Delhi

West Delhi

CC/08/761

LATA YADAV - Complainant(s)

Versus

LIC - Opp.Party(s)

06 Oct 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-III: WEST

GOVT. OF NCT OF DELHI

C-BLOCK, COMMUNITY CENTRE, PANKHA ROAD, JANAK PURI

NEW DELHI

 

Complaint Case No.761/2008

 

In the matter of:

 

	LataYadav H.No. 454, Village & Post Office- Rajokari New Delhi- 110038     …........Complainant
	Versus

 Life Insurance Company

BapuSadan, Sant Nagar,

RavidasMarg, New Delhi-110005..............Opposite Party

 

 

DATE OF INSTITUTION:         JUDGMENT RESERVED ON:           DATE OF DECISION:

17.09.2008 20.09.2022 06.10.2022

 

 

Ms. Sonica Mehrotra, President

Ms.Richa Jindal, Member (Female)

Mr. Anil Kumar Koushal, Member (General)

Order passed byMs.Sonica Mehrotra, President

 

ORDER

1. Concise facts forthe present complaint are that complainant’s deceased husband Ram Yadav(DLA) had availed of JeevanTarang, a Life Insurance Policy from OP vide policy no. 114503512 in mid June 2006 for a total sum assured of Rs. 5 Lacs on payment of premium of Rs. 6281/- payable quarterly for 20 years. The policy was valid from 15.05.2006 with maturity on 15.05.2027. The said policy was given by OP to complainant’s husband after detailed medical examination and at the time of proposal form, the complainant’s husband had no health problems but health issues were detected after few months of taking policy cover which even caused death of the DLA on 02.10.2006. The complainant being nominee of the DLA approach the OP seeking death claim of her husband but OP rejected the claim on ground of concealment of pre-existing disease (PED) of DLA vide repudiation letter dated 25.09.2008. Feeling aggrieved at such unlawful rejection of her claim, the complainant had filed the present complaint praying for issuance of direction to OP to release the claim amount of Rs.5lacs with interest @ 18% pa against the said policy along with Rs. 50,000/- as compensation for mental agony and torture and Rs.20,000/- towards cost of litigation. Complainant has attached copy of ration card as relationship proof with DLA, copy of proposal deposit receipt, copy of premium deposit receipt, copy of policy cover note, copy of certificate of identity and barrieror cremation, Death certificate of DLA, copy of claim intimation letter by complainant to OP along with claim form and repudiation letter issued by OP .
2. Notice was issued on 17.09.2008. OP entered appearance and filed its written statement vide which it took the preliminary objection of DLA having wilfully withheld material information about his health condition and incorporating wrong answers to the questions in the proposal form thereby misleading the OP into acquiring policy cover fraudulently. OP submitted that DLA has been patient of kidney failure prior to his proposing for subject policy and had undergone dialysis four times in June 2006 prior to taking policy cover on 20.06.2006 and cause of his death too was kidney failure but such ailment was concealed by DLA from OP and such a complaint therefore is a gross misuse of process of law as DLA has committed breach of the very principle of contract of insurance i.e. uberrimafidae (utmost good faith). On facts OP resisted the complaint on grounds that DLA had proposed for the policy on 20.06.2006 and not 15.06.2006 as averred by the complainant and policy ran only for three months and 12 days as the DLA died on 02.10.2006 of kidney failure. After the complainant submitted the claim papers, the claim was processed and was rejected by OP in September 2008 on ground of concealment of material facts about health condition of DLA prior to taking cover and this was conveyed to complainant by OP vide letter 25.09.2008 vide which it was recorded that DLA was suffering from chronic renal failure and was on dialysis at the time of taking cover in June 2006, the history of the said deceased having been confirmed by doctors of (Jaipur Golden Hospital) , the treating hospital in replies to questions no. 5 and 8 of form no. 3816 and 3784 respectively. To the effect that DLA had taken four sittings of Haemodialysis in June 2006 when he was diagnosed as a known case of chronic renal failure (CRF). This was further confirmed from replies to question no. 4(c) and 6(2) (a) of form no. 3784 that he was sick since June 2006. Further, the leave record provided by deputed Director (Estt.), employer of DLA revealed that he had taken medical leave from 13.06.2006-17.06.2006 on grounds of self-illness (CKF) i.e. before signing the proposal form on 20.06.2006. The same was hidden by DLA from OP. For defence so taken, OP prayed for dismissal of the complaint with costs.
3. Rejoinder and Evidence by way of affidavit was filed by the complainant wherein the complainant denied DLA having withheld any information about his health condition from OP at the time of taking policy cover and stated that he was not even aware of any such disease that time and had undergone medical examination before taking policy cover. Complainant has exhibited copy of insurance policy and rejection letter as CW 1 & CW 2.
4. Evidence by way of affidavit was filed by OP sworn by its administrative officers exhibiting the proposal form. Certificate of hospital treatment records of DLA., copy of medical attendant certificate of JGH, repudiation letter dated 25.09.2006 and leave record provided by employer of DLA as OP wq1/1-1/5.
5. Written arguments are filed by both parties in reassertion of the respective grievance/defence.
