Delhi

New Delhi

CC/568/2011

Vijay Kumar - Complainant(s)

Versus

M/S. BIRLA SUN LIFE INSURANCE COMPANY LTD. - Opp.Party(s)

18 Mar 2020

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.568/2011            

 

Mr. Vijay Kumar

G-2, New Aruna Nagar

Majnu ka Tila

Delhi- 110054                                                               ….Complainant

 

Vs.

Birla Sun Life Insurance Co. Ltd.

Through its Director

204, Ashoka Estate,

2^nd Floor, Barakhama Road,

Connaught Place, New Delhi

….Opposite Party

 

NIPUR CHANDNA, MEMBER

 

O R D E R

 

 

The complainant has filed the present complaint under section 12 of Consumer Protection Act.  The gist of the complaint is that the complainant is the husband of the DLA in policy bearing No. 002326960 vide policy plan Saral Jeevan Life for Rs. 04,30,000/- each issued by the OP. Unfortunately, the DLA(Deceased Life Assured)  Ms. Dilwer died on 09/09/2010 due to Acute Renal Failure.  

 

2.     The complainant filed the death claim through authorized agent on 15/12/2010. In the month of January, 2011 the surveyor of the OP approached the complainant and collected the relevant document for processing the claim, but the OP repudiated the claim vide letter dated 31/01/2011. The repudiation of the claim in respect of the policies of the DLA is not only illegal but also malafide on the part of OP. The OP also refunded the premium of Rs. 03,307.99/- paid against the renewal premium but the same has not been encashed till date by the complainant. Thereafter, the complainant approached OP on several occasion to reconsider his claim but all in vain. Complainant therefore approached this Forum for redressal of his grievance.

 

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 Rheumatic Heart Disease with CVA left MCA infarct and operated for the same, one and half year back before the issuance of the policy in question. 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, hence, 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 Rheumatic Heart Disease with CVA left MCA infarct since 2005 which is much 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 relied on the copy of the discharge summary dated 02/05/2007 issued by St. Stephen’s Hospital, Delhi. . 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. 04,30,000/- from the OP on 23/12/2008. The Life Assured had died on 09/09/2010. Claim has been repudiated by the OP on the ground that the policy was taken by concealment and suppression   of material fact as the DLA was suffering from Rheumatic Heart Disease with CVA left MCA infarct since 2005 which is much 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 same is reproduced in repudiation letter dated 31/01/2011.

9.     We have gone through the copy of death summary placed on record by the complainant.  Perusal of the same shows that the Life Assured was suffering from  Rheumatic Heart Disease with CVA left MCA infarct since 2005 which is much prior to the solicitation of the policy. Rheumatic Heart Disease is one of the cause of Renal Failure. In the present case the DLA died due to Renal Failure, which is the consequences of Rheumatic Heart Disease. 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. The Life Assured had failed to disclose that he was suffering from Rheumatic Heart Disease with CVA left MCA infarct since 2005 which is much prior to the solicitation of the policy  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 no merits in the present complaint, 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  18/03/2020. 

 

 

         (ARUN KUMAR ARYA)

                     PRESIDENT

                  (NIPUR CHANDNA)                                             (H M VYAS)

                          MEMBER                                                           MEMBER