NCDRC

NCDRC

RP/2828/2012

SAHARA INDIA LIFE INSURANCE CO. LTD. & ANR. - Complainant(s)

Versus

HANSABEN DEEPAK KUMAR PANDYA - Opp.Party(s)

MR. GAUTAM AWASTHI & MR. NIKHIL JAIN

03 Sep 2012

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 2828 OF 2012
 
(Against the Order dated 26/03/2012 in Appeal No. 582/2011 of the State Commission Gujarat)
1. SAHARA INDIA LIFE INSURANCE CO. LTD. & ANR.
Shalimar Complex
Bharuch
Gujarat
2. Manager, Sahara India Centre,
1, Kapoorthala Complex, Aligang
Lucknow
U.P
...........Petitioner(s)
Versus 
1. HANSABEN DEEPAK KUMAR PANDYA
W/o Late Sg Deepak Kumar Pandya 116 Rajhans Society,Ananda Taluka Ankleshwar
Bharuch - 393110
Gujarat
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE J.M. MALIK, PRESIDING MEMBER
 HON'BLE MR. VINAY KUMAR, MEMBER

For the Petitioner :MR. GAUTAM AWASTHI & MR. NIKHIL JAIN
For the Respondent :NEMO

Dated : 03 Sep 2012
ORDER

JUSTICE J.M. MALIK 1. The present controversy revolves round the question hether istory by the illiterate wife of the deceased insured, is a conclusive proof of suppression of an ailment?. 2. Sh. Deepak Kumar Pandya, since deceased, husband of the complainant/respondent, Smt. Hansaben Deepak Kumar Pandya, obtained insurance policy in the sum of Rs.3,60,000/- covering the period from 10.01.2008 to 10.01.2018 for which he has also paid premium amount of Rs. 36,306/-. 3. On 05.07.2008, due to heart attack, Sh. Deepak Kumar Pandya passed away. The complainant filed claim with Sahara India Life Insurance Co. Ltd, one of the petitioners in this case. The petitioner No.1 sent a cheque in the sum of Rs.17,563.96ps to the complainant and repudiated her claim. Complainant sent a Legal notice, but it did not ring the bell. Ultimately, the complainant filed a complaint with the District Forum with the prayer that a sum of Rs.3,60,000/-, along with interest @ 18%, be granted, in her favour. The defence set up by the petitioner was that the insured had suppressed the material fact that he was suffering from heart ailment. The District Forum allowed the complaint and directed the petitioner Nos.1 & 2 to pay Rs.3,42,436/-, to the complainant, with interest @ 8% from the date of filing of complaint till date of payment . It also awarded costs of Rs.5,000/- payable by the petitioners to the complainant. 4. Aggrieved by the order of the District Forum, the insurance company filed appeal before the State Commission. The State Commission affirmed the order passed by the District Forum. 5. Aggrieved by this order, the present revision petition has been filed by the petitioners. 6. We have heard the counsel for the petitioner. He laid emphasis on the ground that the insured had suppressed the material fact. Our attention was invited to the fact that the insured died within six monthsfrom the date of taking the policy in question. In the proposal form, the deceased had stated that he did not suffer from any ailment. The attention of this Commission is invited to Annexure P-4, where the following questions were asked from the insured:- QUESTIONS REPLY A. Proposal Form 3. Q.No. 7-4. o you use or have ever used tobacco or tobacco products, in any form? If es please give the details of the substance and quantity consumed per day No 4. Q.No.7-8 re you presently in good health? If not, please give details Yes 6. However, thereafter, it transpired that the deceased was admitted in Adventist Wockhardt Heart Hospital, Surat, Gujarat, on 04.07.2008, wherein the history of the patient was given his wife, the complainant Smt. Hansaben Deepak Kumar Pandya. The relevant portion of the hospital record is reproduced as follows: ADMISSION HISTORY AND PHYSICAL ASSESSMENT FORM 1. XXXX 2. XXXX 3. XXXX 4. Past History: If yes, since when Hypertension Yes/No No Diabetes Yes/No No Tuberculosis Yes/No No IDH Yes/No----- ---? 4 years Dyslipidemia Yes/No No Jaundice Yes/No No Others 7. Again, to the question of smoking, the answer was given in ositive The learned counsel for the petitioner vehemently argued that this is a clear case of suppression of fact. In another question, regarding description of job, it was mentioned :o be asked The so called history dated 04.07.2008 was humb-markedby the complainant. 8. The entire case of the petitioner hinges upon the above said history. This kind of evidence is exiguous. It carries no value in the eyes of law. The petitioner should have produced some concrete evidence in support of its case. The examination of a Doctor who checked the patient, prior to the obtaining of the policy in question, some treatment papers, some prescriptions, etc., should have been produced. There is no evidence which may go to show that he had ever consulted the Doctor for taking treatment for the said disease. In the absence of solid and unflappable evidence, dallops of mystery surrounds petitioner case. The State Commission has referred to an authority of this Commission, reported in Pravin Damani Vs. Oriental Insurance Co. Ltd. (RP No. 1696/2005), decided on 03.10.2006, which fully dovetails with the facts of this case and favours the complainant. 9. The revision petition is without any merit and, therefore, the same is dismissed.

 
......................J
J.M. MALIK
PRESIDING MEMBER
......................
VINAY KUMAR
MEMBER

Consumer Court Lawyer

Best Law Firm for all your Consumer Court related cases.

Bhanu Pratap

Featured Recomended
Highly recommended!
5.0 (615)

Bhanu Pratap

Featured Recomended
Highly recommended!

Experties

Consumer Court | Cheque Bounce | Civil Cases | Criminal Cases | Matrimonial Disputes

Phone Number

7982270319

Dedicated team of best lawyers for all your legal queries. Our lawyers can help you for you Consumer Court related cases at very affordable fee.