Bihar

Muzaffarpur

CC/69/2016

Shila Devi - Complainant(s)

Versus

Managing Director, Shriram Life Insurance Co. Ltd & Other's - Opp.Party(s)

Anil Kumar Singh & Amir Kumar

18 Jan 2022

ORDER

 

1.  The Complainant  Sheela Devi has filed this complaint petition against the o.ps in the capacity of nominee and legal representation  (wife) of  L.A namely Late Buni Lal Ram.
2. The facts of the complaint case in brief is that the husband  of the complaint  namely Buni Lal Ram took Insurance Policy Bearing No. NN141400022956 from Sri Ram Life Insurance company  Ltd. on 27-02-2014  after paying first installment of Rs. 12226/- for sum assured of Rs. 3,70,000/- risk coverage  was started from 27-02-2014. The Insurance Company after receiving first installment issued bond in the name of L.A. Bunilal Ram. Buni Lal Ram had to pay premium annually.
3. It is stated by the complaint that being satisfied with the soundness of health, income age and other requirement the agent of the Insurance Company had given proposal form to the L.A. Bunilal Ram. Bunilal Ram had no knowledge of English so proposal from was filled up by agent but L.A. gave all the information to the agent which was asked by him.
4. The further case is that on 29-07-2014 all of a sudden life assured Buni Lal Ram became ill and he was brought before Dr. B.Kumar Hajipur but condition was not good then complainant  and other persons brought him to the house for going to Patna for better treatment but on 30-07-2014 Buni Lal Ram died. After funeral   and Shradh function the claimant after fulfilling all formalities filed death claim before o.p company as L.A Buni Lal Ram died during  the period of insurance coverage.
5. Further  case is that the complainant several time went to the  branch office of o.p insurance company but the o.p company repudiated her claim by saying that before signature of proposal form L.A was suffering from tuberculosis   and he concealed the  material facts  and in this way the o.p company rejected the death claim filed by the complainant  on 24-08-15, but the real fact is that L.A had no  any disease nor he was suffering from T.B and insurance  company issued policy after medical examinational of the L.A. and the o.p company repudiated his death claim on false , concocted ground which caused mental and physical harassment to the complainant .

The complainant has prayed for sum assured Rs. 3,70,000/- Rs. 45000/- mental economical loss and Rs. 25,000/- for litigation cost and also prayed for  interest at the rate of  18 % p.a. till final payment  and also for relief and reliefs as the court deems fit.

6.  The complainant has filed the following documents with the complaint  the photocopy of proposal receipt  annexure-1, photocopy of death certificated of Buni Lal Ram annexure-2, photocopy of prescription report of Dr. B. Kumar annexure-3, photocopy of  Sarpanch regarding date of death of Buni Lal Ram annexure-4, photocopy of certificate issued by member Panchayat Samiti regarding death of Buni Lal Ram annexure-5, photocopy of  certificate issued by  ward member  annexure-6, photocopy of claim of sheela Devi annexure-7 , photocopy of  return filed  for the assessment year 2012-2013 and 2013-2014 in the name of L.A. namely Buni Lal Ram annexure-8.
7. On 26-09-2018 the o.ps insurance company filed his w.s. it has been submitted that the L.A Mr. BuniLal Ram didn’t disclose any medical infirmity hence the policy was issued without subjective L.A. for any medical test.  The proposal from is annexed as annexure-A and the insurance policy bearing No. NN141400022956 and  policy claims are annexed as annexure-B where L.A.  did not disclose any medical infirmities.   He has simply  stated about his occupation death of birth age and annual income from. But from investigating report it is apparent and clear that L.A. Buni Lal Ram was suffering from Tuber culosis  prior to the proposal date. Moreover he was a labourer  and did  not possess  any substantial income  and that he belonged to Below Poverty Line (BPL) Family. He mentioned his annual income to be 3 lakhs but from the investigation report he belonged  to BPL family. The Investigator Report, Medical documents and BPL list is submitted as annexure No. C, D. & E  respectively.
8. The further case is that the L.A. Buni Lal Ram had also applied for insurance policies with other companies prior to Appling for a policy with the o.p company the Email exchange   with the other insurance company providing the information of the above insurance policy of L.A. That  is annexed as annexure-F. L.A. declared his annual income to be Rs. 3 lacs but he belonged  to BPL category citizen and he fully concealed this material facts. Although he belonged  to  B.P.L family he bought insurance policies including this policy to the different insurance company and hence the contract is void abinitio  and not legally binding on the o.p company and that is why the o.p had rightly repudiated the claim of the complainant vide letter dated 24-08-2015. There is no deficiency in service hence company will not be responsible to pay any claim.  The non disclosure  of material fact is a violation of the principle  uberrima fide, there is violation of terms and condition  of insurance policy by the L.A. by suppressing  actual income age occupation health preexisting policies  insurance being contract  of ubrrima fides,  the policy holder was duty bound to reveal all relevant  material facts but the L.A. suppressed the material facts hence the repudiation letter was rightly sent to the complainant vide letter dated 24-08-2015 repudiation letter annexed as herewith annexure-G    
9. The o.p company has mentioned several case Laws  in their w.s. such as (a) Life Insurance  Corporation of India & others Vs. Asha Goel & others (2001 ACJ806). (b) United India Insurance Company Ltd. V/s M.K.J. Corporation, 1996 (6) S.C.C.428 (c) Tata AIG Life Insurance Co. Ltd Vs. Orissa State Cooperative Bnk & others (2012) CPJ310MC (d)  Dinesh Bhai Chandana Vs. LIC & others 1^st appeal no. 242/2206 decided on 27^th July 2006  (e) LIC of India Vs. Sampaut  Devi, III (2006) CPJ 32 on the point of concealing  material facts the o.p also mentioned case law AVIVA Life Insurance Company India Ltd. Vs Manohar Bhogawat, RP No. 3694 (2011) decided on 21-01-2013 by N.C. the o.p has also mentioned other case laws in support of contention of his w.s.

