Haryana

StateCommission

CC/133/2015

SUSHMA DEVI - Complainant(s)

Versus

EDELWEISS TOKIO LIFE INSURANCE CO. - Opp.Party(s)

PRAVEEN MEHTA

08 Dec 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

   Complaint No  : 133 of 2015

Date of Institution: 03.08.2015

Date of Decision : 08.12.2016

Smt. Sushma Devi widow of late Sh. Balwan Singh son of Sh. Matu Ram, resident of Gali. No. 2, Arya Nagar, Gharaunda, Distt. Karnal

Complainant

 Versus

1.      Edelwesis Tokio Life Insurance Company, Edelwesis House, 7^th Floor Off C.S.T. Road, Kalina, Mumbai, Maharashtra-400098, through its Managing Director.

2.      Branch Manager, Branch office of Edelwesis Tokio Life Insurance, S.C.O. 253, Sector-12, Second Floor, Opposite Mini Secretariat, Karnal through its Branch Manager.

                                      Opposite Parties

 

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member   

 

Argued by:          Sh. Parveen Mehta, Advocate for the complainant.

Sh. S.C. Thatai, Advocate for the opposite parties.

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

          Sushma Devi-complainant filed complaint under Section 17 of the Consumer Protection Act, 1986 against Edelwesis Tokio Life Insurance Company-opposite parties submitting that Balwan Singh, her husband, real estate agent, purchased a life insurance policy No. 000172332E on 13.03.2012 with a assured sum of Rs.15,00,000/-.  The complainant was the nominee in the said policy.  Balwan Singh enhanced the risk cover from Rs.15,00,000/- to Rs.70,00,000/- with effect from 15^th July, 2012. Balwan Singh met with an accident on 14^th April, 2014 and suffered fatal injuries.  It is submitted that Balwan Singh has also taken other insurance policies from different companies which was detailed as under:-

 

Sr.No.	Company	Policy No.	Sum Assured	Date of commencement
1	Bajaj Allianz	0232219158	20 lakhs	12.09.2011
2	Bharti AXA	5006054687	25 Lakhs	06.08.2010
3	Birla Sunlife	001977040	1,22,800/-	12.09.2008

 

It was further stated that Balwan Singh did not pay the premium of the aforesaid policies and thus policy issued by the Bharti AXA lapsed on 06.08.2013, policy issued by the Bajaj Allianz lapsed on 12.09.2013 and policy issued by the Birla Sunlife lapsed in the year 2008 i.e. prior to the death of Balwan Singh.  Therefore, complainant did not lodge the claim of these policies.  It was also stated that since Balwan Singh was not highly qualified therefore, the agent who filled up the proposal form obtained his signatures by filling the basic information otherwise he had no intention of concealing any information from the Insurance Company. Complainant being nominee lodged the claim, which was repudiated by the Insurance Company on the ground that life assured had concealed the fact of having purchased earlier insurance policies and did not disclose the same in the proposal form. Hence this complaint.

2.      Edelwesis Tokio Life Insurance Company-opposite party contested the complaint stating that Balwan Singh husband of complainant purchased the Life Insurance Policy initially on 13.03.2012 for sum assured of Rs.15,00,000/- and thereafter the sum assured was enhanced to Rs.70,00,000/- on 14.07.2012.  It was stated that the life assured did not disclose the factum of having purchased three earlier policies with a view to defraud with the Insurance Company. Thus Life assured made a false declaration. Thus, Insurance Company rightly repudiated the claim.

3.      To prove her case complainant examined herself as CW1 and placed documents on file, that is,  Proposal Form Exhibit C-1, Renewal Premium Receipt Exhibit C-2, DDR regarding accident Exhibit C-3, Post Mortem Report Exhibit C-4 and on the other hand Insurance Company examined Shirin Patel as OPW-1 and tendered into evidence request for enhancement of insurance cover from Rs.15 lakhs to Rs. 50 lakhs (Exhibit OP-2), cheque for payment of initial premiums as Exhibit OP-3 and enhancement of insurance cover from Rs.50 lakhs to Rs. 70 lakhs Exhibit OP-4.

