State Consumer Disputes Redressal Commission
Smt. Poonam Bishnoi & Another vs Hdfc Standred Life Insurance Company ... on 1 May, 2019
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND
DEHRADUN
CONSUMER COMPLAINT NO. 10 / 2015
1. Smt. Poonam Bishnoi W/o Sh. Arvind Singh Bishnoi
2. Sh. Arvind Singh Bishnoi S/o Sh. Sukhveer Singh Bishnoi
Both R/o 34-B, Balbir Road
Dehradun
......Complainants
Versus
1. HDFC Standard Life Insurance Company Limited
having its Corporate and Registered Office at
Lodha Excelus, 13th Floor
Apollo Mills Compound, N.M. Joshi Marg
Mahalaxmi, Mumbai - 400011 through its Managing Director
2. HDB Financial Services Limited
A company incorporated under the provisions of Companies Act, 1956
and registered with the Reserve Bank of India
as a non-banking financial company having its Registered Office at
Radhika, 2nd Floor, Law Garden Road
Navrangpura, Ahmedabad - 380009 and Branch Office at
G.M.S. Road, Dehradun through its Branch Manager
3. Smt. Ritika Chauhan (Bishnoi) W/o late Sh. Amar Singh Bishnoi
R/o 265, Garhi Cantt.
Dehradun
......Opposite Parties
Sh. M.M. Lamba, Learned Counsel for the Complainants
Sh. Prasoon Srivastava, Learned Counsel for Opposite Party No. 1 with Sh.
Sudhir Singh, Assistant Legal Manager, HDFC Standard Life Insurance
Company Limited
Sh. Vikrant Gambhir, Learned Counsel for Opposite Party No. 2
Sh. Arjun Singh Bisht, Advocate, holding brief of Ms. Anupama Gautam,
Learned Counsel for Opposite Party No. 3
Coram: Hon'ble Mr. Justice B.S. Verma, President
Mrs. Veena Sharma, Member
Dated: 01/05/2019
ORDER
(Per: Justice B.S. Verma, President):
This consumer complaint under Section 12 read with Section 18 of the Consumer Protection Act, 1986 has been filed by Smt. Poonam Bishnoi along with her husband Sh. Arvind Singh Bishnoi (hereinafter 2 referred to as "complainants") against HDFC Standard Life Insurance Company Limited and Sh. HDB Financial Services Limited, alleging deficiency in service on their part. Although Smt. Ritika Chauhan (Bishnoi) has also been made party to the consumer complaint and impleaded as opposite party No. 3, but no relief has been claimed by the complainants against her and she has been impleaded as proforma opposite party.
2. Briefly stated the facts of the case, as set out in the consumer complaint, are that late Sh. Amar Singh Bishnoi, the deceased son of the complainants, during his lifetime, moved an application with the opposite party No. 2 on 27.09.2013 for grant of loan to the tune of Rs. 3,50,00,000/- against property. In pursuance whereof, the opposite party No. 2 sanctioned loan against property amounting to Rs. 2,52,27,902/- in favour of Sh. Amar Singh Bishnoi on 31.10.2013. The said loan carried interest @13.50% p.a. and the tenure of the loan was 10 years'. After sanction of the loan, sum of Rs. 2,44,27,902/- was disbursed by the opposite party No. 2 on 30.11.2013 in loan account No. 510210 of the borrower. The opposite party No. 2 - finance company obtained three insurance policies from opposite party No. 1 - insurance company under HDFC Life Group Credit Protect Plus Insurance Plan in the name of Sh. Amar Singh Bishnoi; Smt. Ritika Chauhan and Smt. Poonam Singh Bishnoi in order to safeguard the above loan granted to Sh. Amar Singh Bishnoi. One of the insurance policies was issued by the opposite party No. 1 in favour of Sh. Amar Singh Bishnoi for insured sum of Rs. 99,90,249/- on 31.10.2013 and the expiry date of the insurance coverage / policy was 30.10.2023. The opposite party No. 2 also got a Health Suraksha Policy (Silver Plan) issued from the opposite party No. 1 in the names of Sh. Amar Singh Bishnoi and Smt. Ritika Bishnoi valid for the period from 05.12.2013 to 04.12.2015 for insured sum of 3 Rs. 2,00,000/- each. Sh. Amar Singh Bishnoi further obtained personal loan of Rs. 5,00,000/- from opposite party No. 2 for purchase of vehicle on 30.11.2013 and the opposite party No. 2 also got the said loan insured by obtaining policy from opposite party No. 1 in the name of Sh. Amar Singh Bishnoi.
