BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 147 of 2013
Date of Institution : 22.8.2013
Date of Decision : 9.9.2016.
Kavita Devi w/o Sh. Bhoop Singh, resident of village Hangera, Tehsil Chopta, District Sirsa.
….Complainant.
Versus
- Birla Sun Life Insurance Company Limited, Registered Office one Indiabulls Centre, Tower 1, 15th & 16th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai- 400013.
- Birla Sun Life Insurance Company Limited, Sirsa through its Branch Manager.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI S.B.LOHIA. ……………………..PRESIDENT.
SHRI RANBIR SIGH PANGHAL……..MEMBER.
Present: Sh.Vijay Bhalla, Advocate for the complainant.
Sh. Ashish Goyal, Advocate for the opposite parties no.1&2.
ORDER
In brief, the complainant’s case is that her husband Bhoop Singh had a life insurance policy from the opposite parties for assured sum of Rs.8 lakhs vide policy No.005174117 on 20.10.2011. The complainant is the nominee of her husband in the said policy. The Insurance company also appointed the panels of the doctor for the medical check up of husband of complainant and they found him fit and healthy, therefore, the ops issued the policy bonds to him. The premium of this policy was payable in yearly installments. The husband of complainant had paid one installment of Rs.34,230/- during his life time. Her husband died on 27.2.2012 at his house at the age of about 38 years due to natural death. However, the medical condition of the deceased was very fit and no pre medical history was recorded or conducted before taking the insurance policy. The complainant being nominee in the policy is entitled to receive the sum assured of Rs.8,00,000/- with accrued bonus from ops. The complainant intimated the opts about the death of her husband and she also submitted original policy as well as original premium receipt with ops but no action was taken by ops. The ops have repudiated the claim of complainant on 30.11.2012 by taking a false stand that husband of the complainant had history of lung cancer which is wrong and illegal. The complainant has to run from pillar to post to receive lawful claim which has been causing great physical and mental agony as well as financial hardship to her, therefore, she is also entitled to compensation in addition to the sum assured with accrued bonus. Hence, this complaint.
2. Upon notice, opposite parties appeared and contested the complaint by filing joint written statement asserting therein that cardinal principle of contract of life insurance is Uberrama Fides i.e. the principle of utmost good faith. The doctrine of good faith requires the proposer to make a complete and truthful disclosure of the material acts pertaining to his/ her health and other history. In the present case, the life assured passed away on 27.2.2012 and answering ops came to know about the same after in receipt of claim form from the complainant and being an early death i.e. within 4 months from the date of commencement of policy, the ops got investigated the matter. The ops after in receipt of investigation report were stunned to know that the life assured Bhoop Singh was suffering from lung cancer and he much prior to the entering into proposal form was regularly taking treatment from Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur. In the registration papers, it is clearly recorded that the DLA was diagnosed of history of lung cancer on 24.8.2011 i.e. much prior to the issuance of the policy in question. So, it is amply clear that the life assured had concealed the material fact regarding his health at the time of submitting of proposal form that he is suffering from cancer. He had provided wrong information and concealed material information by answering questions 11 and 14 (f) in the negative while submitting proposal form and the ops considering the information supplied by the life assured in the proposal form true, had issued the policy. So, the ops have repudiated the claim of the complainant vide repudiation letter dated 30.11.2012.
3. Both the parties have led their evidence in the form of affidavits and documents. The complainant has tendered in evidence her affidavit Ex.P1, application dated 23.3.2013 Ex.P2. Whereas, opposite parties have tendered in evidence affidavit of Sh. Kislay Kartikey, Zonal Legal Head as Ex. RW1/A, copy of proposal form Ex.R1, copy of repudiation letter dated 30.11.2012 Ex.R2, copy of death claim intimation form Ex.R3, copy of death certificate Ex.R4, copy of investigation report Ex.R5.
4. We have heard learned counsel for the parties and have gone through the record carefully.
5. There is no dispute that the husband of the complainant namely Bhoop Singh obtained a life insurance policy from the opposite parties on 20.10.2011 for sum assured of Rs.8,00,000/-. The complainant was made nominee in the said policy. The husband of the complainant has died on 27.2.2012 but the death claim submitted by the complainant to the ops has been repudiated by the ops vide their repudiation letter dated 30.11.2012 placed on file by the ops as Ex.R2. The ground for repudiation of the claim of the complainant is that deceased life assured Bhoop Singh had made false declaration regarding his health in the proposal form at the time of taking policy in question. In the proposal form Ex.R1, to specific questions regarding his health that whether proposer was diagnosed with or treated/ consulted for diseases like diabetes, high or low blood pressure, chest pain, heart attack, asthma or any other lung diseases etc. or whether he was suffering from any disease like cancer, tumor etc. the deceased life assured had given the answers in negative. The opposite parties to support their version that deceased had given wrong answers/ declaration regarding status of his health at the time of filling of proposal from and to justify the repudiation of claim has placed on file copy of investigation report Ex.R5 in which it is mentioned that investigator collected the treatment record of Bhoop Singh issued by Bhagwan Mahaveer Cancer Hospital & Research Centre, Jaipur and as per the same Bhoop Singh son of Mr. Chunni Lal, resident of village Hanjeera, Distt. Sirsa i.e. deceased life assured was suffering from carcinoma lung as on 24.8.2011 i.e. prior to taking of the insurance policy. The opposite parties have appended the said treatment record of the above said hospital with the investigation report Ex.R5 from which it is evident that life assured was treated for the disease of lung cancer in the above said hospital from 24.8.2011 onwards where chemotherapy on his person for the said disease was also conducted. So, the opposite parties have duly proved on record that deceased life assured who died on 27.2.2012 was suffering from pre-existing disease of lung cancer at the time of taking the insurance policy from the ops and he had concealed the said material fact of his health from the ops. The complainant has not been able to submit any credible evidence to rebut the facts in the documents/ records produced from above said hospital. Therefore, we are of the considered view that the repudiation of the claim of the complainant on the ground of suppression of material fact regarding pre-existing disease is justified and as held by Hon’ble National Commission in catena of judgments and also by our own Hon’ble State Commission in case titled as Rajpal Vs. Birla Sun Life Insurance Co. & others, F.A. No.94 of 2015 decided on 20.2.2015.
6. Thus, as a sequel to our above discussion, we find no merit in the present complaint and same is hereby dismissed with no order as to costs. Copy of this order be given to the parties as per rules. File be consigned to record room after due compliance.
Announced in open Forum. President,
Dated: 9.9.2016. Member. District Consumer Disputes
Redressal Forum, Sirsa.
