Haryana

Yamunanagar

CC/257/2012

Rekha W/o Neeraj Kumar - Complainant(s)

Versus

HDFC Standard Insurance Company Ltd. - Opp.Party(s)

Brijesh Chauhan

28 Mar 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

                                                                                    Complaint No. 257 of 2012

                                                                                    Date of institution: 12.03.0212

                                                                                    Date of decision: 28.03.2017.

 

Rekha aged about 32 years widow of late Neeraj Kumar, resident of House No. 33, Shastri Colony, Yamuna Nagar, Tehsil Jagadhri, District Yamuna Nagar.

  …Complainant.

                                                     Versus

HDFC Standard Life Insurance Company Limited, Branch, plot 1/75, First Floor, Opposite Mira Bazaar, Near Fountain Chowk, Yamuna Nagar through its Branch Manager.  

                                                                                                …Respondent.                                       

 

 

BEFORE: SH. ASHOK KUMAR GARG…………….. PRESIDENT.

                 SH. S.C.SHARMA………………………….MEMBER.

 

Present:    Sh. Brijesh Chauhan, Advocate, counsel for complainant.  

                 Sh. M.L.Bansal, Advocate, counsel for respondents.        

 

ORDER  (Ashok Kumar Garg President  )

 

1.                     The present complaint has been filed by complainant Rekha under section 12 of the Consumer Protection Act, 1986.

2.                     Brief facts of the present complaint, as alleged by the complainant, are that the husband of the complainant Neeraj Kumar was got insured for a sum of Rs. 1,61,547/- with the respondent (hereinafter respondent will be referred as OP Insurance Company) vide insurance policy No. 14539430 dated 08.08.2011 for a period of 10 years  and had paid a sum of Rs. 24,994/- as premium amount to the OP Insurance Company. As per the insurance policy of the OP Company, either after the maturity of the policy or after the death of insured, the insurer or his legal heirs are entitled to receive the claim amount of Rs. 1,61,547/-.  In the meantime, on 06.10.2011, Sh. Neeraj Kumar husband of the complainant died and accordingly being legal heir as well as nominee of deceased complainant applied to the claim amount of Rs. 1,61,547/-. After receiving the claim application of the complainant, the official of the OP Insurance Company started making one pretext or the other and ultimately refused to pay the claim amount vide letter dated 02.12.2012. Lastly, prayed for directing the OP Insurance Company to pay a sum of Rs. 1,61,547/- to the complainant alongwith interest as well as compensation. Hence, this complaint.

3.                     Upon notice, Op Insurance Company appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable before this Forum; complainant is not consumer as per provisions of the Consumer Protection Act; complaint is bad for non-joinder of necessary and proper parties; complainant has not come to this Forum with clean hands and has concealed the true and material facts from this Forum and on merit it has been admitted that the complainant is widow of deceased Neeraj Kumar and was the nominee. The complainant is not entitled to for any claim as the proposer has not disclosed regarding his habit of drinking and blood sugar before taking the policy of insurance from the OP Insurance Company and if he had disclosed the same fact to the OP Insurance Company then the OPs Insurance Company would have refused to give the insurance policy. In fact, no information was provided by the husband of the complainant in proposal form and the husband of the complainant had not disclosed the fact regarding consuming of liquor and regarding suffering from diabetes/ blood sugar and the OP Insurance Company in good faith issued the policy. It has been further alleged that Neeraj Kumar had died at Ponta Sahib Himachal Pradesh and as per police file report the deceased Neeraj Kumar had expired due to taking of drugs with drink and the fact regarding consuming liquor was not disclosed by the deceased Neeraj Kumar before taking the policy and as such now the complainant is not entitled in any manner whatsoever. After receiving the claim application, the OP Insurance Company deputed the investigator “ Panther Group India” to investigate the matter and as per report, some kind of drug with drink was the cause of death/diabetes which is also mentioned in the police file report and as such the claim of the claimant has rightly been repudiated by the OP Insurance Company vide letter dated 02.12.2011. As per Annexure-4 Sh. Neeraj Kumar was known case of diabetes since 5 years prior to issuance of policy and this fact has also been admitted by the complainant herself in her statement Annexure R-3. Lastly, prayed for dismissal of complaint.

4.                     To prove the case, counsel for the complainant tendered into evidence affidavit of complainant as Annexure CW/A and documents such as Photo copy of letter dated 12.08.2011 regarding accepting the proposal form as Annexure C-1, Photo copy of death certificate as Annexure C-2,  Photo copy of postmortem report as Annexure C-3 and closed the evidence on behalf of complainant.

