State Consumer Disputes Redressal Commission
L I C Of India vs Hetaben Ashwinbhai Patel on 15 December, 2022
Details DD MM YY
Date of disposal 15 12 2022
Date of filing 13 05 2014
Duration 02 06 08
BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION
GUJARAT STATE AHMEDABAD.
COURT NO: 03
APPEAL NO. 1209 of 2014
Life Insurance Corporation of India
Through its Ahmedabad Division Office,
At "Jivan Prakash",
Tilak Road, P.B. No. 277,
Ahmedabad- 380 001. ...Appellant.
V.s
1. Hetalben Ashwinbhai Patel,
2. Minor Harsh Ashwinbhai Patel,
(No. 2 being minor represented through no.1-mother)
Both Residing at 160, Om Shree Sai Jalaram Society,
Patel Nagar, Opposite Police Chowky,
Udhna, Surat. ...Respondents.
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BEFORE: Mr. I. D. Patel, Judicial Member
APPERANCE: Mr. M. J. Shelat L.A. for the appellant,
Mr. Heta Shah L.A. for the respondent.
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ORDER BY Mr. I. D. PATEL, JUDICIAL MEMBER.
JUDGMENT
1. The appellant original respondent No. 1 has preferred the present appeal as per the provisions of Section 15 of the Consumer Protection Act 1986 against the impugned judgment and order of additional Case No. 639/11 passed by Ld. Consumer Disputes Redressal Forum, Surat (Additional), dated 30.12.2013 on the ground stated in appeal memo. The appellant is the original opponents whereas the respondents are the original complainant.
2. The brief facts of the complainant before the Ld. District Forum, Surat (Additional), are that the husband of the complainant No. 1 Hetalben Ashwinbhai Patel namely Ashwinbhai Patel had taken Life Insurance K.Navlakha A/14/1209 Page 1 of 14 Policy of sum assured of Rs. 7,50,000/- from the opponent Insurance Corporation of India dated 19.06.2010 and the said Policy commences from 15.04.2010. It is further, the case of the complainant that on 28.12.2010 on account of Abdominal pain and Respiratory problem the deceased Ashwinbhai admitted in Vrunda Hospital Pvt. Ltd. where during the course of his medical examination he was a diagnosed of Hepatocelluco Carconina and thereafter, deceased Ashwinbhai discharge from the Hospital on 03.01.2011 and thereafter on 05.01.2011 Ashwinbhai died on account of the said illness. Therefore, the complainant No. 1 being a nomine of the Policy in question lodged the claim with the Life Insurance Corporation of India for getting the sum assured of the said Policy of his Husband but the Insurance Company has repudiated the claim of the deceased Ashwinbhai vide letter dated 31.03,2011 on the ground that deceased ashwinbhai suppress the material information regarding kidney Transplant in his proposal form therefore, the complainants filed the complaint as per provision of the Consumer Protection Act being the additional Case No. 639/11 before the Ld. Consumer Disputes Redressal Forum, Surat (Additional), against the Life Insurance Corporation of India.
3. That the Ld. Consumer Disputes Redressal Forum, issued notice to the opponent Life Insurance Corporation of India in the said case whereby in pursuance of the said notice Life Insurance Corporation of India has appeared and filed the detail reply whereby Life Insurance Corporation of India denied all the facts stated in the complaint and more particularly denied the deficiency in service and unfair trade practice on the part of the LIC. Furthermore, Life Insurance Co. of India has also contended in their reply that the Insurance Company had repudiated the claim of DLA Ashwinbhai on the ground of suppression of material fact in the proposal form and more particularly suppression of the Kidney Transplant in the year 1998. Therefore, contention of the Life Insurance Co. of India is that the Insurance Company has rightly repudiated the claim of the DLA Ashwinbhai and accordingly Life Insurance Co. of India prayed for the dismissal of the complaint of the complainant with costs.