3. Sh. Amar Singh Bishnoi - insured felt pain and swelling in his right leg on 17-18.07.2014 and also had breathing problem on 24.07.2014, whereupon he was admitted in Max Super Speciality Hospital, Malsi, Mussoorie Diversion Road, Dehradun on 25.07.2014. The doctor diagnosed that the life assured was suffering from "right lower limb cellulitis with osteomyelitis with septic shock and mods". The life assured underwent surgery of "incision & drainage under LA" on 25.07.2014 in the said hospital and later on, he was shifted to ICU. Unfortunately, the life assured could not survive and breathed his last on 28.07.2014 in the said hospital. The opposite party No. 2 - finance company lodged death claim of the insured in respect of policy obtained for covering the loan account No. 542757 regarding disbursement of loan of Rs. 5,00,000/- in favour of the life assured. The opposite party No. 1 paid the sum insured under the said policy and the outstanding loan amount of Rs. 4,13,809.05/- was credited in the said loan account on 29.09.2014 and the balance amount was paid to the nominee - opposite party No. 3. Through letter dated 08.01.2015, the opposite party No. 1 informed the opposite party No. 2 that, "our investigations have established that the life assured was suffering from liver cirrhosis and had undergone treatment for same much prior to the policy issuance. Also, life assured had policies with other insurance companies which was not disclosed in the application dated 31st October, 2013. Had this information been provided to the company at the time of applying for the insurance policy, we would have declined the application. Since this vital 4 information was not provided to us at the time of applying for the policy, we regret our inability to accept your claim under PP000001 (Member No. 01137, LAN: 510210)". The said letter was received by the complainant No. 1 on 31.01.2015. After receiving requisite premium and completing all the formalities, the above policy was issued for insured sum of Rs. 99,90,249/-. The act of the opposite party No. 1 in repudiating / denying the subject insurance claim is barred by the Principle of Estoppel and Acquiescence. After the death of the life assured, the complainant No. 2 deposited sum of Rs. 1,09,99,946/- in the loan account No. 510210 of the life assured.
4. The complainant No. 1 sent a legal notice dated 04.02.2015 to the finance company as well as the insurance company, stating therein that the sum assured under policy No. PP000001 be adjusted in the loan account of the life assured. The opposite party No. 1 is liable to pay the insured sum of Rs. 99,90,249/- and the opposite party No. 2 is bound to credit the said amount in the loan account of the life assured, but the opposite party No. 1 has failed to pay the sum insured under the relevant policy to the opposite party No. 2 and the opposite party No. 2 has failed to credit the said amount in the loan account of the life assured, therefore, the opposite party Nos. 1 and 2 have resorted to gross deficiency in service. Thus, the complainants filed the present consumer complaint and sought the reliefs, as mentioned in the relief clause of the consumer complaint.
5. The consumer complaint was allowed by this Commission vide order dated 29.01.2018, with the following conclusion:
"For the reasons aforesaid, consumer complaint is allowed and the opposite party No. 1 - insurance company is directed to pay the insured amount of Rs. 99,90,249/- to 5 the opposite party No. 2 - finance company and the opposite party No. 2 - finance company is directed to credit the said amount of Rs. 99,90,249/- to the loan account No. 510210 of the deceased life insured late Sh. Amar Singh Bishnoi. No order as to costs."
