Haryana

StateCommission

A/1129/2014

SBI Life Insurance Company Ltd - Complainant(s)

Versus

Smt. Kelo Devi - Opp.Party(s)

19 Dec 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA.

 

                                                F.A.No.1129 of 2014

                                             Date of Institution: 08.12.2014

          Date of Decision:19.12.2016

 

1.      SBI Life Insurance Company Ltd. Central processing Centre, Kapas Bhawan, Plot No.3 A, CBD Belapur, Navi Mumbai.

2.      SBI Life Insurance Company Ltd., SCO No.101-103, 2^nd Floor Batra Building, Sector 17-D Chandigarh, through its Branch Manager.

3.      SBI Life Insurance Company Limited,1^st Floor, Malhotra Bhawan, Above Union Bank GT Road, Fatehabad.

…..Appellants

Versus

 

Smt. Kelo Devi W/o Late Shri Shamsher Singh R/o H.No.72, VPO Mangli Tehsil tohana, Distt. Fatehabad.

          …..Respondent

 

CORAM:             Mr. R.K.Bishnoi, Judicial Member.

                   Mrs.Urvashi Agnihotri, Member.                                    

For the parties:  Mr.Rajneesh Malhotra, Advocate counsel for the appellants.

                             Mr.Shailender Mohan, Advocate counsel for the respondent.

 

O R D E R

 

R.K.BISHNOI, JUDICIAL MEMBER :-

As per complainant, her husband-Shamsher Singh obtained SBI Life Flexi Smart Insurance policy from opposite parties (O.Ps.) on 11.06.2012 with sum assured of Rs.4,50,000/-. He died on11.10.2012 at the age of 55 years. He was medically examined by the doctors of insurance company before obtaining insurance policy.  All the documents were submitted, but, the same was repudiated without any reason. 

2.      O.Ps. filed reply controverting her averments and alleged that Deceased Life Assured (DLA) Shamsher Singh concealed the fact of previous ailment while obtaining insurance policy on 11.06.2012. Lateron it came to their knowledge that he was suffering from cancer much before obtaining insurance policy. It is the fundamental principle of insurance law that utmost good faith must be observed by the contracting parties and good faith forbids either party from non-disclosure of the facts which the parties know. She is not entitled for compensation because cardinal principle of contract of life insurance is uberrema fides i.e. the principle of utmost good faith.

3.      After hearing both the parties, learned District Consumer Disputes Redressal Forum, Fatehabad (In short “District Forum”) allowed the complaint vide impugned order dated  14.11.2014 and directed the O.Ps. to pay the amount of Rs.4,50,000/- alongwith interest @ 6% from the date of filing of complaint till realization.

4.      Feeling aggrieved therefrom, O.Ps.-appellants have preferred this appeal.

5.      Arguments heard. File perused.

6.      Learned counsel for the complainant-respondent vehemently argued that DLA was not suffering from any ailment at the time of obtaining insurance policy. He died natural death and not due to cancer, so it cannot be presumed that he concealed the fact of previous ailment. Learned District forum rightly granted compensation and the appeal be dismissed.

7.      This argument is devoid of any force. While obtaining insurance cover DLA submitted proposal form Annexure-B. It was alleged at that time that he was not suffering from any ailment, but, from the perusal of evidence available on the file, it is clear that he was patient of cancer since long and also took treatment from hospital. From the perusal of treatment record Annexure E dated 29.02.2012 it is clear that he was patient of cancer growth below tounque (GBT) and biopsy was done.  It is also mentioned in  Annexure F Sukhda Multispeciality Hospital  dated 14.06.2012 and Annexure H dated  17.09.2012 also shows that he was receiving treatment since long and that is why tests for  Blood Urea, Serum Creatinine and CBC were conducted. Annexure I dated 22.06.2013 issued by Gram Panchayat Nangli shows that DLA died due to cancer and he was suffering from this ailment since one year.  It shows that DLA was suffering from cancer before obtaining policy as biopsy was done on 04.06.2012 and thereafter he obtained this insurance policy on 11.06.2012. He concealed this fact from insurance company. When complainant has concealed the true facts from the opposite party he was not entitled for any relief as per opinion of Hon’ble National Commission expressed in revision petition No.3114 of 2014 titled as Amzad Khan Vs. Aviva Life Insurance Co. Ltd. decided on 30.01.2015. Relevant portion of which is as under:-

“It is submitted that the contract of insurance including the contract of life assurance are contracts uberrima fides and every material fact must be disclosed otherwise there is good ground for rescission of the contract.  The Apex Court Judgement of Satwat Kaur Sandu Vs. New India Assurance Co. Ltd. IV (2009) CPJ 8 (SC) has referred the term “proposal Form” as defined under the Insurance Regulatory and Development Authority, 2002 as a “Form” to be filled in by the proposer for insurance, for furnishing all material information required by the insurer to decide whether to accept or decline, to undertake the risk and in the event of  acceptance of the risk, to determine the rates, terms and conditions of a cover to be granted and observed 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 “material fact”.  If the  proposer has knowledge of such fact, he is obliged to disclose it particularly while answering questions in the proposal form.  It is submitted that the complainant has no “locus standi” to claim any alleged sum assured, as the insurance policy was obtained by the DLI by mis-representation of material facts in order to defraud the opposite party.  The contract of insurance is void, and not tenable in the eyes of law as it is entered by DLI to defraud the opposite party.  In these circumstances, the complaint is liable to be dismissed in limine.”

It is opined in this case that if such like fact is not disclosed at the time of obtaining insurance policy the same is fatal.

8.      In view  of the above discussion, appeal is allowed and the impugned order dated 14.11.2014 of the District Forum is set aside. Complaint is dismissed.

9.      The statutory amount of Rs.25000/- deposited at the time of filing of the appeal be refunded to the appellants against proper receipt and identification.

 

December 19th, 2016

Mrs.Urvashi Agnihotri Member, Addl.Bench

R.K.Bishnoi, Judicial Member Addl.Bench

 

S.K.