State Consumer Disputes Redressal Commission
Santosh Nagnath Kedari, vs Birla Sun Life Insurance Co. Ltd., on 18 March, 2014
CC No.12/2012
1
Date of filing:10.07.2012
Date of order:18.03.2014
MAHARASHTRA STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MUMBAI, CIRCUIT BENCH AT AURANGABAD.
COMPLAINT CASE NO. : 12 OF 2012
Santosh Nagnath Kedari,
R/o Jawahar Nagar, Hyderabad Road,
Vidi Gharkul,
Solapur. ...COMPLAINANT.
VERSUS
1. Branch Manager,
Birla Sun Life Insurance Co. Ltd.,
Near Rama Talkies,
Savewadi,
Latur.
2. Managing Director,
Birla Sun Life Insurance Co. Ltd.,
Van India Bulls Centre,
Tower 1, 15 & 16th floor,
Jupitor Mill Compound,
841 Senapati Bapat Marg,
Elphiston Road,
Mumbai - 400013. ...OPPONENTS.
Coram : Mr.S.M.Shembole, Hon`ble Presiding Judicial
Member.
Mr.K.B.Gawali, Hon`ble Member.
Present : Adv.A.K.Jawalkar for complainant, Adv.Shri.D.D.Choudhary for opponents.
CC No.12/2012 2O R A L JUDGMENT ( Delivered on 18th March 2014 ) Per Mr.S.M.Shembole, Hon`ble Presiding Judicial Member.
1. This is a complaint U/s 12 of Consumer Protection Act 1986(hereinafter referred as 'Act').
2. The brief facts giving rise to this complaint are that:-
Late Nagnath Kedare who was father of complainant Santosh died due to heart attack on 31.12.2010. Late Nagnath was reputed businessman having his business of optical and provision store at Solapur. During his life time on 31.10.2010 Late Nagnath obtained money back policy of Rs.20,28,000/- covering accidental benefit from opponent Birla Sun Life Insurance Company (hereinafter referred as opponent insurance company) having half yearly premium of Rs.51,222/-. According to the complainant after the death of his father he collected relevant case papers and made insurance claim with the opponent insurance company. But opponent insurance company repudiated his claim and by letter dated 28.2.2011 informed him that his claim cannot be settled as insured Late Nagnath while submitting proposal form for obtaining insurance policy suppressed material facts about his illness and also about obtaining another insurance policies prior to the date of obtaining policy in question. It is submitted by complainant that though his father was suffering from diabetes etc. he has not committed any breach of terms and conditions of the policy as he was not aware about such terms and conditions of the policy. According to the complainant, the agent of opponent insurance company obtained signature of his father on blank proposal form giving assurance of obtaining policy. It is submitted that said agent himself subsequently filled the proposal form and by receiving amount of premium from CC No.12/2012 3 insured Late Nagnath deposited said amount towards the premium and opponent insurance company accepted the same and issued the policy. But the opponent insurance company has committed deficiency in service by wrongly repudiated the insurance claim alleging that insured Late Nagnath suppressed material facts and committed breach of terms of policy. Thus alleging deficiency in service on the part of opponent insurance company complainant has filed consumer complaint claiming amount of insurance Rs.20,28,000/- with interest @ 12% p.a. and compensation of Rs.25,000/- for causing mental agony and Rs.20,000/- more towards cost of the proceedings.
3. Opponent insurance company by its written version resisted the claim on the following among other grounds:-
It is not disputed that on 31.10.2010 Late Nagnath submitted proposal for obtaining money back policy through its agent and by accepting premium amount policy was issued. However, it is contended that Late Nagnath by misrepresentation obtained said policy suppressing material facts about his illness and obtaining earlier insurance policies and as such agreement is being void, Late Nagnath was not consumer and therefore consumer complaint is not maintainable. It is submitted that Late Nagnath voluntarily signed the proposal form after understanding the terms and conditions of the policy. But he has suppressed material facts about his illness and also existing insurance policy. It is also contended that Late Nagnath was addicted to liquor but he has not disclosed this fact while submitting insurance policy proposal and gave false declaration etc. It is submitted that Late Nagnath had obtained policy with ulterior motive to extract money from opponent insurance company though he was well aware that he was suffering from chronic disease i.e. diabetes mellitus since three years prior to the date of obtaining policy and he was under treatment of Shri.Markandy CC No.12/2012 4 Solapur Sahakari Rugnalay and Research Centre Niyamit. It is also submitted that Late Nagnath had also obtained other insurance policies prior to the date of obtaining policy in question. But he has not disclosed this fact while making declaration at the time of signing proposal form etc. It is submitted that as insured Nagnath died within two months from the date of obtaining policy, investigation was made and during investigation all these facts are revealed and therefore opponent insurance company has legally repudiated the complainant's claim. It is submitted to dismiss the complaint.
