State Consumer Disputes Redressal Commission
Dhfl Pramerica Life Insurance Co. Ltd. vs Deepak Kumar on 29 March, 2023
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 First Appeal No. A/2014/1156 ( Date of Filing : 03 Jun 2014 ) (Arisen out of Order Dated in Case No. of District State Commission) 1. DHFL Pramerica Life Insurance Co. Ltd. Gurgaon ...........Appellant(s) Versus 1. Deepak Kumar Amroha ...........Respondent(s) BEFORE: HON'BLE MR. Rajendra Singh PRESIDING MEMBER HON'BLE MR. Vikas Saxena JUDICIAL MEMBER PRESENT: Dated : 29 Mar 2023 Final Order / Judgement Reserved State Consumer Disputes Redressal Commission U.P. Lucknow. Appeal No.1156 of 2014 1- DHFL Pramerica Life Insurance Co. Ltd., 4th Floor, Buiding 9B, Cyber City, DLF City, Phase-III, Gurgaon-122002 2- DHFL Pramerica Life Insurance Co. Ltd., 7th Floor, Unit no.710, Ratan Square, 20, Vidhan Sabha Marg, Lucknow. ...Appellants. Versus Sh. Deepak Kumar s/o Sh. Bhagwat Singh Alias Bhagwant Singh, R/o Village Biharpuri, Post Mandi, Dhanora Tehsil Mandi, Dhanora, District, Amroha, Uttar Pradesh. ....Respondent. Present:- 1- Hon'ble Mr. Rajendra Singh, Presiding Member. 2- Hon'ble Mr. Vikas Saxena, Member. Sri Angrez Nath Shukla, Ld. counsel for appellants. Sri A.K. Pandey, Ld. Counsel for respondent. Date 3.11.2023 JUDGMENT
Per Sri Rajendra Singh, Member- This appeal has been filed against the judgment and order dated 16.4.2014 passed by the Ld. District Commission, Amroha in complaint case no.92 of 2013, Deepak Kumar vs. DHFL Pramerica Life Insurance Co. Ltd. & anr.
The brief facts, of the appeal are that, that the appellants are one of the most preferred Life Insurance Companies and has the distinction of being repeatedly adjudged India's best Life Insurance Company. The policy holder Late Ms. Dayamanti after completely understanding the terms and conditions of the insurance product "DPLT Tatkal Surakksha Gold Plan" had voluntarily applied for an insurance policy vide proposal form bearing no.OT001023427 dated and signed on 28.5.2012, wherein the complainant i.e. son of DLA was proposed as nominee. In the proposal form the DLI had given all relevant details and information in the prescribed form, for an assured sum amounting to Rs.3,60,200.00 for which annual premium amounting toRs.25,000.00 was proposed to be paid annually for a period of 20 years. It is pertinent to note that the DLI after understanding all the terms and condition which was duly explained to the DLI and same was signed by the DLI. It is submitted that in the said application section pertaining to Insurability Declaration of life to be insured & medical history of the life assured wherein at question a set of questionnaire were given with respect to the medical history, however, the said questionnaire were answered in negative.
It is submitted that the DLI had also signed a Declaration & Authorization with respect to complete, true and accurate disclosure of all the facts and circumstances as may be relevant for the acceptability of the application form about her health and other relevant information. Under the said declaration, it was specifically mentioned that all material facts which form the basis of the insurance contract should be disclosed correctly, otherwise the policy issued might stand void or voidable. The DLI in this case fully understood the terms and conditions of the policy based on the information and declaration containing in application and further believing the same to be true. The appellant issued a policy commencing from 25.6.2012. After that the appellant received death claim on 19.3.2013 whereby the appellants were given to understand that the DLI expired suddenly on 4.1.2013.
The appellant conducted an investigation and it was found that the DLI was undergoing treatment for diabetes and hypertension prior to the filing of application. It is also found that the DLI was taking OPD treatment for the last 4-5 years and the same has been confirmed by the certificate of Dr. Naresh Dutt in which it is written that she was suffering from DM-type 2 and HP. So it is clear that the insured willfully suppressed the material facts in spite of asking specifically questions in the proposal form. So the claim was repudiated. The contract of insurance being of utmost good faith, DLI was under an obligation to disclose the said material medical details in the proposal form which was necessary to be answered for the purpose of determining the risk under the said policy were intentionally answered in negative by DLI.
The main ground of the appeal is that, that the DLA has suppressed the information of his pre-occupied diseased at the time of filling up the proposal form which is against the terms and conditions of the insurance policy, hence, he is not entitled for any relief. The ld. District Commission has wrongly passed the following judgment:-
"परिवाद आंशिक रूप से विपक्षीगण के विरूद् 4000/- रूपये (रूपये चार हजार मात्र) परिवाद व्यय सहित स्वीकार किया जाता है। विपक्षीगण परिवादी को बामा धनराशि 360200/- रूपये (रूपये तीन लाख साठ हजार दो सौ मात्र) मय 8 प्रतिशत साधारण वार्षिक ब्याज की दर से बीमा खण्डन की तिथि 1-5-13 से वास्तविक वसूली तक अदा करे एवं मानसिक कष्ट की क्षतिपूर्ति के रूप मे 5000/- रूपये (रूपये पांच हजार मात्र) का भुगतान करें। आदेश का अनुपालन एक माह के अंदर किया जाये।"
So, it is most humbly prayed that this appeal be allowed and the impugned judgment and order be set aside.
We have heard the ld. Counsel for the appellant Sri Angrez Nath Shukla and ld. counsel for the respondent Sri A.K. Pandey. We have perused the pleadings, evidence and documents available on the file.
We have perused the documents on record and also the impugned judgment of the ld. District Commission. There is no record of hypertension or diabetes prior to the date of insurance. Dr. Naresh Dutt Gupta has stated that he treated the patient as OPD but surprisingly he had with him the prescription slip. The prescription slip is always given to the patient and the entry is entered in a register kept by the doctor. No such registered has been produced before the ld. District Commission. The ld. District Commission has stated that the prescription filed by Dr. Naresh Dutt Gupta bears no record of diabetes. There is no name of the husband of Smt. Damyanti. No affidavit of any doctor has been produced. No pathological report of Smt. Damyanti has been filed showing diabetes. So in these circumstances, ld. District Commission did not pay attention to the argument of the appellant which was correct. If there is no evidence regarding the regular treatment of diabetes and hypertension, it cannot be presumed that the patient was suffering from diabetes and hypertension. The impugned judgment of the ld. District Commission needs no interference by this Commission. Hence the appeal is liable to be dismissed with costs.
ORDER Appeal is dismissed with costs.
If any amount is deposited by the appellants at the time of filing of this appeal under section 15 of the Consumer Protection Act, 1986, may be remitted to the District Commission concerned for satisfying the decree as per rules alongwith accrued interest upto date.
The stenographer is requested to upload this order on the Website of this Commission today itself.
Certified copy of this judgment be provided to the parties as per rules.
(Vikas Saxena) (Rajendra Singh) Member Presiding Member Judgment dated/typed signed by us and pronounced in the open court. Consign to record. (Vikas Saxena) (Rajendra Singh) Member Presiding Member Dated 3.11.2023 Jafri, PA I Court 2 [HON'BLE MR. Rajendra Singh] PRESIDING MEMBER [HON'BLE MR. Vikas Saxena] JUDICIAL MEMBER