National consumer disputes redressalcommission new delhi

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ORDER 


PER SURESH CHANDRA, MEMBER

The petitioner Paramjit Kaur who is widow of deceased insured Hardev Singh is the original complainant. Respondents insurance co. were opposite parties before the District Forum. In view of this, we have referred to the parties according to the status in the complaint before the District Forum.

2.         Briefly stated, the factual matrix of this case as per the allegations is that Hardev Singh husband of the complainant purchased a life insurance policy for Rs. 2 lakhs w.e.f. 28.2.2004 under plan 75-20 and another policy for Rs.3,05,000/- under plan 14-13 w.e.f. 28.12.2004 from the OP insurance co. Hardev Singh nominated his wife Paramjit Kaur who is the complainant and petitioner herein as nominee in the two policies. Due to sudden illness he died on 20.7.2006. The complainant lodged claim under the two policies with the OPs but the claim under both the policies were repudiated by the OP insurance co. on the ground that the deceased was suffering from diabetes mellitus, pulmonary tuberculosis etc. and that he was suffering from these pre-existing diseases was not disclosed. Alleging the repudiation of her claim on the ground of pre-existing disease after lapse of 2 years from the purchase of the policy against law and by way of unfair trade practice, the complainant filed a consumer complaint against the OP insurance co. before the District Consumer Disputes Redressal Forum, Sirsa (Haryana) for deficiency in service on their part.

3.         On notice, the OP insurance co. contested the complaint by filing written statement before the District Forum. It was submitted by the OPs that as per the leave record obtained from the employer of the deceased, the deceased life assured  had availed  leave on medical grounds from 12.1.2004 to 5.4.2004, 1.5.2004 to 2.6.2004 and 3.6.2004 to 21.12.2004. It was also stated by the OPs that as per Form No.3816  received from Dr. P.K. Prasher, Fortis Hospital, Mohali, the deceased life assured had been admitted in the hospital on 17.7.2006 and expired on 20.7.2006. He had been diagnosed as a case of diabetes mellitus with pulmonary tuberculosis, sepsis etc. and was suffering from diabetes mellitus for the last 7 years. The OPs submitted that history of illness of the deceased goes to the period prior to the date of taking insurance but the life assured did not disclose the material information pertaining to his health at the time of taking insurance and as such the claim lodged by the complainant had to be repudiated in accordance with the terms and conditions of the policy and as such it is legal and valid. Denying any deficiency in service on its part, the OP insurance co. prayed for dismissal of the complaint.

4.         Both the parties adduced evidence in support of their respective claims. The District Forum on consideration of the evidence and the submissions made, dismissed the complaint. The District Forum concluded in its order dated 21.9.2012 that from the material on record, it was evident that the life assured suffered from and was treated for diabetes mellitus, pulmonary tuberculosis,  etc. and had availed leave on medical ground during the period from 12.1.2004 to 21.12.2004 prior to the date of taking insurance policy and this fact was concealed and not disclosed at the time of submitting of the proposal form and as such the complainant is not entitled for any insurable claim. Aggrieved of the order of the District Forum, the complainant filed Appeal No.1366 of 2012 before the Haryana State Consumer Disputes Redressal Commission, Panchkula. The State Commission vide its impugned order dated 21.1.2013 dismissed the appeal and upheld the order of the District Forum. It is in these circumstances that the petitioner has filed the present revision petition challenging the aforesaid order of the State Commission.

5.         We have heard learned Amicus Shri Rohit Kataria, Advocate for the petitioner and Shri Neeraj Gupta, Advocate for the respondents. We have also perused the record. Without denying the allegation of the OP insurance co. that the life assured had suffered from various pre-existing ailments before the date of taking the two insurance policies, the main ground on which the petitioner has challenged the impugned order of the Fora below is that the insured had died after 3 years of purchase of the policies and in these circumstances, no investigation can be done regarding death of the insured and that the respondents have no right to refuse to pay the claim in respect of the polices consequent to the death of the insured person.

6.         We may note that both the Foras below have returned concurrent finding of facts while dismissing the complaint of the petitioner and upholding the defence of the OP insurance co. in repudiating the claim of the complainant. The reasons recorded by the State Commission while upholding the order of the District Forum and dismissing the appeal may be reproduced thus:-

Undisputedly, at the time of taking Insurance Policy the life assured had given answers to the following questions in the proposal form which are re-produced as under:-


Questions:-

Answers:-

11(b)  Have you ever been admitted to any hospital or Nursing home for general check up, observation treatment or operation? NO

11(c)  Are you suffering from or have you ever suffered from diabetes, tuberculosis, high blood pressure, low blood pressure, leprosy or any other disease?  NO

ii (i What has been you used state of Health.  Good

In the present case, the opposite parties have fully established on record that the life assured was suffering from diabetes mellitus pulmonary tuberculosis, sepsis and was suffering from diabetes mellitus from 7 years as per form No.3816 issued by Dr. P.K. Prasher, Fortis Hospital, Mohali. The history of illness of life assured goes prior to the date of submitting of proposal form in respect of the Insurance policies.

It cannot be disputed that the contract of insurance is  contract uberrima fids and there must be complete good faith on the part of the assured and thus the assured is under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not.

In this case, there is sufficient evidence on behalf of the opposite parties to prove the fact that the life assured had made false declaration and concealed the true and material facts with respect to his state of health and illness suffered by him. As such, the complainant is not entitled for any insurable benefits.

For the reasons recorded above, we do not see any infirmity in the impugned order passed by the District Consumer Forum while dismissing the complaint.”

 

7.         We agree with the view taken by the State Commission and the District Forum and do not find any reason to interfere with it. The concurrent finding of the Foras below based on the material before them are in line with the law settled by the Apex Court in various cases including the case of Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. [2009 CTJ 956 (Supreme Court)] and Mithoo Lal Vs. Life Insurance Corporation of India [AIR 1962 Supreme Court 814]. It is well settled that when there is deliberate suppression of material facts pertaining to health on the part of life assured, contract of insurance which is based on principle of utmost good faith gets vitiated and the cause of death become irrelevant.


8.         In view of the above, we do not find any merit in this revision petition and the same stands dismissed with no order as to costs.

..………………Sd/-……………..

(AJIT BHARIHOKE  J.)

PRESIDING MEMBER

 

....…………Sd/-…………………

(SURESH CHANDRA)

MEMBER

SS/


 

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI

  

REVISION PETITION NO.2920 OF 2013

(Against the order dated 30.4.2013 in First Appeal No.1140 & 585/2010 of the Punjab State Consumer Disputes Redressal Commission, Chandigarh)

 

Satnam Singh S/o Sajjan Singh R/o Village Gopalpur Post Office Saheri District – Ropar Punjab



                                                                             …..... Petitioner

  Versus


1. Mahindra & Mahindra Ltd. Through its Managing/Authorized Representative Gateway Building, Apollo Bundar Mumbai, Maharashtra 

2. Goel Motors Pvt. Ltd. Through its Manager Plot No.B-55, Phase-6, Industrial Area,

Opposite Verka Milk Plant Mohali, District – SAS Nagar

                                      …...... Respondents

  

BEFORE: 

HON’BLE MR. JUSTICE AJIT BHARIHOKE, PRESIDING MEMBER

HON’BLE MRS. REKHA GUPTA, MEMBER

For the Petitioner             :    In person

For the Respondents        :    Mr. Shikhar Srivastava, Advocate

 

 Pronounced on : 30th July,  2014 



ORDER




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