Haryana

Karnal

147/2013

Krishan Kumar S/o Balbir Singh - Complainant(s)

Versus

Reliance Gernal Insurance Company Limited - Opp.Party(s)

Sh.Subhash Chander

28 Mar 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                               Complaint No.147 of 2013

                                                               Date of instt.: 19.3.2013

                                                                Date of decision  11.4.2016

Krishan Kumar son of Shri Balbir Singh resident of village Nirjan tehsil and District Jind.

                                                                      …………..Complainant.

                             Versus

Reliance Life Insurance company, Branch office at SCO No.135, Sector 12, Urban Estate, near Mini Secretariat, Karnal through its Branch Manager..

                                                                   ………… Opposite Party.

                     Complaint u/s 12  of the Consumer

                     Protection Act.

 

Before          Sh.K.C.Sharma……….President.

                   Sh.Anil Sharma…….Member.

 

Present:-       Sh.Subhash Chander Advocate for the complainant.

                    Sh.Naveen Sharma Advocate for the Opposite Party. 

ORDER:

 

                        This  complaint has been filed by the complainant u/s 12 of the Consumer Protection Act, 1986, on the averments that   his wife Smt.Sunita Rani  (deceased life assured)  purchased insurance policy No.16651923 dated 23.3.2010 and got herself insured with the Opposite Party  for a sum of Rs. Fifteen lacs and premium was duly deposited with the Opposite Party. Unfortunately, she died on 15.10.2010 due to electric current. He being simple person did not know about technicalities of law, therefore, neither got lodged Daily Diary Report with the police nor got post mortem conducted on the dead body.  After death of the life assured, he being the nominee in the policy, lodged the claim with the Opposite Party and completed all the formalities. However, the Opposite Party, vide letter dated 30.4.2011 alleged that before purchase of the policy, the life assured was suffering from  hypertension and that fact was not disclosed by her at the time of furnishing application form. Thereafter, he visited the office of the Opposite Party and requested for payment of the assured amount, but the Opposite Party postponed the matter on one pretext or the other. He was told that the matter was sent to the Head Office for necessary recommendation, but about one week prior to the filing of the complaint, the Opposite Party flatly refused to accede to his request.   Denial of the benefits of the insurance policy amounted to deficiency in services on the part of the Opposite Party, due to which he suffered mental pain, agony and harassment apart from financial loss.

 

2.                Notice of the complaint was given to the Opposite Party who appeared and filed written statement disputing the claim of the complainant. Objections have been raised that the complaint is not maintainable; that the complaint lacks cause of action and  that the complaint is false, malafide and abuse of the process of law.

 

                   On merits, it has been submitted that the deceased life assured submitted duly signed reliance special term plan(Regular) dated 22.3.2010  bearing  No.B-000018227 giving all relevant details and information   in the prescribed form , for an assured sum of Rs.15,00,000/- .  In the proposal form, the deceased life assured had given declaration that she had made complete, true and accurate disclosure of all the facts and circumstances as may be relevant for acceptability of the risk and had not withheld any information as may be relevant for the acceptability of the proposal.  The questions No.29 and 31 at page 2 in the Section of life style questions and personal medical history of the life to be assured,  were answered by the deceased life assured in negative. The deceased life assured thumb marked the declaration in presence of the witness after understanding the contents of the proposal form.  After receiving the intimation regarding the death of the life assured, the Opposite Party sent letter dated 13.1.2011 to the complainant asking him to furnish some documents, but he failed to provide the requisite documents for a reasonable time, therefore, reminders were sent to him. Being an early claim and also after perusal of the documents submitted by the complainant, the Opposite Party got conducted the investigation through Paramount Consultancy Services. After perusal of the documents provided by the complainant and procured during investigation, the  Opposite Party came to know through treatment record that prior to signing of the proposal form, the deceased life assured was known case of hypertension for three years as per prescription  slip issued by Dr.Trupati Kharub dated 13.1.2010. The deceased life assured was hospitalized/ treated for the said disease, but the questions relating to her health in the proposal form were answered by her in negative. Thus, the deceased life assured had not disclosed that she had been suffering from hypertension for the last three years prior to submission of the proposal form, therefore, claim of the complainant was rightly repudiated by the Opposite Party   on the ground of suppression of material facts by the deceased life assured. The suppression of pre-existing disease of hypertension amounted to suppression of  material facts, therefore, contract of insurance was liable to be rescinded as per Section 45 of the Insurance Act 1938 and no benefit was payable to the complainant.  All other allegations made in the complaint have been denied.

