State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India, vs Smt.Manik Sudhakar Dahale, on 6 January, 2010
Date of filing :04.10.2005 Date of order :06.01.2010 MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL COMMISSION,MUMBAI, CIRCUIT BENCH AT AURANGABAD . FIRST APPEAL NO. :1888 OF 2005 IN COMPLAINT CASE NO.:104 OF 2005 DISTRICT CONSUMER FORUM :AHMEDNAGAR. Life Insurance Corporation of India, Through its Branch Manager, Aurangabad Gulmandi Branch No.98-G, Dwarka Region, Adalat Road, Aurangabad. Life Insurance Corporation of India, Zonal Manager, Through its Zonal Office, Yogakshema, Jeevan Bima Marg, Mumbai 21. APPELLANT (Org.Opponent) VERSUS 1. Smt.Manik Sudhakar Dahale, 2. Smt. Deepali Chandrakant Dahale, 3. Om Chandrakant Dahale, R/o Dattatraya Krupa, Near Jagtap Hospital, Kadu Lane, Nevasa, Tq.Nevasa, Dist.Ahmednagar. RESPONDENTS (Org.Complainants) CORAM : Shri.S.G.Deshmukh, Hon`ble Presiding Judicial Member.
Mrs.Uma S.Bora, Hon`ble Member.
Present : Adv.Shri.S.R.Malani for appellant, Adv.Shri.Ravindra Bedre for respondents.
O R A L O R D E R Per Shri.S.G.Deshmukh Hon`ble Presiding Judicial Member.
1. The present appeal is filed by L.I.C. against the judgment and order dated 05.09.2005 in complaint case No. 104/05 passed by District Consumer Forum, Ahmednagar.
2. Respondents/Org.Complainants case before the Forum is that, deceased Chandrakant Dahale had obtained policy bearing No.982162393 for sum assured of Rs.1,50,000/- on 28.3.2003. It is contended that Chandrakant died on 30.12.2003 at Newasa. Complainant No.1 is the mother, complainant No.2 is the widow and complainant No.3 is the son of deceased Chandrakant. It is contended that after death of Chandrakant complainant approached the appellant and preferred the claim. The claim was repudiated on the ground that at the time of submitting proposal form the necessary particulars about previous policies held by Chandrakant were not mentioned. It is contended that after receipt of said repudiation letter complainant filed application to Western Zonal Office, Mumbai. Zonal officer informed vide letter dated 17.12.2005 that the claim can not be considered. Thus complainant approached the Forum.
3. Present appellant appeared before the Forum and resisted the claim. It is contended that policy holder deceased Chandrakant had not disclosed the particulars of previous insurance policy held by him at the time of submitting proposal for the policy in question. It is contended that question No.9 in the proposal form deals with particulars of all the life insurance policies held by proposer. Said question has been replied in negative by proposer. It is contended that investigation was conducted by appellant officer and appellant came to know that he was holding other 3 policies;
Policy No. Date of Plan & Term Sum Commencement Assured
i) 952302183 28.03.1992 14/30 Rs.1,00,000/-
ii)952307411 28.01.1998 93/25 Rs.1,00,000/-
iii)952378130 28.10.2001 112/25 Rs.5,00,000/-.
It is contended that as per rules, as the sum assured of the policies including present policy exceeds Rs.6,00,000/- appellant would have called for special report like ECG, CBC, ESR. In the instant case, if the policy holder would have disclosed earlier policies, appellant would have called special reports like ECG, CBC, ESR information about existing insurance policies was material which has been concealed by appellant. They have rightly repudiated the claim.
4. The Forum below after going through the papers and hearing the parties allowed the complaint and directed appellant to pay Rs.1,50,000/- with interest @ 12% p.a. from the date of repudiation. Forum also directed that the amount of Rs.50,000/- and interest on it be paid to complainant No.1 i.e. respondent No.1 and Rs.50,000/- and interest on it be paid to respondent No.2 and Rs.50,000/- and interest on it be kept in F.D.R. in Nationalised Bank till respondent No.3 becomes major.
5. Being aggrieved by the said judgment and order passed by the District Forum, Ahmednagar, L.I.C. came in appeal.
6. Notices were issued to the appellant as well as respondents. Learned counsel Shri.S.R.Malani appeared on behalf of appellant whereas learned counsel Shri.Bedre appeared on behalf of respondents. We heard both the counsels.
Learned counsel Shri.Malani submitted that deceased Chandrakant did not disclose the details about his earlier policies. Had he disclosed other existing policies appellant would have called special report of ECG, CBC, ESR as the total sum assured of all policies including present is more than Rs.6 lakhs. He submitted that appellant has rightly rejected the claim on the ground of non discloser of earlier policies. He submitted that Forum erred in concluding that underwriting chart showing the requirement of the special reports shows that if the policies are maturing before age of 65 years, these special reports are not required to be called by Corporation. According to him chart clearly shows, up to age 35 for the sum assured over Rs.6 lakhs to 15 lakhs ECG, CBC, ESR are the special reports to be called. Learned counsel submitted that foot note at the chart which is referred by District Forum clearly states that the requirement in the bracket are not required if the age of maturity is less than or equal to 65 years and age at entry is 45 years or less. According to him, learned Forum overlooked the vital suppression of earlier policies. Learned counsel Shri.Malani relied on ratio in judgment of National Commission in Jashwanthiben Vallabhdas Vs- LIC of India in Revision Petition No.1573 of 2005 dated 11.8.2005(NC). He also relied on LIC Vs- Roshan Lal Gupta in Revision Petition No.982 of 2004 decided on 19th Sept.2005(NC).
7. On the other hand, learned counsel Shri.Bedre fully supported the judgment and order passed by the Forum. Learned counsel submitted that Forum has rightly considered that non discloser of earlier policies in the proposal form is not material suppression.
8. We perused the papers and gave our anxious thoughts to the arguments advanced by both the counsels. On perusal of papers it is apparent that deceased had obtained policy under plan & term 112-25, bearing No.952378130 of Rs.5 lakhs on 28.10.2001. He had also obtained policy under plan & term 93-25 bearing No.952307411 of Rs.1,00,000/- and policy under plan & term 14-30 bearing No.952302183 for Rs.1,00,000/-. It is also apparent that policy holder has answered question No.9 in negative which deals with all life insurance policies held by proposer. As per rules as sum assured of policies exceeds Rs.6,00,000/- LIC would have called special report like ECG, CBC, ESR, had life assured disclosed other existing policies. Principle of utmost good faith was not observed by deceased while submitting proposal. The ratio in Roshanlal`s case is squarely applicable in the instant case. Deceased did not stick to the principle by showing utmost good faith while submitting proposal. Policy was obtained on 28.3.2002 and he died on 30.12.2003. As per provision in Section 45 of Insurance Act 1938 if the claim under the policy occurs within two years from the date of commencement insurer is not required to prove materiality & fraud. It is sufficient ground for the insurer that the claim is based on misrepresentation. Appellant had rightly repudiated the claim in terms of Section 45 of Insurance Act 1938. Forum did not consider this aspect and erred in allowing the complaint. We are inclined to quash and set aside the judgment and order passed by the Forum.
Accordingly we pass the following order.
O R D E R
1. Appeal is allowed.
2. The impugned judgment and order passed by the Forum is hereby quashed and set aside.
3. Complaint stands dismissed.
4. No order as to cost.
5. Copies of the judgment be issued to both the parties.
Sd/- sd/-
Mrs.Uma S.Bora S.G.Deshmukh Member Presiding Judicial Member.
Mane