NCDRC

NCDRC

RP/3076/2012

JAGRUT NAGRIK - Complainant(s)

Versus

LIFE INSURANCE CORPORATION OF INDIA - Opp.Party(s)

MR. P.V. MOORJANI

06 May 2013

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 3076 OF 2012
 
(Against the Order dated 09/06/2012 in Appeal No. 511/2011 of the State Commission Gujarat)
1. JAGRUT NAGRIK
Through their Trustee & Secretary Shri P.V Moorjani, Grahak Surakhsha Bhavan, Near Prena School Sangam Crossinh Karelibaug
Vadodara
Gujarat
2. Shankaribhai Solanki
1 Shardha Park Society,1 Near Samir Park, High Tention Road,Subhanpura
Vadodara
Gujarat
3. Maltiben Shankarabhai Solanki
1 Shardha Park Society,1 Near Samir Park, High Tention Road,Subhanpura
Vadodara
Gujarat
...........Petitioner(s)
Versus 
1. LIFE INSURANCE CORPORATION OF INDIA
Vadodara Divisional Office 4th floor,Suraj Plaza-II Sayajigunj,
Vadodara
Gujarat
2. Manager, Life Insurence Corporation Of India
Dabhoi Branch,Opp Commerce College, Nr ST Deport, Dabhoi
Vadodara
Gujarat
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER
 HON'BLE MR. DR. B.C. GUPTA, MEMBER

For the Petitioner :
Mr. Akhil Dave, Advocate
For the Respondent :
Mr. U.C. Mittal, Advocate

