State Consumer Disputes Redressal Commission
Sbi Life Insurance Company Limited, vs Shri Santosh Nagnath Kedari, on 18 September, 2014
BEFORE THE HON'BLE STATE
CONSUMER DISPUTES REDRESSAL
COMMISSION, MAHARASHTRA,
MUMBAI
First Appeal No. A/13/369
(Arisen out of Order Dated 29/10/2013
in Consumer Case No.382/2011 of District Forum, Solapur)
1.
Manager,
SBI
Life Insurance Company Limited,
Central
Processing Centre,
Plot
No.3/A, Sector 10, CBD Belapur,
Navi
Mumbai 400 614.
2.
Branch Manager,
SBI
Life Insurance Company Limited,
1926,,
N.G. Abdulpurkar Complex,
1st
Floor, Neela Nagar, Samrat Chowk,
Solapur.
...........Appellant(s)
Versus
Shri
Santosh Nagnath Kedari,
R/o
Jawahar Nagar, Hyderabad Raod,
Vidi
Gharkul, Solapur.
...........Respondent(s)
BEFORE:
HON'BLE
MR. JUSTICE R.C.CHAVAN PRESIDENT
HON'BLE
MR. Dhanraj Khamatkar Member
For the Appellant:
Mr.Nikhil Mehta For the Respondent:
Mr.A.K. Jawalkar O R D E R Per Honble Justice Mr.R.C. Chavan President:(1)
This appeal is directed against the order passed by the District Consumer Disputes Redressal Forum, Solapur, allowing the consumer complaint no.382/2011 and directing the appellant to pay a sum of Rs.19,60,000/- to the Complainant.(2)
Facts which are material for deciding this appeal are as under:
One Nagnath Kedari was a big businessman at Solapur. The Appellants agent approached Nagnath Kedari to obtain a policy of insurance. On 15.09.2010 the appellants agent is supposed to have taken signatures of Nagnath Kedari on the proposal form stating that he would fill-up necessary particulars. Nagnath Kedari gave a cheque for Rs.49,000/- on 15.09.2010 itself. Nagnath Kedari was examined by the Doctor on appellants panel. The policy of insurance commenced on 30.12.2010. Premia were to be paid half yearly for a period of five years and sum assured was Rs.19,60,000/-. On 31.12.2010 Nagnath Kedari had a heart attack and expired. The complainant made a claim with the appellant insurance company which repudiated the claim stating that the insured had suppressed from the insurance company that he was suffering from diabetes and had also suffered paralysis. Aggrieved thereby complainant filed the complaint claiming a sum of Rs.19,60,000/- along with further compensation, costs etc. (3) The appellant insurance company filed a written version stating that the insured was suffering from diabetes and his left side was paralyzed. The insured had also obtained various policies of insurance worth Rs.1 crore 58 lac. The insured was taking treatment from 19.02.2010 till 25.02.2010. Since the insured had obtained the policy by suppressing the material facts the insurance company justified the repudiation of the claim.(4)
After considering rival contentions, the Forum came to pass the impugned order.
Aggrieved thereby the insurance company is before us.
(5)We have heard the Ld.Counsel for the parties.
(6)Even the District Forum has observed that Nagnath Kedari had in fact suffered from paralysis as could be seen from record of Shri Markandey Solapur Sahakari Rugnalaya & Research Centre, Solapur. Hospital notes dated 19.02.2010 mentioned that there was no history of hypertension, asthma or tuberculosis and there was no previous history of hospitalization. Against the entry of habits, it has been mentioned that Nagnath Kedari was alcoholic.
Nagnath Kedari had suffered paralysis on the left side. He was treated and then discharged after treatment possibly on or after 24.02.2010.
Thus, when the proposal form was filled-up on 15.09.2010, Nagnath Kedari had already undergone hospitalization for paralysis.
It is not in dispute that in the proposal form it has been mentioned that he did not suffer from any such disease.
It was the Complainants case that the proposal form was filled up by the insurance agent. However, this contention would not help the complainant since the insured was a big businessman and must take the responsibility of contents of document which he signs. Therefore, this contention would not help the complainant. In fact, the Forum was also aware of this and therefore, the Forum observed that the non-disclosure was not fundamental enough for repudiation of the claim. For this purpose the Forum held that the cause of death was heart failure and paralytic stroke suffered by the insured had nothing to do with the cause of death.