 

3.                In evidence of the complainant, his affidavit Ex.C1, affidavit of Ranbir Ex.C2, affidavit of Ram Bhaj Ex.C3, affidavit of Jagbir Ex.C4 and documents Ex.C5 to Ex.C12 have  been tendered.

 

4.                On the  other hand, in evidence of the Opposite Party,  affidavit of Sanjeev Kumar, Ex.OP1/A, affidavit of Shri Amit Rastogi Ex.OP2/A and documents Ex.OP1 to Ex.OP7 have been tendered.

 

5.                We have heard the learned counsel for the parties and have gone through the case file very carefully.

 

6.                Admittedly, Smt.Sunita Rani wife of complainant had obtained insurance policy No. 16651923 dated 23.3.2010 and the sum assured was Rs.15,00,000/-.  She died on 15.10.2010.  As per the case of the complainant, the  deceased life assured had died due to electric current. He being the nominee lodged the claim, but the claim was repudiated by the Opposite Party on 30.4.2011.  The Opposite Party  has submitted that the life assured had been suffering from hypertension for the last three years prior to submission of the proposal form and she got treatment for the same from Trupati Kharub but she did not disclose this fact in the proposal form in reply to the specific questions no.29 and 31 put to her in that regard, therefore, the claim was repudiated on the ground of suppression of material fact.

 

7.                The learned counsel for the complainant vehemently argued that deceased life assured  was not suffering from any disease at the time of obtaining the policy. She was healthy woman.  Even  in the report dated  15.1.2011 by the Paramount Consultancy Services, Lucknow, it was not mentioned that  the deceased life assured was suffering from ailment of high blood pressure  at the time of obtaining the policy. There was no mention of prescription slip dated 1.3.2010 allegedly issued by Dr.Trupati Kharub in the said investigation report.  The copy of prescription  slip allegedly issued by Dr.Trupati Kharub  has been  fabricated and forged as the same was neither submitted by the investigating agency nor by the complainant. Even the Opposite Party failed to produce any evidence of Dr.Trupati Kharub  to prove the genuineness of the prescription slip.  Therefore, no importance can be attached to the said prescription slip allegedly issued by Dr.Trupati Kharub. Consequently, the Opposite Party has altogether failed to prove that the deceased life assured was suffering from hypertension prior to the submission of the proposal form. Claim of the complainant could not be repudiated on the ground of not getting conducted the post mortem on the dead body of the life assured and not reporting the matter to the police. The learned counsel for the complainant further laid stress on the contention that as per investigation report of the investigator appointed by the Opposite Party and evidence of the complainant in the form of affidavits Ex.C1 to Ex.C4, it is established that the deceased life assured had died due to electric shock. Moreover, there was no nexus between the cause of death due to electric shock and hypertension with which she was allegedly suffering. Therefore, the Opposite Party cannot wriggle out of the liability to pay the assured amount to the complainant as per terms and conditions of the policy, on the false ground of suppression of material fact by the deceased life assured in the proposal form.  In support of his contention, he placed reliance upon  Abdul Lateef Versus Life Insurance Corporation of India, revision petition 2370 of 2012 decided by the Hon’ble National Commission on 4.7.2014, New India Assurance Company Limited  Versus Jatinder Kumar Sharma 2013(2) CPC 543 and New India Assurance Co.Ltd. Vs.R.Santhi and others 2013(5) R.C.R.(Civil) 572.