5.                     On the other hand, counsel for the OP Insurance Company tendered into evidence affidavit of Harsimran Singh, DM, Legal HDFC Life Insurance as Annexure RW/A and documents such as Photo copy of proposal form as Annexure R-1, Photo copy of death investigation report as Annexure R-2, Photo copy of statement of Rekha wife of Neeraj Kumar as Annexure R-3, Photo copy of certificate issued by J.P. Hospital as Annexure R-4, Photo copy of DDR No. 30(A) dated 06.10.2011 as Annexure R-5, Photo copy of postmortem report as Annexure R-6, Photo copy of letter dated 02.12.2011 as Annexure R-7 and closed the evidence on behalf of OP.

6.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully.

7.                     It is admitted case of the OP Insurance Company that the husband of complainant Sh. Neeraj Kumar purchased the insurance policy bearing No. 14539430 and had paid a sum of Rs. 24,994/- as premium amount to the OP Insurance Company which is evident from Annexure C-1.

8.                       Learned counsel for the complainant argued at length that genuine claim of the complainant has been repudiated by the OP insurance company illegally whereas the claim of the complainant was covered under the insurance policy in question and referred the case law titled as Arun Kumar Versus New India Assurance Co. Ltd. & Others, 2016(4) CPR page 33 ( NC) wherein it has been held that Repudiation of death claim on ground of suppression of pre-existing disease- Opinion given by panel doctors is based on presumption only that complainant would have been suffering from degenerative joint disease for last 4 to 5 years- Said presumption has not been supported by any medical evidence or record which may indicate that complainant withheld any material fact about his health condition from knowledge of insurance company while making application for getting policy. Further draw our attention towards the case law titled as Sushil Kumar Jain Versus United India Insurance Co. Ltd. 2012(1) CPC page 463 NC, Bajaj Allianz Life Insurance Co. Ltd. and others Versus Raj Kumar (Mrs), 2014 (3) CPC page 24 NC wherein it has been held that death of insured during subsistence of policy- Claim was wrongly repudiated with the plea that insured/deceased had concealed the pre-existing disease of blood cancer- State Commission rightly granted relief as repudiation of claim was not justified-

            Learned counsel for the complainant further draw our attention towards the case law titled as LIC of India Versus Jivraj Bhai P. Domadia, 2015 (3) CPR page 157 (NC) wherein it has been held that Suppression of Material facts pre supposes knowledge- Petitioner has not placed any evidence on record by which it can be inferred that insured was having knowledge of Lt. Ear discharge before filing proposal form- He rightly expressed his state of health as good- There is no suppression of any material fact by insured in proposal form and petitioner has committed deficiency in repudiating claim on flimsy grounds- Revision petition dismissed.  

9.                     On the other hand, counsel for the OP insurance company hotly argued at length that the deceased Neeraj Kumar concealed the true and material facts at the time of taking the insurance policy as he was suffering from diabetes for the last few years and he was consuming alcohol in excess quantity and this fact has been admitted by the complainant in her statement Annexure R-3. Learned counsel for the OP Insurance Company further argued that the insured Neeraj Kumar habitual in drinking and drugs also and he had already got fracture in both legs by the road side accident due to drinking problem and cause of death has also been mentioned in the police file report which is evident from Annexure R-4 and R-5. Learned counsel for the OP Insurance Company further argued that as the husband of complainant had suppressed the fact that he was habitual in drinking and drugs and was suffering from sugar from the last few years and in the past scenario insured already got fracture in both legs by the road side accident due to drinking problem and the cause of death has been mentioned in police file report due to drugs with drink, so, the claim of the complainant has rightly been repudiated and referred the case law titled as Mrs. Shnyni Valsan Pombally Versus State Bank of India & others, 2014(1) CLT page 356 wherein it has been held that Insurance claim- Repudiation- Pre-existing disease-Held- The deceased was suffering from “diabetes mellitus” for which ailment he was on regular medication for over three years- It was not possible to even comprehend that the insured would not know that he was suffering from diabetes- Undoubtedly, these were “material facts” and being within the knowledge of the insured only, he was obliged to disclose the same correctly- Having suppressed the said facts while answering the questionnaire, we are of the opinion that the Insurance Company was within its rights to repudiate the claim of the complainant- In that view of the matter, there was no question of any deficiency in service on their part and referred the another case law titled Kokilaben Narenderabhai Patel Versus Life Insurance Corporation of India, 2011(1) CLT page 181. Further referred the case law titled as Life Insurance Corporation of India Versus Kusum Patro, 2012(2) CPJ Page 272 NC and Life Insurance Corporation of India and others Versus  Asha Goel (Smt. ) and another, 2001(2) SCC page 160.

