Delhi

North East

CC/379/2015

Sunita Kain - Complainant(s)

Versus

India First Life Insurance Co. - Opp.Party(s)

13 Apr 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No.379/15

In the matter of:

 

	Ms. Sunita Kain, W/o Lt. Sh. Brahm Singh Kain, R/o 4/1787, Gali No. 5, Mahavir Block, Bholonath Nagar, Shahdara, Delhi-110032	Complainant
	Versus
	India First Life Insurance Company Ltd., Plot No. 24/25/26, Fun Cinema N.D.M-1 Mall, Netaji Subhas Palace Complex, Pitampura Also at: 301, B, Wing the Qube, Infinity Park, Dindoshi-Film City Road, Malad (East) Mumbai: 400097	Opposite Party

 

DATE OF INSTITUTION:        JUDGMENT RESERVED ON:                        DATE OF ORDER  :

03.10.2015 22.11.2022 13.04.2023

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

 

ORDER

Anil Kumar Bamba, Member

The Complainant has filed the present complaint under Section 12 of the Consumer protection Act, 1986.

Case of the Complainant

1. The case of the Complainant as revealed from the record is that the husband of the Complainant was purchased a Life Insurance policy from the Opposite Party vide policy no. G0000091 and account no. 21290600023506. Mode of premium was one time and Complainant’s husband was paid the premium a sum of Rs. 56,011.46/-. The commencement date of policy was 20.06.2012 and sum assured was Rs. 20,00,000/-. Unfortunate, husband of the Complainant was expired and the Complainant was given the intimation to the Opposite Party. The Complainant was complete all formalities regarding the death claim which was necessary by the Opposite Party. The Complainant which she was supposed to settle the claim in advance but in spite of the fact that all required papers were submitted to the Opposite Party on the very first date and Complainant have been reminding to the Opposite Party over the phone and by personal visit to settle the claim but nothing was done. Death claim was not given by the Opposite Party when the Complainant has spent the entire amount from her pocket and was under acute financial constraint and rejecting the claim thereafter on flimsy grounds under the shelter of terms and conditions of the policy which were never a part of the contract issued to the deponent and were never supplied to the Complainant. The act of the Opposite Party are nothing but fleecing general public under the grab of covering them under the life insurance policies which were created for the benefits of the public at large. The exclusions clauses referred by the Opposite Party are never brought to the knowledge of the general public nor are the beneficiaries made aware of these exclusions which are put in a fine print and are kept only with the insurance companies to defraud the general public of their legitimate claims. Non settlement of the genuine claim amounts to clear deficiency of service on the part of the Opposite Party.  Complainant has prayed to direct the Opposite Party to pay Rs. 20,00,000/- i.e. settlement of the claim

Case of the Opposite Party

2. The Opposite Party contested the case and filed its written statement. It is the case of the Opposite Party is that Mr. Brahm Singh Kain had approached Opposite Party Company for issuance of insurance policy under the “India First Group Credit Life Plan” to cover the risk of the loan amount of Rs. 20,00,000/- which was taken by the Deceased Life Assured from the Bank of Baroda. The Deceased Life Assured had duly submitted the signed Member Form for the same on 18.06.2012. On based upon the information provided in the Member form, more specifically in relation to the health declaration of the life assured, the Opposite Party accepted the proposal and granted the policy bearing master policy no. G0000091 on 20.06.2012, wherein the risk commencement date was also 20.06.2012. Under the said policy the Opposite Party company had undertook to cover the risk of the unpaid loan amount on behalf of the Deceased Life Assured (DLA), subjected to the condition that the Life Assured had disclosed all the health related information to the Opposite Party Company and the information disclosed is complete and true. It is further submitted that under the said policy the Deceased Life Assured declared and agreed that the answers and statements made on the health declaration are full, complete and true and will form the basis of the contract. It was further declared by the Deceased Life Assured under the said policy that failure to make any disclosure by the Life Assured would render the insurance contract voidable under section 45 of the Insurance Act. 1938. It is further submitted that in April, 2014 the Opposite Party had received death claim intimation from the Complainant, stating that the life assured had died on 24.02.2014 due to stomach pain. On receipt of the death claim intimation from the Complainant and the death being within 1 year & 8 months from the issuance of the policy, the claim was investigated to verify is authenticity. During the investigation it was found that the deceased life assured had been diagnosed with Diabetes (Type 2) and was on insulin injection. The deceased life assured was also diagnosed with Chronic Kidney Disease and was on continuous cycling peritoneal dialysis since March 2012 i.e. before signing the proposal form. It is pertinent to mention here that the deceased life assured had consulted AIIMS Hospital for the same on 20.03.2012 under registration no. 68767/12. As per the underwriting opinion if DLA had disclosed his past medial illness at the time of issuance of the policy, the Opposite Party would not have issued the policy to the deceased life assured. It is further submitted that at the time of seeking the insurance policies, deceased Life Assured had answered negatively to the questions sought with regard to Past Medical History under clause 2 of the “Member Forms- IndiaFirst Group Credit Life Plan” and  deceased Life Assured had not entered into the contract of insurance in good faith which is one of the primary requisites of an insurance contract and had failed to disclose the true an correct information specifically for the Questions 1 to 3 pertaining to past medical history. Had the said true and correct past medical history been disclosed to the Opposite Party the said policy would not have been issued to the deceased Life Assured. Thus, the deceased Life Assured with a mala fide intention withheld this pertinent information from the Opposite Party thereby debarring the Opposite Party a chance of fair underwriting of the policy. Thereafter, on the basis of the investigation report the Opposite Party repudiated the claim of the Complainant on the genuine ground that the deceased life assured had not disclosed his past medical history to the Opposite Party during or after signing the member form and further provided wrong information in the Member form regarding the health declaration, whereby the deceased life assured was under the mandatory obligation to disclose accurate and correct information regarding his health and past medical history. The Opposite Party duly intimated the same vide letter dated 10.11.2014. Thereafter, the Complainant sent a legal notice dated 04.12.2014, demanding the settle of the claim. The Opposite Party duly replied to the said legal notice on 11.12.2014 and duly informed the reasons/grounds of the repudiation of the claim of the Complainant id detail. It is further submitted that the deceased life assured had concealed/suppressed material facts from the Opposite Party regarding his health and obtained the policy fraudulently and therefore the claim of the Complainant was rightly repudiated by the Opposite Party.