4. That the Ld. Consumer Disputes Redressal Forum, after going through the material on record and after hearing the Ld. Advocate of the parties allowed the complaint filed by the complainant and directed the Life Insurance Corporation of India to pay Rs. 7,50,000/- to the complainant K.Navlakha A/14/1209 Page 2 of 14 with the interest at rate of 9% and also directed to pay Rs. 50,000/- amount of premium paid by the deceased Ashwinbhai to the complainant. Therefore, being aggrieved and dissatisfied by the said judgment and order of the Ld. Consumer Disputes Redressal Forum, Surat (Additional), passed in Additional Case No. 639/11 dated 30.12.2013 the opponent Life Insurance Co. of India has filed the appeal on the ground stated in the appeal memo.
5. I heard the argument of the Ld. Advocate Mr. M. J. Shelat on behalf of the appellant Life Insurance Co. of India and also heard the arguments of the Ld. proxy Advocate Mr. M. V. Patel on behalf of the Ld. Advocate of the respondent original complainant.
6. That the Ld. Advocate Mr. M. J. Shelat, has submitted that the LIC had issued the Policy in question of sum assured of Rs. 7,50,000/- in favour of the deceased Ashwinbhai which is produced on page 57 to 60 dated 19.06.2010 furthermore, Ld. Advocate Mr. M. J. Shelat has submitted that prior to the issuance of the said Policy Deceased Ashwinbhai has filled up the proposal form the copy thereof is produced on page 45 to
47. The Ld. Advocate Mr. M. J. Shelat has further, submitted that in the Column No. 11 of the said proposal form namely "individual history"
DLA Ashwinbhai had answered in "NO" in respect of the question of any treatment of illness viz. Liver, Heart, Kidney, lungs etc. and DLA Ashwinbhai has also stated in the proposal form that his overall health is good in respect of the answered of the question of Column No. 11 and DLA Ashwinbhai has also sign in the said proposal form by making statement to the effect that he had given true answer of all the question truthful to view in the proposal form not only that an agent of the LIC has also explained the question of the proposal form to the DLA Ashwinbhai and also made his endorsement to that effect. Furthermore, Ld Advocate Mr. M. J. Shelat has submitted that during the course of investigation of the claim lodged by the complainant of DLA Ashwinbhai Life Insurance Co. it has come to the notice of the LIC that in the year March 2010 DLA Ashwinbhai had consulted Dr. Zariwala and also took treatment and DLA Ashwinbhai had also got his Kidney Transplant in the year 1998 and as per USG of Abdomen of Dr. Anil Patel radiologist deceased Life Assured had got his Kidney transplanted and the said material information was not disclosed in the proposal form dated 07.06.2010 and therefore, as per the submission of Ld. Advocate Mr. M. J. Shelat Insurance Company has repudiated the claim of the deceased K.Navlakha A/14/1209 Page 3 of 14 Life Assured Ahwinbhai vide letter dated 31.03.2011 which is produced on page 70 and 71. It is further, submitted by the Ld. Advocate Mr. M. J. Shelat, that the Consumer Disputes Redressal Forum, Surat (Additional), allowed the complaint of the complainant on the ground that the LIC had not produced the proposal form in question but the said findings are totally false because Life Insurance Co. had produced to said proposal form which is also produced in this appeal at page 45 to
47. That the Ld. Advocate Mr. M. J. Shelat has also submitted that the Ld. Consumer Disputes Redressal Forum, Surat (Additional) has also allowed the complaint of the complainant on the ground that deceased died on account of Hepatocellular Carcinoma (Liver Cancer) and the alleged suppression of the deceased Ashwinbhai was Kidney Transplantation. So, there is a no nexus of any suppression and cause of the death of the deceased Ashwinbhai but the said findings of the Ld. Consumer Disputes Redressal Forum, Surat (Additional), is also not correct. The Ld. Advocate Mr. M. J. Shelat, has also submitted that the complainant himself has admitted in para 7 of his complaint that in the year 1998 he had got his Kidney Transplantation.
