Madhya Pradesh

StateCommission

A/17/1491

RELIANCE LIC LTD. - Complainant(s)

Versus

SMT.PRAVESH - Opp.Party(s)

SH.R.N.CHATURVEDI

06 Apr 2023

ORDER

M. P. STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,                          

                             PLOT NO.76, ARERA HILLS, BHOPAL

 

                                      FIRST APPEAL NO. 1491 OF 2017

(Arising out of order dated 23.01.2017 passed in C.C.No.105/2015 by District Commission, Chhindwara)

 

RELIANCE LIFE INSURANCE CO.LTD.

9^TH & 10^TH FLOOR, BUILDING NO.2,

R-TECH PARK, NIRLON COMPOUND,

NEXT TO HUB MALL, BEHIND 1 FLAX BUILDING,

GOREGAON (E) MUMBAI-400 063

THROUGH LOCAL OFFICE,

RELIANCE LIFE INSURANCE CO.LTD.

OPPOSITE ICICI BANK, PARASIA ROAD,

CHHINDWARA (M.P.)                                                                                           ….           APPELLANT.

 

                       Versus

 

SMT. PRAVESH YADAV,

W/O SHRI RAMDAS YADAV,

R/O BEHING G.M.M. OFFICE,

WARD NO.3, TEHSIL-PARASIA,

DISTRICT-CHHINDWARA (M.P.)                                                                       ….           RESPONDENT.                                

                                 

BEFORE :

            HON’BLE SHRI JUSTICE SHANTANU S. KEMKAR   :  PRESIDENT

           HON’BLE SHRI D. K. SHRIVASTAVA                         :  MEMBER

            HON’BLE DR. (MRS) MONIKA MALIK                         :  MEMBER

                     

COUNSEL FOR PARTIES :

                Shri R. N. Chaturvedi, learned counsel for the appellant.

           None for the respondent.

                  

                                                  O R D E R

                                       (Passed on 06.04.2023)

                   The following order of the Commission was delivered by Dr.(Mrs) Monika Malik, Member:

           

                   This appeal by the opposite party/appellant (hereinafter referred to as ‘appellant’) is directed against the order dated 23.01.2017 passed by the District Consumer Disputes Redressal Commission, Chhindwara (for short ‘District Commission’) in C.C.No.105/2015, whereby the District

 

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Commission has partly allowed the complaint filed by the complainant/respondent (hereinafter referred to as respondent).

2.                Briefly put, facts of the case are that the husband (hereinafter referred to as ‘deceased-insured’) of the respondent during his life time had obtained insurance policy no.51088673 on 17.07.2013 from the appellant. Five installments of Rs.50,000/- each were to be paid under the said policy and Rs.3,50,000/- was the sum assured. The respondent was nominee under the said policy.  On 28.09.2013, the husband of the respondent died. The claim form along with requisite documents were submitted with the appellant-insurance company but the claim was denied.   Therefore, alleging deficiency in service on part of the appellant she filed a complaint before the District Commission, in order to seek relief.

3.                The opposite party/appellant in its reply before the District Commission submitted that the respondent in a statement given to the investigator had mentioned that her husband was consuming alcohol since past 15-16 years. She also submitted that her husband was taking treatment for liver relating illness, from last 16 months. It is thus submitted by the appellant that the deceased-insured was taking treatment for ‘Alcoholic Liver Disease’ at the time of filling up of proposal form in order to obtain the subject insurance policy. Since there was suppression of material facts on part of the deceased-insured, the insurance company has rightly denied the

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claim. There is no deficiency in service on part of the opposite party/appellant. It is therefore prayed that the complaint be dismissed.

4.                The District Commission partly allowed the complaint and directed the appellant-insurance company to pay Rs.3,50,000/- i.e. the sum assured under the policy to the respondent with interest @ 9% p.a. from the date of repudiation i.e.  27.03.2014 till realization. In addition costs of Rs.2,000/- is also awarded.

5.                Heard. Perused the record.

6.                Learned counsel for the appellant argued that the deceased-insured had obtained the insurance policy after suppressing the material facts regarding his illness.  Since he suppressed the relevant information in the proposal form, there has been violation of principle of ‘utmost good faith’. He argued that the District Commission has wrongly held that the appellant has not been able to produce sufficient evidence in order to support its contention. He submitted that the same was not required since the complainant/respondent herself disclosed to the Investigator that her husband was chronic alcoholic and was receiving treatment for liver related illness since past 16 months. He therefore argued that the claim is not payable since the deceased-insured had violated the principle of utmost good faith, and the same has rightly been denied by the appellant-insurance company.

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7.                We find that the deceased-insured while filling the proposal form has replied in negative to the queries raised regarding his health. The appellant in support of its contention that there has been suppression of material facts by the deceased-insured, has put forward an investigation report. The Investigator in his investigation report has mentioned that he came to know from the family members and neighbours that the deceased-insured was receiving treatment for liver disease in WCL hospital from past 16 months i.e. prior to taking of the insurance policy. The investigator has also filed certain statements, claimed to have been given by the respondent and her neighbours. The District Commission has held that there is no affidavit of the investigator in support of the investigation report filed by him. On the other hand the complainant/respondent in rebuttal has filed her affidavit along with the affidavits of her neighbours.

8.                We also find that apart from the investigation report, which is undoubtedly not supported with an affidavit, the appellant has not been able to produce a single document which could prove its contention, regarding health condition of the deceased-insured.  In the investigation report, the investigator clearly mentions that he had visited the WCL hospital to get hospital papers but the same were not provided to him.  In the absence of any substantiating evidence, we infer that the opposite party/appellant has not been able to justify the reasons of claim repudiation.

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9.                In view of the foregoing discussion, we conclude that the District Commission has committed no error while passing the impugned order and allowing the complaint.  The same is hereby upheld.

10.              As a result, this appeal, being devoid of any merit is dismissed, with no order as to costs.

 

      (JUSTICE SHANTANU S. KEMKAR) (D.K.SHRIVASTAVA) (DR. MONIKA MALIK)                     

                         PRESIDENT                            MEMBER                MEMBER