Madhya Pradesh

StateCommission

A/17/1942

BAJAJ ALLIANCE LIC - Complainant(s)

Versus

SMT.LEELA BAI - Opp.Party(s)

MS.SANGEETA MOHARIR

16 Mar 2023

ORDER

M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BHOPAL

PLOT NO.76, ARERA HILLS, BHOPAL

 

 FIRST APPEAL NO. 1942 OF 2017

(Arising out of order dated 22.08.2017 passed in C.C.No.35/2016 by the District Commission, Indore-2)

 

BAJAJ ALLIANZ LIFE INSURANCE CO.LTD.

WEST HUB, SECOND FLOOR,

BAJAJ FINE SERVE SARVEY 208/1 B

BEHIND WICKFIELD IT BUILDING,

VIMAN NAGAR ROAD,

PUNE (M.S.)                                                                                                          …         APPELLANT.

 

Versus                

LATE SMT. LEELA BAI W/O LATE RAMCHARAN,

THROUGH LR SMT. ANITA VERMA

W/O LATE SHRI PAWAN VERMA

R/O VILLAGE-JAMGOD,

TEHSIL & DISTRICT-DEWAS (M.P.)                                                                       …      RESPONDENT.                                      

 

BEFORE:

                 HON’BLE SHRI A. K. TIWARI                      :  PRESIDING MEMBER

                HON’BLE DR. SRIKANT PANDEY               :  MEMBER    

 

COUNSEL FOR PARTIES :

      Ms. Sangita Moharir, learned counsel for the appellant.

      Shri Amit Kumar learned counsel for the respondent.

                                                                               

                                                            O R D E R

                                       (Passed On 16.03.2023)

                   The following order of the Commission was delivered by A. K. Tiwari, Presiding Member:    

                         This is an appeal by the opposite party/appellant-insurance company against the order dated 22.08.2017 passed by the District Consumer Disputes Redressal Commission, Indore-2 (for short ‘District Commission’) in C.C.No.35/2016, whereby the complaint filed by the complainant/respondent against it has been allowed.

 

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2.                The facts of the case in short are that son of the complainant Pawan Verma during his life time had obtained insurance policy no.0315271490 from the opposite party/appellant having risk commencement from 02.05.2014. The total premium for a sum of Rs.3,19,103/- was to be paid in 20 years and the sum assured was Rs.9,00,000/- under the said policy. During the policy cover period, son of the complainant Pawan Verma died on 23.09.2014 due to severe chest pain. The complainant being nominee of her son Pawan Verma (hereinafter referred to as deceased-insured) filed death claim with the opposite party-insurance company which was repudiated by the insurance company on the ground of concealment of material fact that the deceased-insured was treated for cancer before obtaining the policy and this fact was suppressed by him while filling the proposal form in order to obtain the insurance policy.  The complainant therefore alleging deficiency in service on part of the opposite party-insurance company approached the District Commission seeking relief of Rs.10,00,000/-.

3.                The opposite party-insurance company though admitting issuance of policy to the deceased-insured stated that complainant’s son deceased-insured was suffering from cancer before obtaining the insurance policy and this fact was concealed by him in the proposal form in order to obtain the insurance policy. The insurance company has rightly repudiated

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the claim and therefore there is no deficiency in service on part of the opposite party-insurance company.  It is therefore prayed that the complaint be dismissed with costs.

4.                The District Commission after appreciating facts and circumstances of the matter held that the opposite party has not been able to prove their allegations against the insured that the insured was suffering from cancer before obtaining the policy.  The District Commission therefore allowed the complaint and directed the opposite party-insurance company to pay sum assured Rs.9,00,000/- within a period of two months failing which the amount shall carry interest @ 8% p.a. Costs of Rs.3,000/- is also awarded.