It has been further submitted that the complaint being  frivolous and vexatious is liable to be dismissed u/s 26 of the Consumer Protection Act as the complaint has failed to make  out  case of deficiency of service the burden of proving the deficiency in service is upon the person who alleged it but the complainant who alleged , fail to prove deficiency in service the o.p has prayed to dismiss the complaint in favour of o.p and no sum assured, compensation,  litigation cost or interest there upon other benefit is payable to the complainant.  Since contract of insurance herein is declared null and void on the basis of settled principle of law hence the instant complaint is liable to be dismissed as there is no deficiency in service rendered by the o.ps  the o.ps  has prayed to dismiss the complaint with  cost in the interest of justice.

10.  The o.p Insurance Company has filed true photocopy of proposal  annexure/exhibit-A, photocopy of policy documents which includes first premium receipt, policy schedule & terms and conditions is annexure/Exhibit-B, photocopy of Investigation Report is annexure/Exhibit –C, photocopy of  medical report is annexure/exhibit-D, photocopy of BPL list is annexure/exhibit-E, photocopy of emails exchanged with other companies is annexure/exhibit F & photocopy of  repudiation letter dated 24-08-2015 is annexure/exhibit-G
1645629057.  
11.  The case of the complainant is short is that her husband  Late Buni Lal Ram  took Life Insurance Policy of Rs. 3,70,000/- from o.p Sri Ram Life Insurance Company Ltd.  vide Policy No.NN141400022956. He paid first installment of Rs.12226/- L.A had to pay installment  annually and the company issued bond and risk coverage  was started on     27-02-2014 it is also stated that the life assured was physically fit. The further case is that on 29-07-2014 all of a sudden life assured Buni Lal Ram fell ill he was brought before Dr B.Kumar Hazipur but his  condition  was bad then the  complainant  and other person brought him Hazipur to proceed for Patna  for better treatment  but on 30-07-2014 Buni Lal Ram died.

The o.p Insurance Company in his w.s. admitted the policy. The o.pin repudiation letter has repudiated the claim of the complainant on two ground (i) L.A was suffering from Tuberculosis  prior to taking of this policy and the material fact was suppressed (2) earlier L.A had also taken policy from other insurance company.

In w.s. the op has also added   that LA had no sufficient income he declared his annual income to be Rs. 3 lakhs  but he belonged to BPL family.  He also concealed his actual income occupation and the said non disclosure of material facts is a violation of the principle  uberrima fides. It is further stated that the complaint has failed to prove deficiency in service. The burden of proving  the deficiency in service in upon the person who alleged it. Therefore the op has  rightly repudiated  the claim of the complainant  and  she is not entitled to get  relief as prayed for.  The o.p has prayed to dismiss the complaint in the   interest of the justice.

