Rajasthan

StateCommission

A/431/2015

Birla Sun Life Insurance Co. Ltd. - Complainant(s)

Versus

Smt. Leela Devi W/o Late Sh. Jai Kishan Kumawat - Opp.Party(s)

Vishal Jain

06 Jul 2016

ORDER

BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR BENCH NO.1

 

FIRST APPEAL NO:431 /2015

 

Birla Sun Life Insurance Company Ltd. regd.office One India Bulls Centre, Tower I, 16^th floor, Jupiter Mill compound 841, Senapati Bapat Marg, Elphinstone Road, Mumbai & ors.

 

Vs.

 

Smt.Leela Devi w/o Late Shri Jai Kishan Kumawat, r/o Madhorajpura, Tehsil Fagi, Distt. Jaipur.

 

Date of Order 6.7.2016

Before:

 

Hon'ble Mr.Vinay Kumar Chawla-Presiding Member

Mr.Kailash Soyal- Member

 

Mr. Vishal Jain counsel for the appellant

Mr.Vikas Kabra counsel for the respondent

 

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BY THE STATE COMMISSION

 

This appeal has been filed against the judgment dated 20.2.2015 passed by learned DCF Tonk by which it allowed the complaint of the complainant and directed the appellant company to pass the death claim of the husband of the complainant.

 

The husband of the complainant had taken two policies on his life on 16.8.2012 – policy no. 005717410 sum assured Rs. 1 lakh and policy no. 005717411 sum assured Rs. 10 lakhs. The complainant's husband died on 10.7.2013 and his death claim was repudiated by the insurance company on the ground of suppression of material facts regarding his health by the complainant's husband. The company submitted that on the basis of the report of the investigator it was found that complainant's husband was suffering from tongue cancer and this fact was concealed by him in the proposal form. Therefore, the claim is liable to be repudiated. The learned DCF however, came to the conclusion that company has not been able to prove the fact that complainant's husband was

 

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suffering from tongue cancer as no sufficient evidence was on record.

 

The learned counsel for the company arguing his appeal submitted that on the basis of the report of the investigator and the medical record Anx. 1 of SMS Hospital,Jaipur it is amply proved that deceased was suffering from tongue cancer and he was admitted to SMS Hospital,Jaipur. He submitted that learned DCF has erred in rejecting this evidence. The learned counsel for the company has relied on the judgment of the Hon'ble National Commission in I (2015) CPJ 121 (NC) Ram Ratti Vs. Life Insurance Corporation of India. In this case the fact of previous disease was suppressed which was proved by true attested copies of history and findings of the deceased. He also relied on II (2016) CPJ 396 Life Insurance Corporation of India Vs. Maya Devi but this judgment is not directly related to the question before us. This judgment related to the question of nexus of death with the ailment suffered by the deceased.

 

On the other hand the learned counsel for the complainant has cited the judgment of the Hon'ble National

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Commission in R.P.No. 1490/2014 and other connected matters ICICI Prudential Life Insurance Co. Vs. Mrs.Veena Sharma. The learned counsel submitted that it has been held that onus of proving that deceased had obtained the policy by suppressing facts relating to his illness is always on the insurance company.

 

We have heard the arguments of both sides and have perused the record.

 

We are in agreement with the contention of the learned counsel for the company that in case of suppression of material facts regarding illness the claim is liable to be rejected. At the same time we are also in agreement with the contention of the learned counsel for the complainant that onus of proving suppression of material facts regarding illness lies on the insurance company.

 

We have to see whether the company has been able to discharge its burden to prove the previous illness of the deceased. Only three documents Anx.1 have been produced in support of this fact. Anx. 1 is an Admission and Discharge

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record dated 19.12.2011 but page 1 of Anx. 1 bears no name of the patient. It only states that patient be admitted in Day Care Ward of Dr.O.P.Sharma. Patient's name is missing on this paper. Next paper also does not bear any patient's name. Few medicines have been prescribed in this paper. To whom this prescription was made is not proved. Third paper of Anx.1 is also Admission and Discharge record dated 10.7.2012. The date mentioned is not clear. In this paper also it is mentioned that admit patient in Day Care Ward though it bears the name of Jai Kishan the deceased husband of the complainant. Another prescription is page 4 of Anx. 1 dated 10.1.2012 also prescribes some medicines but to whom this prescription was made is not proved and on this paper word 'prostate' has been mentioned. This prescription is with regard to tongue cancer is also not proved. Except for these four papers there is no other evidence on record to support the allegation of the company that deceased was suffering from tongue cancer and had taken treatment before taking the insurance on his life.

 

On the basis of this record where the papers do not bear the name of the deceased and there are two Admission and

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Discharge records and it is not proved whether deceased was ever admitted for treatment in the hospital or not, what treatment was given, when he was discharged, under whose care he was admitted, is nothing on record and company has failed to prove the fact of suppression of facts regarding illness. The learned DCF has rightly rejected the evidence of the company on this point and relying on the judgment of the Hon'ble National Commission in ICICI Prudential Life Insurance Vs. Mrs.Veena Sharma we hold that the fact of previous existing illness has not been proved and there is no ground to interfere with the order of the learned DCF. The appeal is dismissed.

 

 

(Kailash Soyal) (Vinay Kumar Chawla)

Member Presiding Member

 

 

 

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