4. In support of complaint, complainant has filed his evidence affidavit and also produced copy of insurance policy, copies of death certificate and copies of income tax return of deceased Nagnath etc. whereas in support of written version, opponent insurance co. filed affidavit of Jaykumar who is authorized signatory of opponent and also copies of proposal form, investigation case papers including medical certificate and copies of medical case papers pertaining to the medical treatment which was given to Late Nagnath in Shri.Markanday Solapur Sahakari Rugnalay and Research Centre Niyamit and also copies of letter collecting information about other policies obtained by Nagnath from Bajaj Allianze and other insurance companies.
5. In view of the above pleading of the parties and evidence lead by them, following issues arise to our determination and we record our findings against each issue for the reasons which follows:-
No. ISSUES FINDINGS I) Whether it is proved by complainant that his
father Late Nagnath had legally obtained insurance policy from opponent insurance company by CC No.12/2012 5 signing blank proposal form on the say of agent of opponent without knowing terms and conditions of the policy? ...In the negative.
II) If yes, whether complainant has proved that opponent Insurance company committed deficiency in service by wrongly repudiating claim? ...Does not survive.
III) Whether opponent has proved that deceased Nagnath fraudulently obtained insurance policy by suppressing material fact? ...In the affirmative.
IV) If yes, whether opponent has legally
Repudiated the complainant's claim? ...In the
affirmative.
V) What order? ...Complaint is
dismissed as
per final order.
6. Issues Nos.I to IV :
In order to avoid repetition we feel it just and proper to decide all the issues simultaneously. Undisputed facts are that, on 31.10.2010 deceased Nagnath had obtained insurance policy in question and thereafter he died on 31.12.2010. His signature on the proposal form is not disputed. However, it is contended by complainant that a agent of opponent insurance company had obtained signature of his father Nagnath on blank proposal form giving assurance to issue policy covering risk of Rs.20,28,000/-. It is contended that subsequently in the absence of insured Nagnath said agent of opponent filled the proposal form and the opponent insurance company issued policy by accepting CC No.12/2012 6 the amount of premium. But except the bare contention of complainant there is no evidence to fortify it. Even complainant has not disclosed the name of agent if any who obtained the signature of deceased Nagnath. In our opinion no businessman would make signatures on blank papers or forms though any assurance is given by any agent of the insurance company. Therefore such contention of complainant is being not probable, cannot be relied on.
7. Apart from the above facts when undisputedly Late Nagnath had obtained other insurance policies, it cannot be accepted that he was in a habit to sign blank proposal forms though he was suffering from chronic disease like diabetes mellitus since about three years prior to the date of obtaining insurance policy in question. But from the copy of proposal form it manifests that deceased Nagnath denied questionnaires pertaining to the existing disease and also existing other policies and addiction with liquor etc. The copies of certificate and medical case papers issued by Shri.Markanday Solapur Sahakari Rugnalaya & Research Centre Niyamit, it manifests that deceased Nagnath was suffering from diabetes and was regularly taking treatment for the same. Copies of post mortem report also manifests that insured Nagnath died due to heart attack. Further medical case papers specifically dated 19.2.2010 which are at page 76 of compilation clearly reveals that insured deceased Nagnath was addicted to liquor and therefore it is noted down that he was alcoholic in habit. These papers are also not denied by the complainant.