7. That the Ld Advocate Mr. M. J. Shelat has place reliance upon the decision of the Hon'ble National Commission reported in I (2014) CPJ 409 in Case of LIC Vs. Nita Bhardwaj and submitted that it is immaterial whether cause of death had any nexus or not with decease suffered and suppressed by insured. Furthermore, Ld. Advocate Mr. M. J. Shelat has also place reliance upon the decision of the Hon'ble Gujarat State Consumer Disputes Redressal Commission, Appeal No. 1943/13 in Case of Met Life Insurance Co. Ltd Vs. Prabhaben Ashok kumar Panchal and submitted that it is not for the proposer to determine whether the information sought for is material for the purpose of Policy or not. So, it is bounden duty of the assured to disclose material facts in the proposal form and nexus point has to be eschewed out of consideration otherwise the uberrima fide shall stand vitiated. Ld. Advocate Mr. M. J. Shelat has also place reliance upon the decision of the Hon'ble Apex Court Reported in 2020 (4) CPJ 460 in Case of Branch Manager, Bajaj Allianz Life Insurance Co. Ltd Vs. Dalbir Kaur and submitted that in the said decision also the Hon'ble Apex Court Place Reliance upon the decision of the Reliance Life Insurance Co. Ltd Vs. Rekhaben Nareshbhai Rathod 2019 6 SCC 175 and held that material misrepresentation or concealment in insurance has a significant effect upon both the insured and the insurer in the event of a dispute, the fact it would influence the decision of a prudent insurer in K.Navlakha A/14/1209 Page 4 of 14 deciding as to whether or not to accept a risk is a material fact. That the Ld. Advocate Mr. M. J. Shelat has also further, submitted that in the said decision Hon'ble Apex Court has also referred the decision of the Hon'ble Apex Court in Sulbha Prakash Motegaonkar Vs. LIC and held that the aliment concealed by the deceased was a life threaten a deceased then the said suppression can be said to be material and in that event it is immaterial whether cause of death had any nexus or not the deceased suffered and suppressed by the insured. So, in this case deceased has suppressed of Kidney Transplantation in the proposal form which is Life threatening deceased and deceased diagnoses of Liver Cancer which is also Life threatening deceased. Hence the suppression can said to be material for repudiation of the claim of deceased Ashwinbhai. That the Ld. Advocate Mr. M. J. Shelat has also place reliance on the decision of the Hon'ble Apex Court in the case of P. C. Chacko Vs. Chairman LIC Reported AIR 2008 Supreme Court 424 and also place reliance upon the decision of the Hon'ble Apex Court in the Case of Reliance Life Insurance Co. Ltd. Vs. Rekhaben Nareshbhai Rathod, reported AIR 2019 Supreme Court 2039 and accordingly Ld. Advocate Mr. M. J. Shelat has vehemently submitted that Life Insurance Co. had rightly and validly repudiated claim of the deceased Ashwinbhai. Howsoever, Ld. Consumer Disputes Redressal Forum, Surat (Additional), not considered the said aspects and the principal law laid down by the Hon'ble Apex Court in various decisions and accordingly the findings recorded by the Ld. Consumer Disputes Redressal Forum, Surat (Addition), in the said case as well as the impugned judgment and order of the Ld. Consumer Disputes Redressal Forum, Surat (Additional), passed in Case 693/11 dated 30.12.13 are perverse and erroneous which requires to be quashed set aside in the appeal and accordingly submitted to allow the present appeal.
