DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, LUCKNOW
CASE No.467 of 2012
Sri Gajendra Pratap Singh, aged about 39 yrs.,
S/o Late Sri Kaushlendra Pratap Singh,
R/o House No.139/1, Jaihind Nagar,
Gabhariya, Sultanpur, U.P.
……Complainant
Versus
1. SBI Life Insurance Co. Ltd.,
Central Processing Centre,
Kapas Bhawan, Plot No.3A,
Sector No.-10, C.B.D. Belapur,
Navi Mumbai-400614.
Through Pradahan (Dawa).
2. SBI Life Insurance Co. Ltd.,
Zonal Office, 2nd Floor,
Metro Tower, In front of Saharaganj,
Shahnajaf Road, Lucknow.
Through Authorised Officer.
.......Opp. Parties
Present:-
Sri Vijai Varma, President.
Smt. Anju Awasthy, Member.
JUDGMENT
This complaint has been filed by the Complainant against the OPs for payment of balance insured amount with interest, compensation of Rs.1,50,000.00 and cost of litigation of Rs.15,000.00.
The case in brief of the Complainant is that the Complainant’s father got insured in 2009 for a sum of Rs.5.00 lakhs where Rs.1.00 lakh was to be deposited each year as premium. The Complainant’s father had told the representatives of the OPs at the time of getting the insurance that he had suffered a heart attack in the year 1998 and had also to be admitted in the hospital during that period. The Complainant’s father had also told to the representatives of the
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OPs that he has undergone treatment and after the medical examination if any fault was found then the insurance of the Complainant should not be done. On this condition the OPs had filled the proposal form of the Complainant’s father wherein there were many empty columns and the signature of the Complainant’s father was obtained on the ground that they would be filled up after doctor’s report and after all the formalities and the report of the medical examination, his proposal was accepted and he was asked to deposit the premium amount. Under the policy the benefits were to accrue to the Complainant’s father or a person nominated by him. On 09.02.2012 the Complainant’s father Sri Kaushlendra Pratap Singh died and the Complainant informed the OPs about it and thereafter pressed insurance claim with the OP but on 02.04.2012 Complainant received a letter from the OP that the claim of the Complainant was repudiated on the ground of the insured concealing facts about the illness and then the Complainant also came to know that a sum of Rs.2,60,634.00 has been credited in his a/c without the permission of the Complainant but the Complainant made the OPs aware of dissatisfaction of the amount paid to him. The Complainant should be paid Rs.5.00 lakhs insured amount with accrued benefits and interest. Since the OPs have made part payment to the Complainant, therefore he is entitled to the remaining balance amount also. The OPs have committed deficiency in service, therefore he should be paid the balance amount of the insured amount and compensation of Rs.1,50,000.00 as also cost of litigation of Rs.15,000.00.
The OPs have filed the WS wherein it is mainly submitted that the life insurance contract is a contract of utmost good faith but the Complainant has committed a breach of principle of utmost good faith by intentionally suppressing
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the material facts. Sri Kaushlendra Pratap Singh Complainant’s father had undergone “coronary angioplasty” prior to the date of signing the proposal form. Had the deceased life assured disclosed the above facts, the risk cover would not have been accepted by the OPs and the proposal itself would have been rejected by them. The proposal form should disclose all the material facts for availing the insurance cover but the insured Sri Kaushlendra Pratap Singh had replied in negative to the question as to whether during the last 10 years had he undergone or advised to undergo hospitalisation and operation or any investigation or test or medical treatment. He had also replied in negative to the question as to whether he was suffering from or had suffered or underwent any investigation or treatment for heart disease. In many cases decided by the Hon’ble Apex Court and Hon’ble NCDRC it has been held that the life assured is bound to disclose honestly and truthfully in the proposal form but the life assured had concealed material facts for obtaining the insurance cover. As per the discharge summary 31.10.2011 of Sahara Hospital the clinical diagnosis of the deceased was mentioned as hypertension, CAD, COPD, old AWMI, Post PTCA, CHB, Post Cardiac Arrest. The Complainant had also claimed reimbursement of the medical expenses of the treatment during his hospitalisation in Sahara Hospital. He had also replied in negative about suffering from any heart disease or investigation done for the same in the preliminary medical examination conducted by the OPs. On the basis of suppressing of the material facts by the deceased life assured the claim of the Complainant was repudiated but as per the policy terms and conditions the OPs have refunded the fund value of Rs.2,60,634.00 directly crediting to the Complainants saving bank a/c No.91001001729113 on 26.03.2012. Since the policy was taken by the deceased life assured on the basis of suppression of material facts, therefore the OPs were well
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within their rights to repudiate the claim and hence they have not committed any deficiency in service, therefore this complaint deserves to be dismissed.