4.      We have heard learned counsel for the parties and gone through the record.

5.      Undisputed facts are that Balwan Singh purchased the Life Insurance Policy which commenced from 13.03.2012 with sum assured of Rs.15,00,000/- vide proposal form (Exhibit-C-1). The insurance cover was enhanced from Rs.15,00,000/- to Rs.50,00,000/- with effect from 04.07.2012 and later further enhanced to Rs.70,00,000/- with effect from 15.07.2012.  Balwan Singh died in an accident on 14.04.2014 and Daily Diary Report (Exhibit C-3) was recorded in Police Post Bauli, Distt. Panipat and Post Mortem examination was conducted (Exhibit C-4).  It is not disputed that the Balwan Singh while purchasing the policy did not disclose of having purchased earlier policies in column No.8 of the proposal form which contains information about existing policies on the date of purchase of policy.  In this column requiring information of existing policies it has been mentioned as N.A.  In the complaint, the complainant herself admitted that life assured had taken another three policies, which are as under:-

Sr.No.	Company	Policy No.	Sum Assured	Date of commencement
1	Bajaj Allianz	0232219158	20 lakhs	12.09.2011
2	Bharti AXA	5006054687	25 Lakhs	06.08.2010
3	Birla Sunlife	001977040	1,22,800/-	12.09.2008

 

6.      Thus all these three policies have been purchased prior to the filling up of the proposal form Exhibit C-1 on 15.03.2012. Factum of earlier policies was not disclosed. The fact that life assured had three existing policies before the purchase of the policy in question is an admitted fact by the complainant herself.  It has also not been disputed that those policies were existing on 15.03.2012.  Though policies lapsed in the year 2013 however, that does not matter as those policies were alive on 15.03.2012 when the proposal form for purchase of present policy was filled up. Complainant examined herself as CW-1. On her cross-examination, she admitted that her husband was also doing insurance business though not much.  However, the facts remains that Balwan Singh, deceased was an insurance agent and knew the importance of giving details of existing policies as also the consequence for concealing the same. 

7.      Thus the only question to be decided is as to what is the consequence of non-disclosure of earlier policies. Hon’ble National Consumer Disputes Redressal Commission, New Delhi in Laxmi Bai and others versus Birula Sun Life Insurance Company Revision Petition No.497 of 2013 decided on 12.04.2016 upholding repudiation of the claim observed that the concealment of existing policies was a material fact and non-disclosure justified the Life Insurance Corporation in repudiating the claim.  The relevant para of the judgment is reproduced below:-

“11.   It is pertinent to mention that earlier to purchase of subject insurance policy, the insured had two insurance policies, one for Rs.3.00 lacs and other for Rs.3.00 lacs with Life Insurance Corporation of India.  On perusal of proposal form, we find that proposal from contains the column for seeking details in which proposer is supposed to give details of his application for issue of previous policy, year of issue and the face value of the earlier insurance policy.  The said column has been left blank by the proposer, meaning thereby that the insured concealed existence of previous two insurance policies from the respondent.  It may not be out of place to mention that earlier two insurance policies were for Rs.2.00 lacs and Rs.3.00 lacs whereas in March, 2003, the petitioner applied for insurance policy of much larger amount of Rs.15.00 lacs and he died within a year from the date of issue of subject insurance policy.”

“12.   It is well settled that contract of insurance is based on the doctrine of ‘uberrima fides’ i.e. utmost good faith.  The life assured while obtaining the insurance policy is under obligation to disclose relevant material aspect with respect to his/her life.  Reference be made to the judgment of the Supreme Court in the cases of P.C. Chacko & Anr. Vs. Chairman, LIC of India (2008) 1 SCC 321, Satwant Kaur Sandhu Vs. New India Assurance Company (2009) 8 SCC 316 and judgment of this commission in the matter of Crown Consultants Pvt. Ltd. Vs. Oriental Insurance  Company Ltd. III (2011) CPJ 439 (NC).

13.    In view of the law laid down in above noted judgments and the fact that insured had obtained insurance policy by concealment of material facts, we do not find any fault with the order of the State Commission setting aside the order of the District Forum.  The petitioner has not been able to show any material irregularity or jurisdiction error which may call for interference in exercise of revisional jurisdiction.  Revision Petition is, therefore, dismissed.”        

8.      The same view was held in LIC of India Vs. Vidya Devi Revision Petition No. 382 and 383 of 2011 and Dinesh Bhai Chandaran Vs. Life Insurance Corporation (NCDRC) 2011(1) C.P.R. 63.  Though complainant relied upon Life Insurance Corporation of India Vs. Shahida Begum 2011(3) C.P.J. 373 however, that is on a different facts. In that case Life Insurance Corporation itself had issued earlier policies. However in the case in hand the earlier policies were issued by different Insurance Companies.  In view of the discussion above, since the life assured concealed the factum of earlier policies, therefore, the opposite parties were justified in repudiating the claim.  No merit in the complaint hence dismissed.   

 

 

Announced 08.12.2016

(Diwan Singh Chauhan) Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President