State Consumer Disputes Redressal Commission
Bharat Bhushan Singla vs Pnb Metlife India Insurance Co. Ltd on 18 March, 2014
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH First Appeal No. : 37 of 2014 Date of Institution : 28.01.2014 Date of Decision : 18.03.2014 Sh. Bharat Bhushan Singla being representative and nominee of Late Meenu Singla, H.No.241, Sector 22-A, Chandigarh. Appellant/Complainant. Versus M/s PNB Metlife India Insurance Co. Ltd., through its Managing Director, No.5 Brigade Seshmahal Vani Vilas Road, Basavanagudi, Bangalore. ....Respondent/Opposite Party. Appeal under Section 15 of the Consumer Protection Act, 1986. BEFORE: JUSTICE SHAM SUNDER (RETD.), PRESIDENT. MR. DEV RAJ, MEMBER.
MRS. PADMA PANDEY, MEMBER Argued by: Sh. Yogesh Gupta, Advocate for the appellant.
Sh. U. K. Kanwar, Advocate for the respondent.
PER DEV RAJ, MEMBER.
This appeal is directed against the order dated 24.12.2013 rendered by the District Consumer Disputes Redressal Forum-I, UT, Chandigarh (hereinafter to be called as the District Forum only) vide which, it dismissed the complaint, filed by the complainant (now appellant).
2. The facts, in brief, are that Late Smt. Meenu Singla, wife of the complainant, had purchased a Life Insurance Policy bearing No.1200800716462 on 21.11.2008 from the Opposite Party through its agent Mrs. Jaspal Kaur, who was based at Chandigarh. It was stated that the complainants wife was regularly making payment of premium for the said Policy without any default and the complainant had been declared as a nominee in the said Policy. It was further stated that at the time of buying the Policy, it was duly disclosed to the agent that the complainants wife had been diagnosed with Brain Tumor and was getting treatment for the same. It was further stated that copy of her income tax return for the assessment year 2006-2007, wherein deduction of Rs.40,000/- u/s 80DDB of Income Tax Act was claimed by her for the treatment taken for major disease, was also supplied. It was further stated that the said agent informed that the terms and conditions of the Policy covered the insured persons who had a preexisting disease, if they survived one year from the date of the issuance of the Policy. It was further stated that this statement of the agent was also supported by her supervisor namely Sh. Sanjeev Gauba. It was further stated that on the insistence of the said agent, the signatures of the complainants wife were taken, on the blank application form, for the purchase of Insurance Policy. It was further stated that the wife of the complainant expired on 16.5.2010, and consequent to her death, the complainant being her nominee, submitted death claim form to the Opposite Party, alongwith all the requisite enclosures. It was further stated that the claim was rejected vide letter dated (Annexure C-2) on the ground of non disclosure of material facts. It was further stated that the complainant preferred an appeal to the Opposite Party but the said request was also rejected vide letter dated 19.5.2011 (Annexure C-3). It was further stated that the complainant filed complaint with the Insurance Ombudsman, Chandigarh on 23.5.2011, which vide its award dated 20.6.2013 (Annexure C-4) directed the Opposite Party to refund the amount of premium received under the Policy. It was further stated that Insurance premium paid by the complainants wife, amounting to Rs.24,000/-, had already been received by the complainant from the Opposite Party. It was further stated that the aforesaid acts of the Opposite Party, amounted to deficiency, in rendering service, as also indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), was filed, directing the Opposite Party to pay full and final insurance amount of Rs.1,20,000/- alongwith interest @18% per annum w.e.f. 16.5.2010; an amount of Rs.50,000/- as compensation for mental agony and physical harassment and Rs.22,000/- as costs of litigation.
3. Though the Counsel for the Opposite Party, had appeared on 9.9.2013 and was given time to file reply and evidence on 24.9.2013, yet on the date fixed i.e. 24.9.2013, none appeared on behalf of the Opposite Party and, as such, it was proceeded against exparte by the District Forum.
4. Subsequently, the Opposite Party moved an application before the District Forum on 4.10.2013 for setting aside the exparte proceedings dated 24.9.2013, attaching therewith written statement, short affidavit alongwith certain documents, with the same. However, the said application was dismissed by the District Forum, vide order dated 15.11.2013, being not maintainable in view of the law laid down in Rajeev Hitendra Pathak & Ors. Vs. Achyut Kashinath Karekar & Anr., 2011 (9) SCC 541.
5. The complainant led evidence, in support of his case.
6. After hearing the Counsel for the complainant, and, on going through the evidence, and record of the case, the District Forum, dismissed the complaint, as stated in the opening para of the instant order.
7. Feeling aggrieved, the instant appeal, has been filed by the appellant/complainant.
8. We have heard the Counsel for the parties, and, have gone through the evidence, and record of the case, carefully.
9. The Counsel for the appellant/complainant submitted that no doubt, the wife of the complainant was suffering from Brain Tumor, a preexisting disease, yet the complainant was told by the agent of the Opposite Parties that the terms and conditions of the Policy covered the insured persons who had a preexisting disease, if they survived for one year from the date of the issuance of the Policy. It was further submitted that, thus, the wife of the complainant was entitled to the benefit under the said Policy. It was further submitted that the oral promises made by the respondent/Opposite Party were not incorporated in the Insurance Policy. It was further submitted that the Proposal Form was never brought on record by the respondent/Opposite Party.