 

 

8.                To wriggle out of the aforesaid contention, the learned counsel for the Opposite Party submitted that contract of insurance is based upon principle of uberrima fide i.e. utmost  good faith and concealment of any material fact renders the policy void. The deceased life assured submitted  the proposal form , the copy of which is Ex.OP1, for obtaining the insurance policy from the Opposite Party. At page 2  of the said proposal form, questions no.24 to 34  are relating to her health.  She replied all the questions in negative. She was specifically put questions no.29 and 31 whether she was taking any medicines or drugs prescribed by the doctor during the past five years and whether she had suffered or was presently suffering from high blood pressure and other ailments mentioned in question no.31, but she replied in negative. On investigation, it was found that she had been suffering from hypertension for the last  three years prior to submitting the proposal form and got treatment for the same from Sanjeevni Hospital, Jind and  Dr.Trupati Kharub prescribed medicines for her treatment, vide slip Ex.OP6. However, in the proposal form she concealed about her ailment for which she was suffering i.e. hypertension, which amounted to suppression of material fact. She did not disclose about the problem of hypertension in the proposal form knowingly and intentionally, therefore, the claim regarding death of life assured was rightly repudiated by the  Opposite Party on this ground. In support of his contention, he relied upon  Satwant Kaur Sandhu Versus New India Assurance company IV (2009) CPJ 8 (SC),  Life Insurance Corporation of India Versus Sahida Khatun 2014(1) CPC 88, Life  Insurance  Corporation of India Versus Krishan Chander Sharma, revision petition no.1935 of 1999 decided by Hon’ble  National Commission on 23.1.2006 and Life Insurance Corporation of India and another Versus Bimla  Devi revision petition no.3806 of 2009 decided by Hon’ble National Commission on 12.8.2015.The learned counsel for the  Opposite Party further argued that deceased life assured was suffering from serious problem of high blood pressure. She had taken some other insurance policies from other insurance companies also. She died due to hypertension and for that reason neither the complainant  got registered Daily Diary Report nor got post mortem conducted despite being educated person and  government employee and  in order to get claim from the Opposite Party and other insurance companies  made out a false story  that deceased life assured died due to electric shock.

 

9.                In Abdul Lateef’s case (Supra)  the deceased life assured was suffering from  Bipolar mood disorder at the time of submitting proposal form for purchasing the policy, but he died due to Cancer.  LIC repudiated the claim on the ground that insured suppressed previous ailment i.e. Bipolar mood disorder.  Under those circumstances,  it was held by the Hon’ble National Commission that there was no nexus at all between the ailment suppressed and cause of death i.e. cancer. The deceased life insured did not suppress any material fact with any fraudulent intention.  Revision petition was allowed and the OP was directed to pay the sum assured alongwith interest.

 

10.               In Jatinder Kumar’s case (Supra) the claim was repudiated by the insurance company for the reason that neither First Information Report was lodged nor any hospital record relating to the treatment of head injury and paralysis treatment was produced. It was held by the Hon’ble National Commission that merely that no FIR was lodged does not prove that the complainant had not suffered head injury or paralysis in  the body,  which was apparently established.   In  R. Santhi and other’s case (Supra), the evidence on record showed that the  deceased died due to head injury sustained by him in road accident. It was held by the Hon’ble Madras High court that merely because post mortem was not conducted, it cannot be said that death was not due to injury sustained in road accident. It can be decided based on other relevant materials produced before the Court.

 

11.                    In Satwant Kaur Sandhu’s case (Supra)   the policy holder was suffering from chronic diabetic renal failure, but that fact was not disclosed while obtaining the policy. It was held by the Hon’ble Supreme Court that term “material fact” is not defined in the Insurance Act and therefore, it has been understood and explained by the courts in general term to mean as any  fact which would influence the judgment of a prudent insurer in fixing premium or determining whether he would like to accept the risk.  Any fact which goes to the root of the contract of Insurance and has a bearing on the risk involved would be material.   As cited in Pollock and Mulla’s Indian Contract and Specific Relief Act any fact, the knowledge or ignorance of which would materially influence an insurer in making contract or estimating the degree and character of risk in fixing rate of premium is a material fact. If, the proposer   has knowledge of  such facts, he is obliged to disclose it  particularly while answering the questions in the proposal form. Needless to emphasis that any inaccurate answer will entitle to insurer to  repudiate his liability, because there is clear term that information sought for in the proposal form is material for the purpose of a entering into a contract of Insurance. It was further held that contract of insurance is a uberrima fide meaning a contract of utmost good faith of the assured.  Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. It is not for the proposer to determine, whether the information sought for is material for the purpose of the policy or not. Of course, obligation to disclose extends only to fact which are known to the applicant and not  what he ought to have known. The obligation to disclose necessarily depends upon the knowledge one possesses.

