State Consumer Disputes Redressal Commission
Jaswinder Singh vs Pnb Met Life India Insurance Co. Ltd. on 21 January, 2020
FIRST ADDITONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
Consumer Complaint No.454 of 2018
Date of institution : 25.05.2018
Date of decision : 21.01.2020
Jaswinder Singh S/o Late Sh. Gurmeet Singh, R/o Village Jodh Singh
Wala, P.O. Bhangala, Tehsil Patti, District Tarn Taran-143416.
....Complainant
Versus
PNB Metlife Insurance Co. Ltd., Regd. Office: Unit No.701, 702 and
703, 7th Floor, West Wing, Raheja Towers, 26/27, M.G. Road,
Banglore-560001-Karnataka, through its Manager/Authorized
Representative.
([email protected]) (www.pnbmetlife.com)
IInd Address:
PNB Metlife Insurance Co. Ltd., Property No.10, Keneddy Avenue,
Mall Road, near Passport Office, Amritsar-143001, through its
Manager/Authorized Representative.
([email protected]) (www.pnbmetlife.com)
....Opposite Party
Consumer Complaint under Section 17 of
the Consumer Protection Act, 1986.
Quorum:-
Hon'ble Mr. Justice Paramjeet Singh Dhaliwal, President
Mr. Rajinder Kumar Goyal, Member
Mrs. Kiran Sibal, Member
1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No
2) To be referred to the Reporters or not? Yes/No
3) Whether judgment should be reported in the Digest? Yes/No Present:-
For the complainant : Sh. Sandeep Bhardwaj, Advocate For the opposite party : Sh. Sanjeev Goyal, Advocate. Consumer Complaint No.454 of 2018 2 JUSTICE PARAMJEET SINGH DHALIWAL, PRESIDENT Misc. Application No.2554 of 2018 This application has been filed by the opposite party, for summoning the medical record from PGI, Chandigarh; PBM Hospital, Bikaner; Fortis Escorts Hospital, Amritsar and SMO, PHC, Rajoke and Khemkaran, District Tarn Taran.
Reply to the application was filed.
Heard.
There is sufficient material on record for adjudicating the controversy between the parties and, therefore, this application is disposed of.
Misc. Application No.921 of 2019 This application has been filed by the complainant for issuing directions to the opposite party to place on record legible copies of documents.
Reply to the application has been filed. Heard.
The legible copies of documents have been filed, along with reply filed by the opposite party to the said application. Hence, the application stands disposed of.
Main Case:
The complainant has filed this complaint, under Section 17 of the Consumer Protection Act, 1986 (in short, "the Act"), against the opposite party, seeking following directions to it: Consumer Complaint No.454 of 2018 3
i) to pay the sum insured of ₹91,00,000/- to the complainant immediately;
ii) to pay compensation of ₹2,00,000/- for the mental agony and harassment suffered by the complainant; and
iii) to pay ₹1,00,000/- towards litigation expenses.