6. Feeling aggrieved, the opposite party No. 1 - insurance company went in appeal before the Hon'ble National Commission. The appeal filed by the insurance company was registered as First Appeal No. 608 of 2018; HDFC Standard Life Insurance Company Limited Vs. Poonam Bishnoi and others. The said appeal was decided by the Hon'ble National Commission vide order dated 06.06.2018, with the following observations:
"After some arguments, it has been agreed that the impugned order may be set aside and the complaint filed by the respondents be remitted back to the concerned State Commission for deciding the same afresh after taking into consideration the written version filed by the appellant as well as the affidavits and documents filed by it along with affidavits and documents filed by the complainants, subject to appropriate cost. Therefore, subject to payment of Rs. 50,000/- as cost by the appellant to the complainants, the impugned order is set aside and the matter is remitted back to the State Commission to decide the complaint afresh after considering the written version filed by the appellant as well as the affidavits and documents filed by the parties. In case, the discharge summary dated January 2014 issued by Max Hospital was filed before the State Commission, the said discharge summary shall also be considered. The parties are directed to appear before the concerned State Commission on 30.07.2018.6
The cost shall be paid on or before the next date of hearing fixed before the State Commission."
7. Upon remand of the case, the opposite party No. 1 - insurance company filed affidavit of Sh. Sudhir Singh, Assistant Legal Manager, HDFC Standard Life Insurance Company Limited, as an additional affidavit (Paper Nos. 282 to 283). The perusal of the said affidavit will show that the same has been filed in the form of written statement, as in para 1 of the said affidavit, it has been averred that the said deponent has been authorised by the insurance company to file the present written statement supported with an affidavit on its behalf. It has been stated that the deceased life insured suppressed the material fact in the proposal form dated 31.10.2013 that he was suffering from chronic liver disease / liver cirrhosis since 16.01.2013. The deceased life insured admitted before the consulting doctor of Max Super Speciality Hospital, Dehradun on 16.01.2014 that he was suffering from chronic liver disease / liver cirrhosis since one year back from the date of consultation, i.e., 16.01.2014.
8. In the written statement filed by opposite party No. 1 (Paper Nos. 99 to 111), it has been pleaded that that the deceased life insured signed the proposal form bearing No. PP000001 on 31.10.2013; that the assured sum under the policy was Rs. 99,90,249/-; that Ritika Chauhan was the nominee in the policy; that the insurance company received death claim application form of the deceased life insured, stating therein that the deceased life insured had passed away on 28.07.2014; that in the proposal form, the deceased had given a declaration that he had made complete, true and accurate disclosure of all the relevant facts and circumstances; that the question Nos. 1, 2 and 8 in the proposal form were answered by the deceased as "NO"; that as per the attending Physician's statement dated 11.10.2014 filled 7 up by Dr. Sanjay Prakash Saxena, the deceased life insured was a known case of chronic liver disease and was under consultation since December, 2013; that investigation was conducted by the opposite party No. 1 through an investigation agency named Saaransh Service Agency; that the investigation agency reported that the deceased was suffering from chronic liver disease; that the medical reports submitted by the deceased's father further confirmed the fact that the deceased was under treatment since December, 2013 in relation to chronic liver disease and had died due to the said disease coupled with septic shock; that the deceased life insured had not disclosed the above facts in the proposal form; that the insurance company has repudiated the claim on the ground of medical non-disclosure on the part of the insured and the same was communicated vide letter dated 08.01.2015; that the medical reports and death summary submitted by the father of the deceased life insured show that the deceased was admitted in the hospital on 25.07.2014 with Chronic Liver Disease with Cellulitis RT Lower Limb with Osteomyelitis Tibia with Septic Shock and had Bradycardia followed by Cardiac Arrest and was declared dead on 28.07.2014; that the complainants have themselves affirmed that the insured was suffering from chronic liver disease since last three years' and was under treatment from Max Super Speciality Hospital, Dehradun; that the complainant No. 2 himself submitted medical reports of the deceased life insured since January, 2014 till 28.07.2014, death summary and other related documents, which were confirmed by the investigating agency and which undoubtedly prove that the deceased had concealed the material information in the proposal form and with malafide intention, got his home loan insured from opposite party No. 1; that the nominee under the policy admitted full and final settlement done by opposite party No. 1 in accordance with the terms and conditions of the policy contract and had taken the liability of the loan amount; that the 8 complainants admitted the loan liability and had paid the loan amount to opposite party No. 2; that the insurance company has acted in compliance of the terms and conditions as agreed by the deceased life insured; that the insurance company settled the claim in terms of the policy contract and the opposite party No. 2 is bound to recover the loan amount from the nominee or the complainants only and that the complainants have no locus standi to file the consumer complaint and that there is no deficiency in service on their part.