 

12.                       In  Krishan Chander’s case(Supra), the deceased life assured got treatment for Asthma  and allergic  bronchitis from 23.5.92 to  9.6.1993 and again from 28.7.1993 to 12.8.1993, but that fact was not disclosed  in the proposal form.  Though the life assured died due to heart failure on 22.9.1994, yet claim  put forth by her husband was repudiated on the ground that she withheld information regarding  her health at the time of purchasing the policy. It was held by the Hon’ble National Commission that answers given by the life assured in the  proposal form were false  to her knowledge, therefore, insurance company was justified in repudiating the claim. In  Shahida Khatoon’s case (Supra), the  deceased life assured was suffering from Diabetes Mellitus, but he did not disclose about the said disease in the proposal form.  Under those circumstances, it was held by the Hon’ble National Commission that material fact was not disclosed, which amounted to violation of the terms of insurance contract on the part of the insured, therefore, claim was rightly repudiated by the insurer. It was also held that  term material fact is not defined in the  Act, therefore, it has been understood and explained in the general terms to mean as any fact which influences the judgment of a prudent insurer  in fixing the premium or determine whether he would like to accept the risk. In Bimla Devi’s case (Supra)  the deceased had undergone an operation for right kidney stone on 18.5.1998 and had availed medical leave for 46 days i.e. from 16.5.1998 to 30.6.1998.The deceased had also taken treatment from Apollo Hospital, New Delhi. The claim was repudiated by the Corporation on the ground that deceased had concealed vital facts regarding his health at the time of making proposal for insurance.  Therefore, the complainant was not entitled to any claim under the policy. The Hon’ble National Commission, considered the judgment of Hon’ble Supreme court in  P.C.Chako and others Vs.Chairman, Life Insurance Corporation of India and others 2008(1) SSC 321, Life Insurance Corporation of India  Versus Asha  Goel, Rattan Lal and Anr.Vs.Metropolitan Insurance co.Ltd. , Satwant Kaur Sandhu ‘s case (Supra), United India Insurance Co.Limited Versus  M.K.J.Corporation  1996 (6) SCC 428,  Carter Vs.Boehm (V) 1766 BURR 1905 and held that  upshot of the entire discussion is that in a contract of Insurance  any fact which   would influence the mind of a prudent insurer in deciding whether to accept or not to accept the risk is a “material fact” .If the proposer has knowledge of such fact, he is obliged to disclose it particularly while answering questions in the proposal form. Needless to emphasise that any inaccurate answer will entitle the insurer to repudiate his liability because there is clear presumption that any information sought for in the proposal form is material fact  for the purpose of entering into a contract of insurance.  Under the facts and circumstances of the case, it was held that it was clear that the insured had suppressed the material  information about the procedure   he had  undergone in 1998  and his  medical condition thereafter, therefore, the claim was rightly repudiated.

 

13.               The facts of the present case are to be analyzed  keeping in view the  proposition of law laid down in the aforediscussed authorities. As per the case of the complainant, the deceased life assured had died due to electric shock. The matter  was  neither reported to the police nor post mortem was got conducted on the dead body.  Except oral evidence, there is no documentary evidence regarding death of deceased life assured  due to electric shock. However, the insurance company has not repudiated the claim of the complainant on this ground, therefore, there is no need to decide the question regarding  the cause of death of the deceased life assured.

 

14.               The material question which falls  for consideration is whether the deceased life assured was suffering from hypertension ( high blood pressure) prior to submission of the proposal form  and she had knowledge about the  said problem.