5.                Heard learned counsels for the parties and perused the record.

6.                Learned counsel for the appellant argued that the impugned order is patently perverse and is passed without considering the documents filed on record. The District Commission overlooked the admission ticket filed by the opposite party-insurance company clearing demonstrating that deceased-insured was treated for Cancer in Hard Palate in Government Cancer Hospital, Indore and this fact was not disclosed by him in the proposal form while obtaining the insurance policy. The District Commission has grossly erred in considering the fact that even the cause of death of deceased-insured was cancer. The District Commission did not consider the

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investigation report filed by the insurance company stating that the deceased-insured was suffering from cancer of Hard Palate since 20.08.2013 and was hospitalized for the same before obtaining the insurance policy.  She further argued that the deceased-insured had not disclosed the material fact and thus the complainant/respondent is not entitled to any claim amount. She therefore prayed that this appeal be allowed and the impugned order be set-aside. She placed reliance on the decisions of Hon’ble Supreme Court in Mithoolal Nayak Vs Life Insurance Corporation of India 1962 AIR 814 SC, Oriental Insurance Co. Ltd. Vs Sony Cherian decided on 19 August 1999 and Satwant Kaur Sandhu Vs New India Assurance Co. Ltd decided on 10.07.2009.

7.                Learned counsel for the complainant/respondent argued that the appeal is liable to be dismissed on account of misjoinder of parties. He argued that without any documentary evidence that the deceased-insured was suffering from cancer, the opposite party-insurance company wrongly repudiated the claim. The deceased-insured was never suffered from cancer and has not been treated for the same. The complainant/respondent asked the documents collected during the investigation but the same were not provided.  The District Commission has rightly allowed the complaint.

 

 

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8.                During the pendency of the appeal, the complainant/respondent died and was substituted by her Legal Representative Smt. Anita Verma W/O Late Pawan Verma (deceased-insured).

9.                After hearing learned counsel for the parties and on careful perusal of the evidence available on record we observe that in the repudiation letter dated 02.01.2016 (P-7) wherein it is stated that due to hospitalization treatment vide ticket no.13/1717 on 20.08.2013, the deceased-insured was diagnosed as a case of cancer. The insurance company has also filed investigation report dated 20.09.2015 (R-1) of Investigator Uma Shankar Das, wherein he has stated that the life assured was died due to cancer and he was suffering from Cancer of Hard Palate since 2013 which is evident from medical papers of MY Hospital, Indore. The investigator has filed declaration and investigation report.

10.              In the order sheet of the District Commission, it is mentioned that the opposite party-insurance company has filed investigation report and documents, which were provided to the complainant.  However, the complainant did not file any affidavit stating that the investigation report and documents filed by the opposite party-insurance company are false. The defense of the opposite party-insurance company is that the deceased-insured was suffering from cancer whereas the complainant has submitted that her son was not suffering from cancer. From the documents filed on

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record and the investigation report, which was not controverted by the complainant, it is found that the deceased-insured was suffering from cancer. Had he is not suffering from cancer why he has gone to cancer hospital.

11.              The contract of insurance is based on the principle of uberrimae fidei i.e. ‘utmost good faith’, and therefore, it is binding on the deceased-insured to disclose correct information regarding his health condition in the proposal form while obtaining the insurance policy.  From the investigation report as also medical treatment paper, it was found that the insured was suffering from cancer and he took treatment in this regard. However, the deceased-insured has given answer in ‘No’ regarding query made of his health in the proposal form for obtaining the insurance policy. 

12.              It is also pertinent to mention here that the complainant had obtained insurance policy covering the risk from 02.05.2014 and within a very short period of four months, he died on 23.09.2014 which also creates doubt. Even if it is presumed that the deceased-insured had not suppressed the material information while filling the proposal, for obtaining the insurance policy, the complainant is not entitled to get any relief as he died within a period of four months from the date of obtaining the insurance policy.

13.              The District Commission has overlooked this fact and while allowing the complaint and has awarded compensation to the

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complainant/respondent on the ground that there was no suppression of material fact.

14.              Therefore, in view of the above, we are of the considered opinion that the insurance company has rightly repudiated the claim of the complainant/respondent and the District Commission erred in directing the

opposite party-insurance company to pay compensation to the complainant/respondent whereas the complainant/respondent was entitled to get any relief.

15.              In the result, the appeal is allowed and the impugned order is set-aside. No order as to costs.  

 

                    (A. K. Tiwari)                  (Dr. Srikant Pandey)

               Presiding Member                      Member