Facts of the Complaint
2. Brief facts, as set out in the complaint, are that father of the complainant namely late Sh. Gurmit Singh was a Government employee in the Health Department of the Government of Punjab. He took a life insurance policy No.21691979 from the opposite party in the year 2015, after clearing all his medical bills. A premium of ₹1,01,400/- was paid for the first year and premium of ₹1,03,310/- was paid for the second year, vide receipt dated 28.09.2016 Ex.C-1. Father of the complainant expired on 06.12.2016 due to heart attack in Guru Nanak Dev Super Specialty Hospital. The complainant lodged claim with the opposite party, vide Claim Form dated 17.01.2017 Ex.C-2. The opposite party informed the complainant, vide letter dated 09.03.2017, about appointment of one Company namely ISTA Services of Mumbai for investigating the claim. The said Company appointed one Mahendra Balotiya for investigation of the claim; who wrote letter to the treating hospital and collected entire medical record pertaining to father of the complainant, including Death Summary, as per letter dated 18.03.2017, Ex.C-4. The opposite party kept on dilly dallying the matter for payment of claim to the complainant, by writing letters 25.08.2017, 09.09.2017, 21.09.2017 and 10.10.2017 Ex.C-5 to Ex.C- 9, stating that the same was under process. Ultimately, the Consumer Complaint No.454 of 2018 4 complainant sent legal notice dated 08.01.2018, Ex.C-10, to the opposite party, requesting it to release the claim amount immediately. However, the opposite party repudiated claim of the complainant, vide letter dated 02.02.2018, Ex.C-11, on the ground that his father was suffering from hepatitis-C and Renal Cell Carcinoma prior to issuance of policy which he failed to disclose at the time of taking the policy. It was further averred that the father of the complainant was not suffering from the alleged diseases, nor he ever took any medical leave for treatment of the same. The cause of his death was heart attack and there is no nexus between the cause of death and diseases mentioned in the repudiation letter. Father of the complainant was never got admitted in the hospital nor he ever took treatment for the alleged diseases prior to inception of the insurance policy. No condition of the policy was disclosed, under which the claim was repudiated, nor any details of terms and conditions of the policy were ever communicated to his father. It was further averred that the Insurance Regulatory Development Authority (IRDA) issued a guidelines i.e. (Protection of Policyholder Interest) Regulations, 2002 dated 26.04.2002. As per Clause-3 of those Regulations, if the insurer finds the survey report to be incomplete, it shall ask the surveyor within 15 days of receipt of original survey report, to furnish additional report on certain/specific issues. However, no intimation of any kind has been received in accordance with Clause-3 of the said Regulations. Further, as per Clause-5 of the said Regulations, on receipt of survey report or additional survey report, as the case may be, an insurer shall within a period of 30 days offer a settlement of the claim to the insured. If the Consumer Complaint No.454 of 2018 5 insurer decides to reject the claim, the same can be done within 30 days from receipt of survey/additional survey report. Further, as per Clause-6 of those Regulations, upon acceptance of settlement as per Clause-5 by the insured, the payment of amount shall be made within 7 days from the date of acceptance of offer of the insured and in case of delay in making payment, the insurer shall be liable to pay interest at the rate which is 2% above the Bank rate prevalent at the beginning of the financial year, in which the claim is reviewed by it. However, the opposite party failed to comply with the above said provisions of IRDA. The opposite party issued premium paid certificate dated 03.04.2018, Ex.C-13. It also collected all the original documents, medical record etc. from the complainant under the garb of processing the claim, but the survey report was never sent to him. The claim of the complainant was wrongly and illegally repudiated. The aforesaid act and conduct of the opposite parties amount to deficiency in service. Hence, the present complaint.
Defence of the Opposite Parties