8. Per contra Ld. Proxy Advocate Mr. M. V. Patel, on behalf of the Ld. Advocate Ms. Heta Shah, has vehemently supported the impugned judgment and order passed by the Ld. Consumer Disputes Redressal Forum, Surat (Additional), passed in additional case No. 639/11 dated 30.12.2013 Ld. Advocate Mr. M. V. Patel has also supported the finding recorded by the Ld. Consumer Disputes Redressal Forum, in the said judgment. Furthermore, Ld. Proxy Advocate Mr. M. V. Patel, has submitted that in their repudiated letter Insurance Company has mentioned the certificate the treatment of Dr. Zariwala taken by Deceased Life assured Ashwinbhai but the Insurance Company has not produced the said certificate before the Consumer Disputes Redressal K.Navlakha A/14/1209 Page 5 of 14 Forum, and therefore, repudiation of the claim of the deceased Ashwinbhai on the part of the Life Insurance Co. is not justified. Furthermore, Ld. Advocate Mr. M. V. Patel, has vehemently submitted that as per the repudiation letter deceased Ashwinbhai suppress his Kidney Transplantation but Insurance Company has not produced any medical record of Kidney Transplantation before the Consumer Disputes Redressal Forum, therefore, it cannot be said that deceased has suppress his Kidney Transplantation in the proposal form. Furthermore, Ld. Proxy Advocate Mr. M. V. Patel, has also submitted that deceased had alleged the suppress Kidney Transplantation but he died on account of the Hepatocellular Carcinoma (Liver Cancer). So, there is no nexus between this any suppression and the cause of death of the deceased on account of Hepatocellular Carcinoma (Liver Cancer). So, when there is no nexus it cannot be said that there was a material suppression on the part of the deceased Ashwinbhai. That the Ld. Proxy Advocate Mr. M. V. Patel has place reliance upon the decision of the Hon'ble Apex Court rendered in Civil Appeal No. 8245/15 in the Case of Sulbha Prakash Motegauonkar Vs. LIC and submitted that when there was no nexus between the suppression of the illness and cause of death of the deceased Insurance Company cannot repudiate the claim of the Policy. Furthermore, Ld. Proxy Advocate Mr. M. V. Patel has also place reliance upon the decision of the National Commission in Case of PNB Met Life Vs. Vinitadevi Reported (I) 2019 CPJ 441. That the Ld. Advocate Mr. M. V. Patel has also submitted that as per the proposal form and the report of the empenaled Doctor of the Life Insurance Co. the Policy in question was issued after due medical examination by the empenaled Doctor of the Insurance Co. and therefore, also as per the decision of the Hon'ble National Commission rendered in revision Petition No. 1782/18 in the case of LIC Vs. Reena Nanda Insurance Company cannot repudiate the claim of the deceased Ashwinbhai So, as per the submission of the Ld. Proxy Advocate Mr. M. V. Patel, the findings recorded by the Ld. Consumer Disputes Redressal Forum, Surat (Additional), for allowing the complaint in additional case No. 639/11 cannot be said to be perverse erroneous and accordingly the impugned judgment and order is also just and proper which requires to be confirmed in this appeal and accordingly the appeal filed by the appellant Insurance Co. requires to be dismissed with costs.
9. I have considered the argument of Ld. Advocate Mr. M. J. Shelat appellant Insurance Company and argument of Ld. Proxy Advocate M. K.Navlakha A/14/1209 Page 6 of 14 V. Patel on behalf of the original Advocate Heta Shah for the respondent complainant and I have also gone through the impugned judgment and order passed by the Ld. Consumer Disputes Redressal Forum, Surat (Additional), in the Additional Case No. 639/11 dated 30.12.2013. That this commission has also considered the documentary evidence produced by the parties before the Consumer Disputes Redressal Forum.
