Delhi

New Delhi

CC/192/2015

Menka - Complainant(s)

Versus

M/S. DHFL Pramerica 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.192/2015

 

Mrs. Menka,

253, C/B, Munirka Village,

Near Vasant Vihar Depot,

New Delhi-67.

….Complainant

Vs.

 

DHFL Pramerica Life Insurance Co. Ltd.,

Registered office at:

DLF Centre, Sansad Marg,

New Delhi-110001.

 

 

Head Office at:

4^th Floor, Building No.9B,

Cyber City, DLF City Ph.3,

Gurgaon-122002.

    …Opposite Party

 

ARUN KUMAR ARYA, PRESIDENT

 

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 nominee of the DLA in policy bearing No.000168944 issued by the OP for which DLA had paid the premium of Rs.25,000/- through cheque. The DLA(Deceased Life Assured)  Sh. Rohtash Jain had died on 13.2.2013 as natural death. The complainant filed the death claim with the OP.  On 13.11.2013, the OP asked the complainant to submit certain documents for processing the claim.  The complainant vide letter dt. 25.11.2013 submitted the relevant document for processing the claim, but the OP settled the claim of the complainant for a sum of Rs.21,673 which was paid through NEFT vide letter dated 26/06/2014. The settlement of the claim in respect of the policy of the DLA is arbitrarily done by the OP. Thereafter, the complainant approached OP on several occasion to reconsider her claim and pay the entire benefits under the policy but all in vain. The complainant sent a legal notice dt. 10.10.2014 but of no use.  Complainant therefore approached this Forum for redressal of her grievance.

 

2.     Complaint has been contested by OP. OP filed written statement opposing complaint of the complainant. It was alleged that Life Assured was suffering from Tuberculosis’ as well as liver disorder and was treated for the same 25 years back before the issuance of the policy in question. It was alleged 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, hence, the claim was rightly repudiated.

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

4.     Ld. counsel for the OP has contended that Life Assured was suffering from Tuberculosis’ as well as liver disorder and was treated for the same 25 years back 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 medical documents of Hygiea Hospital, Rockland Hospital, Daya Memorial Hospital as well the investigation report submitted by M/s  The Third Eye Investigator. It was further argued that the claim was rightly settled as the policy was obtained by concealment and suppression of material facts.

5.     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.

6.     It is admitted position that the Life Assured had taken insurance policy, wherein total sum assured was Rs.5 lacs from the OP on 6/9/2012. The Life Assured had died on 13/02/2013. Claim has been settled  by the OP by refunding the balance premium of Rs.21,673/- on the ground that the policy was taken by concealment and suppression   of material fact as the DLA was suffering from Tuberculosis’ as well as liver disorder and was treated for the same 25 years back 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.

7.     To prove the aforesaid contention, OP has relied upon copy of the medical documents of Hygiea Hospital, Rockland Hospital, Daya Memorial Hospital as well the investigation report submitted by M/s  The Third Eye Investigator.

8.     We have gone through the aforesaid copies placed on record by the OP.  Perusal of the same shows that the Life Assured was suffering from Tuberculosis’ as well as liver disorder and was treated for the same 25 years back which is much prior to the solicitation of the policy.  The perusal of OPD Card of AIIMS Hospital proves that the DLA was brought dead to the Hospital by Constable Arun Sharma.  It is further mentioned in MLC of said  hospital that the DLA  was known case of chronic liver disease as stated by his elder brother and in the last night he was seriously ill and early morning not responding.  The material on record clearly shows that the Life Assured had not given correct answers and had obtained the policy by suppressing material facts.

9.     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. 

10.    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‟.”

11.    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.

12.    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.

13.    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  Tuberculosis’ as well as liver disorder and was treated for the same 25 years back which is much prior to the solicitation of the policy.  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.

14.    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