Delhi

New Delhi

CC/420/2014

Jyoti Gupta - Complainant(s)

Versus

M/S. Zonal Manager Life Insurance Company Ltd. - Opp.Party(s)

24 Feb 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.420/2014

 

Smt. Jyoti Gupta,

W/o Late Sh. Vijay Kumar Gupta,

R/o H.No.N-59, Laxmi Nagar,

Delhi-92.

                                ….Complainant

 

Vs.

1. The Zonal Manager,

Life Insurance Corpn. Of India,

Northern Zonal Office,

Connaught Place, New Delhi-01.

 

2. The Manager,

Life Insurance Corpn. Of India,

Delhi Divisiona-II,

Branch Unit-327,

Sunlight Building,

Asaf Ali Road, New Delhi.

 

3. Sh. D.K. Sharma,

Agent No.39938111,

At – Delhi Division-II,

Branch Unit -327,

Sunlight Building,

Asaf Ali Road, New Delhi.

….Opposite Parties

 

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 nominee of the DLA in policy bearing Nos.120827633 and 120827638 both dt. 28.7.2002, policy plan Jeevan Kishore and Jeevan Chhaya for Rs.2 lacs each issued by the OPs. Unfortunately, the DLA(Deceased Life Assured)  Mr. Vijay Kumar Gupta died on 24.11.2002 and  the complainant due to mental depression could not filed her claim in the year 2004.  When the complainant approached the agent i.e. OP-3, he asked the complainant to contact with OP-1 & 2. All the OPs misguided the complainant on the basis of misrepresentation and threatening of repudiation of claim, she was also forced to pay the premium in respect of the same policies upto 2008 for the one policy, while the other policy premium is regularly paid till date due to apprehension of lapse of policy and the complainant continuously made the payment.  On the advice of another policy agent , the complainant filed the death claim along with the premium already paid by her after the death of her husband, but the OPs repudiated the claim vide letter dt. 25.5.2010. The repudiation of the claim in respect of the policies of the DLA is not only illegal but also malafide on the part of OPs.  Thereafter, the complainant sent a legal notice dt. 8.10.2013 to the OPs but all in vain.  Despite several requests and follow up OPs failed to release the assured amount to the  complainant, hence this complaint.

 

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 cancer since April 2002 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.

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

4.     Ld. counsel for the OPs has contended that Life Assured was suffering from cancer since April 2002 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 OPs relied on the copy of the death . It was further argued that the claim was rightly repudiated 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. 2 lacs from the OP on 28.07.2002. The Life Assured had died on 24.11.2002. 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 cancer since April 2002 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 the queries answered by the Life Assured in the proposal form,  the same is reproduced in repudiation letter dt. 7.5.2010.

8.     We have gone through the death summary report placed on record by the complainant.  Perusal of the same shows that the  Life Assured was suffering from  cancer since April 2002 which is much prior to the solicitation of the policy.  Moreover, the cause of death of the DLA was cancer.   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 cancer since April 2002 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.

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  24/02/2020. 

 

 

(ARUN KUMAR ARYA)

          PRESIDENT

 

(NIPUR CHANDNA)                                                  (H M VYAS)

       MEMBER                                                                MEMBER