| This revision petition comes in the face of concurrent orders of the District Consumer Protection Forum, Churu and Rajasthan State Consumer Disputes Redressal Commission. The matter pertains to the claim under a life insurance policy, which was in operation since 28.12.2008. The insured allegedly died due to electrocution on 8.9.2009. The Complainant, wife of the insured, made a claim under the insurance policy, which was repudiated by the opposite party/ revision petitioner in the present proceedings, Bajaj Allianz Life Insurance Company Ltd. 2. The letter of 15.1.2010 address by the revision petitioner/OP to the respondent/Complainant gave the following reasons for repudiation of the claim e regret to inform you that the death claim under captioned policy has been declined for the following reason: The company had covered the risk for the above said policy on the basis of the facts mentioned in the proposal form. However, on receiving the death claim intimation for the above said policy, the various investigations and the various medical certificates confirm that the deceased life assured had history of hospitalization and treatment during 28/09/2006 to 4/10/2006 for insulin dependent diabetes mellitus with refractory lymphadenitis failure with lymphadenitis with right ankle cellulites. The facts known to deceased life assured were not disclosed in the proposal form dated 06/12/2008. Had these facts been disclosed the company would not have covered the risk for the policy. Hence, the claim has been repudiated due to non-disclosure of material facts. 3. The District Forum allowed the complaint, holding that the complainant was entitled to receive the insured amount, with 9% interest from the date of the complaint. In the appeal filed by the OP/revision petitioner, challenging the decision of the District Forum, the State Commission held that the appellant had not clarified what was the ailment for which the deceased was treated before commencement of the policy. Also, that the death was caused by electrocution and not by any disease. The treatment, if any, would have been taken more than two years prior to the date of commencement of the insurance policy. Further, the decision of Honle Supreme Court of India in P.C.Chacko & Anr. Vs. Chairman Life Insurance Corporation of India & Ors. (2008) 1 SCC 321 was held to be not applicable to the fact of this case. In the matter before the Supreme Court, the insured had died subsequent to a major surgery, while in the present case the death was caused by electrocution of the insured. Therefore, the question whether or not any material fact was concealed was held to be not relevant to the facts of this case. The State Commission therefore, held that repudiation of the claim on the ground of some past ailment was not justified as the insured had died due to electric shock. 4. The order of the State Commission is now challenged before this Commission, by the OP/revision petitioner. We have carefully considered the records of the case and heard learned counsels for the two parties. 5. In the written statement of the OPs before the District Forum an issue has been raised about the cause of death of the assured, stating that it was a case of nnatural deathas per police report of 8.9.2009 and therefore the claim of the complainant, that it was due to electrocution, would need to be established by independent evidence. This appears to be a meaningless attempt to raise a doubt about the cause of death. The report of the post-mortem is on record. The medical officer, who conducted the post-mortem, has recorded in his own hand that fter conducting PM examination I am of the opinion that cause of death is cardio respiratory failure due to electrocution Therefore, this contention of the petitioner has to be rejected without any further consideration. In para O of the revision petition, it is stated that:- or, the State Commission erred in the interpretation of Section 45 of Insurance Act. Hence, if the life insured has concealed material facts, which was to his knowledge, at the time of filing in the Proposal Form, yet he suppressed the same, the provisions of Section 45 of the Insurance Act would get attracted and it is within the domain of the Petitioner Company to rescind the insurance contract or repudiate a claim under the insurance contract. The said policies have been repudiated within a period of two years from the date of issuance of the said policies. As per Section 45 of the Insurance Act, a period of 2 years is effectively provided to the insurance company to verify the facts as mentioned in the proposal form and in case a claim is raised within the said period of 2 years as contemplated under section 45 the insurance company is entitled to reject the claim under a policy on the ground that any information as contained in the proposal form is factually incorrect, irrespective of whether the same is connected with the cause of death or otherwise. 6. In view of this contention of the revision petitioner, we find it necessary to reproduce the provision in Section 45 of the Insurance Act, 1938. It reads as follows:- 5. Policy not to be called in question on ground of mis-statement after two years.- No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement [was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made] by the policy-holder and that the policy-holder knew at the time of making it that the statement was false [or that it suppressed facts which it was material to disclose]: [Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.] 7. There is no misinterpretation of the above provision by the State Commission. In the case before us, as already noted, the policy commenced on 28.12.2008 and the repudiation of the claim was done on 15.1.2010 i.e. within two years. The contents of the proposal form of 6.12.2008, on which the policy was based, are being called in question by the Insurance Company. For this, as observed by the State Commission, the OP/revision petitioner is relying on alleged medical treatment of the insured two years before the commencement of the policy. The State Commission has come to a conclusion that the appellant has not clarified what was the illness for which the deceased was admitted to NH Nursing Home, Churu during the period 28.9.2006 to 4.10.2006. 8. Having called the facts in to question, it was incumbent upon the revision petitioner to specifically point out what evidence was led before the fora below in support of its claim that the deceased had been suffering from nsulin dependant diabetes mellitus with refractory lymphadenitis failure with lymphadenitis with right ankle cellulites Instead of discharging this burden of proof, the revision petition merely states he Life Insured despite being questioned with regard to the said fact in the Proposal Form did not disclose that he was suffering from IDDM with RLF with lymphadenitis with right ankle cellulites or that he was undergoing treatment for the same. 9. The letter of repudiation referred to various medical certificates and various investigations as the basis for decision. But, from the list of documents produced on behalf of the revision petitioner before the District Forum, we find that five documents were produced. Among them, the only document of any relevance to the claim of pre-existing disease was a photocopy of the admission slip of the deceased at HN Nursing Home Churu. There is no indication of any record of treatment having been filed before the fora below. 10. Further, it is also claimed in the revision petition that the company had conducted an investigation in which documents and information obtained were collated and analysed and professional medical opinion taken. It allegedly brought the company to a conclusion that the assured had misrepresented facts and had deliberately concealed the material fact that he was suffering from IDDM with RLF with lymphadenitis. If this was the case, we fail to understand what prevented the revision petitioner/OP from submitting this report before the District Forum and from examining the investigator as well as the expert, whose assessment it has claimed to have relied upon. 11. A similar matter had come up for consideration in Civil Appeal No.7437 of 2011 decided by Honle Supreme Court of India on 26.8.2011 (P. Venkat Naidu Branch Manager, LIC Kurnool and Anr). A Life Insurance Police of Rs.10 lakhs was taken by the insured with effect from 28.4.2002. In the proposal form for insurance, the insured had not indicated whether during the last five years he had consulted any medical practitioner for any ailment. The insured died on 19.12.2003 due to cardio respiratory failure. The claim under the policy was contested by the insurance company on the ground that the insured had suppressed facts relating to his illness at the time of taking the policy. 12. The Supreme Court has held that ince the respondents had come out with the case that the deceased did not disclose correct facts relating to his illness, it was for them to produce cogent evidence to prove the allegation. The respondents were found to have failed to produce any tangible evidence to prove that the deceased had withheld information about his hospitalization and treatment. Therefore, the claim under the policy was allowed. 13. For the reasons detailed above, we find that revision petition has failed to make out any case against the impugned order. It is consequently dismissed for want of merit. No orders as to costs. | |
