Haryana

Karnal

390/2010

Megha D/o Vijendra Singh - Complainant(s)

Versus

ICICI Prudential Life Insurance Company Limited - Opp.Party(s)

S.S. Rana

12 Oct 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.  

                                                          Complaint No.          390 of 2010                                                                         

                                                               Date of instt.: 28.5.2010

                                                          Date of decision: 30.12.2015

 

Megha(minor) d/o Mr.Vijender Singh through her mother as natural guardian 2.Smt.Suman Lata wd/o Mr.Vijender Singh r/o House No.891, Sector 9, Urban Estate, Karnal  tehsil and district Karnal.

                                                                ……..Complainant.

                   Vs.

1.Branch Manager, ICICI PRUDENTIAL Life Insurance Company, Sector 12, Karnal.

2.MD/SR MANAGER, ICICI PRUENTIAL Life Insurance Company, ICICI Pru Life  Towers, 1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai – 400 025.

.

                                                                  …..Opposite Parties.

 

                     Complaint u/s 12 of the Consumer

                     Protection Act.

 

Before          Sh.K.C.Sharma……….President.                

                   Sh.Anil Sharma…….Member.

 

Present:-        Sh. S.S.Rana Advocate for the complainant.

                   Sh.Vineet Rathore Advocate for the Ops.

                  

ORDER:

 

            This  complaint  has been filed by the complainant u/s 12 of the Consumer Protection Act 1986, on the averments that Vijender Singh since deceased, the father of complainant no.1 and husband of the complainant no.2 was insured by the Opposite Parties ( in short Ops)vide policy No.05737004. He was duly medically examined before issuance of the insurance policy by the doctor, who was on the panal of OPs. He expired on 31.7.2008. After his death, the complainant no.2 visited the office of OPs and informed about the death. OPs asked her to deposit Rs.10000/- and accordingly she deposited the amount of Rs.10,000/- on 13.8.2008. She was assured that all the benefits of the policy would lbe paid shortly. However, on 18.12.2009 she received a letter regarding  repudiation of the claim  under the policy. Thereafter, she made representation on 22.1.2010 and approached the Ops number of times, but the Ops  had not paid the benefits of the policy intentionally and willfully which caused her mental harassment apart from financial loss.  In this way, there was deficiency in services on the part of the OPs.

 

2.                 Notice of the complaint was given to the Ops, who put into appearance and filed written statement controverting the claim of the complainant. Objections have been filed that complainant has no cause of action; that complaint is not maintainable and that the policy was obtained by the deceased life assured fraudulently, dishonestly and by misrepresentation.

                   On merits, issuance of the policy has been admitted, but it has been denied that the  life assured was got medically examined before issuance of the policy. It has been submitted that deceased life assured did not disclose all the material facts relating to his health at the time of policy. Proposal form was filled by him on 18.7 .2007 and he intentionally did  answer the questions in the proposal form correctly.  He was a known case of left  Renal Sarcoma and underwent Left Radical Nephropathy, Intrahepatic Carotomy and retrieval of thrombus in January, 2007. He was also suffering from Bronchial asthma for the last  twenty years and was on treatment for the same. He availed leave on medical ground from January, 2007 to May, 2007. However, he concealed all these material facts regarding his health from the Ops. Such concealment of material facts rendered the policy void, abinito, because  if he had disclosed about his ailments, the Ops would not have issued the policy to him. Therefore, the OPs were not liable to pay any claim  under such policy. It has further been averred that deceased life assured paid the first premium of Rs.10,000/- on 19.7.2007 and another payment was made on 25.8.2008 after his death. Therefore, the money deposited by the complainants after the death of deceased life assured was not applied to the policy and refunded to the complainant, vide cheque no.438774 dated 22.10.2009. It has further been pleaded that request of the complainants to reconsider their claim under the policy was duly reconsidered by the  Grievances  Redressal Committee of the company, which decided and duly communicated, vide letter dated 16.3.2010. The other allegations made in the complaint have been denied.

 

3.                 In evidence of the complainant,  affidavit of the complainant No.1  Ex.CW1/A and documents Ex.C1 to Ex.C9 have been tendered.

 

4.                 On the other hand in evidence of the Ops, affidavit Ms.Sudha Sharma, Senior Manager, Legal, Ex.O1/A and documents Ex.OP1/B to Ex.OP1/F have been tendered.

 

5.                 We have appraised the evidence on record,  the material circumstances of the case and the arguments advanced by the learned Counsel for the parties.

 

6.                 It is admitted  fact that Vijender Singh, deceased life assured, father of the complainant no.1 and husband of complainant lno.2 was insured by the Ops vide insurance policy No.   05737004. The date of commencement of the policy was 18.7.2007 and the first premium was deposited by him on 18.7.2007. However, before depositing the second premium, he died on 31.7.2008  The complainants deposited the second premium after his death on 13.8.2008, but the Ops refunded that amount to the complainants as the premium was not accepted. The claim of the complainants was repudiated by the OPs on the ground that deceased life assured had concealed the material facts in the proposal form regarding his health, which rendered the policy void abnitio.

