PRESENT
Complainant by Adv.Smt. Anita Marathe present.
Opponent by Adv.Shri.Ameya Tamhane present.
ORDER
(Per- Mr. S. D. MADAKE, Hon’ble President.)
Late Gop H Varjani was self employed businessman in electrical goods. He had a large family to support and having no other means of saving for his family, he Preferred to subscribe in life insurance policies with the object of getting the benefits of the savings in his old age and also covering the risk to his life by securing the well being of his family in the event of his death.
The Complainant is a widow of late Gop H. Varjani,who died on 14/05/2009 by snake bite at Titwala. That late Gop H. Varjani, had taken Two life insurance policies from Opposite Parties. The Complainant is the nominee of the said two Policies namely 1) Birla Suns Life Policy No. 000200634 having sum assured Rs. 1,oo,ooo and Yearly Premium Rs. 8464 from 23/03/2004. 2) Birla Suns Life Policy No. 001165315 having sum assured Rs. 5,74,125 and MonthlyPremium Rs. 6222 since 17/10/2007.
That late Gop H. Varjani succumbed to a snake bite on 14/05/2009, while he had gone to Titwala for visit to Lord Ganpati Temple. The Complainant reported the death of the life assured under the policy to the opposite parties and applied for the claim.
The claim was allowed in respect of Policy No. 000200634 having sum assured Rs. 1,oo,ooo and Yearly Premium Rs. 8464 from 23/03/2004. However Opposite Parties rejected the claim on 18/08/2009 in respect of Policy No. 001165315 having sum assured Rs. 5,74,125 and MonthlyPremium Rs. 6222 since 17/10/2007 on the ground that the life assured had not answered the question No. VIII A and B in the proposal form correctly. The action of repudiation and forfeiture of premium is highly objectionable and illegal.
5) That late Gop H. Varjani answered the question No. VIII A and B in the proposal form correctly, truthfully based on his personal knowledge and belief. He had disclosed the policies taken from LIC and the BSLI and none of these policies were declined.
6) The Complainant stated that Opposite parties did not stop at the repudiation of the claim but hastily sent a cheque for Rs. 8665 in the name of late Gop H. Varjani towards the post registration cancellation.
7) The Complainant stated that Opposite parties are liable to pay to the complainant in respect of Policy No. 001165315 having sum assured Rs. 5,74,125 with interest @ 12% p.a. from 15/05/2009. It is further submitted that Opposite parties are liable to invest a part of the annual premium in the units till the date of the maturity of the policy and pay the amount so realized as and when due.
8) The Complainant prayed that opposite party be directed to pay Rs. 50,000/ being compensation for mental agony and to pay Rs. 50,000/- being the cost of the complaint.
9) The Complaint was admitted on 14/07/2011. The opposite party filed written statement on 02/05/2012 and denied all the allegations contained in the complaint. It is stated that complaint is false, malicious, incorrect and baseless.
10) The opposite party stated that non discloser of material medical fact by the life assured is a sufficient ground for rejection of the said policy. It is submitted that the life assured had submitted an application for insurance to another life insurance company prior to his application for insurance submitted to them and that the said LIC had charged an extra premium under the policy issued by it on account of medical history of the life assured not disclosed to them.
11) The opposite party submitted that had the life assured disclose the information truthfully, the company would not have issued the policy on the existing terms. The claim is rejected on merit as per law.
12) We have perused all the documents produced on record as well as affidavits and written arguments submitted by both sides. The death of the complainant’s husband is due to snake bite and she is nominee in respect of above mentioned both policies, is not seriously disputed and the documents clearly show that late Gop H. Varjani died due to snake bite.
13) The record shows that late Gop H. Varjani was having various policies and it is evident that he did not disclose regarding the insurance policy taken from AVIVA Life Insurance Company prior to Birla Suns Life Policy No. 001165315 having sum assured Rs. 5,74,125 and Monthly Premium Rs. 6222 since 17/10/2007.
14) The learned Advocate of complainant Anita Marathe argued that the Life assured had no intention of not disclosing the other policies he held, nor would he was benefited by doing the same.
15) The learned Advocate of complainant Anita Marathe further submitted that there is no specific clause in the terms and conditions of the policy which educates the life assured that it is binding and mandatory for the proposed life assured to disclose all the policies of all other insurance companies to take decision of issuing a policy.
16) The learned Advocate of complainant Anita Marathe argued that AVIVA insurance company and the opposite parties entered into contract of insurance after medical examination and on the basis of medical reports.
17) The learned Advocate of complainant Anita Marathe submitted that opposite party has wrongfully repudiated the genuine claim. She submitted that opposite party fail to established that late Gop H. Varjani fraudulently suppressed material facts.
18) The learned Advocate of opposite parties Ameya Tamhane submitted that life assured had fully understood the terms and conditions of insurance policy and further agreed that if any untrue statement be contained in the application the policy contract shall be null and void.
19. The learned Advocate of opposite parties Ameya Tamhane submitted that the life assured had signed the proposal for insurance of AVIVA life insurance on 13/07/2007 i.e. prior to three months than Birla Suns Life Policy No. 001165315 having sum assured Rs. 5,74,125 and Monthly Premium Rs. 6222 since 17/10/2007.
20) The learned Advocate of opposite parties Ameya Tamhane submitted that the contract of insurance being of utmost good faith and late Gop H. Varjani was under an obligation to disclose the material past insurance history details in the proposal form but he intentionally concealed the same and the claim was rightly rejected on merit.
21) The Hon’ble apex court in Skandia Insurance Co. Ltd vs Kokilaben Chandravadan & Ors in para 8 observed as under
“When the option is between opting for a view which
will relieve the distress and misery of the victims of
accidents or their dependents on the one hand and the equal-
ly plausible view which will reduce the profitability of the
insurer in regard to the occupational hazard undertaken by
him by way of business activity, there is hardly any choice.
The Court cannot but opt for the former view”.
22) We are of the view that there is no fundamental breach of the policy contract. The insurer failed to prove that late Gop H. Varjani fraudulently suppressed material facts. There is no direct nexus between the cause of death and the information given by assured. Therefore we hold that opposite parties rejected the claimed without justifiable ground.
23) Complainant being nominee and wife of late Gop H. Varjani entitled to receive the amount in respect of Policy No. 001165315 having sum assured Rs. 5,74,125. The complainant is entitled to claim interest @ of 9% p.a. from the date of rejection i.e. 18/08/2009.
24) The complainant is entitle for reasonable compensation as per sec. 73 of the Indian Contract Act 1872 to the amount of Rs. 25,000/- as well as cost of Rs. 10,000 from opposite parties
25 . In result we pass following order..
ORDER
The Complaint No. RBT/CC/11/323 is partly allowed.
The opposite parties are ordered to pay Rs. 5,74,125/-with interest @ 9%
p.a. to complainant from the date of rejection of the claim i.e.
18/08/2009 till realization.
The opposite parties are ordered to pay Rs. 25,000/- as compensation for
mental agony to complainant within two months failing which the said
amount shall carry interest @ 9% from the date of order.
The opposite parties are ordered to pay Rs. 10,000/- as a cost to
complainant.
Copy of this order be sent to both parties.