3. Upon notice, the opposite party appeared and filed reply to the complaint, raising preliminary objections that the complaint is frivolous, vexatious and is liable to be dismissed under Section 26 of the Act. The complainant has failed to make out any case of deficiency in service on the part of the opposite party. The complainant has not come to the Commission with clean hands and his father, since deceased, (in short, "(DLA"), has suppressed true and correct facts about his previous ailments at the time of getting the insurance policy from the opposite party, as he was suffering from Hepatitis-C and Consumer Complaint No.454 of 2018 6 Renal Cell Carcinoma and was getting treatment from PGI, Chandigarh, PBM Hospital, Bikaner and Fortis Escort Hospital, Amritsar for the last 3 years before getting the insurance policy i.e. on 25.09.2015. By doing so, the DLA misled the opposite party to issue insurance cover to him. Had those facts been disclosed at the time of submitting proposal form, the policy would not have been issued. The contract of insurance is based on utmost good faith and the DLA was duty bound to disclose true and correct facts at the time of issuance of the policy. Reference to various authorities has been made, the relevant of which would be discussed in the later part of the order. It was further pleaded that the opposite party has taken into consideration the provisions of Section 2 (d) of the Protection of Policy Holders' Interest Regulations, 2002 at the time of issuing the insurance policy to the DLA. The complainant is not a valid complainant, as defined in Section 2 (d) of the Act, as there is no relation between the complainant and the opposite party, as per provisions of the Act. On merits, it was pleaded that the claim of the complainant was rightly repudiated. This Commission has no jurisdiction to try and decide the complaint, as detailed evidence, including summoning of witnesses, cross-examination, is required to adjudicate the matter and, as such, only the Civil Court is competent. It was further pleaded that proposal form No.192989322 dated 25.09.2015 was submitted by the DLA for issuance of life insurance policy under "MET FAMILY INCOME PROTECTOR PLUS PLAN" for 20 years term, having sum assured of ₹91 lac. The DLA gave all the answers in negative regarding his health, by declaring that he was neither suffering from any ailment nor Consumer Complaint No.454 of 2018 7 consulted any doctor or health practitioner for illness lasting for more than 4 days; except for fever, common cold or cough and he also declared that he never underwent ECG, X-ray, blood test or other tests, nor he was ever admitted in any hospital for any medical facility during last 5 years. On the basis of information given by the DLA in the proposal form, the policy, in question, was issued to him. However, the DLA was suffering from dreaded diseases of cancer and Hepatitis-C before getting the policy. He was admitted in Guru Nanak Dev Super Specialty Hospital, Tarn Taran in serious condition and died due to complications of said ailments. After getting information about death of the DLA, the opposite party appointed ISTA as investigator to investigate the genuineness of the claim of the DLA. The investigator visited the house of the complainant and Guru Nanak Dev Super Specialty Hospital, Tarn Taran and also made secret inquiries about death of the DLA. During investigation, it was found that the DLA was suffering from the dreaded diseases of cancer and Hepatitis-C for the last 3 years before getting the policy. Besides this, the DLA had also taken treatment from PGI, Chandigarh; PBM Hospital, Bikaner; and Fortis Escorts Hospital, Amritsar. The investigator also visited Fortis Escorts Hospital, Amritsar and procured detailed medical check-up and investigation reports dated 05.11.2014 of the DLA, from which it was found that he was suffering from Hepatitis-C and his createnine level was beyond permissible limit. However, Fortis Escorts Hospital refused to provide other medical treatment documents. The investigator also visited PGI, Chandigarh and PBM Hospital, Bikaner; but they refused to provide any document. The investigator sent letter Consumer Complaint No.454 of 2018 8 dated 25.04.2017 to PGI, Chandigarh under RTI Act for providing requisite information, but even then it refused to provide the requisite information. He also wrote letter dated 20.03.2017 to SMO, PHC, Khemkararn, District Tarn Taran to provide two years' medical leave and attendance sheet of the DLA, but no reply was received. However, during investigation, Rajwinder Kaur (Asha Worker) wife of Sh. Harjit Singh and Kulwinder Kaur (Anganwari Worker) W/o Sh. Jagmohan Singh, both residents of village Jodh Singh Wala gave written statement to the investigator, to the effect that the DLA died due to cancer, which he was suffering from last 3 years. Thereafter, the investigator submitted his report dated 18.06.2017 with the opposite party, concluding that the DLA was suffering from cancer and Hepatitis-C for the last 3 years and that the policy was obtained by him, by playing fraud upon the opposite party. Thereafter, the claim of the complainant was repudiated, vide letter dated 02.02.2018, as per terms and conditions of the policy. All other allegations levelled in the complaint were denied and it was prayed that the complaint be dismissed.
Evidence of the Parties
4. To prove his claim, the complainant tendered in evidence his own affidavit Ex.C-A, along with copies of documents i.e. receipt dated 28.09.2016 Ex.C-1, claim form Ex.C-2, letters Ex.C-3 to Ex.C-9, legal notice dated 08.01.2018 Ex.C-10, repudiation letter dated 02.02.2018 Ex.C-11, letter dated 03.04.2018 Ex.C-12 and IRDA Regulation dated 26.04.2002 Ex.C-13.