 

15.               The main plank of the Opposite Party is the copy of the prescription slip Ex.OP6 issued by Dr.Trupati Kharub of Sanjeevni Hospital, Jind on 13.1.2010. In the said prescription slip, it was mentioned that the deceased life assured had been suffering from hypertension for the last three years. Her age was mentioned as 24 years on the date of examination and  blood pressure was  noted as 130/100. Such Blood Pressure at young age is  generally considered on  the higher side.  The  medicines prescribed in the slip were also for treating hypertension  antibiotic   and pain killer. Some tests  and ultra sound were also advised by the doctor. However, there is no evidence  whether those tests were got conducted by the deceased life assured or not. Ex.OP6 is not a computer generated   copy as argued by the learned counsel for the complainant.  The concerned doctor had written the history,  Blood Pressure noted by her,  advice and prescription   in her hand. No doubt the Opposite Party has not produced any affidavit regarding genuineness of the Ex.OP6, but the document cannot be discarded merely for this reason. This Forum is to follow summary procedure, therefore, strict evidence to prove a document by observing mode of proof as per provisions of Evidence Act is not required. If, the complainant wanted to challenge the genuineness of this document, he could also summon the concerned doctor who issued the same to prove that the document is not genuine, but no effort was made by him also in that direction. Therefore, in the absence of any specific material on record, it cannot be considered that the copy of prescription slip Ex.OP6 is forged document and is not genuine. Thus, from this document, it stands established that deceased life assured had been suffering from the problem of hypertension for the last three years  prior to the date of her examination by the doctor on 13.1.2010. Mere fact that  investigator could not lay hands upon the said prescription slip during the course of investigation  does not lead to the conclusion that the said prescription slip was forged by the Opposite Party later on.

 

16.               The copy of the proposal form is Ex.OP1.  The same was signed by the deceased life assured. It is  neither the case of the complainant nor there is  material  on record, which may show that document was not read over and explained to the deceased life assured and her signatures were obtained on blank Proforma. The questions no.29 and 31 are relevant for deciding the present case. Therefore, for proper appreciation of the matter, the same are reproduced as under:

 

Question 29: Are you currently taking any medication or drug, other than minor conditions ( e. g colds and flu) either prescribed or not prescribed by a doctor or have any suffered from any illness, disorder, disability or injury during the past five years which  has  required any form of medical or specialized examination( including  chest  x-rays gynecological investigations, pap smear, or blood tests), consultation, hospitalization or surgery…… NO

 

31. Do you suffer from any medical ailment e.g. diabetes, high blood pressure, cancer, respiratory, daises( including asthma), kidney or liver disease, stroke, any blood disorder. Heard Problems Hepatitis or Tuberculosis, Psychiatric Disorder, Depression, HIV, AIDS or related infection? ………….. NO

 

                             Thus, it is emphatically clear that deceased life assured concealed that she had been suffering from Hypertension(high blood pressure) for the last three years and taking medicines for the same even before submission of the proposal form.It cannot be said by any stretch of imagination that she had no knowledge that she was suffering from hypertension.

 

17.               No doubt, the Opposite Party has neither alleged nor led any evidence that there was nexus between the  cause of death of the deceased life assured and the problem of hypertension with which she was suffering at the time of submission of the proposal form, but the fact remains that deceased life assured had concealed material fact from the Opposite Party regarding her problem of high blood pressure, while submitting proposal form  for obtaining the insurance policy. The law laid down by the Hon’ble National Commission in Abdul Lateef’s case (Supra) does not render any help to the complainant in view of the facts and circumstances of the present case and the law laid down by the Hon’ble Supreme Court in Satwant Kaur Sandhu’s case (Supra) and other authorities relied upon  by the Opposite Party and discussed in the preceding paragraph no.12. The deceased life assured was bound to disclose all the material fact regarding condition of her health under the proposal form, but she knowingly concealed about her disease of hypertension. Therefore, the policy became void on account of concealment of material fact by the life assured in the proposal form

 

 

and in such a situation repudiation of the claim  of the complainant by the Opposite Party cannot be considered as illegal or unjustified in any manner.

 

18.               As a sequel to the foregoing reasons, we do not find any merit in the present complaint. Therefore, the same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:11.04.2016.

                                                               (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

            (Anil Sharma ) 

               Member.

 

 

 

 

 

Present:-       Sh.Subhash Chander Advocate for the complainant.

                    Sh.Naveen Sharma Advocate for the Opposite Party. 

 

                   Vide our separate  order of the even date, the present complaint has been dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

 

Announced
dated:11.04.2016.

                                                               (K.C.Sharma)

                                                                   President,

                                                         District Consumer Disputes

                                                          Redressal Forum, Karnal.

            (Anil Sharma ) 

               Member.

 

 

 

                  

 

 

 

 

 

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