Delhi

New Delhi

CC/946/2011

Nutan Jain - Complainant(s)

Versus

M/S. Birla Sun Life Insurance Company Ltd. - Opp.Party(s)

03 Oct 2019

ORDER

 

 

 

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTRICT NEW DELHI,  M-BLOCK, 1^ST FLOOR,

VIKAS BHAWAN, I.P. ESTATE. NEW DELHI-1100001.

 

C.C.No.946/2011

 

Smt. Nutan Jain,

Widow of Late Ashok Kumar,

R/o H.No.281/23, Inderlok,

Gali No.9, Gul Mandir,

Sonepat, Haryana.

                                  ….Complainant

 

Vs.

 

Birla Sun Life Insurance  Co. Ltd.,

2^nd Floor, Ashok Estate,

Barakhamba Road,

Connaught Place(Branch Office),

New Delhi-110001

 ….Opposite Party

 

NIPUR CHANDNA, MEMBER

 

 

O R D E R

 

 

The complainant has filed the present complaint against the OPs under section 12 of Consumer Protection Act, 1986. The brief facts  of the present complaint are that the complainant’s late husband had taken a Life Insurance Policy, bearing no.002756845 for assured sum of Rs.73,750/- from the OP on 28.03.2009. It was alleged that under the said policy, the complainant was declared as nominee by Life Assured.

2.     It was alleged that before issuing policy, the Life Assured was medically examined and after completing other formalities the policy certificate was issued to him. It was alleged that on 18/9/2009 complainant’s husband along with his cousin Sh. Inder Sain Jain has gone to take the blessing of Mata Bala Sundari.  On 19/9/09, while going to the temple suddenly, he fell down on the way, he was taken to hospital, where he was declared dead by the attending doctor. It was alleged that the respondent/complainant being the nominee under the aforesaid policy preferred a claim with the OP. The claim was repudiated by OP on the ground that the Life Assured was suffering from chest pain, diabetes which was not disclosed in the application/proposal form by him. The complainant made several request to the OP to consider her claim but OP stuck up on the repudiation made by it.  Denial of the claim by the OP on false and frivolous ground amounts to deficiency in services, hence this complaint.

 3.    Complaint has been contested by OP. OP filed written statement opposing complaint of the complainant. It was alleged that Life Assured was suffering from hypertension and diabetes mellitus for last 5 years which is much prior to the solicitation of the policy. It was alleged, the Life Assured had given false replies in the application for insurance as such the policy was obtained by concealment and suppression of material facts. It was alleged that the claim was rightly repudiated.

4.     Both the parties filed evidence by way of affidavit. Parties also filed written arguments.

5.     Ld. counsel for the OP has contended that Life Assured was suffering from hypertension and diabetes mellitus, for which he was on medication from last 5 years prior to the solicitation of the policy. It was argued that the Life Assured had given false replies in the application for insurance as such the policy was obtained by concealment and suppression of material facts. In support of its contention counsel for OP has drawn our attention towards the proposal form as well as the copies of post mortem report. It was further argued that the claim was rightly repudiated as the policy was obtained by concealment and suppression of material facts.

6.     On the other hand, ld. counsel for the complainant has contended that there is no concealment of material facts by the Life Assured, and prayed that the relief claims be granted.

7.     It is admitted position that the Life Assured had taken insurance policy, wherein total sum assured was Rs.73,750/- from the OP on 28.03.2009. The Life Assured had died on 19/9/09. Claim has been repudiated by the OP on the ground that the Life Assured was suffering from hypertension and diabetes mellitus, for which he was on medication from last 5 years prior to the solicitation of the policy.  It was alleged by OP that  the Life Assured had given false replies in the application for insurance as such the policy was obtained by concealment and suppression of material facts.

8.     To prove the aforesaid contention, OP has relied upon the queries answered by the Life Assured in the proposal form. The relevant portion of the same is reproduced as under: ,

“ (IX) MEDICAL AND PERSONAL HISTORY OF THE LIFE TO BE INSURED

 

1. Life  Style Information

 

6.  

