State Consumer Disputes Redressal Commission
Madhu vs Icici Prudential Life Insurance ... on 23 November, 2015
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No.723 of 2012
Date of Institution: 31.05.2012.
Date of Decision : 23.11.2015.
Madhu widow of Sh. Prem Kumar r/o 35/9, Central Town, Jalandhar.
.....Appellant/complainant
Versus
1. ICICI Prudential Life Insurance Co. Ltd., Regd. Office ICICI Pru
Life Towers, 1089 Appa Saheb, Marathe Marg, Prabha Devi,
Mumbai-40025 through its Chairman/Mg. Director.
2. ICICI Prudential Life Insurance Co. Ltd., Plot No.22-23, First
Floor, G.T. Road, above Punjab & Sind Bank, Jalandhar
144001, through its Branch Manager.
.....Respondents/opposite parties
First appeal against order dated
18.04.2012 passed by the District
Consumer Disputes Redressal
Forum, Jalandhar.
Quorum:-
Shri J. S. Klar, Presiding Judicial Member.
Shri H.S. Guram, Member.
Present:-
For the appellant : Sh. Mandeep Singh, Advocate
For the respondent : Sh. K.S. Cheema, Advocate
..................................................... J. S. KLAR, PRESIDING JUDICIAL MEMBER:-
The appellant of this appeal (the complainant in the complaint) has directed this appeal against the respondents herein (the opposite parties in the complaint [in short the 'OPs']), assailing order dated 18.04.2012 of District Consumer Disputes Redressal Forum Jalandhar (in short, "the District Forum"), dismissing the complaint of the complainant.
2. Complainant Madhu has filed the complaint under Section 12 of the Consumer Protection Act, 1986 (in short, "the Act") First Appeal No.723 of 2012 2 against the OPs on the pleaded facts that her husband Prem Kumar deceased obtained life insurance policy (Life Time Super) from OPs, vide policy no.04718864 dated 02.03.2007 of Rs.4,50,000/-. As per policy terms, the husband of the complainant was to pay half yearly installment of Rs.45,000/- to OPs. Prem Kumar paid four installments of Rs.45,000/- each. The husband of the complainant Prem Kumar, who took the policy fell ill and died on 31.12.2008 at Jalandhar. The complainant approached OPs and submitted claim form by completing the formalities for insurance claim, but OPs repudiated the insurance claim, vide letter dated 22.12.2009 on the ground that deceased/insured had habit of chronic alcohol consumption and had Cirrhogenic Liver since 20 years. The complainant has, thus, prayed that OPs be directed to pay her Rs.4,50,000/- as insurance claim alongwith bonus and interest from the date of filing the complaint till actual payment, besides Rs.10,000/- as compensation and litigation expenses.
3. Upon notice, OPs filed their written reply and contested the complaint of the complainant by raising preliminary objections that OPs rightly rejected the insurance claim of the complainant, as the insured had given wrong information and suppressed the material information and he furnished the false information in the proposal form. At the time of filling up the proposal form life assured did not disclose this fact that he had habit of chronic alcohol consumption and had cirrhogenic liver since 20 years. It was further averred by the OPs that from the stated circumstances, it is evident First Appeal No.723 of 2012 3 that the insured had the knowledge of his adverse medical condition and he willfully suppressed the same, when he took the policy. It was further pleaded that Contract of Insurance is based on utmost good faith. As per the contract, the Insurer is bound to honour the claim under the policy in the event of death of the life assured provided to the life assured at the time of applying for the policy, if life assured had disclosed all material information with regard to his health etc., which are the basis on which the insurer decides to cover the said life and at what rates. During the claim processing, the OPs obtained the medical record of life assured from Patel Hospital, Jalandhar and on the basis of medical record, it is evident that life assured was chronic alcoholic since 20 years and cirrhogenic liver in itself means liver damage due to consumption of alcohol. It was further averred that insurance claim has been repudiated bonafide and on the basis of documentary evidence of suppression of material facts by the life assured in his proposal form. The OPs prayed for the dismissal of the complaint.
4. The complainant tendered in evidence her affidavit Ex.C-A, alongwith documents Ex.C-1 to Ex.C-3 and closed the evidence. As against it, OPs tendered in evidence affidavit of Shana Kashyap, Manager of the OPs alongwith documents Ex.OP-1 to OP-5 and closed the evidence. On conclusion of evidence and arguments, the District Forum dismissed the complaint of the complainant, vide order dated 18.04.2012. Dissatisfied with the order First Appeal No.723 of 2012 4 of the District Forum, the complainant now appellant has carried this appeal against the same.