9. The complainants have filed the affidavit dated 24.08.2016 of complainant No. 2 (Paper Nos. 75 to 81) in evidence. The opposite party No. 1 has filed the affidavit dated 22.05.2017 of Sh. Aditya Singh, Zonal Manager Legal (North Zone), HDFC Standard Life Insurance Company Limited (Paper Nos. 189 to 193) in evidence. The opposite party No. 2 has filed the affidavit dated 03.11.2017 of Sh. Gagandeep, Manager & Authorised Signatory, HDB Financial Services Limited, Branch Office, Dehradun (Paper No. 196) in evidence.
10. Vide order dated 08.03.2016, the opportunity of opposite party Nos. 2 and 3 of filing the written statement was closed in view of the judgment of the Hon'ble Apex Court given in the case of New India Assurance Co. Ltd. Vs. HILLI Multipurpose Cold Storage Pvt. Ltd.; 2015 (4) CCC 909 (SC), as the written statement was not filed within the statutory period of filing the written statement and also in view of the fact that 45' days period for filing the written statement had already lapsed.
11. In the affidavit filed on behalf of opposite party No. 2, it has been stated that no cause of action has arisen in favour of the complainants against the opposite party No. 2; that the complainants 9 have wrongly impleaded opposite party No. 2 as party to the consumer complaint; that the opposite party No. 2 is entitled to recover the entire amount due in regard to the loan taken by late Sh. Amar Singh Bishnoi and that there is no deficiency in service on their part.
12. We have heard the learned counsel for the parties and gone through the record available before us. We have also perused the written arguments filed on record.
13. The insurance company has turned down / repudiated the claim per their letter dated 08.01.2015 (Paper Nos. 72 to 73) on the ground that the life assured had given wrong answer to question Nos. 1, 2 and 8 given in the proposal form for the policy in question. The answer to the said questions were given by the life assured in the negative as "NO". The said questions are quoted below:
(i) Have you ever suffered or are currently suffering from:
(a) Chest pain or heart attack or any other heart disease
(b) Cancer, tumor growth or cyst of any kind (c) Stroke, paralysis, Epilepsy, any psychiatric/mental disorder, disorder of brain/nervous system or any kind of physical disabilities (d) Asthma, Tuberculosis or other lung disorder (e) Diseases or disorder of muscles, bones or joints, arthritis or blood disorder (anemia) or any endocrine disorder (f) Diseases of the kidney, digestive system (stomach, pancreas, gall bladder, intestine) liver, hepatitis B or C or HIV / AIDS infection (g) Diabetes, high blood pressure.
(ii) During the last 5 years have you undergone any major surgery or been hospitalized for more than one week?10
(iii) Have you ever been declined, deferred and accepted at special terms, had cover reduced or had exclusion imposed for any life, health or accident insurer cover?
14. During the pendency of the consumer complaint, the learned counsel for the complainants served interrogatories dated 24.08.2016 (Paper Nos. 86 to 87) upon the opposite parties. Question No. A(1) was to the effect whether the opposite party No. 1 had given any insurance cover to the deceased life insured in order to protect the loan bearing loan account No. 542757 taken by the life insured from opposite party No. 2 for purchase of the car and question No. A(2) was to the effect whether the opposite party No. 1 had paid any claim against the said insurance policy taken in order to protect the car loan and if so, how much amount has been paid and to whom. The answers to the above interrogatories submitted by opposite party No. 1 along with application dated 10.03.2017 (Paper Nos. 163 to
164) demolishes the defence set up by the opposite party No. 1 in the present case.