10. That in this case Life Insurance Co. of India had repudiated the claim of DLA Ashwinbhai on the ground of suppression of material fact that is the suppression of Kidney Transplantation in the proposal form. Hence before the said action of repudiation of the Insurance Company can be adjudicated in this appeal it would be profitable to makes reference of some of the important principle of Law Governing issue on hand propounded by the Hon'ble Apex Court in the various decision namely viz. (1) LIC Vs. Aasha Gohel 2001(2) SCC 160 (2) P.C. Chako Vs. Chairman LIC 2008 (1) SCC 521 (3) Satvantkaur Sandhu Vs. New India Assurance Co. Ltd. 2009 (1) SCC 316 (4) Reliance Life Insurance Co. Vs. Rekhaben Nareshbhai Rathod AIR 2019 SC 2039 (5) Bajaj Life Allianz Life Insurance Co. Vs Dalbir Kaur 2020 (4) CPJ 16.
A. It is well settled that the contracts of insurance including the contract of life assurance are contracts uberrima fides and every fact of material (sic material fact) must be disclosed, otherwise, there is good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract and also implies any material alteration in the character of the risk which may take place between the proposal and its acceptance. If there are any misstatements or suppression of material facts, the policy can be called into question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person. B. "Proposal form" means a form to be filled in by the proposer for insurance, for furnishing all material information required by the insurer in respect of a risk, in order to enable the insurer to decide whether to accept or decline, to undertake the risk, and in the event of acceptance of the risk, to determine the rates, terms and conditions of a cover to be granted. Explanation: "Material" for the K.Navlakha A/14/1209 Page 7 of 14 purpose of these regulations shall mean and include all important, essential and relevant information in the context of underwriting the risk to be covered by the insurer."The expression "material" in the context of an insurance policy can be defined as any contingency or event that may have an impact upon the risk appetite or willingness of the insurer to provide insurance cover. "Any fact which goes to the root of the contract of insurance and has a bearing on the risk involved would be "material"."Materiality of a fact also depends on the surrounding circumstances and the nature of information sought by the insurer. It covers a failure to disclose vital information which the insurer requires in order to determine firstly, whether or not to assume the risk of insurance, and secondly, if it does accept the risk, upon what terms it should do so. The insurer is better equipped to determine the limits of risk-taking as it deals with the exercise of assessments on a day- to-day basis. In a contract of insurance, any fact which would influence the mind of a prudent insurer in deciding whether to accept or not accept the risk is a material fact. If the proposer has knowledge of such fact, she or he is obliged to disclose it particularly while answering questions in the proposal form. An inaccurate answer will entitle the insurer to repudiate because there is a presumption that information sought in the proposal form is material for the purpose of entering into a contract of insurance.
C. It is standard practice for the insurer to set out in the application a series of specific questions regarding the applicant's health history and other matters relevant to insurability. The object of the proposal form is to gather information about a potential client, allowing the insurer to get all information which is material to the insurer to know in order to assess the risk and fix the premium for each potential client. Proposal forms are a significant part of the disclosure procedure and warrant accuracy of statements. Utmost care must be exercised in filling the proposal form. In a proposal form the applicant declares that she/he warrants truth. The contractual duty so imposed is such that any suppression, untruth or inaccuracy in the statement in the proposal form will be considered as a breach of the duty of good faith and will render the policy voidable by the insurer. The system of adequate disclosure helps buyers and sellers of insurance policies to meet at a common point and narrow down the gap of information asymmetries. This K.Navlakha A/14/1209 Page 8 of 14 allows the parties to serve their interests better and understand the true extent of the contractual agreement. The finding of a material misrepresentation or concealment in insurance has a significant effect upon both the insured and the insurer in the event of a dispute. The fact it would influence the decision of a prudent insurer in deciding as to whether or not to accept a risk is a material fact.
D. "there is a clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance." Each representation or statement may be material to the risk. The insurance company may still offer insurance protection on altered terms."