The Complainant has filed his reply to the WS.
The Complainant has filed his affidavit with paper No.3/2 to 3/10. The OPs have filed the affidavit of Sri V. Srinivas, authorised representative, SBI Life Insurance Co. Ltd. and annexure A to G with the WS.
None was present from the side of the Complainant to argue the case. Heard Counsel for the OP and perused the entire record.
Now, it is to be seen as to whether the Complainant’s father had taken the insurance policy from the OPs, concealing and suppressing material facts in the proposal form and therefore the OPs have rightly repudiated the claim of the Complainant or not and whether the OPs have by repudiating the claim of the Complainant committed deficiency in service as also unfair trade practice and its consequences.
In this case, the Complainant’s father had taken an insurance policy with the OPs but when he died the assured amount was not given to the Complainant. The ground taken by the OPs for repudiating the claim of the Complainant is that the Complainant had concealed material facts in the proposal form and therefore there was breach of utmost good faith on the part of the deceased life assured and hence the repudiation. The Complainant on the contrary has taken the stand that there was no concealment of facts and the fact about the heart disease and the consequent hospitalisation was divulged to the representative of the OPs and therefore there was no concealment of material facts and hence the repudiation was wrong and the OPs have committed deficiency in service. In this regard, it is important to peruse the proposal form. In the proposal form the deceased life assured had answered in negative to a question as whether during last 10 years he had
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undergone and advised to undergo for hospitalisation, operation or any investigation or test or medical treatment. He has also answered in negative to a question whether he was suffering from or suffered or underwent investigation or treatment for heart disease. Thus, there is no mention by deceased life assured that he ever suffered from heart disease whereas the Complainant has admitted in his complaint that his father did suffer heart attack in the year 1998 and was hospitalised during that period. Now, here a simple question arises as to when the assured suffered from heart attack in 1998 and also was admitted in the hospital during that period then why did he not mention this fact in his proposal form. The explanation given is that there was certain columns which were unfilled because the representatives of the OPs told the deceased life assured that these columns were to be filled up after his medical examination. But this appears to be very lame excuse as the proposal form is supposed to be filled up by the life assured on a particular date and place. Besides, in the form for medical examination, a copy of which is annexure A, the deceased had answered in negative about the heart attack or any other heart trouble. Now, even if it is taken, for the arguments sake, that there was certain columns which remain unfilled in the proposal form because of the medical examination by the OPs for the deceased, then too there is no justification for not answering correctly to the questions given in the medical examination form. Besides the proposal form appears to have been filled on 06.11.2009 which is the date subsequent to the date of medical examination for the life assured. Therefore, there is no justification for the life assured not to correctly fill up the form after the medical examination was done and there is no substance in the stand taken by the Complainant that certain columns remain unfilled because the medical examination was to be done. Thus, it is absolutely
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clear that the Complainant’s father had suffered heart attack in 1998 and was also hospitalised for the same and this material fact was concealed by the deceased life assured while taking policy from the OPs. Such a material concealment of fact by the deceased life assured is in fact breach of the trust of utmost good faith on the part of the life assured and therefore the OPs were well within their rights in repudiating the claim of the Complainant on the aforesaid grounds of concealment of material facts and hence they have not committed any deficiency in service in the repudiation of the claim and therefore this complaint deserves to be dismissed as devoid of merit.
ORDER
The complaint is dismissed.
The parties to bear their own costs.
(Anju Awasthy) (Vijai Varma)
Member President
Dated: 9 April, 2015
