NCDRC

NCDRC

RP/3773/2012

SANTRO DEVI - Complainant(s)

Versus

MAX NEW YORK, LIFE INSURANCE CO. LTD. & ANR. - Opp.Party(s)

MR. GAUTAM GODARA

12 Oct 2012

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 3773 OF 2012
 
(Against the Order dated 27/06/2012 in Appeal No. 897/2010 of the State Commission Haryana)
1. SANTRO DEVI
W/o Sher Singh R/o House No-328 Village & Post Office,Kaagdana
Sirsa
Haryana
...........Petitioner(s)
Versus 
1. MAX NEW YORK, LIFE INSURANCE CO. LTD. & ANR.
Above Union Bank Of India, Branch Office Through its Branch manager
Fatehabad
Haryana
2. Max New York Life Insurence Co Ltd Operation Centre
Plot No-90-A Sector-18, Udyog Vihar, Through its General Manager
Gurgaon - 122015
Haryana
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE J.M. MALIK, PRESIDING MEMBER
 HON'BLE MR. VINAY KUMAR, MEMBER

For the Petitioner :MR. GAUTAM GODARA
For the Respondent :NEMO

Dated : 12 Oct 2012
ORDER

JUSTICE J. M. MALIK, PRESIDING MEMBER (ORAL)

 

1.       Learned counsel for the petitioner heard.   The proposal form was filled up by Shri Dariya Singh, the insured, on 7th March 2009.  He is the brother of Smt. Santro Devi, the complainant.  This is an admitted fact that Dariya Singh suffered from T.B. ailment in the year 2007.  According to counsel for the

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petitioner, the said ailment was cured within 7 months.  He further submitted that on the day of filling up of the proposal form, he was hale and hearty but did not disclose in the proposal form that he had been a T. B. patient.  He passed away on 6.5.2009  due to Tuberculosis.  It also came to light that the deceased was receiving treatment from Primary Health Centre, Chopta before obtaining the policy. 

3.       This is clearly a case of suppression of material fact.  The order passed by the State Commission cannot be faulted.  The case is further supported by Apex Court judgment reported in Satwant Kaur Sandhu vs. New India Assurance Co. Ltd. 2009 (8) SCC 316,  relevant paras of which read as under:-

“18.…………  A mediclaim policy is a non-life insurance policy meant to assure the policy holder in respect of certain expenses pertaining to injury, accidents or hospitalisations.  Nonetheless, it is a contract of insurance falling in the category of contract uberrimae fides, meaning a contract of utmost good faith on the part of the assured.  Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge.  It is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not.  Of course, the obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known.  The obligation to disclose necessarily depends upon the knowledge one possesses.  His opinion of the materiality of that knowledge is of no moment.  (See Joel v Law Union & Crown Insurance Co.)

(Emphasis supplied)

2.1       Further on what would constitute a “material fact” in the context of an insurance policy, the Court ruled:

 

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“22. The term “material fact” is not defined in the Act and, therefore, it has been understood and explained by the courts in general terms to mean as any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether he would like to accept the risk.  Any fact which goes to the root of the contract of insurance and has a bearing on the risk involved would be “material”.

 

23.  As stated in Pollock and Mulla’s Indian Contract and Specific Relief Acts:

“Any fact the knowledge or ignorance of which would materially influence an insurer in making the contract or in estimating the degree and character of risks in fixing the rate of premium is a material fact.”

 

3.       The ratio of the above said judgment has also been applied by this Commission in Dineshbhai Chandrana and another vs. Life Insurance Corporation and another, first Appeal No. 242 of 2006 decided on 27.10.2010.

          The revision petition is sans merits and deserve dismissal which we hereby direct.

 
......................J
J.M. MALIK
PRESIDING MEMBER
......................
VINAY KUMAR
MEMBER

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