Consumer Complaint No.454 of 2018 9
5. On the other hand, the opposite party tendered in evidence affidavit of Sh. Pardeep Basra, Authorized Signatory Ex.OP-A, along with copies of documents i.e. policy document dated 08.08.2018 Ex.OP-1, replies under RTI Act Ex.OP-2 (colly.), medical tests and investigation report Ex.OP-3 (colly.), letter dated 20.03.2017 Ex.OP-4 and investigation report Ex.OP-5.
Contentions of the Parties
6. We have heard learned counsel for the parties, perused the written arguments submitted by them and have gone through the record carefully.
7. The written arguments submitted on behalf of the complainant are on the lines of the complaint. Learned counsel for the complainant has further contended that the opposite party has repudiated the genuine claim of the complainant, wrongly, illegally and arbitrarily. The DLA was hale and hearty at the time of taking the insurance policy and was not suffering from any serious disease or the diseases of cancer or Hepatitis-C. The policy was issued by the opposite party, only after verifying the health status of the DLA. At the time of obtaining the policy, various medical tests of the DLA were got conducted by the Insurance Company, but no medical problem was found. The DLA had supplied all the relevant documents/information to the Insurance Company and no material fact was ever suppressed by him. No medical history regarding the alleged diseases of cancer and Hepatitis-C has been produced by the opposite party to prove that the DLA was suffering from these diseases prior to taking of the policy. The onus was upon the opposite party to prove that there was Consumer Complaint No.454 of 2018 10 concealment of material facts, but they failed to produce any cogent or convincing evidence for proving the same. It has been further contended that as per Clause 8(2) of IRDA (Protection of Policyholders Interests) Regulation, 2002, the opposite party was required to raise queries and fulfil requirement of documents within 15 days. As per Clause 8(3) of said Regulations, the opposite party had to initiate and complete the investigation not later than 6 months from the date of lodging the claim. Admittedly, the claim was lodged on 18.03.2017 and period of six months expired on 17.09.2017, whereas the claim was repudiated on 02.02.2018. Thus, the opposite party violated the provisions of above said Regulations. Further, the opposite party failed to produce requisite original documents, sought to be produced by way of Misc. Application No.921 of 2019 filed by the complainant. Thus, the repudiation of the claim was not based on any documentary proof. There is deficiency in service on the part of the opposite party and, thus, the complaint is liable to be allowed and all the directions, as prayed in the complaint, are liable to be issued to the opposite party. In support of his contentions, learned counsel for the complainant relied upon following cases:
i) Sulbha Prakash Motegaonkar & Ors. v. LIC of India Civil Appeal No. 8245 of 2015 decided on 05.10.2015 (SC)
ii) Life Insurance Corporation of India v. Sudesh Kumari Revision Petition No.2170 of 2018, decided on 13.12.2018 (NC);
iii) Vipin Grover v. New India Assurance Co. Ltd. II (2018) CPJ 374 (NC); and Consumer Complaint No.454 of 2018 11
iv) Gurbax Singh v. Star Health and Allied Insurance Co. Ltd. II (2018) CPJ 159 (NC);
8. The written arguments submitted on behalf of the opposite party are also on the lines of the reply filed on its behalf. It has been further contended that the DLA had submitted wrong answers regarding his health status, while filling up the proposal form. He was suffering from cancer and Hepatitis-C for the last three years of taking of the policy, for which he was taking treatment from PGI, Chandigarh, PBM Hospital Bikaner and Fortis Escorts Hospital, Amritsar, but he concealed this fact and obtained the policy, in question, by fraud. The contract of insurance, being based on the principal of utmost good faith, was vitiated and, as such, the claim of the complainant was rightly and legally repudiated. It has been further contended that the policy was taken on 24.11.2015 and the DLA died on 06.12.2016, i.e. just after one year of taking the policy. As per medical record Ex.R-3 of Fortis Escorts Hospital, Amritsar, the DLA was admitted on 05.11.2014 and a number of tests were conducted upon him. As per reports, his Hepatitis-C was reactive and his red blood cells were 40-50, against the permissible limit of 0-5. Furthermore, as per report dated 05.11.2014, the DLA was suffering from disease of Renal Cell Carcinoma (caner). All the relevant questions regarding his health were wrongly given in negative by the DLA and, thus, material facts qua his health were intentionally withheld. In the Death Summary at page-95, it is mentioned that the DLA was very critical and he died due to cardiac arrest, but the complainant concealed this fact in the complaint. There is no deficiency in service on the part of the opposite Consumer Complaint No.454 of 2018 12 party and the complaint is liable to be dismissed. In support of his contentions, learned counsel for the opposite party relied upon following cases:
i) Reliance Life Insurance Co. Ltd. & Anr. v. Rekhaben Nareshbhai Rathod 2019 (2) CPJ 53 (SC);
ii) Satwant Kaur Sandhu v. New India Assurance Company Ltd.