15. In reply to interrogatory No. 1, the opposite party No. 1 - insurance company has submitted that, "we have received these cases as a separate intimations claim No. VC000111 (Car Loan) intimation received on 13.09.2014, since it was a low sum assured case and intimated separately claim approved on 22.09.2014. In reply to interrogatory No. 2, the opposite party No. 1 has stated that sum of Rs. 4,13,809.05/- was paid to HDB Financial Services Limited and sum of Rs. 86,190.95/- was paid to Ritika Chauhan. Thus, as per the own admission of the opposite party No. 1 - insurance company, they have paid / settled the claim lodged against the insurance policy issued in favour of the deceased life insured for protecting the personal loan (car loan) taken by him for purchase of the vehicle. In 11 reply to similar sort of interrogatories through reply dated 03.02.2017 (Paper No. 150), the opposite party No. 2 - finance company has stated that they have received the amount of Rs. 4,13,809.05/- on 29.09.2014 towards personal loan insurance from opposite party No. 2 and the said amount was adjusted in the said loan account and thereafter rest of the amount has been paid by the insurance company to the deceased's nominee, i.e., his wife. In reply to interrogatory No. C(1) in regard to opposite party No. 3 as to whether she has received any amount after adjustment of car loan account No. 542757, the opposite party No. 3 has submitted through application dated 03.12.2017 (Paper No. 149) that she has received an amount of Rs. 86,190/- on 24.09.2014.
16. Thus, it is crystal clear that the insurance company has settled the personal / car loan taken by the deceased life insured. The said loan was taken by the deceased on 21.12.2013, the amount when the amount was disbursed in his favour, as would be evident from the statement of account in respect of loan account No. 542757 (Paper Nos. 33 to 35). The said loan was a later loan taken by the deceased life insured than the loan against property bearing loan account No. 510210 taken by him and which was disbursed in his favour on 30.11.2013, as would be evident from the statement of account in respect of the said account (Paper Nos. 28 to 32). Therefore, if the life assured was guilty of suppression of any material fact with regard to his health and had made any false statement with regard to his health etc. in the proposal form, the insurance company ought to have also declined the claim in respect of the insurance policy issued in favour of the deceased life insured for protecting the personal / car loan of Rs. 5,00,000/-, which loan, as is stated above and has also been admitted by the insurance company, has been settled / paid by them. The insurance company can not be allowed to blow hot and 12 cold at the same breath and to say that since the claim of Rs. 5,00,000/- was not a heavy claim and was not of huge sum, they have approved and settled the said claim and since the claim in question was for a heavy amount, they have repudiated the same. The factual position from which both the claim arise, is the same and in fact, as is stated above, the personal / car loan was taken by the deceased life insured later in time. The law regarding suppression of material fact is same for all the claims, whether the sum assured under the policy is low or high and if there is suppression of any material fact on the part of the life assured, the insurance company is not liable to honour the claim irrespective of the claim amount. Thus, the insurance company is estopped by the Principle of Estoppel and Acquiescence.
17. This apart, we do not find any force in the stand taken by the opposite party No. 1 - insurance company for repudiation of the claim in question. The reason being that as per the own saying of the insurance company, the deceased life insured was under consultation since December, 2013. The loan against property was disbursed in favour of the deceased life insured on 30.11.2013. There is nothing on record to show that the deceased life insured was suffering from chronic liver disease from before taking the loan or issuance of the insurance policy in his favour and he deliberately and intentionally suppressed the said fact in the proposal form and gave wrong / false answers to the questions asked for in the proposal form with regard to his state of health. Even otherwise, it was the duty of the insurance company to get the deceased life insured thoroughly medically examined before providing such a huge insurance cover, as the deceased life insured was got insured by the finance company with the insurance company for covering the loan against property of heavy sum of Rs. 3,50,00,000/-. Secondly, since the insurance company has 13 settled the claim in respect of the later loan taken by the deceased life insured and hence the insurance company can not escape from its liability to honour the claim in question and we are of the considered view that the insurance company has certainly made / resorted to deficiency in service by denying the claim.
