Father of the petitioner/complainant had taken a life policy for a sum of Rs.1 Lac from the respondent insurance company on 29.12.2003 and paid a sum of Rs.6,838/- towards the premium. He was 54 years of age at the time he took the policy. Insured died on 09.3.2004 due to heart failure. Petitioner being the nominee filed a claim with the insurance company which was
-2- repudiated on the ground of suppression of material facts, that the insured was suffering from liver disease and having Jaundice and epigastric pain. Aggrieved by this, petitioner filed a complaint before the District Forum. District Forum allowed the complaint vide order dated 30.1.2008 and directed the respondent to pay the assured amount of Rs.1 Lac along with interest at the rate of 12% per annum. Rs.1,000/- were awarded by way of compensation and Rs.2,000/- as costs. Respondent being aggrieved filed an appeal before the State Commission which by the impugned order has allowed the appeal and set aside the order of the District Forum. The State Commission came to the conclusion that the petitioner was guilty of suppression of material facts regarding his health and, therefore, the insurance company was justified in repudiating the claim. Learned counsel for the petitioner has raised twofold arguments. One that the impugned order cannot be sustained as the same has been passed by a single Member of the Commission. We
-3- do not find any substance in this submission. As per Section 16 (1B) (ii) of the Consumer Protection Act, 1986 the President can constitute Bench with one or more Members. The petitioner in the Grounds of Revision Petition has nowhere stated that in the present case, the President of the Commission did not constitute the Bench comprising of one Member and, therefore, the order passed by a single Member was bad in law. In the absence of such an averment, we would presume that the President of the Commission had constituted the Bench with one Member. The second submission put forth by the counsel for the petitioner is that the insured was not guilty of suppression of facts as he was suffering from Jaundice, which is a curable disease. We do not find any substance in this submission as well. From the record, we find that the petitioner had taken treatment for Jaundice and epigastric pain on 10.5.2003, 14.12.2003, 16.12.2003 and 01.12.2003 i.e. before taking the policy and on 07.1.2004, 9.1.2004 and 11.1.2004 after taking of the policy. He died within three months of taking of the policy. Insured did not disclose these facts while -4- filling in the proposal form and rather gave deliberate incorrect answers to Questions No. a, b, d, e and i which read as follows: Personal History Answer ‘Yes’ or ‘No’ a) During the last five years did you No consult a Medical Practitioner for any ailment requiring treatment for more than a week? b) Have you ever been admitted to any No Hospital or nursing home for general Check-up, observation, treatment or Operation? d) Are you suffering from or have you ever No Suffered from ailments pertaining to Liver Stomach, Hearth, Lungs, Kidney, Brain Or Nervous system e) Are you suffering from or have you ever No Suffered from diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, Epilepsy, Hernia, Hydrocelem, Leprosy or any other Disease? i) Whether your usual state of heath has No Been good? If not give details It has repeatedly been held by this Commission as well as Supreme Court of India that insurance contract is based on utmost good faith. Wrong answers given in the proposal form by the insured clearly shows that the insured had acted malafide by not disclosing -5- the fact that he was suffering from liver disease and was taking treatment for the same when he took the policy. This was clearly in breach of good faith. He died within three months of taking of the policy. The State Commission has discussed all these facts in detail in paras 8, 9 and 10 of its order with which we agree. No merits. Dismissed.
......................JASHOK BHANPRESIDENT ......................VINEETA RAIMEMBER | |