5. We have heard the learned counsel for the parties at considerable length and also examined the record of the case. Only point falling for adjudication in this appeal is whether the repudiation of the claim by the OPs, vide letter dated 22.12.2009 is justified on the ground that deceased Prem Kumar life assured was in the habit of chronic alcohol consumption and had cirrhogenic liver since last 20 years. The complainant stated in her affidavit that life assured Prem Kumar was not alcoholic. Ex.C-1 is the copy of letter dated 22.12.2009 issued by OPs to the complainant, vide which the insurance claim of the complainant was repudiated on the ground that life assured had habit of chronic alcohol consumption and had cirrhogenic liver since 20 years. Ex.C-2 is the copy of Renewal Premium Receipt dated 10.03.2008 of Rs.45,000/-. Ex.C-3 is the copy of Premium Receipt dated 11.09.2007 of Rs.45,000/- paid by the life assured to the OPs. Ex.OW-1/A is the affidavit of Shana Kashyap Manager of the OPs to the effect that Prem Kumar life assured was already suffering from cirrhogenic liver, being chronic alcohol consumption and he concealed this material fact when he took the policy deliberately and deceptively from the OPs. He further stated in his affidavit that as per summary record of Patel Hospital Jalandhar dated 06.08.2007, the life assured was diagnosed as alcoholic liver disease - alcoholic hepatitis with underlying cirrhosis diabetes mellitus. As per history, the life assured was chronic First Appeal No.723 of 2012 5 alcoholic - cirrhogenic liver since 20 years. Ex.OP-1 is the copy of proposal form filled in by the life assured Prem Kumar and he nowhere disclosed in it that he suffered from any liver cirrhosis or alcoholic habit. Ex.OP-2 is the copy of death claim intimation-cum- claimant's statement submitted by the complainant with the OPs. Ex.OP-3 is the copy of Treating Doctor's Certificate, who diagnosed the life assured and it is recorded in the discharge summary of life assured issued by Patel Hospital Jalandhar that life assured was diagnosed as ALD-alcoholic hepatitis with underlying cirrhosis. It has been recorded in the history that Prem Kumar is patient of 46 years old, who is known case of diabetes Mellitus II and basically chronic alcoholic, cirrhogenic liver since 20 years. Now, he presented with complaint of jaundice and weakness since last 5 days. From the discharge summary and record of Patel Hospital Jalandhar, it is evident that life assured Prem Kumar was suffering from cirrhogenic liver, being chronic alcohol consumption for the last 20 years. He has concealed this material information from the OPs deliberately and fraudulently when he took the insurance policy. He gave wrong answers with regard to his above referred conditions. The Apex Court has held in case "Life Insurance Corporation of India Vs. Smt. G.M. Channabasemma" 1991 AIR-392 (SC) that the assured is under obligation to make full disclosure of material facts. The allegations of assured being guilty of making false representation and suppressing material facts deliberately, the burden of proof to prove it is on the Corporation. We find that the OPs have discharged the burden of proof in this case, as the above referred medical First Appeal No.723 of 2012 6 record of Patel Hospital Jalandhar cannot be held to be false. The Apex Court has also held in case "Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd." 2009 CTJ-956 (Supreme Court) (CP) that in case of deliberate concealment of material facts by the insured, the repudiation of insurance contract is justified. The contract of insurance is uberrima-fides (based on utmost good faith) and any deliberate suppression of information by the proposer could lead to repudiation of the contract. The life assured suffered from liver cirrhogenic, generally liver cirrhogenic does not develop overnight and it takes 4-5 years to develop it. The suppression of material fact was deceptively on the part of policy holder in this case. The OPs are justified in repudiating the contract of insurance and the order of the District Forum to this effect under challenge in this appeal does not call for any interference in this appeal and we affirm and same.
6. As a result of our above discussions, we find no merit in the appeal and the same is hereby dismissed.
7. Arguments in this appeal were heard on 19.11.2015 and the order was reserved. Now the order be communicated to the parties. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR)
PRESIDING JUDICIAL MEMBER
(H.S.GURAM)
November 23, 2015 MEMBER
(MM)
First Appeal No.723 of 2012 7