2009 (IV) PCJ 8 (SC);
iii) Life Insurance Corporation of India v. Manish Gupta Civil Appeal No.3944 of 2019 (@SLP © No.5001/2019) decided on 15.04.2019 (SC).
iv) Tata AIG Life Insurance Co. Ltd. v. Orissa State Co-operative Bank & Anr. 2012 (IV) CPJ 310 (NC);
v) Life Insurance Corporation of India & Anr. v. Mandava Geetha 2012 (III) CPJ 644 (NC);
vi) Sadanand Bag v. Life Insurance Corporation of India & Anr.
2012 (III) CPJ 398 (NC);
vii) LIC of India v. Rukma 2012 (II) CPJ 44 (NC);
viii) Life Insurance Corporation of India v. Francis Antony D'souza 2012 (2) CLT 176 (NC);
ix) LIC of India v. Premlata Aggarwal 2012 (2) CLT 182 (NC);
x) Meenaben Ashok Kumar Patel v. Life Insurance Corporation of India 2012 (2) CLT 415 (NC);
Consideration of Contentions
9. We have given our thoughtful consideration to the respective contentions raised by the learned counsel for the parties. Consumer Complaint No.454 of 2018 13
10. Admittedly, Sh. Gurmit Singh (DLA), father of the complainant, had obtained life insurance policy from the opposite party i.e. "MET FAMILY INCOME PROTECTOR PLUS PLAN", Ex.OP-1 (colly.) for a term of 20 years term. Premium of ₹1,01,400/- was paid for getting that policy and the basic sum assured thereunder was ₹91,00,000/-. The policy incepted on 29.09.2015 and completion date of the same was 29.09.2035. Under the policy, the Guaranteed Monthly Regular Income was ₹1,00,000/-. Father of the complainant died on 06.12.2016 in Guru Nanak Dev Super Specialty Hospital, Tarn Taran, as per Death Summary, Ex.OP-5 (colly.). The complainant lodged the claim with the opposite party; who repudiated the same, vide letter dated 02.02.2018 Ex.C-11, on the ground that the DLA was suffering from Hepatitis C and renal cell carcinoma prior to issuance of the policy and he concealed this fact, while filling up the Proposal Form dated 25.09.2015.
11. The only question to be decided in the instant complaint is, whether the repudiation of the claim by the opposite party on the above referred grounds is justified?
12. It would be appropriate to examine the Proposal Form dated 25.09.2015, Ex.OP-1 (colly.) filled up by the DLA at the time of taking the above said insurance policy. While filling up the said Proposal Form, the DLA had given all the answers in negative to the questionnaire given under head "Medical Details". The relevant questions/answers given in the Proposal Form are reproduced as under:
Consumer Complaint No.454 of 2018 14
4. Cancer, Tumour, Cyst, Leukemia, Growth, Lump No or other Malignancy?
14. During the past five years:
a) Have you consulted any doctor or health No practitioner for illness lasting for more than 4 days except for fever, common cold or cough?
b) Have you undergone ECG, x-ray, blood test or No other tests?
c) c) Have been admitted/advised to be admitted to No any hospital or any other medical facility?