11. That in this case it is an admitted fact that deceased Life Assured namely Ashwinbhai Patel had taken Life Insurance Policy bearing Policy No. 885057334 dated 19.06.2010 of sum assured of Rs. 7,50,000/- from the Life Insurance Co. of India namely Jivan Saral (with profits). That during the subsistence of the said Policy deceased Ashwinbhai admitted in the udhna Hospital Pvt. Ltd. on 28/12/2010 to 03.01.2011 for the treatment of Hepatocellular Carcinoma (most common type of primary Liver Cancer) and on account of the said illness deceased died on 05.01.2011 therefore, the complaint No. 1 Hetalben Ashwinbhai Patel being nomine of the DLA Ashwinbhai lodged the claim with the LIC of India under the said Policy but LIC of India had repudiated the claim of the DLA Ashwinbhai vide letter dated 31.03.2011 produced on page 70 and 71. The ground of the repudiation of letter was that deceased suppressed Kidney Transplantation in the question put forth to him in the Column No. 11 namely "individual history" as stated in the repudiation letter. That it is also admitted fact that Insurance Company has not produced certificate of Dr. Zariwala to whom deceased Life Assured Consulted on March 2010 and taken treatment and had got his Kidney Transplantation in 1998 but in para 7 of the Complaint No. 639/11 complainant had categorically admitted that in the year 1998 deceased got his Kidney Transplantation. So, in absence of certificate of Dr. Zariwala it cannot be said that deceased had not got his Kidney Transplantation in the year 1998. That before taking the said Insurance Policy deceased had filed up the proposal form which is produced at page 45 to 47 and on page 46 in column No. 11 namely "individual history" there is a question put to DLA Ashwinbhai that as to whether he was having any illness of Liver, Abdomen, Heart, lungs, Kidney, K.Navlakha A/14/1209 Page 9 of 14 Brain etc. and DLA had answered the said question in "NO" and another question also put to DLA to the effect that how is your average health and DLA had answered to the said question as "Good" not only that looking to the said proposal form more particularly page 47 DLA also made declaration to the effect that he had given true answer of all the question in the proposal form and the agent of the Insurance Company has also made an endorsement that he had explain all the question in the proposal form to DLA Ashwinbhai and put his signature in the proposal form. So, on the basis of the said proposal form Insurance Company has issued the Policy in question in favour of the deceased Ashwinbhai that as per the repudiation letter dated 31.03.2011 though it was within the knowledge of the DLA that he had got transplantation of Kidney in the year 1998 that is before the date of the proposal form of the Policy in question he had deliberately suppress or withheld the said information in the proposal form.
12. That as per the various decisions of the Hon'ble Apex Court the contract of Insuring including the contract of Life Insurance is uberrrima fides so every material fact has to disclose in the proposal form otherwise there is a good ground for rescission of the contract and any fact which goes to the root of the contract of insurance and has bearing on the risk involved would to material and any deliberate wrong answer which has a great bearing on the contract of Insurance, if discovered may lead to the Policy being vitiated in Law. That the complainant has categorically admitted in the complaint in para 7 of the complaint that DLA had got transplantation of the Kidney in the year 1998. Not only that from the report of USG Abdomen of Dr. Anil N. Patel, MD Radiologist dated 22.11.2010 also appears that DLA had got transplantation of Kidney. So, the Insurance Company has duly established that before submitting the proposal form of the Policy in question DLA was very well knowing that he had got Transplantation of Kidney in the year 1998 and the said fact has been suppressed by the DLA in the proposal form. That it is also admitted fact that DLA Ashwinbhai died on account of the Hepatocellular Carcinoma (Liver Cancer). So, according to view of this commission the Insurance Company has duly establish and proved before the Consumer Disputes Redressal Forum, that DLA Ashwinbhai has suppress of the correct material information about his Kidney Transplantation in the proposal Form and when the DLA has suppressed the material information then as per Section 45 of the Insurance Act. it was well with the right of Insurance Company to K.Navlakha A/14/1209 Page 10 of 14 repudiate the claim of the DLA as per the terms and condition of the Insurance Policy also.