10. The Counsel for the respondent/Opposite Party, submitted that the wife of the appellant/complainant was suffering from Brain Tumor, which was a preexisting disease and this fact was concealed in the Proposal Form. It was further submitted that the contract of Insurance is based on utmost good faith and by not disclosing the true information regarding preexisting disease, the Policy stood vitiated and, thus, no benefit under the Insurance Policy could be extended to the complainants wife.
11. After giving our thoughtful consideration, to the submissions, made by the Counsel for the parties, and the evidence, on record, produced by the complainant, we are of the considered opinion, that the appeal is liable to be dismissed, for the reasons to be recorded hereinafter.
12. It is evident from the record of the District Forum, that the appellant/complainant had filed a complaint with the Insurance Ombudsman, Chandigarh on 23.5.2011, who after considering all the pros and cons of the case, vide the order dated 20.06.2013, specifically observed that under item (3) pertaining to medical details in the proposal form dated 21.11.2008, seeking insurance cover, it was answered as No and, accordingly, the claim was repudiated on the ground of non disclosure of material information on health. The material documents viz. Insurance Policy and the Proposal Form, which, as per the Insurance Regulatory Development Authority (IRDA) guidelines, forms part of the Insurance Policy, have not been brought in evidence by the appellant/complainant. It is not the case of the appellant/complainant that he did not receive the Policy, in question. Once he received the Insurance Policy, in case the terms and conditions thereof were not acceptable, and the same were not in tune with what the agent had told the insured, at the time of her opting for the same (Policy), the Insured/complainant was at liberty to return the Policy within the free-look period. Once it did not do so, the complainant could not rake up the matter later on. It is clear from the order of the Insurance Ombudsman produced in the District Forum order that there was concealment of material information by the complainants wife. Though the decision of the Insurance Ombudsman is not binding upon the complainant, yet the findings by the Insurance Ombudsman were recorded apparently on the basis of the evidence produced before him, including the fact that when Late Smt. Meenu Singla had a history of brain tumor yet under item 3 pertaining to medical details in the proposal form dated 21.11.2008, seeking insurance cover, she answered the same as No. We do not find any perversity or illegality in the same. The Insurance Ombudsman, on the face of facts and circumstances of the case also allowed refund of whole amount of premiums received by the respondent/Opposite Party after deducting the amount of money already refunded.
13. In cases Kapil Sharma Vs. Life Insurance Corporation of India, III (2013) 684 (NC) and Rajesh Sharma Vs. Life Insurance Corporation of India, III (2013) CPJ 650 (NC), it was held by the National Commission that Contract of Insurance is based on doctrine of utmost good faith and life assured was under obligation to disclose each and every aspect with respect to his health at time of submitting proposal form as well at time of revival of lapsed policy, as revival amounts to new contract of policy. In Life Insurance Corporation of India & Anr. Vs. Surekha Shankar & Ors., III (2012) CPJ 651 (NC), it was held that when there is deliberate suppression of material fact 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 becomes irrelevant. In National Insurance Company Ltd. Vs. Ashok Kumar Gupta, I (2012) CPJ 547 (NC), it was held that duty of utmost good faith in disclosing the material facts lies with the insured when he seeks insurance cover for the insurers assessment of risk involved in accepting the insurance coverage would depend on such disclosure.
14. In the instant case, since the wife of the complainant, while opting for the Insurance Policy, did not disclose that she was undergoing treatment for Brain Tumor, no deficiency could be attributed to the Opposite Party in repudiating the death claim. The law laid down, in the aforesaid cases, is fully applicable to the facts of the instant case. In our considered view, the District Forum was right in holding that the Opposite Party rightly denied its liability due to non disclosure of material facts.
15. No other point, was urged, by the Counsel for the parties.
16. In view of the above discussion, it is held that the order passed by the District Forum, being based on the correct appreciation of evidence, and law, on the point, does not suffer from any illegality or perversity, warranting the interference of this Commission.
17. For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, with no order as to costs. The order of the District Forum is upheld.
18. Certified copies of this order, be sent to the parties, free of charge.
19. The file be consigned to Record Room, after completion.
Pronounced.
March 18, 2014.
Sd/-
[JUSTICE SHAM SUNDER (RETD.)] PRESIDENT Sd/-
(DEV RAJ) MEMBER Sd/-
(PADMA PANDEY) MEMBER Ad STATE COMMISSION (First Appeal No.37 of 2014) Argued by: Sh. Yogesh Gupta, Advocate for the appellant.
Sh. U. K. Kanwar, Advocate for the respondent.
Dated the 18th day of March, 2014 ORDER Vide our detailed order of the even date, recorded separately, the appeal has been dismissed, with no order as to costs. The order of the District Forum has been upheld.
(DEV RAJ) MEMBER (JUSTICE SHAM SUNDER (RETD.)) PRESIDENT (PADMA PANDEY) MEMBER Ad