Haryana

Karnal

429/2012

Pooja Sharma W/ Ravi Kant Sharma - Complainant(s)

Versus

Tata AIG Life Insurance Company Limited - Opp.Party(s)

J.P. Singh

25 Apr 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.     

                                                               Complaint No.429 of 2012

                                                               Date of instt.: 6.9.2012

                                                                Date of decision: 26.04.2016

 

Pooja Sharma widow of Shri Ravi Kant Sharma, resident of house no.3, MIG Madhuban, District Karnal, (Haryana)

.                                                                   ……..Complainant.

                                     

Versus

TATA AIG Life Insurance Company Ltd. (Reg. No.110) KL02 TATA AIG Karnal UM SCO 244-245, 246, 2^nd floor, Sector-12, Karnal-132001. (Haryana)

 

                                                                   ………… Opposite Party.

 

                     Complaint u/s 12  of the Consumer Protection Act.

 

Before          Sh.K.C.Sharma……….President.

                   Sh.Anil Sharma…….Member.

 

Present:-        Sh. J.P.Singh Advocate for the complainant.

                     Sh.A.K.Vohra Advocate for the Opposite party.

 

 ORDER:

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986, on the averments that her husband Ravi Kant (the deceased life assured) obtained policy no.U138978923 from the opposite party on 7.4.2009 and the total sum assured was Rs.1,50,000/-. The Deceased Life Assured was paying the premium of amount regularly. Unfortunately, he died on  1.3.2011, while admitted in Sir Ganga Ram Hospital, New Delhi. She being nominee under the policy submitted claim to the opposite party, but the opposite party refused to pay the claim, which amounted to deficiency in service and due to that she suffered mental pain and harassment apart from financial loss.

2.                Notice of the complaint was given to opposite party who appeared and filed written statement disputing the claim of the complainant. Objections have been raised that the complaint is not maintainable; that the complaint is premature and that the complaint is an abuse of process of law.

                   On merits it has been submitted that the policy was taken by the deceased life assured, by concealing the true and material facts regarding his health at the time of filling application form. In the death claim intimation form the complainant mentioned that  the deceased life assured had undergone Kidney Transplant at Sir Ganga Ram Hospital in January, 2008, which was prior to the insurance application dated 2.4.2009. After claim intimation from the complainant, the claim was sent for investigation with Sir Ganga Ram Hospital. The claim of the complainant was pending at the time of filing the present complaint. It has been denied that there was deficiency in service on the part of the opposite party. The other allegations made in the complaint have not been admitted.

3.                In evidence of the complainant, his affidavit Ex.C1 and documents Ex.C2 to C10 have been tendered.

4.                On the other hand in evidence of the opposite party, affidavit of Harsimran Singh, Assitant Manager Ex.OP/1 and documents Ex.R1 to R8 have been tendered.

5.                We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

6.                The deceased life assured had obtained the insurance policy from the opposite party on 7.4.2009. He submitted proposal form for obtaining the policy on 2.4.2009. He died on 1.3.2011. The complainant being nominee submitted claim to the opposite party. As per the pleadings of the opposite party, in the claim form it was submitted by the complainant that the deceased life assured had undergone Kidney Transplant at Sir Ganga Ram Hospital, New Delhi in January 2008. Therefore, the matter was under investigation at the time of the filing of the present complaint. It has further been pleaded that deceased life assured had concealed the material facts regarding Kidney Transplant operation in the application form.

7.                The opposite party had not repudiated the claim of the complainant at the time of filing of the present complaint, rather the matter was under investigation. However, it is case of the opposite party that deceased life assured had concealed material fact regarding his kidney Transplant in January, 2008 in Sir Ganga Ram hospital, in the application form submitted by him for obtaining the policy. Therefore, the material question which arises for consideration is whether the deceased life assured had undergone Kidney Transplant operation in January 2008 in Sir Ganga Ram hospital

8.                Copy of the death certificate of deceased life assured Ex.C10 shows that the deceased life assured had died on 1.3.2011, while admitted in Sir Ganga Ram hospital, New Delhi. The opposite party sought information from Sir Ganga Ram hospital regarding claim of the deceased life assured. Junior Medical Record Officer of Sir Ganga Ram hospital sent the report prepared by Dr. A.K. Bhalla of the said hospital, the copy of which is Ex.R7 alongwith the covering letter, the copy of which is Ex.R6. A perusal of Ex.R7 shows that Renal transplant surgery was conducted in 2008 and the cause of death was sepsis, mucormycosis. The complainant in the claim form Ex.R5 also admitted that operation of the deceased life assured for Kidney transplant was performed in January, 2008 in Sir Ganga Ram hospital. From such evidence on record this fact stands proved that the deceased life assured had undergone surgery for Kidney transplant in January, 2008 in Sir Ganga Ram hospital.

9.                Now, the question arises whether the deceased life assured had concealed about his surgery of kidney transplant in the application form submitted for obtaining insurance policy on 2.4.2009. The copy of the application form is Ex.R2. Step 10 of the application form is regarding “health details of life assured/proposer.” There were specific questions no.5 to 9 regarding health of the deceased life assured.  All those questions were replied by him in negative. Meaning thereby, that as per the application form he was having no medical problem, he never got treatment and never remained admitted in any hospital and was hale and hearty at the time of submitting the application form. Thus, it is emphatically clear that the deceased life assured had concealed the fact that he had undergone surgery for kidney transplant in January, 2008 in Sir Ganga Ram hospital.

10.               It is settled principle of law that contract of insurance is a contract uberrima fides and utmost faith must be observed by the contracting parties. Every material fact must be disclosed, otherwise there is good ground for rescission of contract. If, there are mis-statements or suppression of material facts, the policy can be called into question. Concealment of previous ailments is suppression of material facts. 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 a material fact. If the proposer has knowledge of such fact, he is obliged to disclose it particularly while answering questions in the proposal form. Needless to emphasis that any inaccurate answer will entitle the insurer to repudiate his liability because there is clear presumption that any information sought for in the proposal form is material fact for the purpose of entering into a contract of insurance. In this context reference may be made to the judgment of Honble Supreme Court in case titled Satwant Kaur Sandhu Versus New India Assurance Company IV (2009) CPJ 8, (SC) and Life Insurance Coporation of India and another Versus Bimla Devi revision petition no.3806 of 2009 decided by Hon’ble National Commission on 12.8.2015.  

11.               The deceased life assured had died on 1.3.2011 while admitted in Sir Ganga Ram hospital. Prior to that he got surgery performed in Sir Ganga Ram hospital for kidney transplant in January 2008. He submitted application/ proposal form for obtaining policy on 2.4.2009. However, he did not disclose in the said proposal form that he had undergone surgery for kidney transplant in January, 2008. Thus he had suppressed material fact in the application form submitted for obtaining the policy whereas he was bound to disclose all the material facts regarding condition of his health in the proposal form. Therefore, the policy became void on the ground of concealment of material fact by the deceased life assured in the proposal form. Under such circumstances, the complainant has not been able to establish that there was any deficiency in service on the part of the opposite party.

12.               As a sequel to the foregoing reasons, we do not find any merit in the present complaint. Therefore, the same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 26.4.2016

                                                                        (K.C.Sharma)

                                                                           President,

                                                                District Consumer Disputes

                                                                Redressal Forum, Karnal.

                        (Anil Sharma)

                          Member