13. That as per the decision of the Hon'ble Apex Court in Branch Manager Bajaj Allianz Life Insurance Co. Ltd. Vs. Dalbir Kaur reported in 2020 (4) CPJ 60 failure of insured to disclosed any material information or concealment as a significant fact of the both the insured and insurer in the event of dispute. That in the said decision of Bajaj Allianz Vs. Dalbir Kaur Hon'ble Apex Court has also referred the earlier decision of the Hon'ble Apex Court rendered in the case of Sulbha Prakash Motegaunkar Vs. LIC of India and clearly distinguished the said decision on the ground that in the said Case of the Sulbha Prakash assured suffered a myocardial infarction and succumbed to it. The claim was repudiated by the insurance company on the ground that there was a suppression of a pre-existing lumber spondilitis. It was in this background that Hon'ble Apex Court held that the alleged concealment was of such a nature that would not dis-entitle the deceased from getting his lifeinsured. In other words, the pre-existing ailment was clearly unrelated to the cause of death. Hon'ble court had also observed in its decision that the ailment concealed by the deceased was not a life-threatening disease. This decision must, therefore, be distinguished from the factual position as it has emerged before this Court. Here in this case looking to the findings recorded by the Ld. Consumer Disputes Redressal Forum, forum has mainly allow the complaint of the complainant on the ground that deceased died on account of Hepatocellular Carcinoma and he has alleged the suppress his Kidney Transplantation. So, there is no any nexus between the alleged suppression and cause of death of the DLA. But in view of the above observation of Hon'ble Apex Court in the case of Bajaj Life Insurance Vs. Dalbir Kaur the said finding of the Ld. District Consumer Disputes Redressal Forum, for allowing the complain cannot be sustain. That the Ld. Advocate Mr. M. J. Shelat has also place reliance upon the another decision of the Hon'ble National Commission, reported in I (2014) CPJ 409 in the case of LIC Vs. Neeta Bhardwaj wherein also the Hon'ble National Commission has categorical held that it is immaterial whether cause of death had any nexus or not with deceased suffered and suppressed by insured. So, as per decision of the Sulbha Prakash Motegaunkar Vs. LIC of India if there is a suppression of Non life threatening deceased and cause of death is on account of Life threatening a deceased then it can be said that there is no nexus between suppression of illness and the cause of death or in other words K.Navlakha A/14/1209 Page 11 of 14 the suppression of the illness cannot be said to be material suppression of the facts for repudiation claim by the Insurance Company. That the Ld. Advocate Mr. M. J. Shelat has also place reliance upon the decision of the Hon'ble Apex Court in the case of Reliance Life Insurance Co. Vs. Rekhaben Nareshbhai Rathod reported AIR 2019 page 2039 and according to said decision also when the DLA has suppress the material information in his proposal form then Insurance Company can legally repudiate the claim of the DLA in view of the Section 45 of the Insurance Act.
14. That on the other side the Ld. Proxy Advocate Mr. M. V. Patel has place reliance upon the decision of the Hon'ble Apex Court in case of Sulbha Prakash Motegaonkar Vs. LIC rendered in Civil Appeal No. 8245/15 it submitted that since the deceased had died on account of H. C. and he had suppressed his Kidney Transplantation and therefore, there is no nexus between suppression of material facts and cause of death therefore, Insurance Company cannot repudiate the claim but I do not agree with the submission of the Ld. Advocate Mr. M. V. Patel because in the case of Sulbhaprakash Motegaoukar assured suffered in myocardial infarction and succumbed to it. The claim was repudiated by the insurance company on the ground that there was a suppression of a pre-existing lumber spondilitis, cannot be said to be life-threatening disease and therefore, in view of the said factual position of the case Hon'ble Apex Court held in the said case that there was no nexus between any suppression of illness and cause of death but here in this case the fact is altogether different as stated here in above. Furthermore, Ld. Proxy Advocate Mr. M. V. Patel has also place reliance upon the decision of the Hon'ble National Commission in P&B Met Life Insurance Co. Ltd. Vs. Vinitadevi reported (I) 2019 CPJ 441 on the point of nexus between any suppression and cause of death but as stated earlier the said decision also not applicable in this case. Because herein this case there is a nexus between the suppression of the illness and the cause of death of DLA Ashwinbhai.
