C.VISWANATH

1. The present Revision Petition is filed by the Petitioner under Section 21(b) of the Consumer Protection Act, 1986 against the Order passed by the Bihar State Consumer Disputes Redressal Commission (hereinafter referred to as the “State Commission”) in F.A. No. 142/2016 dated 31.07.2018.

    

2. In the Complaint Case, the Respondent/Complainant’s mother Leela Devi had purchased a Life Insurance Policy from the Petitioner Insurance Company for Rs.1,95,000/- on 11.03.2013,vide Policy No. 50835195.Respondent was the nominee in this Policy. On 27.04.2013, the Respondent’s mother had high fever and went to Dr. Krishna Bhushan Nath for treatment.He, however, could not save her and she died. According to the certificate given by the doctor, Respondent’s mother was suffering from acute encephalitis.Thereafter, the Respondent submitted the claim with all relevant papers as required by the Petitioner and pursued the claim with the Petitioner.The Petitioner was later informed by the Respondent, vide letter dated 18.03.2014, that his claim was rejected on the ground of misrepresentation about the occupation and income of the Deceased Life Assured.A Complaint was, thus, filed by the Respondent alleging deficiency of service on the part of the Petitioner.

    

3. The Complaint was contested by the Petitioner in the District Forum, by contending that the claim of the Respondent was based on a Policy which was void ab-initio, invalid and unenforceable and was not maintainable. The Respondent’s mother concealed information about her occupation, nature of duties and income and gave false information in the proposal form. The Respondent’s mother mentioned in the Policy that she was having an annual income of Rs.1,50,000/- from business. But, on investigation, it was found that she was not engaged in any business, but was a housewife and a BPL person. Although the Petitioner made repeated requests, the Respondent did not provide any income proof, business registration documents etc. to the Petitioner.

    

4. District Forum, vide order 09.03.2016, allowed the Complaint and directed the Petitioner to pay Rs.1,95,000/-, sum assured amount, with interest @8% from the date of death of the insured person. The Petitioner was further directed to pay Rs.20,000/- for mental, physical harassment as well as litigation cost. Both the payments were to be made within 30 days of order, otherwise the Respondent was entitled to recover it from the process of law.

    

5. Petitioner filed an Appeal before the State Commission against the orders passed by the District Forum. State Commission, vide order dated 31.07.2018, partly allowed the appeal and directed that instead of payment of interest from the date of death of life assured, interest should be paid from the date of filing of the Complaint i.e. 12.02.2015. The said amount should be paid within a period of 2 months on receipt/production of the certified copy of the order, failing which interest @10% p.a. shall be payable till payment.

    

6. Aggrieved by the order of the State Commission, the Petitioner has filed the present Revision Petition on the following grounds:

a.      The DLA had concealed the material fact that she belonged to BPL family. Both the Foras below failed to consider the fact that DLA was under solemn obligation to disclose all the material facts in the proposal form.

b.      The Hon’ble Commission below had failed to note that the Respondent and the family members of the DLA failed to provide any document substantiating the income or business of the DLA at the time of claim investigation.

c.       By not giving true information about income and occupation, the Respondent violated the provisions of the Section 2(1)(d) of the IRDAI (Protection of Policyholders’ Interests) Regulations, 2002 (as superseded by Section 4(8) of the IRDAI [Protection of Policyholders’ Interests Regulations, 2017].

d.      State Commission passed the order in a mechanical way without appreciating the written statement, documents such as BPL Ration Card of the DLA which clearly established  that the DLA had mispresented her income to be Rs.1,50,000 annually.

e.      The State Commission did not take into consideration the fact that Insurance is a matter of utmost good faith and if the Policy holder has concealed material facts, then the contract of Insurance becomes void ab initio and the Petitioner is not liable to pay any benefits under a void contract.

f.       The order passed by the State Commission itself shows that they have failed to opine on the BPL ration card of the DLA and the investigation report. 

g.      The Hon’ble Commission below ought to have disposed of the case on its own merits in the interest of justice.

1. Heard the Learned Counsel for the Petitioner. He reiterated his contentions as stated above.Also carefully perused the record.

    

2. It is an undisputed and admitted fact that the Respondent’s mother purchased a life insurance policy from the Petitioner Insurance Company on 13.03.2013.  The Policyholder died on 27.04.2013, having suffered high fever and convulsion and cardiac arrest at her residence.  As per the investigation conducted by the Insurance Company, the disease or the ailment, due to which she died was first suspected only 2 days before her death. The death was natural as per medical certificate. 

    

3. The Petitioner, while expressing heart-felt condolences on the early demise of the Respondent’s mother, repudiated the claim of the Respondent, vide letter dated 18.03.2014.In the letter of repudiation, it was mentioned that upon investigation they understand that there was a gross misstatement of occupation and income as mentioned in the proposal form.The Respondent has misled them to grant insurance cover under the Policy.Hence the contract was void abinitio and as per the terms and conditions of the Policy, all premiums paid would be forfeited by the company.Normally, it is seen that claims are repudiated for the period not being covered by the policy or due to statutory violations like having no validity of driving licence etc., pre-existing disease in so far as medical insurance cover is concerned etc.This is a case where it is alleged that the deceased had misrepresented her occupation and income and hence called for repudiation of the claim.

    

4. It is not the case of the Petitioner that the Respondent’s mother was suffering from any terminal disease and the Policy was taken only to make the subsequent claim.In fact, the investigation report of the Insurance Company clearly states that, except suspected hypertension and diabetes, there was no other ailment from which the Respondent’s mother suffered.She suddenly developed high fever shivering and breathlessness and soon after expired at her residence, due to cardiac arrest.The only ground on which the claim has been repudiated is that her source of income was declared as business with an annual income of Rs.1,50,000/-.A copy of the ration card has been placed without any date before us, which declares her husband’s occupation as farmer and indicates BPL No. 3672.It is logical for a farmer’s wife to deal in the business of sale and purchase of foodgrains and earn some money.The only unanswered issue is how much money.However, there certainly does not appear to be any gross misstatement of occupation and income, nor any willful suppression of information, especially in the light of the fact that she is an illiterate person and the form was filled-up by another person.The financial standing and income proof of the proposer and the life assured had been personally verified and duly certified by IRDA licensed advisor as well as the authorized signatory.The occupation of the Policyholder is certainly not a hazardous occupation nor the sum assured is a very huge amount, which warrants the Petitioner Company to create much ado about the alleged suppression of the occupation and income of the insured.Life Insurance Policy is taken to cover the risk to life, which is equally dear and costly to every person, whether rich or poor.After having got the financial standing and income checked and verified by IRDA licensed advisor and authorized signatory, repudiation of the claim is not justified.The District Forum and the State Commission have rightly supported the claim of the Respondent/Complainant.

    

5. In view of the above, the present Revision Petition is dismissed.There shall be no order as to costs.