BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 28 of 2017
Date of Institution : 8.2.2017
Date of Decision : 27.10.2017.
Surender Kumar son of Shri Shishpal, resident of village Bangaon, Tehsil and District Fatehabad.
……Complainant.
Versus.
1. ICICI Prudential Life Insurance Company Limited, Unit No.1-A & 2-A, Raheja Tipco Plaza, Rani Sati Marg, Malaad (East) Mumbai- 400097 through its Chairman cum Managing Director.
2. ICICI Prudential Life Insurance Company Limited, Dabwali Road, Sirsa, Tehsil and District Sirsa through its Branch Manager.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH. R.L.AHUJA…………………………PRESIDENT
SMT. RAJNI GOYAT ………………… MEMBER
SH. MOHINDER PAUL RATHEE …… MEMBER.
Present: Sh. Sukhbir Dhaka, Advocate for the complainant.
Sh. Sandeep Kamboj, Advocate for opposite parties.
ORDER
The case of the complainant in brief is that mother of the complainant namely Smt. Savitri wife of Shri Shish Pal, resident of village Bangaon, Tehsil and District Fatehabad had obtained an insurance policy No.19101594 for sum assured of Rs.2,03,000/- from the opposite parties and she paid a sum of Rs.14,500/- as premium amount to the op no.2. The date of maturity of the above said insurance policy was 22.1.2025 and the date of receipt of premium was 19.1.2015 vide receipt no.E4121873 and the risk commencement date was 22.1.2015. It is further averred that complainant is nominee in respect of the said insurance policy. That the mother of the complainant has died on 13.2.2015 and after her death, the complainant intimated the ops about her death and also submitted claim form with the ops for settlement of the claim of the complainant and he was assured that he would be released the benefits of sum assured very soon. It is further averred that the ops instead of settling the claim of the complainant under the said policy vide repudiation letter dated 18.5.2015 have repudiated the claim of the complainant on false and flimsy grounds. The ops prior to issuing the insurance policy had thoroughly examined her and the information furnished to the ops was based on facts and the repudiation of the claim of complainant by the ops is with a view to escape from the liability of indemnifying. As such the repudiation letter is wrong, against law and facts and same is null and void and is not binding on the rights of the complainant. That the complainant has repeatedly asked the ops to release the payment of the sum assured alongwith interest as per terms and conditions of the policy but to no effect. Hence, this complaint.
2. On notice, opposite parties appeared and filed reply raising certain preliminary objections. It is submitted that op company received duly signed proposal form bearing no. OS03585737 in favour of Savitri. On the basis of the same, policy bearing no. 19101594 was issued on 22.1.2015. Since the information provided by the life assured in the proposal form was established to be untrue and false by answering ops, hence the answering ops were well within their rights to repudiate the said claim of the complainant. It is further submitted that the repudiation of the claim under the subject policy was on the grounds of misstatement of information, suppression of material information and furnishing of false information in the proposal form. The life assured at the time of filling up the proposal form, did not disclose the correct information and suppressed material information about her health and lifestyle. At the investigation stage, it is noted that the life assured had undergone Biochemistry Test on December 14, 2014 which revealed elevated Serum Creatinine levels and elevated Bilateral Urea levels. Further, on December 15, 2014, the life assured had undergone ultrasonography which revealed Bilateral Medical Renal Disease. The life assured repeated the biochemistry test on December 16, 2014 which also revealed elevated Serum Creatinine levels. On December, 17, 2014, the life assured had undergone computerized tomography (CT_ Scan which revealed Bronchiectatic changes in Bilateral upper lobes with right middle and bilateral lower lobes with subsegmental atelectasis in the right middle lobe. The life assured had also undergone Ultrasonography on January 18, 2015 which revealed Bilateral Renal Parenchymal Changes with Minimal Ascites with Right Pleural Effusion. All of the above mentioned medical history is prior to policy issuance. Had the company been informed of the above stated facts, the company would under no circumstances have processed the proposal further and would have declined the proposal upfront. From the stated circumstances, it is evident that the life assured had given wrong information and suppressed material facts from the ops in order to wrongfully obtained the subject policy from the ops. It is further submitted that complainant submitted a claim informing that the life assured expired on 13.2.2015 i.e. within 22 days from the date of commencement of the policy. Insurance Contracts are contracts based on “Utmost Good Faith”. The life assured concealed material facts which were necessary to be disclosed at the time of taking insurance, thereby rendering the contract of insurance void-ab-initio and inoperative, which is the reason for the claim being repudiated. With these averments, dismissal of complaint has been prayed for.
