DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
(CENTRAL) ISBT KASHMERE GATE DELHI
CC No. 228/2015
No. DF/ Central/ Date
Sh. Vishwanath Pandey,
S/o Late Sh. Kapil Dev Pandey,
R/o House No. 13, Gali No. 2 L,
Adarsh Enclave,
Prem Nagar – II, Nangloi, Delhi
...COMPLAINANT
VERSUS
Shri Ram Life Insurance
Through its Director/Manager/
Authorized Representative
Having its Office at:
1005, 10th Floor, Vikrant Tower,
New Delhi - 08
…..OPPOSITE PARTY
Ms. Rekha Rani President
Sh. Vikram Kumar Dabas, Member Mrs. Manju Bala Sharma, Member
ORDER Date: 11.01 .2018
Sh. Vikram Kumar Dabas
1. The complainant is a beneficiary in respect of 3 polices of Insurance in the name of his wife. The details of the complainant are as under:
Policy No. NP131200029202, NP131200018563, NP131200061685 for the period from 30.03.2012 to 28.03.2012, 25.02.2012 to 15.03.2012 and 09.08.2012
to 16.08.2012 respectively. The wife of the complainant was admitted to Singh
Medical and Research Centre Pvt. Ltd Varanasi UP on 23/11/2012 and after surgery
she was shifted to Ramkrishan Mishan Home of Savas, Laksa, Varanasi on 17/12/2012 where she expired on 19/12/12 at 11:25 PM due to sudden Cardio Respiratory arrest. The complainant filed claim with OP for the insured amount of
Rs. 3,52,000/-. The OP repudiated the claim of the complainant. Hence the complaint. The complainant has prayed that insured amount of Rs. 3,50,000/- a sum of Rs. 5,00,000/- towards mental agony and harassment and Rs. 50,000/- as litigation charges be paid to the complainant by the OP.
2. The OP has contested the complainant and has filed its written statement. It has claimed that this complaint is not maintainable and is liable to be dismissed as the complainant has not approached this Forum with clean hands. It has stated that the complainant himself is the Insurance Agent for the policies purchased in the name of his deceased wife. It has stated that in the proposal form the Insured did not disclose true facts about her state of health. It has stated that the Insured was suffering from DM II (Diabetes Mellitus Type II) & HTN (Hypertension) for a period of 03 years before purchase of the policies which fact was concealed at the time of purchase. It is stated that a contract of Insurance is governed by the principles of Uberrima Fide and since the insured had concealed material facts the contract stood vitiated and no benefit can be derived for the same. It has stated that
the claim lodged by the complainant was repudiated because of non disclosure and
concealment of facts in the proposal form. It has stated that there are no merits in
the complaint and the same is liable to be dismissed. It has prayed accordingly.
3. The complainant has filed his own affidavit wherein he has reiterated the contents of the complaint filed by him. OP has also filed an affidavit of evidence and has relied upon the proposal form and other documents placed on record.
4. We have heard arguments advanced at the bar and have perused the record.
The Learned Counsel for the OP has taken us through the proposal form vide which the polices were purchased in the name of the Insured. He has pointed out that the Insured was specifically asked as to whether she had ever suffered or was suffering from Diabetes, High/Low BP to which she had replied in the negative. He has also pointed out that the complainant himself has made a recommendation at the foot of the proposal form with the remarks that he had verified the information given in the proposal form by discrete inquiries and had found that the information was true to the best of his knowledge & belief. The Learned Counsel has then taken us through the case record prepared at Ramkrishan Mishan Home of Savas, Laksa, Varanasi. The case record shows that the Insured/deceased had a past history of DM II (Diabetes Mellitus Type II ) and HTN (Hypertension) for the last 3 years.
5. We are convinced that the policies were obtained by the deceased by suppression and concealment of material facts which she was bound to disclose. The complainant himself was the Insurance agent in respect of the Polices. The OP was justified in repudiating the claim lodged by the complainant as the contract of Insurance stood vitiated because of absence of good faith. There are no merits in this complaint. The same is hereby dismissed. Copy of the order be supplied to the parties as per rules.
Announced this ___________day of __________2018.
