NCDRC

NCDRC

RP/3121/2006

LIFE INSURANCE CORP. OF INDIA - Complainant(s)

Versus

RUPINDER KAUR - Opp.Party(s)

MR. ANOOP K. KAUSHAL

18 Jan 2011

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 3121 OF 2006
 
(Against the Order dated 22/05/2006 in Appeal No. 79/2006 of the State Commission Punjab)
1. LIFE INSURANCE CORP. OF INDIA
HAVING ITS NORTHEN ZONAL OFFICE
AT JEEVAN BHARTI BULIDING TOWER -II 124, CONNAUGH
NEW DELHI
...........Petitioner(s)
Versus 
1. RUPINDER KAUR
VILLAGE CHOTIA POST OFFICE SAHIB CHAND TEHSIL GIDDERBAHA
DISTT MUKTSAR
PUNJAB
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE R.K. BATTA, PRESIDING MEMBER
 HON'BLE MR. VINAY KUMAR, MEMBER

For the Petitioner :
Mr. A.K. Kaushal, Advocate
For the Respondent :
Mr. R.S. Mann, Advocate

Dated : 18 Jan 2011
ORDER

 

1.      This Revision Petition is filed against the order of the Punjab, State Consumer Disputes Redressal Commission, in Appeal No.79 of 2006. The husband of the present Respondent had obtained a life insurance policy for Rs.3, lakhs from the Revision Petitioner on 14.02.2004 and died, less than a month thereafter, on 10.03.2004. The present Respondent/Complainant claims as the nominee of the insured. The insurance claim was repudiated by the Revision Petitioner, on 30.08.2004 on the ground of the deceased having withheld material information regarding his health at the time of obtaining the policy. It was alleged in this letter that “before he submitted the proposal for the above policy he was taking treatment for Hypertension and suffering from High Blood Pressure and Depression. In addition to this he was a patient for Fracture. (Calvie. Rt. Side) He did not, however, disclose these facts in his proposal. Instead he gave false answers therein as stated above.”
 
2.      In the Consumer Complaint filed by the Complainant Rupinder Kaur, the District Consumer Disputes Redressal Commission, Muktsar held that there was no attempt by the LIC to prove the pre-existing disease and therefore, the repudiation was unsustainable. The LIC/OP was directed to pay the insured amount along with a compensation of Rs.5000/- for mental harassment and litigation expenses.
 
3.      The Appeal by the Revision Petitioner/LIC was dismissed by the Punjab, State Consumer Disputes Redressal Commission, with the following observation :-
“In “Mithoolal Nayak V. Life Insurance Corporation of India” AIR, 1962 SC 814it was observed by the Supreme Court that the three conditions for the application of the second part of Section 45 are:
(a)                           the statement must be on a material matter or must suppress facts which it was material to disclose;
(b)                           the suppression must be fraudulently made by the policy-holder; and
(c)                           the policy-holder must have known at the time of making the statement that it was false or that it suppressed fact which was material to disclose.”
 
According to us, none of the three conditions are present in the case in hand.  According to us, the ground for repudiation was not well based. So far as the question of fracture is concerned, that is not a disease and otherwise also the date of the fracture is not coming on the record and moreover by the time the policy was taken the assured had fully recovered from the fracture. It has also been mentioned by the investigator that the assured’s employer had given a certificate that no medical leave had been taken by the assured. The doctor of the LIC had examined the assured before he was given the insurance policy and he had given certificate of good health and he also did not notice anything wrong with the assured. If the person is suffering from blood pressure, certainly the doctor of the LIC who examined the assured before taking the insurance policy would notice that the assured is suffering from blood pressure. Nexus also becomes relevant between the alleged suppression of the disease and the cause of death. There is no nexus of the cause of death with the alleged suppression of the diseases.”
 
 
4.      The above order has been challenged by the Revision petitioner primarily on the ground that it was a case of deliberate suppression of material facts and the deceased/assured knew that the facts were material, but chose not to disclose them. It is argued that this amounted to violation of principle of utmost good faith on which a contract of insurance is based.
 
5.      We have perused the records of this case and heard the counsel for the two parties. It was pointed out that the case fall within the scope of Section 45 of the Insurance Act, 1938, which makes the following provisions:-
“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]”.
 
 
6.      The present case being one of the death of the insured within a month of commencement of the policy, was accordingly got investigated by the LIC and the finding thereof had been made basis for repudiation of the claim. The grounds for repudiation was non-disclosure of the following in the insurance proposal form:-
a)                That he has taken treatment for hypertension.
b)                That he had suffered a fracture. 
 
7.      The deceased was a Police Constable in Muktsar. We find from the records of the case that before the District Forum, both grounds relied upon by the Revision Petitioner/LIC were challenged on behalf of the Complainant through documentary evidence from the office of Senior Superintendent of Police Muktsar, that the insured had not taken leave during the period in question and not remained on medical rest. The District Forum has also recorded that no evidence was led on behalf of the LIC against it and in support of their claim in the letter of repudiation. In the appeal, the State Commission has even observed that if the proposer was suffering from the Blood pressure, the Doctor of the LIC who examined him before the insurance would certainly found it out. Further, we fail to understand why could the LIC not check with the Police department instead of relying on uncorroborated evidence from private sources.
 
8.      In the result, we agree with the concurrent findings of fora below that the LIC has used grounds for repudiation of the claim which have not travelled beyond the stage of allegations before the District Forum and the State Commission. In neither Forum has the Revision Petitioner/LIC been able to prove with evidence that the policy was obtained by suppressing information relevant in column no.11 dealing with personal history of the proposer in the Proposal For Insurance on own life. The Revision Petition, is accordingly dismissed and the order of the State Commission confirmed.
 
......................J
R.K. BATTA
PRESIDING MEMBER
......................
VINAY KUMAR
MEMBER

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