18. It would not be out of place to mention here that in the prescription dated 11.10.2014 issued by Dr. Sanjay Prakash Saxena (Paper No. 125), the date of diagnosis has been mentioned as 02.12.2013. The proposal form is dated 31.10.2013. On behalf of the insurance company, reliance was placed on the discharge summary dated 16.01.2014 of the life insured issued by Max Super Speciality Hospital, Dehradun (Paper Nos. 137 to 138), wherein it has been stated that the patient is a known case of liver cirrhosis diagnosed 1 year back and is chronic alcoholic. He was admitted in a local hospital and was diagnosed as massive pleural effusion and was referred for further management. No such treatment or hospitalization record of the deceased life insured has been placed on record to show that he has been taking treatment in regard to the said disease since 16.01.2013. Reliance was further placed on the death summary dated 28.07.2014 of the deceased life insured issued by Max Super Speciality Hospital, Dehradun (Paper Nos. 144 to 145). In the said summary, it has been stated that the deceased was a known patient of chronic liver disease and was admitted on 25.07.2014 with complaints of increasing pain and redness over right lower limb after trauma 1 month back. The said summary also does not prove the case of the insurance company that the deceased life insured was suffering from liver disease from before taking the insurance policy and the said fact was concealed by him at the time of filling / submitting the proposal form.
1419. It was also submitted on behalf of the insurance company that the consumer complaint has not been filed by the nominee under the insurance policy and, as such, the complainants have no locus standi to maintain the consumer complaint. We see no merit in the said submission made on behalf of the insurance company. The reason being that in para 22 of the consumer complaint, the complainants have specifically stated that after the death of the deceased, the opposite party No. 3 is living separately and is not ready to sign the consumer complaint, therefore, she has been impleaded as proforma opposite party. In the present facts and circumstances of the case, non-filing of the consumer complaint by the nominee will not make any difference, in view of the fact that the proforma opposite party No. 3, the wife of the deceased, has not objected to the claim so made by the complainants, in-laws of proforma opposite party No. 3 and parents of the deceased life insured. Even otherwise, the policy amount is not to be given to the complainants or the proforma opposite party No. 3, but is to be paid by the insurance company to the finance company for adjustment of the same in the loan account of the deceased life insured and the complainants have also not prayed for payment of the insured amount to them, rather they have prayed that the opposite party No. 1 be directed to pay the insured sum to the opposite party No. 2 for adjustment of the said amount in the loan account of the deceased life insured. It would not be out of place to mention here that against the claim made in respect of the insurance policy issued in favour of the deceased life insured to secure the personal / car loan, the opposite party No. 3 has received a sum of Rs. 86,190/- from the opposite party No. 1 - insurance company on 24.09.2014, as has been admitted by her in reply (Paper No. 149) submitted against the interrogatory served upon her and hence if any amount was to be paid to her in respect of the claim (subject matter of the consumer complaint), she would have definitely joined the 15 complainants in the consumer complaint or should have filed the consumer complaint on her own. However, whatever may be the reason of not filing the consumer complaint by the nominee, but non-filing of the consumer complaint by the nominee under the policy, in the present set of facts and in view of the relief sought by the complainants, will not make any difference and the complainants can not be denied the relief on the said technical ground, which does not have any material impact on the merits of the case. It would also not be out of place to mention here that the complainants before us are the legal heirs of the deceased life insured, being his parents.