The opposite party has produced on record medical record of DLA maintained at Fortis Escorts Hospital, Ex.OP-3 (colly.). As per test report of Serology dated 05.11.2014 at page-70, Hepatitis C was reactive. Further, test report dated 05.11.2014 at page-71 shows that the Red Blood Cells of the DLA were 40-50 against the permissible limit of 0.5. Perusal of Haematology report dated 07.11.2014 at page- 73 shows that Sedimentation Rate (ESR) of the DLA was very high 24 against the normal value of 0-15. It needs to be mentioned that certain types of cancer, including some types of lymphoma and multiple myeloma are amongst the causes of high range of ESR. From perusal of report dated 05.11.2014 at page 76, it is clear that the DLA was suffering from disease of Renal Cell Carcinoma (cancer). The relevant part of that report reads as under:
"The study reveals evidence of Lobulated mixed density mass lesion showing enhancing solid component with nonenhancing hypodense areas and of size of 12x14x7 cm. in relation with right adrenal gland. Sorrounding fat planes are preserved. The mass is extending superiorly up to infrahepatic surface. It is displacing right kidney laterally and interiorly. The mass is comprising the right renal vane with resultant dilation of its proximal part."Consumer Complaint No.454 of 2018 15
13. Furthermore, in the Investigation Report, Ex.OP-5, it is mentioned that the investigator verified that DLA underwent various tests at Fortis Escorts Hospital and was found suffering from Hepatitis C and his Creatinine level was also beyond the permissible limit. Not only this, in the Death Summary of the DLA, Ex.OP-5 (colly.), issued by Guru Nanak Dev Super-Specialty Hospital, the diagnosis is given as under:
"Diagnosis: Case of renal cell carcinoma metastasis with cerebral metastasis & cerebellar metastasis with HCV positive."
Furthermore, in the History of DLA recorded in above said Death Summary, following observations were made:
"History: Patient was diagnosed case of renal cell carcinoma metastasis with cerebral metastasis & cerebellar metastasis with HCV positive. He was operated for hydrocephalus in PGI & also received radiotherapy from PGI. Patient came in our Hospital at 3.44 PM on 01.12.2016 in drowsy state with decreased appetite. On examination, his G.C.S. was (E4 M6 V5)-pupils were NSERL. Patient was conscious but not following commands. He was evaluated including routine investigation and imaging (CT scan was done)-which shows cerebral & cerebellar metastasis. He was treated with antibiotics and antioedema measures (from 01.12.2016 to 06.12.2016).
Patient hand sudden cardiac arrest on 06.12.2016 at 10.00 AM. He was resuscitated for half hour but could not be revived. On examination, pupils were fixed, dilated. All brachial, carotid, femoral pulses were absent. ECG taken at 10.34 AM. It reveals straight line. Patient declared dead and explained to attendants."
Consumer Complaint No.454 of 2018 16From the above discussed evidence, it is clearly proved that the DLA was suffering from Hepatitis C and renal cell carcinoma (cancer) prior to taking the insurance policy, in question, by filling up the aforesaid Proposal Form. Cerebral metastasis is the last stage of cancer. However, he answered in negative to the aforesaid questions, whether he ever suffered from Cancer, Tumour, Cyst, Leukemia, Growth, Lump or other Malignancy and whether he ever consulted any doctor or health practitioner for illness lasting for more than 4 days except for fever, common cold or cough, and whether he was ever admitted/advised to be admitted to any hospital or any other medical facility. From the evidence discussed above, it is proved that DLA gave misstatement, knowingly well that he was already suffering Hepatitis C and cancer; for which he took treatment from Fortis Escorts Hospital, Amritsar and other hospitals and underwent various investigations, as per above discussed documents. Had the material information regarding the health of the DLA been disclosed by him at the time of filling up the Proposal Form, that would have certainly affected the decision of the Insurance Company in issuing the insurance policy.