10.                   After hearing both the parties, we are of the considered view that the claim of the complainant has been rightly repudiated by the OPs Insurance Company as from the entire record of investigation report as well as statement of complainant, DDR, postmortem report and certificate issued by the J.P.Hospital (Annexure R- 2 to R-6) it is evident that the husband of the complainant namely Neeraj Kumar was suffering from diabetes for the last 5-6 years and in the past scenario insured already got fracture in both legs by the road side accident due to drinking problem and the cause of death has been mentioned in police file report due to drugs with drink which is evident from Annexure R-3 to R-5.  Although, no affidavit of any doctor has been placed on file by the OP Insurance Company even then the complainant has totally failed to controvert the version of the OP Insurance Company and the statement of complainant, certificate issued by J.P.Hospital, DDR as well as postmortem report cannot be disbelieved. We have also perused the proposal form dated 09.08.2011 submitted by deceased Neeraj Kumar  Annexure R-1 in which the deceased Neeraj Kumar  specifically gave the answer to the questions No. 2-A in negative. The question No. 2A and the answer there to is reproduced as under:

Question No. 2(A) Have you ever suffered from or received treatment for any symptoms or medical conditions for any of the following?

 Diabetes or High blood sugar/ Sugar in urine.

The insured gave answer in negative to the above question.

11.                   From the above evidence, it is duly established that insured did not disclose the true and material facts regarding his health in the proposal form Annexure R-1.

12.                   It is well settled principle of law that any in correct information and false statement made by the insured regarding health, age and income makes the insurance contract null and void. The same view has been held in the judgment rendered by Hon’ble National Commission in Life Insurance Corporation of India Versus Smt. Minu Kalita 2002(3) CPJ page No.10 National Commission.     

13.                   Even in further judgment titled as Modern Insulator Limited Vs. Oriental Insurance Company Ltd. 2000(2) SCC page 734 it has been held as under:

“ It is fundamental principle of insurance law that utmost good faith must be observed by the contracting parties and the good faith forbids either party from non-disclosure of the facts which the parties know-“

14.                   Further, in case titled as P.C. Chacko Vs. Chairman LIC of India 2008(1) Supreme Court Cases 321 Hon’ble Apex Court has held as under:

“20. we are not unmindful of the fact that life insurance corporation being a estate within the meaning of article 12 of the constitution of India, its action must be fair just and equitable but the same would not mean that it shall be asked to make a charity of public money, although the contract of insurance is found to be vitiated by reason of an act of the insured. This is not a case where the contract of insurance or a clause thereof is unreasonable, unfair or irrational which could make the court quarry the bargaining powers of the contracting parties. It is also not the case of the appellant that in framing the aforesaid questionnaire in the application/proposal form, the respondents had acted unjustifiably or the conditions imposed are unconstitutional.”

15.                   Even in the latest law titled as Life Insurance Corporation of India Versus Bimla Devi 2016 (1) CPJ page 57, it has been held by the Hon’ble National Commission that any contract of insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not to accept the risk is a “material fact” If the proposer has knowledge of such fact, he is obliged to disclose it particularly while answering question in the proposal form. Needless to emphasize that in accurate answer will entitle the insurer to repudiate his 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.

16.                   The law cited by the complainant is not applicable to the facts of the present case as in the present case the deceased Neeraj Kumar was suffering from diabetes and habitual of taking drugs with drink  before taking the insurance policy which is duly proved from the entire record placed on file by the OP Insurance Company. 

17.                   In view of the above noted facts and circumstances of the case and law referred above, we are of the considered view that insured had concealed the true facts regarding his health which was material at the time of obtaining the insurance policy in question. Since, the policy was obtained by the insured on misstatement and by concealing the true facts, so, the insurer is not liable to pay sum insured to the complainant.

18.                   Resultantly, we find no merit in the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced: 28.03.2017.

                                                                        (ASHOK KUMAR GARG)

                                                                        PRESIDENT

                                                                        DCDRF, YAMUNANAGAR

 

 

                                                                        (S.C.SHARMA    )

                                                                        MEMBER