State Consumer Disputes Redressal Commission
Manoj Kumar Yadav vs The Zonal Manager Life Insurance ... on 23 June, 2022
Before the State Consumer Disputes Redressal Commission
(constituted under the Consumer Protection Act, 2019)
of Telangana, Eruvaka Building, Khairathabad at Hyderabad
FA NO.246 OF 2017 AGAINST CC NO.704 OF 2013
ON THE FILE OF DISTRICT cOMMISSION-I,HYDERABAD
Between:
Manoj Kumar Yadav
S/o late Khailash Narayan Yadav,
aged about 33 years, Occ: Unemployee,
R/o H.No.17-49, Jyothinagar,
Malkajgiri, Hyderabad.
Appellant/Complainant
And
The Zonal Manager,
Life Insurance Corporation of India,
South Central Zonal Office,
Secretariat Road, Hyderabad- 500 022.
Respondent/0pposite party
Counsel for the Appellant Sri V.Gouri Sankara Rao
Counsel for the Respondent . Ms.T.V.Sridevi
CORAM:
Hon'ble Sri Justice MSK Jaiswal President
and
Smt Meena Ramanathan Member
Thursday, the Twenty Third day of June Two Thousand Twenty Two Oral Order: **** This is an appeal preferred by the Complainant aggrieved by the orders dated 10.06.2015 passed by the District Consumer Forum-, Hyderabad in CC No.704/2013 against dismissal of the complaint.
For the sake of convenience, the parties are referred to as arrayed
2) in the complaint.
3) It is the case of Complainant that her father Kailash Narayan Yadav obtained two policies bearing Nos.602200124 and 602201475, which commenced on 28.12.2010 and 09.06.2011 for an assured sum of Rs.1,87,500/- and Rs.2,00,000/- and her father died on 04.12.2011.
Thereafter, on the claim made by her, the Opposite party repudiated the 2 that the policy holder claim by letter dated 11.08.212 on the premise the policy documents has wrongly entered Nil" against question No.9 in and for dated 18.12.2010 while submitting the proposal assurance 15.05.2012 respectively, which were found to be false as the deceased life assured had another three policies bearing Nos.602198376, 6021298377 and 602199389 and also suppressed the existing disease.
Hence, complaining the same to be deficient, filed the present complaint with a prayer to direct the Opposite party to release the assured sum of Rs.1,87,500/- and Rs.2,00,000/- towards policies in question With interest@ 18% per annum and costs of the complaint.
4) Opposite party filed its written version admitting the issuance of policies in question and rejection of the claim as the life assured answered Nil against the question posed. In fact, the life assured had three policies which he suppressed in the proposal form. Had he answered the questions properly, he could have been subjected to medical examination as the cause of death is heart-attack. Hence, they repudiated the claim which is proper and legal. Therefore, prayed to dismiss the complaint.
5) During the course of enquiry before the District Forum, in order to prove his case, the Complainant filed his affidavit evidence as PW1 and got marked the documents Ex.A1 to A9. On behalf of Opposite party, one Madan Mohan Rao, their Manager (L & HPF) filed his affidavit evidence as RW1 and got marked the documents Ex.B1 to B4.
6) The District Forum after considering the material available on record, dismissed the complaint bearing CC No.704 of 2013, by orders dated 10.06.2015, as stated, at paragraph No.1, supra.
7) Aggrieved by the said orders, the Appellant preferred the present appeal contending that the forum below failed to consider the evidence brought on record in proper perspective. It failed to consider the fact that the proposal form was in English, whereas, the proposer signed in Hindi and the same was filled by agent. Since all the policies in question were obtained from the Respondent, it is fully aware of all the policies. Hence, prayed to allow the appeal by setting aside the orders impugned and consequently allow the complaint as prayed for.
8) he point that arises for consideration is whether the impugned order as
passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner? To what relief?
9) The controversy in the case boils down to the question as to whether the repudiation as made by the Respondent insurance company vide Ex.A3 dated 11.08.2012 can be sustained.
