Delhi

New Delhi

CC/31/2016

Vinay Malhotra - Complainant(s)

Versus

HDFC ERGO General Insurance Co Ltd - Opp.Party(s)

08 Jan 2019

ORDER

 

 

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTRICT NEW DELHI,  M-BLOCK, 1^ST FLOOR,

VIKAS BHAWAN, I.P. ESTATE. NEW DELHI-1100001.

 

C.C.No.31/2016

 

Ms. Vinay Malhotra,

I-6, Lajpat Nagar-2,

New Delhi-110024.

                                  ….Complainant

 

Vs.

 

1. HDFC Standard  Life Insurance  Co. Ltd.,

F-69, 1^st Floor, Connaught Circle,

        New Delhi-110001

 

Also at:

 

4^th Floor, Vijaya Building

17 Barakhamba Road,

New Delhi.

Opposite Party

 

NIPUR CHANDNA, MEMBER

 

 

O R D E R

 

 

The complainant has filed the present complaint against the OP under section 12 of Consumer Protection Act, 1986. The brief facts of the present complaint are that the complainant’s husband had taken a Policy, bearing no. 15695529 for assured sum of Rs.1,75,000/- from the OP on 31.12.2012. It was alleged that under the said policy, the complainant was declared as nominee by Life Assured.

2.     It was alleged that before issuing policy, the Life Assured was medically examined and after completing other formalities the policy certificate was issued to him. It was alleged that on 4/3/2013 the husband of the complainant expired at Fortis Hospital, Vasant Kunj due to cardiac failure. It was alleged that the complainant being the nominee under the aforesaid policy preferred a claim with the OP. The claim was repudiated by OP informing complainant that as per investigation carried out it was established that her husband was suffering from diabetes and heart diseases which was not disclosed in the Proposal Form. It was further alleged that by way of representation dated 20.4.2013, she informed OP that her husband was never under the treatment for heart disease but the OP failed to consider the same.  As such she approached Insurance Ombudsman, who vide its order dated 12.8.13 rejected her claim.  It is submitted that her husband never filled the Proposal Form, he had merely signed the same on the instance of Insurance Agent, who approached him for getting the policy done.  It is further submitted that despite her repeated requests, OP failed to consider her genuine claim and repudiated the same on false and frivolous ground, complainant, therefore, approached this Forums for redressal of her grievance.

 3.    OP had filed written statement opposing complaint of the complainant. It was alleged that Life Assured was suffering from diabetes mellitus and cardiovascular disease at the time of proposal.  While filling the Proposal Form on 29.12.12 for the subject policy the DLA answered Question No.13(Ia) related to diabetes and Question No.(13 (1b) (q) related to heart disease in negative.  It is further stated that the prescription recorded in the BHEL Panel, doctor book dated 7.1.11, 7.12.11, 4.6.12 and 6.8.12 clearly reflects that DLA was suffering from  diabetes mellitus and cardiovascular disease. It was stated that the Life Assured had given false replies in the application for insurance, as such the policy was obtained by concealment and suppression of material facts. It was alleged that the claim was rightly repudiated as the policy was obtained by concealment and suppression of material facts.

4.     Both the parties filed evidence by way of affidavit. Parties also filed written arguments.

5.     Ld. counsel for the OP has contended that Life Assured was suffering from  diabetes mellitus and cardiovascular disease at the time of proposal.  While filling the Proposal Form on 29.12.12 for the subject policy the DLA answered Question No.13(Ia) related to diabetes and Question No.(13 (1b) (q) related to heart disease in negative.  It is further stated that the prescription recorded in the BHEL Panel, doctor book dated 7.1.11, 7.12.11, 4.6.12 and 6.8.12 clearly reflects that DLA was suffering from diabetes mellitus and cardiovascular disease. It was stated that the Life Assured had given false replies in the application for insurance, as such the policy was obtained by concealment and suppression of material facts.

6.     On the other hand, it is argued by the complainant that there is no concealment of material facts by the Life Assured, and prayed that the relief claims be granted.

 

7.     It is admitted position that the Life Assured had taken insurance policy from the OP on 29.12.12. and, had died on 4.3.2013. Claim has been repudiated by the OP on the ground that the Life Assured was suffering from diabetes mellitus and cardiovascular disease.  In support of his contention, counsel for OP has placed on record the copy of prescription recorded in the BHEL Panel, doctor book dated 7.1.11, 7.12.11, 4.6.12 and 6.8.12 clearly reflects that DLA was suffering from diabetes mellitus and cardiovascular disease. It was alleged  that the Life Assured had given false replies in the application for insurance, as such the policy was obtained by concealment and suppression of material facts. 

 

8.     Perusal of the file shows that the Proposal Form attached with the complainant as well as the written statement shows that while filling the Proposal Form on 29.12.12 for the subject policy the DLA answered Question No.13(Ia) related to diabetes and Question No.(13 (1b) (q) related to heart disease in negative.  Moreover, the perusal of the death certificate placed by the complainant clearly shows that the antecedent cause of death was pulmonary koch’s with diabetic mellitus.  The complainant has placed on record the certificate of treating doctor dated 25.2.2013 in which, Dr. Tapan Ghose, stated that the husband of the complainant was admitted for bronchoscopy to rule out kochs and was found to be in heart failure, he was advised for coronary Artery Bypass Grafting at the earliest.

9.     The contracts of insurance are contracts of uberrima fides and every material fact is required to be disclosed. In United India Page 11 of 13 Insurance Co. Ltd. v. M.K.J. Corpn., III (1996) CPJ 8 (SC), a two Judge Bench of Hon‟ble Supreme Court has observed: “It is a fundamental principle of Insurance law that utmost good faith must be observed by the contracting parties. Good faith forbids either party from concealing (non-disclosure) what he privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. Just as the insured has a duty to disclose, „similarly, it is the duty of the insurers and their agents to disclose all material facts within their knowledge, since obligation of good faith applies to them equally with the assured‟.”

 

10.    In Satwant Kaur Sandhu v New India Assurance Company reported in IV (2009) CPJ 8 (SC), Hon‟ble Supreme Court has observed that in a contract of insurance, the expression “material fact” is to be understood in general terms, to mean as any fact which would influence the mind of a prudent Insurer, in deciding whether to accept the risk or not. If the proposer has knowledge of such fact, he is obliged to disclose it, particularly while answering questions in the proposal form. Any inaccurate answer will entitle the Insurer to repudiate its liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance, which is based on the principle of utmost faith– uberrimae fidei. Good faith forbids either party from non-disclosure of the facts which the party privately knows, to draw the other into a bargain, from his ignorance of that Page 12 of 13 fact and his believing the contrary. It has also been emphasized that it is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not.

 

11.    In PC Chacko and Anr. v. Chairman, Life Insurance Corporation of India & Ors. (2008) 1 SCC 321, the Hon‟ble Supreme Court has upheld the repudiation of the contract of insurance on the ground of non-disclosure and mis-statement in the proposal form to the various questions to which the answers were given by the insured.

 

12.    The document annexed with the complaint shows that the deceased had not given correct answers and had obtained the policy by suppressing material facts. 

13.    In the facts and circumstances of the present case, the OP was justified in repudiating the present claim. In view of the above discussion, we find not merits in the present compliant, same is hereby dismissed.

A copy of this order each be sent to both the parties free of cost by post. This final order be sent to server (www.confonet.nic.in ). File be consigned to Record Room.

Announced in open Forum on 08/01/2019. 

 

 

 

(ARUN KUMAR ARYA)

          PRESIDENT

 

(NIPUR CHANDNA)                                                  (H M VYAS)

       MEMBER                                                                MEMBER