DATE OF FILING: 8.9.2010.
DATE OF DISPOSAL: 25.11.2016.
Dr. N.Tuna Sahu, Member:
The complainant has filed this consumer complaint alleging deficiency in insurance service against the Opposite Parties (for short, O.Ps) and for redressal of his grievance before this Forum.
2. Brief facts of the case of the complainant is that, her deceased son Desiti Krishna had obtained two insurance policy i.e. “Tata AIG Llife Mahalife Gold” bearing policy No. C-171521667 dated 24.8.2009 for a sum of Rs.1,10,000/- (Rupees One Lakh Ten Thousand) only valid from 24.8.2009 to 24.8.2023 and another policy i.e. “TATA AIG Life Raksha 25”scheme bearing No. C017779531 dated 23.9.2009 for a sum of Rs.10,00,000/- (Rupees Ten Lakhs) only valid from 23.9.2009 to 23.9.2034 from the O.P. Insurance Company and the complainant was the nominee in the said two policies. During subsistence of the said policy the insured died on dated 28.10.2009 due to ‘falcifarum malaria fever’. So the complainant being the nominee lodged a claim against these two policies with the Opposite Parties along with the relevant documents as per requirement but the said claim was repudiated by the O.P. Insurance Company on dated 09.09.2010 on the ground of suppression of material facts at the time of making the policies were issued in its present Forum. As according to the complainant, since there was no material suppression of facts on the part of the life assured while taking the policy, such repudiation was illegal and contrary to the insurance contract, the same amount to deficiency in service, as such filed this complaint claiming the amount under the policy and compensation etc. The complainant has also stated that the applicant at column 27 specifically indicated the life insurance coverage of her deceased son i.e. in the insured therein with other companies as follows: (1) HDFC Standard Life Insurance Policy bearing No. 10440066 dated 30.11.2005. (2) ICICI Prudential Life Insurance Life guard policy bearing No.05152188 dated 16.4.2007 and the death claims as against the aforesaid above policies have since been settled by the respective companies. The complainant filed a written argument and stated that she had filed CC 80/2010 before this Hon’ble Forum against Max New York Life Insurance Co. ltd. for payment of death claim which has since been settled upon payment of the policy amount. So the entire action of the O.Ps amount to gross deficiency in service because instead of settling the death claim of her deceased son taking the plea of multiple life insurance policies from other insurers have repudiated the claim. Hence, the complainant has prayed before this Forum to direct the O.P. No.1 to pay Rs.11,10,000/- towards sum assured under both policies and to pay interest, awards Rs.2,00,000/- as compensation and Rs.30,000/- as cost of litigation in the interest of justice.
3. Notice was issued against O.Ps and the O.Ps appeared before this Forum through their learned counsel Mr. Bishnu Mohan Prasad, Advocate and Associates. The O.P.No.1&2 in his written version/argument stated that the instant case is false, malicious and abuse of the process of the law and it is an attempt to waste the precious time of this Hon’ble Forum. The complaint is liable to be dismissed under Section 26 of the Consumer Protection Act, 1986. The complaint is neither maintainable in law nor on facts and the same is liable to be dismissed in limine. The complainant has not approached this Forum with clean hands since the case is baseless and lacking a bona fide cause of action. In the beginning of the case the O.Ps states that there is no negligence or deficiency in service on part of the O.P. in dealing with the concerned policy. The complainant is trying to deceive and mislead the Forum by stating wrong fact. It is further contended that the deceased insured had suppressed the material fact that he has already taken Life Insurance policies from Reliance Life Insurance Company Limited, Bharati AXA Life Insurance Co. Ltd and ING Vyasya Life Insurance Co. Ltd amounting to more than Rs.20,00,000/- (Rupees Twenty Lakhs) only. It is also submitted that during procurement of policy the deceased life insured did not disclose policies taken previously which amounts to suppression of material facts. He also cited a decision of Hon’ble National Commission in the case of Smt. Asha Garg versus M/S National Insurance Company Ltd vide Original Petition No. 272 of 2001 reported in IV (2005) CPJ 269 (NC) wherein it was held that where the insured not disclosed the material fact the insurer was entitled to avoid the contract. It is further submitted that after understanding all the terms and conditions the deceased policy holder filled up the proposal Form giving all relevant details and information in the prescribed form for an assured sum of Rs.10,00,000/- on payment of premium of Rs.2,504/- only annually. Similarly, the deceased policy holder filled up another proposal form bearing No. C171521667 giving all relevant details and information in the prescribed form for an assured sum of Rs.1,10,000/- on payment of premium of Rs.10,169/- annually. Basing on the information provided and declaration given in the proposal Form the said policies were issued in favour of the deceased policy holder on 23.9.2009 and 24.8.2009 respectively. However within two months from issuance of the said policies, the O.Ps received claims under the said policies. On receipt of the intimation from the complainant about the demise of deceased policy holder on 28.10.2009 the O.P. vide letter dated 3.8.2010 asked for documents. Thereafter the O.P. initiated an investigation into the claims. During the course of its investigation the O.P. came to know that the Deceased Life Insured (DLI) had taken various life insurance policies from different Life Insurance Companies and the said insurance policies were not disclosed during taking of the said two policies. It is pertinent to note that the DLI suppressed the information at the time of filing and signing the proposal form based on which the said policy was issued. Hence the O.P. repudiated the claim of the complainant on the ground of suppression of material fact and the same was communicated to the complainant vide letter dated 9.9.2010. It is also submitted by the learned counsel for the O.P. that it is a well established principle of law that the life insurance contracts are contracts of ‘uberrimae fides’ where observance of utmost good faith is enjoined on the parties to the contract, i.e. they must disclose all material facts in respect of the risk to be covered by the insurance. The insured is obliged to give full and correct information on all matters which would influence the judgment of a prudent insurer in determining whether he will accept the risk and if he would at what rate of premium and subject to what conditions. If the material fact is suppressed, the insurer will be misled about the risk covered and hence the same will vitiate the contract. The insurer will then be well within its right to treat the contract as void as per the terms and conditions of the policy document. The same has been reiterated in the case of Life Insurance Corporation of India and others versus Smt. Asha Goel and Anr reported in (2001) ACJ 806. So the complainant is not entitled to his claim due to suppression of material fact while takings the policy, hence prayed to dismiss the case in the interest of justice.