Rejoinder to the written statement of Opposite Party

3. The Complainant filed rejoinder to the written statement of Opposite Party wherein the Complainant has denied the pleas raised by the Opposite Party and has reiterated the assertion made in the complaint.

Evidence of the Complainant

4. The Complainant in support of his case filed his affidavit wherein he has supported the assertions made in the complaint.

Evidence of the Opposite Party

5. To support its case Opposite Party has filed affidavit of Shri K.R. Viswanarayan Head-Governance & Company Secretary, India First Life Insurance Co. Ltd. He has supported the case of the Opposite Party as mentioned in the written statement.

Arguments & Conclusion

6. We have heard the Counsel for the Complainant and Opposite Party. We have also perused the file and written arguments filed by the Complainant. The case of the complainant is that her husband took a policy from the Opposite Party under the IndiaFirst Group Credit Life Plan issued to Bank of Baroda which is Master Policy holder. As per certificate of the insurance issued by the Opposite Party loan amount of Rs. 20,00,000/- was assured on the death of the Brahm Singh Kain i.e. husband of the Complainant and Complainant gave intimation to the Opposite Party regarding the death of the husband of the complainant to settle the amount by completing all formalities regarding death claim. Opposite Party repudiated the claim on account of non-disclosure of preexisting disease prior to his proposal for insurance. As per the Complainant the exclusion clauses referred by the Opposite Party are never brought to the knowledge of the general public or nor beneficiaries. Hence, non-settlement of claim amount is clear deficiency of service on the part of Opposite Party.
7. It is admitted by the Opposite Party that husband of the Complainant has approached the Opposite Party for issuance of insurance policy under the IndiaFirst Group Credit Life Plan to cover the risk of the loan amount of Rs. 20,00,000/- which was taken by the  Deceased Life Assured from the Bank of Baroda. The deceased life assured had duly submitted the signed Member form for the same. On the bases upon the information provided in the Member form, more specifically in relation to the health declaration of the life assured, the Opposite Party accepted the proposal and granted the policy. Under the said policy the Opposite Party had undertook to cover the risk of the unpaid loan amount on behalf of the deceased life assured, subjected to the condition that the Life assured had disclosed all the health related information to the Opposite Party and the information disclosed is complete and true. It is the case of Opposite Party that under the said policy the Deceased Life Assured declared and agreed that the answers and statements made on the health declaration are full, complete and true and will form the basis of the contract. It was further declared by the Deceased Life Assured under the said policy that failure to make any disclosure by the Life Assured would render the insurance contract voidable under the Insurance Act.  On receipt death claim intimation from the Complainant, the claim was investigated to verify is authenticity. During the investigation it was found that the deceased life assured had been diagnosed with Diabetes and was on insulin injection. The deceased life assured was also diagnosed with Chronic Kidney Disease and was on continuous cycling peritoneal dialysis before signing the proposal form. If husband of the Complainant had disclosed his past medical history at the time of insurance policy, Opposite Party would not have issued the policy to the husband of the Complainant. The deceased Life Assured had not entered into the contract of insurance in good faith which is one of the primary requisites of an insurance contract and had failed to disclose the true and correct information pertaining to past medical history. Therefore, on the basis of the investigation report, Opposite Party repudiated the claim of the Complainant on the genuine ground that the deceased life assured had not disclosed his past medical history to the Opposite Party during or after signing the Member form and further provided wrong information in the Member form regarding the health declaration.
8. It was held by the Hon'ble Supreme Court of India in, Satwant Kaur Sandhu Vs. New India Assurance Company Ltd.(2009), 8 SCC 316:

 “25. The upshot of the entire discussion is that in a 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 questions in the proposal form. Needless to emphasise that any inaccurate 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”.

10.In this present case, medical report which have been obtained during the course of the investigation clearly indicate that the deceased was suffering from a serious pre-existing medical condition which was not disclosed to the insurer and Complainant is nowhere denied that her husband was not suffering from  pre-existing medical condition prior to obtaining the policy and has failed to produce any evidence in rebuttal.

11. In view of the above facts and case law, the Complainant failed to prove any deficiency of service on part of the Opposite Party, hence, the complaint is dismissed.

12. Order announced on 13.04.23.

Copy of this order be given to the parties free of cost

File be consigned to Record Room.

(Anil Kumar Bamba)           Member

(Surinder Kumar Sharma) President