20. Learned counsel for opposite party No. 1 cited a decision of the Hon'ble Apex Court given in the case of P.C. Chacko and another Vs. Chairman, Life Insurance Corporation of India and others; III (2008) CPJ 78 (SC), wherein it has been held that the well-settled law in the field of insurance is that the contracts of insurance including the contracts of life assurance are contracts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission and this duty to disclose continues up to the conclusion of the contract and covers any material alteration in the character of the risk which may take place between proposal and acceptance. In the present case, we do not find any misstatement on the part of the deceased life insured while taking the policy. Even otherwise, as is stated above, if there was any misstatement on the part of the insured, the insurance company ought to have also declined the claim in respect of the policy issued in favour of the insured against the car loan disbursed in his favour by the finance company. Learned counsel also cited another decision of the Hon'ble Apex Court in the case of Satwant Kaur Sandhu Vs. New India Assurance Company Ltd.; IV (2009) CPJ 8 (SC), wherein it was held that the contract of insurance is based on uberrima fides (utmost good faith) and the 16 insured is under obligation to make true and full disclosure of the information within his knowledge. There can not be any dispute about the above proposition of law pronounced by the Hon'ble Apex Court, but the fact remains that the insurance company has to prove by cogent and reliable evidence that there has been misstatement and material on concealment fact on the part of the insured at the time of submitting the proposal form for the policy in question. Learned counsel further cited decision dated 09.08.2016 of the Hon'ble National Commission given in Revision Petition No. 1992 of 2016; Swadesh Pal Singh Vs. HDFC Standard Life Insurance Company Limited and another. In the said case, the insurance company did not accept the proposal of insurance in view of medical condition of the wife of the complainant that she was under weight. Additional premium of Rs. 4,041/- was charged and offer was accepted after paying additional premium on 28.03.2005. Therefore, the insured risk was started from 28.03.2005. It was held that it is clear that the insured underwent FNAC on 07.03.2005 and diagnosed as malignancy (Metastatic Carcinoma). She paid extra premium of Rs. 4,041/- on 28.08.2005, thus, the proposal was accepted on 28.03.2005. Therefore, it is a clear case of concealment of material facts by the insured (deceased) person. There is no such eventuality in the case at hand. Learned counsel cited another decision dated 12.08.2015 of the Hon'ble National Commission rendered in Revision Petition No. 833 of 2009; LIC of India Vs. Braham Singh. In the said case, before obtaining the insurance policy, the insured was suffering from AIDS, which fact, admittedly had been concealed in answering the questionnaire pertaining to the personal history. It was held that the insured had obtained the insurance policy by concealment of material fact and, as such, the insurance contract is not a valid contract and the insurance company was justified in repudiating the claim. In the instant case, as is stated above, there is nothing on record to show that 17 the deceased life insured was suffering from chronic liver disease from before taking the loan or issuance of the insurance policy in his favour. Learned counsel further cited another decision dated 12.01.2015 of the Hon'ble National Commission rendered in Revision Petition No. 3223 of 2010; LIC of India Vs. Ms. Mamta. In the said case, the life assured was admitted in hospital on 19.08.2005 and at the time of admission, the doctor was informed that the patient had a history of diabetes mellitus for the last five years and was on insulin for the last three years. In the instant case, as per the own saying the insurance company, the deceased life insured was under consultation since December, 2013, whereas the loan against property was disbursed in favour of the deceased life insured on 30.11.2013. Learned counsel also cited decision dated 15.04.2019 of the Hon'ble Apex Court given in Civil Appeal No. 3944 of 2019; Life Insurance Corporation of India Vs. Manish Gupta. In the said case, the past history of the insured showed that he was a known case of rheumatic heart disease since childhood. There is no evidence on record to prove that on the date of submitting the proposal form, the deceased life insured was suffering from any sort of disease and he deliberately suppressed the same in the proposal form and gave wrong answer with regard to his health status. The net result is that the case laws cited by the learned counsel for opposite party No. 1 do not apply to the facts and circumstances of the present case and do not provide any help to the opposite party No. 1.
21. In view of the above discussions, we are of the considered opinion that there has certainly been deficiency in service on the part of the opposite party No. 1 - insurance company in denying the subject claim and we do not find anything to go against our previous verdict and we are forced to go by the same conclusion.
1822. For the reasons aforesaid, consumer complaint is allowed and the opposite party No. 1 - insurance company is directed to pay within one month the insured amount of Rs. 99,90,249/- to the opposite party No. 2 - finance company and the opposite party No. 2 - finance company is directed to credit the said amount of Rs. 99,90,249/- to the loan account No. 510210 of the deceased life insured late Sh. Amar Singh Bishnoi. No order as to costs.
(MRS. VEENA SHARMA) (JUSTICE B.S. VERMA) K