10) The admitted fact is that the father of the Complainant has taken five policies from the very same insurance company under Salary Savings Scheme, he being an employee of the Police Department. Three policies which were taken by the deceased have been settled. When the claim for the two policies was made, the same was repudiated on the grounds stated supra. The Respondent insurance company has not taken any ground other than the fact the life assured has suppressed the existing policies. The District Forum has accepted the contention of the insurance company and held that non-disclosure of the existing insurance policies is a material fact which affects the contract hernce dismissed the complaint.
11) Upon carefully perusing the material on record and the legal position on the subject, we do not find ourselves to be in agreement with the view taken by the District Forum. In a decision rendered by the National Consumer Disputes Redressal Commission, in RP No.4204/2011, in the matter of Aviva Life Insurance Co., Ltd., and others and others versus Rekhaben Ramjibhai Parmar, decided on 12.04.2017, the facts are glaringly similar to the facts of the case in hand. After referring to several decisions of Hon'ble Supreme Court, the Hon'ble NcDRC held that suppression of existing policies cannot be held to be a material fact as a fraudulent suppression entitling the insurance company to repudiate the claim on the stated ground. For the sake of clarity, paragraphs-15 and 16 of the said Judgment are extracted, which reads as under:
"15. in CEO, Sahara India Life Insurance Company Ltd., and another versus Rayani Ramanjaneyulu in SLP (C) No.30740 of 2014 dated 21.11.2014 the Hon 'ble Supreme Court has reconfirmed that for any omission or commission of an insurance agent, the insured or his or her LRs cannot be made India case to suffer. The main question involved in Sahara not mention about the (supra) uwas that the insured did previous insurance policies. The Hon'ble Apex Court upheld the view of this Commission that by no stretch of imagination the information about any previous insurance policies could be held to be material. The Court has observed that it was difficult to fathom a s to why these facts would influence the Judgment of a prudent insurer in ficing premium or determining the cover or whether he would like to take the risk. There appears to be a mistake committed by the Agent and repudiation on this ground alone smacks of mala fide intention on the part of the OP. This stand has been reiterated by this Commission in Smt. Sulochana Indukar Vs. The Life nsurance Corporation of India in R.P. No.587 of 2015 dated 11.09.2015, wherein the repudiation on similar grounds, viz., that the insured had suppressed information regarding his previous policies, has been held to be bad.
16. Keeping in view the facts and circumstances of this case, in our opinion, the non-disclosure of the other insurance policies does not fall within the ambit of Section-45 of the Insurance Act, as the concealment was neither wilful nor fraudulent. To reiterate, the Agent himself admitted that it is the normal practice that in non medi-claim policies, the question regarding existence of other insurance policies is not asked and that he himself had filled the proposal form. By no stretch of imagination it can be held to be a material fact fraudulently suppressed, entitling the insurance companyy repudiate the claim on the stated ground."
In view of the foregoing categoric findings of the NCDRC, which
12) are based upon the Judgments of the Apex Court, we have no hesitation in holding that merely because the life assured has not disclosed the three other policies which he has taken from the insurance company, in the proposal form, that can be taken as material facts suppressed thereby entitling the insurance company to repudiate the claim. No ground other than that has been taken and hence the claim of the discussions, it Complainant cannot be denied. In view of the foregoing 1s held that the Complainant is entitled for the reliefs as prayed for.
set aside.
ACCOrdingly, the impugned order is liable to be order is set
13) n the result, the appeal is allowed and the impugned the claim of the aside. directed to settle The Respondents are Nos.602200124 for Complainant covered by two policies bearing with Rs. 1,87,500/- and policy No.602201475 for Rs.2,00,000/- together all attendant benefits with interest on the said amounts @ 7% per is annum from the date of repudiation i.e., 11.08.2012 till payment is also entitled to Costs of made. The Appellant/Complainant Rs.5,000/-. Time for compliance: 45 days.