4. On the date of hearing both parties were absent. In fact both parties have remained absent since and as it is a year old case the Forum decided to disposed of the case on merit as per Section 13(2) (c ) of Consumer Protection Act, 1986.
5. We have gone through the complaint petition, written version, written arguments and documents filed by both parties at length. We have also perused the pleadings of both parties submitted in shape of written arguments. We have also verified the policy document and other materials filed by the complainant as well as O.Ps placed on the case record.
On perusal of the policy document and other materials filed by the complainant, we found that the deceased policy holder procured two policies bearing No. C017779531 on 23.09.2009 for a sum assured Rs.10,00,000/- and another policy bearing No.C171521667 dated 24.08.2009. However, deceased policy holder unfortunately died on 28.10.2009. The nominee intimated the death claim to the O.Ps on 6.3.2010 and the O.Ps after conducting investigation repudiated claim of the complainant on 9.9.2010 on the ground of suppression of material fact. The only point to be adjudicated in this dispute where the deceased policy holder was suppressed any material fact during obtaining of aforesaid two insurance policies? If so, are the O.Ps justified by repudiating the claim of the complainant?
5. With regard to first question, we would like to state that the deceased policy holder procured the policies on 23.9.2009 and 24.8.2009 and unfortunately died on 28.10.2009 i.e. within two months of obtaining those two insurance policies. It is also a fact on record that the deceased policy holder had obtained different life insurance policies from different insurance companies of which some insurance claims have already been settled by some insurance companies. The copies of settlement letter and photocopy of cheques have been placed on the case record for reference. But as per the contention of the learned counsel for the O.Ps. the deceased life assured had not disclosed those policies prior to taking of these two policies in dispute for which the O.Ps repudiated the claim of the nominee complainant in these two policies on the ground of suppression of material facts. The learned counsel for the O.Ps have also cited a decision of Hon’ble National Commission in the case of Smt. Asha Garg Vs. M/s. National Insurance Company Ltd vide Original Petition No.272 of 2001 reported in IV I2005) CPJ 269(NC) in support of his case. On careful perusal of the case record and after going through the materials and the statement of life assured, it is established that he had concealed true and material facts with respect to previous life insurance policies at the time of obtaining aforesaid two insurance policies in dispute. When the life assured has suppressed the previous policies at the time of taking those two policies in dispute, there is no wrong in repudiating the claim of the complainant as the deceased life assured had suppressed the material facts with regard to his previous insurance policies. In our considered view, the insurance company has rightly repudiated the claim of the complainant on the ground of suppression of material facts. The contention raised by the learned counsel for the complainant that the policies taken from other insurance companies have already been settled in favour of the deceased life assured does not bear any merit in this instant case hence we are not inclined to accept the argument advance by the counsel for the complainant. In view of the aforesaid discussion and in the fact and circumstance of the case, we also accept the citation of the learned counsel for the O.Ps in the case of Life Insurance Corporation of India & Ors. Vs. Smt. Asha Goel & Anr reported in 2001 ACJ 806 regarding non-disclosure and misstatement of material facts. Further, we also rely on the citation of Hon’ble National Commission in the case of Rakesh Patel Vs. LIC of India & Anr reported in 2015 (I) CPR 584 (NC ) where it was held “insurance cover can be vitiated on account of suppression of material facts”. In the light of the aforesaid discussion and citations, in our considered view, the insurance company has rightly repudiated the claim of the complainant since the complaint of the complainant has no merit for consideration. Since the complaint of the complainant deserves no consideration, we dismissed the same due to devoid of any merits.
6. In the result, the case of complaint is dismissed against all O.Ps due to devoid of any merits. However, in the fact and circumstance of the case, we are not inclined to award any cost. The case of the complainant is disposed of accordingly.
7. The order is pronounced on this day of 25th November 2016 under the signature and seal of this Forum. The office is directed to supply the copy of the order Copy of the order be supplied to the parties free of cost as per rules.