   (D) MEDICAL INFORMATION

2.     Within the past five years have you:

a)     Consulted any doctor or other health practitioner  except for common cold, influenza lasting less than 4 days?                                                                               No.  

b)     Submitted to ECG, X-rays, Blood test or other tests                     No.

3.     Have you ever had or sought advice for the following:

(a)    Chest pain, high blood pressure, stroke heart attack, heart murmur or heart disorder?.                                                                       No 

(c )   Diabetes or sugar in the urine?                                                  No                   

 

9.     We have gone through the post mortem report placed on record by the complainant as well as the OP.  Perusal of the same shows that the  Life Assured was suffering  from hypertension and diabetes mellitus, for which he was on medication from last 5 years prior to the solicitation of the policy.  Moreover, the DLA in his proposal form against the life style information in query (6)  i.e.  Do you smoke cigarettes/bidis or used any  other form of tobacco like paan, gutka etc?.    Answered in negative, whereas as per the post mortem report he was a chain smoker for a long time, his right and left lungs was congested dark black.   The material on record clearly shows that the Life Assured had not given correct answers and had obtained the policy by suppressing material facts.

10.    Due to Non-Disclosure” of the true and correct facts pertaining to the medical history at the proposal stage by the DLA amounts to misleading the OP Insurance Co., resulting in the violation and infringement of the terms of contract between the parties, hence the repudiation is justified. 

11.    The contracts of insurance are contracts of uberrima fides and every material fact is required to be disclosed. In United India Page 11 of 13 Insurance Co. Ltd. v. M.K.J. Corpn., III (1996) CPJ 8 (SC), a two Judge Bench of Hon‟ble Supreme Court has observed: “It is a fundamental principle of Insurance law that utmost good faith must be observed by the contracting parties. Good faith forbids either party from concealing (non-disclosure) what he privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. Just as the insured has a duty to disclose, „similarly, it is the duty of the insurers and their agents to disclose all material facts within their knowledge, since obligation of good faith applies to them equally with the assured‟.”

12.    In Satwant Kaur Sandhu v New India Assurance Company reported in IV (2009) CPJ 8 (SC), Hon‟ble Supreme Court has observed that in a contract of insurance, the expression “material fact” is to be understood in general terms, to mean as any fact which would influence the mind of a prudent Insurer, in deciding whether to accept the risk or not. If the proposer has knowledge of such fact, he is obliged to disclose it, particularly while answering questions in the proposal form. Any inaccurate answer will entitle the Insurer to repudiate its liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance, which is based on the principle of utmost faith– uberrimae fidei. Good faith forbids either party from non-disclosure of the facts which the party privately knows, to draw the other into a bargain, from his ignorance of that Page 12 of 13 fact and his believing the contrary. It has also been emphasized that it is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not.

13.    In PC Chacko and Anr. v. Chairman, Life Insurance Corporation of India & Ors. (2008) 1 SCC 321, the Hon‟ble Supreme Court has upheld the repudiation of the contract of insurance on the ground of non-disclosure and mis-statement in the proposal form to the various questions to which the answers were given by the insured.

14.    In the present case, the material on record discussed above clearly establishes that the Life Assured had concealed material facts about his health as well as life style in the proposal form. The Life Assured had failed to disclose that he was suffering from hypertension and diabetes mellitus  and was a chain smoker prior to the issuance of the policy in question. Further, when the application for insurance was filled up by Life Assured he had replied questions in respect of aforesaid ailments in negative. There is clear suppression of material facts in relation to diseases suffered by him prior to date of application for insurance. Material on record  proves that policy was obtained by concealment of material facts. In the facts and circumstances of the present case, we are of the  considered view that the OP was justified in repudiating the claim.

15.    In view of the above discussion, we find not merits in the present compliant, same is hereby dismissed.

A copy of this order each be sent to both the parties free of cost by post. This final order be sent to server (www.confonet.nic.in ). File be consigned to Record Room.

Announced in open Forum on 03/10/2019. 

 

 

(ARUN KUMAR ARYA)

          PRESIDENT

 

(NIPUR CHANDNA)                                                  (H M VYAS)

       MEMBER                                                                MEMBER