 

7.                          The learned counsel for the complainant put a great thrust upon the contention that life assured was duly examined by the medical officer of the OPs before issuance of the policy. The proposal form was filled up by the agent of the Ops, to whom all the necessary facts regarding his health were  disclosed but he intentionally did not mention those facts in the proposal form, therefore, the complainants cannot be denied the benefits under the policy on such grounds.

 

8.                          It is settled principle of insurance law that contract of insurance is a contract uberrima fides and utmost faith must be observed by the contracting parties .  Every material fact must be disclosed, otherwise there is good ground for rescission of contract. If, there are misstatements or suppression of material facts, the policy can be called into question. Concealment of previous ailments is suppression of material facts and complainant is not entitled for compensation.  In this regard reference may be made to the judgment of the Hon’ble Supreme Court in case titled Satwant Kaur Sandhu Vs.New India Assurance Co.  IV (2009) CPJ 8 (SC).

 

9.                          The facts of the present case are to be analyzed keeping in view the aforesaid proposition of law. The copy of the proposal form is Ex.OP1/B submitted by the deceased life assured.The relevant portion of the questions of Insurance Company  and answers given by the life assured are as under:

Q  No.          Question                                                                                             Answer.        

 

21(a)            Are you  presently in good health?                                        Yes

                   Please submit Previous Medical reports(if any) as receipt of

                   These reports helps us in faster assessment of the health of the

                   Life to be assured.

 

22(b)            Have you ever consulted any doctor or are you currently          No

                   Undergoing/have undergone any test, investigations, awaiting

                   Results of any tests or investigations or have you ever been

                   Advised  to undergo any tests, investigations or surgery or been

                   Hospitalized for general check up, observation treatment or

                   Surgery.

 

22©             Are you aware of or have you ever been treated or hospitalized No

                   For cancer, tumor, cysts or any other growths?

22(d)            Have you ever been referred to an oncologist or cancer hospital No

                   for any investigation or treatment?

22(f)             Have you ever availed leave on medical grounds in the last two  No

                   Years.

 

22(g)            Have you ever suffered or are suffering from any of the           NA

                   Following:

                   *vii)Asthma, bronchitis, blood spitting, tuberculosis or other

                   Respiratory disorders.        

 

                                      Thus, it is emphatically clear that the  life assured did not disclose about any ailment suffered by him prior to submission of the proposal form.

 

10.               The Ops have produced the copy of the certificate issued by the employer Ex.OP1/F, according to which the life assured remained on earned leave from 11..1.2007 to 31.5.2007 for operation  of renal cell  Carcinoma left kidney with tumor  thrombus.  He further availed earned leave from 18.10.2007 to 31.10.2007  for medical checkup, from 16.1.2008 to 29.2=2.2008 again for operation and for rest from 1.3.2008 to 17.6.2008, from 26.6.2008 to 20.7.2008  and  21.7.2008 to 31.7.2008. He also claimed medical reimbursement for operation for renal cell Carcinoma left kidney with tumor thrombus.  This documentary evidence is sufficient to prove that life assured was suffering from renal cell  Carcinoma left kidney with tumor  thrombus prior to January, 2007 and he was operated upon for the same and remained on earned leave for the period from 11.1.2007 to 31.5.2007. The policy was obtained by him on 18.7.2007, but in the proposal form he concealed the factum of his operation regarding renal cell Carcinoma left kidney with tumor thrombus in January, 2007. Had he disclosed about the condition of his health at the time of submitting proposal form that could influence the decision of the insurance company to issue or not to issue insurance policy or as to what amount of premium was to be charged. if the policy was to be issued.  The argument of the learned counsel for the complainant that agent of the Ops who filled the proposal form did not mention about the disease of renal carcinoma, though disclosed him by the life assured, cannot be accepted. The life assured was an educated person, as is evident from the fact that he signed the proposal form in English. He could also get the proposal form read over, before putting his signatures. . There is no evidence that any medical officer of the Ops examined the life assured before issuance of the policy.  In fact, the  life assured was bound to disclose all the material facts regarding the condition of his health in the proposal form but he knowingly concealed about his disease and the operation got conducted by him. Therefore, the policy became void on account of concealment of the material facts by the life assured in the proposal form and in such a situation, repudiation of the claim of the complainant, by the Ops cannot be considered as illegal and unjustified in any manner.  For such view sustenance may also be sought from the judgment of the Hon’ble National Commission in case  Life Insurance Corporation of India and another Vs. Bimla Devi revision petition No.3806 of 2009 decided on  12.08.2015.

 

11.               As a sequel to the foregoing discussion, we do not find any merit in the present complaint and consequently the same is hereby dismissed. The parties concerned be communicated of the order accordingly land the file be consigned to the record room after due compliance.

 

Announced
dated:30.12.2015                                                                      

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

(Anil Sharma ) 

   Member.

 

 

 

Present:-        Sh. S.S.Rana Advocate for the complainant.

                   Sh.Vineet Rathore Advocate for the Ops.

 

                   Arguments heard. Vide our separate order of the even date, the present complaint has been dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:30.12.2015                                                                       

                                                                    (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

(Anil Sharma ) 

   Member.