8. Thus, it is obvious from the record that deceased Nagnath was suffering from chronic disease viz. diabetes mellitus, he was habited to liquor and further he had obtained other insurance policies, just before obtaining insurance policy in question from opponent insurance company. But he has not disclosed all these facts in the insurance CC No.12/2012 7 proposal form and thereby suppressing these material facts fraudulently obtained insurance policy just two months prior to his death.
9. Further as stated above it is merely contended by the complainant that proposal form was not filled by his father deceased Nagnath but insurance agent who had obtained signature of his father on blank form subsequently by filling the form managed to issue insurance policy. It is also contended that insured deceased Nagnath was not aware about terms and conditions of the policy but opponent insurance company has falsely repudiated the claim on the ground that insured Late Nagnath suppressed material facts etc. Mr.Jawalkar learned counsel for the complainant has tried to support his contention by relying on the decision of National Commission in case of LIC of India -Vs- K.Purushottamma 2006(3) CPR 74(NC), in which it is observed by Hon'ble National Commission that "when it is obvious from the proposal form that it is filled by agent and not by the insured, the insured cannot be said to have provided incorrect and false information regarding insurance policy". It is further observed that "LIC agent can be seen moving from heaven to earth to secure the business during January to March i.e. last quarter of the financial year. They also get a flat commission from first premium etc." Further learned counsel for the complainant also relied on judgment of this Commission in case of Branch Manager, Central Bank of India -Vs- Bagwan Vishnoo Mahadeshwar, 2004(2) CPR 185, in which it is held that " where agent of the Bank having collected money from account holder did not deposit it in bank and committed fraud, Bank will be responsible for misconduct of its agent to pay amount to the account holder". But with due respect considering the undisputed facts of this case above decision of National Commission as well as this Commission cannot be applicable to the present case. Though it is contended by the complainant that agent of opponent insurance CC No.12/2012 8 company obtained the signature of insured deceased Nagnath on blank proposal form and managed to issue insurance policy to the insured, there is no evidence to substantiate the same. When undisputedly the insured was a businessman having business in large scale in Solapur city, the contention of complainant that his father insured Late Nagnath signed blank proposal form etc, cannot be accepted.
10. As against the argument of Mr.Jawalkar learned counsel for the complainant, Mr.D.D.Choudhary learned counsel appearing for opponent insurance company submitted that when it is obvious from the evidence on record that insured suppressed material facts while submitting proposal form, the insurance claim cannot be settled. He has supported his contention by relying on the decision of Hon'ble Supreme Court in case of United India Insurance Co.Ltd. -Vs- MKJ Corporation (1996) 6 SCC 428, wherein it is observed by Hon'ble Apex Court that " it is fundamental principle of insurance law that utmost faith must be observed by contracting parties. Good faith forbids either party from non- disclosure of the facts." Same view was also taken by Hon'ble Apex Court in the case of Modern Insulator Ltd. -Vs- Oriental Insurance Co. Ltd. (2000) 2SCC 734 and held that "non-disclosure of the material fact is sufficient ground for repudiation of claim". It is also followed by Hon'ble National Commission in case of LIC -Vs- Sampat Devi, III(2006) CPJ 32 and many other cases.
11. For the foregoing reasons and undisputed facts as pointed above, we have no hesitation to hold that insured deceased Nagnath had obtained insurance policy by misrepresenting and suppressing material facts viz. pre-existing ailment, alcoholic habit, and obtaining insurance policies from other insurance companies such as Birla Sunlife Insurance, HDFC Standard Life Insurance Policy , Bajaj Allianz Life Assurance policy just a month or couple of months before obtaining insurance in CC No.12/2012 9 question from opponent insurance company with a malafide intention to get monetary benefit to his L.R.s including his son complainant Santosh. Therefore in our considered view opponent insurance company has rightly repudiated complainant's claim.
12. For the foregoing reasons we answer the issues accordingly.
13. In the result, complainant fails and complaint deserves to be dismissed. Hence the following order.
O R D E R
1. Complaint stands dismissed.
2. Having regard to the undisputed facts we direct the parties to bear their own cost.
3. Copies of the order be sent to both the parties.
Sd/- Sd/- K.B.Gawali S.M.Shembole, Member Presiding Judicial Member Mane