Dated : 06 May 2013
ORDER

PER JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER This revision petition has been filed by the Petitioners/Complainants against the impugned order dated 31.1.2012 passed by the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad (in short, he State Commission in Appeal No. 511/2011 Jagrut Nagrik & Ors. Vs. The Manager, LIC & Anr. by which, while dismissing appeal, order of District Forum dismissing complaint was upheld. 2. Brief facts of the case are that Complainant No. 2 obtained Insurance Policy No.872846295 of Rs.6,00,000/- on the life of his daughter Unnati S. Patel on 25.4.2002, as Unnati was minor at the time of obtaining policy. Unnati died in July, 2004 and Complainants No. 2 & 3 submitted claim papers to the OP/respondent, but OP denied benefits to be allowed in the policy and passed claim of Rs.2,25,000/- instead of Rs.6,00,000/-, which was not accepted by the complainants. Matter was referred to Ombudsman, but no purpose was served. Alleging deficiency on the part of OP, complainants filed complaint and claimed compensation of Rs.8,75,000/-. OPs resisted complaint, filed written statement and submitted that complainants are not entitled to get compensation of Rs.6,00,000/- under the disputed policy issued in the name of complainant minor daughter Unnati. Policy was issued on the basis of information given by the complainant in the proposal form. As per guidelines, insurance amount of minor policy should not exceed the total insurance of parents. Complainants submitted wrong information in the proposal form stating that total polices held by him in his name were to the tune of Rs.6,25,000/-, whereas policy of only Rs.1,25,000/- was in the name of the Complainant No. 2 and Policy No. 870296554 for Rs.5,00,000/- was in the name of complainant daughter Zankhana S. Patel. Complainant also did not disclose another policy of Rs.1,00,000/- in the proposal form, but later on after investigation, claim of Rs.2,25,000 with bonus of Rs.43,875/- was allowed. OP denying deficiency, prayed for dismissal of complaint. Learned District Forum after hearing both the parties allowed complaint partly and directed OP to pay Rs.2,25,000/- with bonus of Rs.43,875/- with 9% interest from 10.1.2005 till realization. Complainant/petitioner filed appeal against the order of District Forum, which was dismissed by learned State Commission vide impugned order against which, this revision petition has been filed. 3. Heard learned Counsel for the parties at admission stage and perused record. 4. Learned Counsel for the petitioner submitted that under Section 45 of the Insurance Act, the insurance policy cannot be called in question on the ground of mis-statement after 2 years and learned District Forum has committed error in partly disallowing complaint and learned State Commission has committed error in dismissing appeal; hence, revision petition be allowed and full policy amount may be given to the complainants. On the other hand, learned Counsel for the respondent submitted that order passed by learned State Commission is in accordance with law, which does not call for any interference; hence, revision petition be dismissed. 5. Perusal of record reveals that proposal form for the disputed policy on the life of minor daughter Unnati was filled by Complainant No. 2 who was Graduate in Engineering and well educated person. He mentioned four policies worth Rs.6,25,000/- in his name, whereas on investigation, it was revealed that Policy No. 870296544 worth Rs.5,00,000/- was not in his name, but in the name of his daughter Zankhana S. Patel. As per guidelines dated 28.02.2002, which are applicable to the present case as proposal form was filled on 8.4.2002, risk of minor could not exceed total amount of insurance on the lives of parents. Clause Risk Plans Minors of these guidelines runs as under: aximum permissible rated-up Sum Assured upto Rs.50 lacs, but not exceeding the insurance duly rated up on the proposer (father or mother) life, subject to total insurance on the lives of parents and children under all plans put together does not exceed the maximum permissible limit admissible to the person paying the premium. (The maximum permissible limit admissible is the age related multiple of income that is taken for financial underwriting on the adult life) 6. Thus, it becomes clear that deceased Unnati policy could not have been for more than Rs.2,25,000/-, the amount of insurance coverage taken by Complainant No. 2, but complainant No. 2 submitted false and wrong information in the proposal form about amount of insurance coverage of polices in his name, whereas policy worth Rs.5,00,000/- was issued in the name of another daughter of Complainant No. 2. 7. Learned Counsel for the petitioner submitted that policy cannot be called in question on ground of mis-statement after 2 years of issuance as per Section 45 of the Insurance Act. He placed reliance on Civil Appeal No. 4186-87/1988 Life Insurance Corporation of India & Ors. Vs. Smt. Asha Goel & Anr. in which Honle Apex Court observed as under: oming to the question of scope of repudiation of claim of the insured or nominee by the Corporation, the provisions of section 45 of the Insurance Act is of relevance in the matter. The section provides, inter alia, that no policy of life insurance effected after the coming into force of this Act shall, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policy-holder knew at the time of making it that the statement was false or that is suppressed facts which it was material to disclose. The proviso which deals with proof of age of the insured is not relevant for the purpose of the present proceeding. On a fair reading of the section it is clear that it is restrictive in nature. It lays down three conditions for applicability of the second part of the section namely : - (a) the statement must be on a material matter or must suppress facts which it was material to disclose ; (b) the supression must be fraudulently made by the policy holder; and (c) the policy holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose. Mere inaccuracy of falsity in respect of some recitals or items in the proposal is not sufficient. The burden of proof is on the insurer to establish these circumstances and unless the insurer is able to do so there is no question of the policy being avoided on ground of misstatement of facts. The contracts of insurance including the contract of life assurance are contracts uberrima fides and every fact of material must be disclosed, otherwise, there is good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract and also implies any material alteration in the character of the risk which may take place between the proposal and its acceptance. If there are any misstatements or suppression of material facts, the policy can be called in question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person. In this connection we may notice the decision of this Court in Mithoolal Nayak Vs. Life Insurance Corporation of India (AIR 1962 SC 814), in which the position of law was stated thus: The three conditions for the application of the second part of s. 45 are: (a) the statement must be on a material matter or must suppress facts which it was material to disclose ; (b) the suppression must be fraudulently made by the policy holder; and (c) the policy holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose 8. Thus, it becomes clear that policy can be challenged under Section 45 of the Insurance Act only when (a) the statement is on a material matter; and (b) the policy holder must have known at the time of making the statement that it was false. Perusal of proposal form clearly reveals that Complainant No. 2 filled proposal form, who is Graduate in Engineering and well educated person has shown policy of Rs.5,00,000/- in his name which was actually in the name of his daughter and from this fact it can very well be inferred that Complainant No. 2 was knowing at the time of making the statement that it was false statement depicting policy of Rs.5,00,000/- in his name. This statement was only the material matter because as per guidelines, the risk coverage of minor could not have exceeded the total insurance coverage of parents of the minor. Once these two conditions are fulfilled, Insurance Policy can be challenged on the ground of mis-statement even after 2 years of issuance of policy. On investigation, when this fact revealed that complainant insurance coverage was only to the tune of Rs.2,25,000/-, OP/respondent has not committed any error in allowing claim only to the extent of Rs.2,25,000/- with bonus. Learned District Forum rightly directed OP to pay Rs.2,25,000/- along with bonus amount and learned State Commission has not committed any error in dismissing appeal. 9. On the other hand, learned Counsel for the respondent placed reliance on (2008) I SC 321 P.C. Chacko and Another Vs. Chairman, Life Insurance Corporation of India in which it was observed that : isstatement by itself is not material for repudiation of the policy unless the same is material in nature. But, a deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiated in law. The purpose for taking a policy of insurance is not very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered Thus, it becomes clear that policy can be assailed on the ground of deliberate wrong answer on material issue. 10. We do not find any illegality, impropriety or jurisdictional error in the impugned order, which calls for any interference and revision petition is liable to be dismissed. 11. Consequently, revision petition is dismissed at admission stage with no order as to costs.

 
......................J
K.S. CHAUDHARI
PRESIDING MEMBER
......................
DR. B.C. GUPTA
MEMBER

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