. The complainant is entitled to get insurance amount plus the fund value as per the policy and also entitled to get refund of Rs. 24,000/- the annual premium together with compensation of Rs. One lakh. This complaint hence.
2. The version of the opposite party is as follows:
The opposite parties issued an insurance policy in favour of the complainant’s husband commencing from 17-12-2007. The complainant’s husband did not disclose his previous ailments in the proposal form. The insured died on 21-05-2009 due to liver cirrhosis He had been undergoing treatment for the disease prior to the inception of the policy in various hospitals. The insured has suppressed the material facts in the proposal form thereby is disentitled for insurance claim from the opposite party.
3. The complainant and her witness were examined as PWs1 and 2. Exts. A1 to A7 were marked in the side of the complainant. The witness for the opposite parties were examined as DWs 1 to 3. Exts. X1 to X3 were marked. Heard the counsel.
4. The points that arose for consideration are as follows:
i. Whether the complainant is entitled to get insurance claim
from the opposite party?
ii. Whether the complainant is entitled to get refund of the premium amount of Rs. 24,000/-?
iii. Whether the opposite party is liable to pay compensation of Rs. 1,00,000/- to the complainant.
5. Point No. i. Admittedly the complainants husband late M.S. Ramanan availed a Bajaj Allianz new family gain policy from the opposite party with effect from 17-12-2007. It is not in dispute that the sum assured in the policy was Rs. 1,80,000/- and the death benefit was Rs. 1,80,000/- and the fund value stated in the policy. It is also not in dispute that the insured breathed his last on 21-05-2009.
6. The opposite party repudiated the insurance claim of the complainant as per ext. A3 letter dated 16-09-2009 which reads as follows:
We regret to inform you that the death claim under captioned policy has been declined for the following reason:
The company had covered the risk for the above said policy on the basis of the facts mentioned in the proposal form. However, on receiving the death claim intimation for the above said policy, the various investigations and the various medical certificates confirm that the deceased life assured was under medical investigation in May 2006 and was also hospitalized and treated for cirrhosis of liver, psoriasis in June 2006. These facts known to deceased life assured were not disclosed in the proposal form dated 07-12-2007.
Had these facts been disclosed the company would not have covered the risk for the policy.
7. During evidence the doctors who treated the deceased were examined as DWs 1 to 3 and the treatment records were marked as Ext. X1 to X3. Ext. X2 is the case sheet of the deceased maintained by Lourde’s Hospital, Ernakulam. As per Ext. X2 the deceased had undergone treatment at the hospital from 13-10-2006 to 18-11-2006. During the treatment at the hospital he had been subjected to ultra sound scanning. The report dated 08/08/2007 reads as follows:
“IMPRESSIONS:
Cirrhosis liver, partial hypertension.
Splenomegaly.
Mild – moderate amount of ascites.
Tiny right renal calculus. No hydronephrosis.”
8. The above ailment as per Ext. X2 go to show that the insured was suffering from various ailments prior to the inception of the policy which was not disclosed in the proposal form. The definite contention of the opposite party is that the insured had suppressed the material facts in the proposal form submitted before the opposite party to avail the disputed policy which has not been disputed. So the deposition of the complainant that her husband had no previous ailment cannot be taken as true. The learned counsel for the complainant submitted that in spite of repeated directions from this Forum the opposite party failed to produce the proposal form before the forum which goes to show that the insured had not suppressed any ailment in his proposal form. We are not to agree with the contention of the complainant especially so because the contents in Ext. X2 speaks for its own which would show that the insured had suppressed his previous ailments before availing the policy.
9. The law has been settled by the Hon’ble Supreme Court in a plethora of Judgments that the contract of Insurance is a contract of “Uberrima fides” and the parties are bound to disclose the material facts to each other. Refrence can be made to the judgement reported in Mithoolal Nayak V. LIC of India AIR 1962 SC 814. The dictum of law was reiterated by the Hon’ble Supreme Court in LIC of India & Ors. Vs. Asha Goel (Smt) & Anr. 1 (2001) SLT 89, and in PC Chacko & Anr. Vs. Chairman LIC of India III (2008) CPJ 78.
10. In view of the above this Forum is of the considered view that this complaint is only to be dismissed. We do so.
Pronounced in the open Forum on this the 26th day of September 2012
Sd/- A Rajesh, President.
Sd/- Paul Gomez, Member
Sd/- C.K. Lekhamma, Member.
Forwarded/By Order,
Senior Superintendent.
Appendix
Complainant’s exhibits :
Ext. A1 : Copy of schedule dt
A2 : Copy of deposit Renewal Premium
Receipt dt. 22-01-2009
A3 : Copy of letter dt. 16/09/2009
A4 : Copy of proposal form for life insurance
A5 : Copy of First Premium receipt
dt. 28-03-2007
A6 : Copy of letter dt. 19/12/2007
A7 : Copy of schedule
X1 : Hospital record of Lakshmi hospital
X2 : Medical record,
Lourdes Hospital, Ernakulam.
X3 : Medical record of PVS
Memorial Hospital Ltd.,
Opposite party’s Exhibits : Nil
Depositions:
PW1 : Jayarajam M.R.
PW2 : Satheesan
DW1 : Dr. K.A. Ranganath
DW2 : Dr. Varghese Jaison
DW3 : Mathew Philip