12.   Both parties have adduced evidence on affidavit in support of the case. The complainant has also filed additional evidence on affidavit. The complainant  Sheela Devi has fully supported her case. In her additional evidence . She has also stated in para 6 that the life assured never suffers from tuberculosis in para7  she has stated  that LA also never suffered from any disease   since last several year before purchasing policy. In para 8  she has  stated that LA never suppressed any material fails. He at the time of filling up the proposal form had told the agent and the Sales Manager, about his other policy but the agent and Sales Manager told that it is not essential to mention about  other policy due to some technicality of the insurance company.  She has further  stated  in the same para that life assured did not know  English  so the whole columns  was filled up by the agent in  presence of  Sales Manager  and the complainant  and the  life assured  singed on the proposal  from in Hindi, in para -9 she has stated that the  annual income of LA was Rs. 3 lakhs. In this way the complaint has fully corroborated the contests of complaint petition.

      The o.p insurance company has also filed  evidence on affidavit  opw1 is E Sridhar who in General Manager, M/S Sri Ram Life Insurance Company Ltd.  The complainant in her evidence has stated that L.A disclosed about his other policy to the agent and Sales Manager, but  they told that  it was not  necessary due to techanality  in issuing policy so this witness is not an eye witnesses.  

13.   The o.ps has repudiated claim on two grounds first L.A was suffering from T.B. prior to the taking of policy that was suppressed by him. Learned council for the o.p has argued that it was material fact and the contract of insurance is Ubrrima fides and there is violation of contract. He has mentioned about investigating report annexure-3 also the photocopy of medical report (annexure-4). But  from medical report  it appears that the name of patient in Muni Lal and not Buni Lal and photocopy of medical report is also not very clear. Learned council on behalf of o.ps has given much emphasis on the case law LIC of  India V/s Sampuat Devi III 2006 CPJ 32 in which it was held  that there are certain diseases such as kidney heart and brain and they are connected with the Life Span of person and if any miss statement is  made in respect of such type of disease by the person seeking insurance in such case it can be believed that knowingly  the person taking out the insurance has made mis-statement but in the instant case complainant  has totally denied that her husband (L.A) was suffering from T.B or any other disease before taking the policy. Learned  council  for the complainant has filed case law Pnb met life Insurance Company V/s Veenita Devi (first appeal N.C.D.R.C New Delhi)  24-09-2018 in which it has been observed that  the burden to prove that the life assured was suffering from any pre-existing disease lies with  the Insurance company and the Insurance Company had not filed any documentary evidence or affidavit of the treating  doctor  is support of their contention. In the instant case also o.p has not filed affidavit of the doctor and  prescription filed by o.p  shows the name of Muni Ram so I do not find any merit in the plea of o.p.  The o.p. The  has also mentioned in the repudiation letter that the L.A. suppressed  about his policies taken before taking this policy. In this respect learned council of the complainant  has argued that L.A. disclosed about policy before agent and Sales Manager at the time of filing up proposal form but the sales Manager told that it was not necessary due to techanality  in taking this policy. The complainant in his evidence  on affidavit has also stated the  same fact. The o.p has adduced evidence on affidavit of General Manager, who is not an eye witnesses.  Sales Manager, or agent has not been examined by the o.p.  The o.p has mentioned several case law to show that the contract of insurance is  Uberrima fides and it was duty of the L.A to disclose about the material fact but from above discussion  I find that the L.A has not suppressed  any material fact.
14.  The O.P insurance company in his w.s. has also mentioned that L.A has suppressed his occupation income and his health condition but in repudiation letter he has not mentioned these points. In this connection the complainant has filed the case law Saurastra chemical Vs National  Insurance  Company Ltd. 13 December 2019 in  civil appellate  jurisdiction  Civil appeal No.2059 to 2015 (S.C) in which it was observed by the Hon’ble S.C. that it is settle  position that an Insurance Company cannot travel beyond the grounds  mentioned in the letter of repudiation. So this plea of o.p is not tenable. The complainant however  has filed income tax return of L.A (annexure-8 ) to So, his income show the plea of the o.p that the L.A had suppressed  fact is not tenable.
15.  From the above discussion I find and hold that the complainant fully proved her case and proved deficiency in service on the part of the o.p therefore o.ps are directed to pay Rs.3,70,000/- sum assured with interest @ 8 % p.a. from the date of filing of this complaint case the o.p is also directed to pay Rs. 20,000/- as mental economical loss and Rs. 10,000/- for litigation cost. within Two month  from the date of receipt of this order  till final payment failing which the o.p will pay the above said assured amount with interest  @ of 10 % p.a. full final payment.