6. We have heard the rival contentions of both parties and have given our anxious consideration to the material on record placed by both sides. The policy cover granted to DLA by OP under Jeevan Tarang Policy in June 2006 and complainant being his nominee is admitted. However, it being an early death claim where the death of DLA occurred in October 2006 barely three and a half months from policy inception, was investigated by OP as per law. The documents filed and exhibited by OP viz. the certificate of Hospital treatment, medical attendant certificate and statement of leave unequivocally established that the DLA was suffering from end stage renal failure having undergone four dialysis in June 2006 before taking policy cover from OP and medical leave as well on this ground from 13.06.2007-17.06.2006. The primary cause of death as revealed by the attending doctors of JGH is also end stage renal disease with symptoms of uraemic encephalopathy with uremic convulsion and disease at least since June 2006. However,contrary information about his health was given by DLA in the proposal form citing his health condition to be ‘good’ in clause 11(i). In our view, this amounts to wilful concealment of a terminal disease which was not only pre-existing but life threatening and of which DLA was evidently in prior knowledge of at the time of taking policy cover. The onus of proof which shifted from complainant to OP to justify the repudiation of death claim has been duly discharged as OP has been able to establish a direct Nexus between the pre-existing disease and cause of death,  former having been concealed by DLA and latter having been revealed from his medical record.Therefore, the condition to prove any suppression in the proposal form, the burden of proof of which lies with the Insurance Company has been satisfied and in this regard we are guided by the verdict of Hon’ ble Supreme Court in LIC Vs. Smt. G. M. Channabasamma I 1991 (ACC) 411 SC. Even otherwise it is settled law that if a document is mentioned as exhibit on consent reservation, the contents are not only evidence but are also taken as admitted as has been held by Honble National Commission in Sunita Vs. HDFC Standard Life Insurance Co. Ltd. I (2021) CPJ 287 (NC).The Honble Supreme Court in Landmark judgements of Reliance Life Insurance Company Ltd. Vs. Rekha ben Naresh bhai Rathod II (2019) CPJ 53 (SC) and LIC of India Vs. Manish Gupta III (2019) CPJ 31 (SC)has echoed its previous verdict in the iconic judgement of Satwant Kaur Sandhu Vs New India Insurance Co. Ltd. IV (2009) CPJ 8 (SC)passed by Hon’ble Supreme Court on 10.07.2009  in which too the DLA had concealed his pre-existing disease of chronic renal failure/diabetic nephropathy and being on regular haemodialysis prior to taking policy cover in which the Hon’ble Supreme Court dismissed the complaint on observations that DLA being a chronic renal failure patient and on regular haemodialysis leaves no doubt that he was well aware of his health condition prior to taking policy cover and therefore was a clear suppression of material facts in rega4rd to health of the insured and held that the insurer was a fully justified in repudiating the insurance contract and rejection of death claim, thereby reversing the order of Hon’ble National Commission which had allowed the complaint. The Hon’ble Supreme Court in both Manish Gupta (supra) and Rekhaben (supra) judgements observed that non-disclosure of any health event is specifically set out as a ground for excluding the liability of the insurer, since the object of the proposal form is to gather information about a potential client and are a significant part of the disclosure procedure and warrant accuracy of statements pertaining to health etc.. The contractual duty so imposed is such that any suppression, untruth or inaccuracy in the statement in the proposal form will be considered as a breach of duty of good faith and will render the policy voidable by the ensurer. The finding of a material misrepresentation or concealment in insurance has a significant effect both on insured and the insurer in the event of her dispute. The fact it would influence the decision of a prudent insurer in deciding as to whether or not to accept a risk is a material fact. The said judgement of Hon’ble Supreme Court has been consistently followed by the Hon’ble National Commission in Rina Karmakar Vs. LIC II (2020) CPJ 153 (NC), T. Manjulatha Vs. Birla sun Life Insurance Co. Ltd. II (2020) CPJ 429 (NC), LIC Vs. Deep Chand Sood II (2020) CPJ 138 (NC), Seema Begum Vs. HDFC Standard Life insurance Co. Ltd. I (2020) CPJ 411 (NC), Royal Sundaram Alliance Insurance Co. Ltd. Vs. Sumit J. Ram chandani II (2020) CPJ 287 (NC) and the recent judgement of HDFC Standard Life Insurance Co. LTd. Vs. Poonam Bishnoi III (2021) CPJ 146 (NC) passed on 14.06.2021 in all of which aforecited judgements the Hon’ble National Commission relying upon the judgement of Hon’ble Supreme Court in Satwant Kaur(supra), Rekhaben (supra) held that suppression of previous health condition of life assured in the proposal form is wilful concealment and breach of the principle of contract of insurance of utmost trust and any claim arising from such wilful concealment merits repudiation.
7. Having exhaustively dealt with the legal proposition relevant to the case in hand by way of exhaustive judicial discourse of settled law pertaining to concealment of a pre-existing health condition and close nexus between such a condition and death, we are of the considered opinion that the complainant deserves no relief and the complaint is devoid of merits and that she has come to court with unclean hands and is therefore not entitled to any relief as was also held by Hon’ble National Commission in the case of TATA Motors Ltd. Vs. Hazoor Maharaj Baba Des Rajji Chela Baba Dewa singh ji (Radha Soami) IV (2013) CPJ 444 (NC) that person coming with unclean hands to the court deserves no relief.
8. The complaint is accordingly dismissed. Let a copy of this order be given to each party free of cost on proper application to the President of this Commission as per Regulation 21 of the Consumer Protection Regulations, 2005.
9.  File be consigned to record room.
10.  Announced on  06.10.2022.

 

 

Richa Jindal                              Anil Kumar Koushal                   Sonica Mehrotra

(Member)                                           (Member)                                (President)