14. Plea of the complainant is that the DLA died due to heart attack and there is no nexus between heart attack and the diseases mentioned in the repudiation letter. No doubt, the DLA died due to heart attack, but as already discussed above, it is clearly proved from perusal of the History of DLA discussed above that he was suffering from Hepatitis C and renal cell carcinoma (cancer) prior to taking the insurance policy, in question. Furthermore, cancer treatment can cause the heart to pump less efficiently, cause changes in blood flow Consumer Complaint No.454 of 2018 17 and increases the risk for blood clots (thrombosis); which can cause heart attack. In such circumstances, the plea of the complainant that there is no nexus between heart attack and cancer is not tenable. Therefore, it is clearly proved on record that the DLA obtained the insurance policy, in question, by concealing material information regarding his health and by giving wrong declaration in the Proposal Form, in which he declared that he had made complete, true and accurate disclosure of all the facts to the best of his knowledge. As a result, the contract of insurance between the parties, which is based on utmost good faith, stood vitiated. It was categorically held by the Hon'ble Supreme Court in Satwant Kaur Sandhu Vs. New India Assurance Company Ltd. (IV) (2009) CPJ 8 (SC) that where there is concealment of fact regarding the health of the insured, which was in his/her knowledge, the same amounts to suppression of material fact and the Insurance Company is justified in repudiating the Insurance Contract. The law laid down in Satwant Kaur's case has been further reiterated and strengthened by the Hon'ble Supreme Court in Rekhaben Nareshbhai Rathod and Manish Gupta's cases (supra).
15. In P.C. Chacko & Anr. v. Chairman, Life Insurance Corporation of India & Ors. 2008(3) CPC 248 (SC) also, the insured had undergone thyroid operation, which was not disclosed by him at the time of obtaining the policy and he died within six months after taking that policy. It was held therein that the deliberate wrong answer may lead to policy being vitiated in law. The contract of insurance was held to be null and void and the repudiation of the claim was upheld. It was held therein that it is a well settled law in the field of insurance that Consumer Complaint No.454 of 2018 18 contracts of insurance including the contracts of life assurance are contacts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission.
16. In LIC of India v. Dalbir Kaur 2011(2) CLT 281 (NC) before taking the insurance policy, the insured had undergone treatment as an inpatient in Sony Nursing Home from 8.5.1999 to 16.5.1999 and from 1.2.2002 to 28.2.2002. He was also an outpatient in the same Nursing Home till 22.4.2012 and it was also on the record that he had been sanctioned two months' earned leave from 11.4.2002. While filling up the proposal form, he had given answers in the negative to the relevant questions. It was held by the Hon'ble National Commission that the Insurance Company was entitled to repudiate the insurance claim as the declaration made by the insured was found to be false.
17. Still further, in Maya Devi v. Life Insurance Corpn. of India 2011 (3) CPJ 43 (NC), it was held by the Hon'ble National Commission that insurance policy is an agreement of utmost good faith between the insurer and the insuree and breach by suppressing material facts on the part of the insuree would result in repudiation of claim by the insurer.
18. In view of the law laid down in the above noted authorities as well as in view of our above discussion, it has been clearly proved that the DLA intentionally and willfully concealed the material information and gave wrong answers, while filling up the Proposal Form. Therefore, the claim of the complainant has been legally and rightly repudiated by the opposite party. So far as the plea of the Consumer Complaint No.454 of 2018 19 complainant regarding alleged non-compliance of regulations of IRDA is concerned, it needs to be mentioned that since the insurance policy was taken by the DLA by playing fraud upon the opposite party, as discussed above, so there is no need to discuss the alleged regulations of IRDA. Thus, no deficiency in service on the part of the opposite parties is established.
19. In view of our above discussion, there is no merit in the present complaint and the same is hereby dismissed.
20. The complaint could not be decided within the stipulated timeframe, due to heavy pendency of Court cases.
(JUSTICE PARAMJEET SINGH DHALIWAL) PRESIDENT (RAJINDER KUMAR GOYAL) MEMBER (MRS. KIRAN SIBAL) MEMBER January 21, 2020.
(Gurmeet S)