3. The complainant produced his affidavit Ex.CW1/A, repudiation letter dated 18.5.2015 Ex.C1, insurance policy Ex.C2 and death certificate Ex.C3. On the other hand, ops produced affidavit of Ms. Chittesha Sharma, Senior Manager Legal Ex.RW1/A, copy of proposal form Ex.R1, copy of death claim form Ex.R2, treatment record Ex.R3 and copy of repudiation letter Ex.R4.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. Learned counsel for complainant has contended that it is proved on record that mother of complainant namely Savitri Devi wife of Shish Pal had obtained an insurance policy No.19101594 for sum assured of Rs.2,03,000/- and she has died on 13.2.2015 after issuance of the policy. The complainant is the nominee. The complainant lodged claim but the ops have arbitrarily and illegally repudiated the death claim. Learned counsel for complainant relied upon the judgment of Hon’ble National Commission in case titled as Bajaj Allianz Life Insurance Co. Ltd. & Ors. Vs. Raj Kumar, III (2014) CPJ 221 (NC), judgment of the Hon’ble Madhya Pradesh State Commission, Bhopal in case titled as Kalyan Dutta @ K.D. Sharma Vs. Life Insurance Corporation of India & Anr. III (2014) CPJ 181 (MP) and judgment of the Hon’ble Chhattisgarh State Commission, Raipur in case titled as Life Insurance Corporation of India Vs. Kanchan Thawait, I (2015) CPJ 7.
6. On the other hand, learned counsel for opposite parties has strongly contended that mother of complainant namely Savitri Devi had obtained the policy on 19.1.2015 to be commenced from 22.1.2015 but same was obtained by the deceased life assured Savitri Devi by concealing the facts qua her pre-existing disease. She was suffering from kidney problem since long and had been treated from Sukhda Hospital, Hisar and she was under the regular treatment being a kidney patient. However, while filing declaration form alongwith proposal form, the deceased Savitri Devi had not declared qua her pre-existing disease in the proposal and the declaration form rather had committed a fraud while getting the insurance policy from the ops and in view of the latest law laid down by the Hon’ble Supreme Court and the Hon’ble National Commission where there is a concealment of fact while making the declaration qua any pre-existing disease of the life assured, the insurance company is fully competent to repudiate the claim of the complainant. So, the ops have rightly repudiated the claim of the complainant.
7. We have considered the rival contentions of the parties. The perusal of the record reveal that complainant in order to prove his case has furnished his affidavit Ex.CW1/A in which he has reiterated all the averments made in the complaint and has relied upon documents Ex.C1 i.e. repudiation letter, Ex.C2 insurance policy and Ex.C3 death certificate. On the other hand, opposite parties have furnished affidavit of Ms. Chittesha Sharma, Senior Manager Legal as Ex.RW1/A and filed documents i.e. copy of proposal form Ex.R1, copy of death claim form Ex.R2, treatment record Ex.R3 and copy of repudiation letter Ex.R4.
8. It is undisputed fact between the parties that life assured Savitri Devi now deceased while filling the proposal form and making her declaration she did not disclose that she was suffering from any disease and obtained the policy from the ops which was to be commenced with effect from 22.1.2015 by making payment of the premium amount. It is further undisputed fact that she died on 13.2.2015 within 22 days of the commencement of the policy. It is also undisputed fact that death claim was lodged by her nominee Surender Kumar present complainant which has been repudiated by the ops on the ground that deceased Savitri Devi had concealed the fact qua her pre-existing disease as she was suffering from kidney problem prior to the commencement of the policy.
9. The evidence of the opposite parties reveal that ops have placed on file the medical record of Sukhda Hospital, Hisar of the deceased Savitri Devi as Ex.R3 from which it is proved that she was a kidney patient and she was getting treatment for her kidney disease. So, it is proved fact that deceased Savitri Devi was suffering from kidney disease prior to her death and this fact was fully concealed by the life assured at the time of getting insurance policy from the ops. So, it appears that ops have rightly repudiated the claim of the complainant. The judgments relied upon by learned counsel for complainant are of no help to the complainant as facts reported in the above said judgments are quite distinguish from the facts of the present case.
10. In view of our above discussion, we find no merit in the present complaint and same is hereby dismissed but with no order as to costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room.
Announced in open Forum. President,
Dated:27.10.2017. Member Member District Consumer Disputes
Redressal Forum, Sirsa.