A number of judgements were relied on by the Forum for coming to said conclusion. Ld.Counsel for the respondent relied particularly on a decision of this Commission in L.I.C. of India V/s Pushpabai Devidas Bansode & Ors., reported in 2011(2) CPR 89. In that case the insured was handicapped due to polio which fact was not disclosed in the proposal. The insured had also suffered from paralytic stroke and had been hospitalized from 30.11.1998 to 14.12.1998. The policy itself was taken on 11.03.2001. The Commission observed in paragraph 15 as under:
In the instant cases, it is the contention of appellant that deceased has availed leave on medical ground. Appellant did not adduce evidence in that respect even appellant did not adduce evidence to show deceased was suffering from paralysis and he had paralytic attach. Appellant simply produced the certificate of concerned doctor. Affidavit of doctor not brought on record. Further it is to be noted that there is no evidence to show that deceased was knowing that non-discloser of earlier policies will help him in obtaining present policy. It was necessary for the appellant to bring on record the evidence showing that because of non-discloser of earlier policies deceased is getting benefit in issuing policy in question. Deceased died due to heart attack. He was said to have suppressed the deformity and paralytic attack. There is no nexus between cause of death and the alleged suppression of material particular. Forum has considered all these aspects in right perspective and rightly allowed the complaint. We are not inclined to interfere the order passed by the Forum and dismissed the appeal.(7)
We have carefully considered this as well as the other decisions on which the Forum relied. It is to be noted that in the complaint the Complainant had omitted to specifically state whether the insured has suffered from paralysis and was hospitalized for said disease in the past before the proposal was filled-up. The pleadings would show that the complainant wanted to suggest that the proposal was filled-up by the agent of the Insurance Company, without explicitly stating that had the insured filled the form, he would not have omitted to mention that he had suffered from paralysis. In paragraph 9 of the complaint the Complainant again did not explicitly state whether the insured suffered from paralysis but went on to add that insured did not die due to paralysis. The Complainant again went on to plead that the proposal was accepted after the medical examination and if the insured was suffering from paralysis, this would have been mentioned in the Doctors certificate. Rather than relying on these inferences it was necessary for the complainant to state whether his father had in fact suffered from paralysis and had been hospitalised. Failure to categorically state so in spite of such specific mention in the letter of repudiation would lead to the inference that the insured did suffer from paralysis and this fact was suppressed while taking policy of insurance.(8)
In paragraph 15 of the judgement quoted above what the Commission was observed, was that the insurance company did not adduce evidence that the insured was suffering from paralysis. In the case at hand such evidence was not necessary in the face of the fact that the Complainant had not specifically denied this. He was happy beating around the bush. In the complaint, or even in the subsequent affidavit after a written version was filed by the appellant affidavits of three persons who attended the cremation were filed stating that deceased did not suffer from any major disease and was never admitted in the hospital for major disease. This would not be a substitute for a word from the insureds son denying that his father was ever admitted in Shri Markandey Solapur Sahakari Rugnalaya & Research Centre, Solapur and stating that the papers of the hospital were false. Therefore, it is clear that the insured was hospitalized for paralytic stroke and he had suppressed this information while making a proposal.(9)
As already observed, the District Forum has repeatedly stated that this fact had no nexus to the case of death. Now, this is an inference drawn by the Forum without any medical opinion. Since the insured was about 49 years old at the time of his death and had suffered a paralytic stroke and died of heart failure it would be difficult to conclude that the ailment for which he suffered hospitalization had nothing to do with the case of death.(10)
Since providing an insurance cover is based upon utmost good faith the insured was obliged to inform about everything concerning his health. Merely because the insured was subjected to medical check-up before the policy was issued, he was not absolved from responsibility of truthfully disclosing correct facts about his health. In view of this we find that repudiation by the appellant company was justified and the finding of the District Forum was not justified.(11)
In view of this we allow the appeal, set aside the impugned order and dismiss the complaint, leaving the parties to bear their own costs.
Pronounced on 18th September, 2014.
[Honble Justice Mr. R.C.Chavan] PRESIDENT [Honble Mr.Dhanraj Khamatkar] MEMBER ep