DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

Udyog Sadan, C-22 & 23, Qutub Institutional Area

(Behind Qutub Hotel), New Delhi- 110016

Case No.73/2019

Smt. Anita Devi,

W/o Late Sh. Gian Chand,

R/o 169/1A, Gali No.6, Anand Parbat,

Delhi

….Complainant

Versus

Postal Life Insurance, Deptt. of Post (India),

Through its Chief Post Master General,

Delhi Circle,

New Delhi-110001

        ….Opposite Party

 Date of Institution    :  15.03.2019     

 Date of Order            :  11.05.2023    

Coram:

Ms. Monika A Srivastava, President

Ms. Kiran Kaushal, Member

Sh. U.K. Tyagi, Member

ORDER

Member: Ms. Kiran Kaushal

1.      Complaint has been filed by wife of the deceased Sh. Gian Chand, who was insured with Postal Life Insurance Department, of Post (India), hereinafter referred to as OP. The deceased husband was insured with OP vide Policy No.BL-74130-CS with effect from 19.09.2005, which was to mature in August, 2010. Sh. Gian Chand died on 30.01.2008 in Jeewan Mala Hospital, leaving behind widow, two sons and one daughter.

2.      It is stated by the Complainant that her deceased husband was insured for a sum of Rs.1,00,000/-. As per policy, the insured was required to pay monthly premium @ Rs.535/- and the deceased paid the same till his death.

3.      The Complainant, who was nominee in the insurance policy preferred a claim  as per the policy with OP which was rejected vide letter dated 01.12.2008 ,on the ground that deceased had not disclosed the pre-existing disease and the true status of his health in the proposal form. It is stated by the Complainant that the policy was accepted by OP after verification, due check up and medical fitness of the deceased. Therefore, OP cannot be allowed to repudiate the claim and state that the deceased had concealed material information.

4.      Aggrieved by  the claim being repudiated, Complainant approached this Commission with prayers to direct OP to pay Rs 62,000/- towards interest @24% per annum w.e.f 31.01.2008; Rs.50,000/- towards  mental shock and agony; Rs.22,000/- towards the counsel fee and the Rs11,000/- the charges of notice and Rs.1000/- towards litigation and expenses including drafting, typing, etc. Complainant has prayed for direction to OP to pay Rs.2,36,100/- alongwith future and pendente lite interest to the Complainant @24% per annum.

5.      OP resisted the complaint stating interalia that the Complainant’s deceased husband while filling up the proposal form, concealed the material fact with regard to his pre-existing disease i.e Broncho Pleural Fistula and puss discharge due to  tubercular infection (complicated) in the lungs. It is stated that deceased Sh. Gian Chand was taking treatment from Malik Hospital since 2002, whereas the present policy was obtained in the year 2005. It is next stated that the Complainant’s late husband had declared in Column No. 16 of the Proposal form that;

          “I hereby declare that I am good in health and free from disease, that I have not had any serious illness or major operation for the last three years that no proposal of insurance on my life as ever been adversely treated”

6.      Copy of the Proposal Form is annexed as Annexure R1. It is further stated that the contract of insurance   is  a contract of uberrima fides and every  material fact must be disclosed otherwise there is good ground for rescission. OP on enquiry got to know that the insured was frequently taking leaves on account of his ill health . OP as per rule obtained the information from the respective department of the deceased  insured regarding his medical leaves vide letter dated 24.07.2008 alongwith all the medical certificates of insured.

7.      It is further stated that the pre-existing illness is also fortified by Dr. V.S Malik who opined that;

          “patient (Gian Chand) brought to me in the month of September, 2002 patient had bronchy pleunal fistula and puss discharge due to tubercular infection (complicated) in lungs. Patient was earlier treated at Sir Ganga Ram Hospital for the same problem”

8.      It is thus stated that claim of the Complainant was rejected on the ground of concealment of illness as per the Clause (X) of the Policy. It is thus prayed that the complaint being not sustainable in the eyes of law, be rejected.

9.      Complainant has filed rejoinder reiterating the averments made in the complaint. Evidence has been filed on behalf of parties. Written submissions are filed on behalf of OP. Submissions made on behalf of parties are heard. Material placed on record is perused.

10.    Admittedly, deceased husband of the Complainant , was insured by OP for the sum assured of  Rs.1,00,000/- and Complainant is the nominee in the above stated policy. Complainant’s deceased husband, wherein personal history of the Complainant was asked  has stated  that he never suffered from various ailments mentioned at Clause No15  which is not true as per the Government hospital  Doctor .For ready perusal Clause 15 of the proposal form  is reproduced as under:

Have you ever  suffered from any of the following?

1. Tuberculosis (ii) Cancer (iii) Paralysis (iv) Insanity (v) Any disease of the heart and lungs (vi) Kidney disease (vii)  Any disease of  brain (viii) Diabetes (ix) Hypertension (x) Any other serious disease (xi) Any physical deformity or handicap.

                                                                                                             NO

 For All Applicants:

  I hereby declare that I am in good health and free from disease, that I have not had any serious illness or major operations for the last three years and that no proposal of  insurance on my life as ever been adversely treatments.

          The said  statement is duly signed by Complainant’s deceased husband.

11.    OP has placed on record a letter received from the employer of late Sh. Gian Chand. It is seen that the Complainant was on leave from 01.09.2002 till 15.02.2003 i.e for almost about six months. OP has placed various medical certificates from Malik Hospital which were given to the late Sh. Gian Chand towards his medical fitness. OP has also annexed as Annexure R3 wherein it is clearly stated by Dr. V.S Malik (Malik Hospital) that;

          “patient presented to me in the month of September, 2002

Patient had Broncho Pleural Fistula alongwith puss discharge due to tubercular infection (complicated) in the lungs. Patient was earlier was being treated at Sir Ganga Ram Hospital for the same problem”.   

12.    As per Oriental Insurance Co. Ltd Vs Mahendera Construction (2019) 18  decided by Hon’ble Supreme Court in   Case No. 209, it is held that;

          “ Insurance is governed by the principle of utmost good faith, which imposes a duty of disclosure on the insured with regard to  material facts. In  MacGillivray on Insurance Law the rule concerning duty of disclosure is stated in the following terms:

           [Subject to certain qualifications considered below], the assured must disclose to the insurer all facts material to an insurer’s appraisal of the risk which are known or deemed to be known by the assured but neither known or deemed to be known by the insurer. Breach of this duty by the assured entitles the insurer to avoid the contract of insurance so long as he can show that the non-disclosure induced the making of the contract on the relevant terms..”

13.    From the above stated facts and ratio in the judgment supra, it can be concluded that the Complainant concealed the fact of pre existing disease while filling the proposal form. In view of the same this Commission is of the opinion that claim of the Complainant was rightly repudiated.

14.    Hence, the complaint is dismissed with no order as to costs.