15. That the Ld. Proxy Advocate Mr. M. V. Patel place reliance on the decision of the Hon'ble National Commission passed in Revision Petition No. 1782/18 in LIC Vs. Reena Nanda has submitted that deceased life assured was examined by the empenal Doctor of the Insurance Company before issuance of the Policy and if the Doctor appointed by the LIC does not filed any disease in way of the issuance of the Insurance Policy it is not open to the LIC to take up plea that there was suppression of K.Navlakha A/14/1209 Page 12 of 14 illness/disease in the proposal form and Insurance Company cannot repudiated the claim of the ground of concealment of any material fact in the proposal form. But as per the decision of the Hon'ble Apex Court in Reliance General Life Insurance Vs. Rekhaben Nareshbhai Rathod proposal form is a document on the basis of which Insurance contract came in to existence between insured and insurer furthermore, as per the decision of the Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. of the Hon'ble Apex Court, contract of Insurance is based on at most good faith of parties of contact hence insured is supposed to give true and correct answer of question of the proposal form. Moreover, in the proposal form insured also makes declaration that he had read all the question of the proposal form and he has given true and correct answer of this proposal form even insured has also makes declaration on the proposal form that if any answered given by him/her found to be incorrect or untrue in that case Insurance Company is entitle to cancel the contract of Insurance. That here in this case deceased life assured Ashwinbhai had made such declaration in the proposal form hence medical examination of DLA by empaneled Doctor of Insurance Company does not absolve of DLA from giving correct answer in the proposal form hence argument advanced by the Ld. Advocate Mr. M. V. Patel is devoid of merits.
16. So, in view of the above according to view of this Commission, LIC has repudiated claim of the DLA Ashwinbhai on account of the suppression of the material information in the proposal form and the said fact is also duly established by the LIC before the Consumer Disputes Redressal Forum, howsoever, it appears the Consumer Disputes Redressal Form, Surat (Additional), had not taken into consideration the said legal aspect in the right prospective and accordingly whatever findings recorded by the Consumer Disputes Redressal Forum, for allowing the said complaint of the complainant cannot be said to be valid and legal and the said finding are erroneous and perverse and accordingly the impugned judgment and order passed by the Ld. Consumer Disputes Redressal Forum, Surat (Additional), in the Additional Case No. 639/11 on 30.12.13 allowing the complaint of the complainant requires to be quashed and set aside in this appeal and accordingly present appeal filed by the Life Insurance Co. of India deserves to be allowed and hence, I passed the following order.
K.Navlakha A/14/1209 Page 13 of 14ORDER
1. The appeal No. 1209/14 filed by the Life Insurance Corporation of India is hereby allowed.
2. The impugned judgment and order passed by the Ld. Consumer Disputes Redressal Forum, Surat (Additional), in Additional Case No. 639/11 dated 30.12.13 is hereby quashed and set aside.
3. Appellant is directed to apply to the Account Department of the State Commission with all details of Appeal No.1209 of 2014, Xerox copy of the receipt to withdraw the amount deposited in the State Commission. The office is hereby ordered to pay deposited amount with occurred interest on proper verification to the appellant by Account payee cheque and the cheque be handed over to the learned advocate for the appellant after obtaining receipt.
4. No order as to costs.
5. Registry is hereby instructed to send a copy of this order in PDF format by E-mail to learned District Forum, Surat (Additional), for taking necessary action.
6. Office is directed to forward a free of cost certified copy of this judgment and order to the respective parties.
Pronounced in the open Court today on 15th December 2022.
[I. D. Patel] Judicial Member.
K.Navlakha A/14/1209 Page 14 of 14