Document Fragment View

Matching Fragments

2.      Upon notice, OP no.1 and 2 appeared and filed their separate written reply denying all the averments of the complainant raised in the complaint. It was further averred in the written reply by OP no.1 and 2 that deceased life assured Sukhdev Singh proposed for Unit Linked Bajaj Allianz policy for a sum assured of Rs.25,00,000/-, vide proposal dated 20.08.2008. The risk on the life of Sukhdev Singh was accepted by the OPs on the basis of answers, information, statements, documents and declarations made by him  in the said proposal form and policy bearing no. 0106641783  with date of commencement of risk as 05.09.2008, which was issued to said deceased life assured and original policy bond containing the terms and conditions of the contract was accordingly delivered to him. Sukhdev Singh life assured died on 29.03.2009 by giving rise to death claim under the policy. Smt. Bhupinder Kaur wife of the deceased lodged the insurance claim regarding death of her husband Sukhdev Singh, which was considered by the OPs in view of the terms and conditions of the contract of the insurance. The investigation of the case was conducted by the OPs to ascertain the bonafide of the claim and it was revealed that the deceased life assured Mr. Sukhdev Singh was not maintaining good health at the time of filling up the proposal form for insurance under the policy. From the Medical Attendant Certificate and Certificate from Usual/Family Doctor of the complainant, it transpired that deceased life assured had been taking treatment from Dr. Neel Patel (Hospital of the University of Pennsylvania) U.S.A since 28.08.2007 and was suffering from Diabetes, COPD, CAD, artic valve disorder on the date of proposal form dated 20.08.2008. Dr. Neel Patel (Hospital of the University of Pennsylvania) also provided a certificate of hospital treatment, which was produced by the complainant and the date of first treatment as an outpatient has been mentioned as 28.08.07 for diabetes, COPD (supra). The deceased life assured was on regular treatment of the said disease and ailments thereafter and he expired on 29.03.2009. The deceased life assured fraudulently misrepresented the material information of his pre-existing disease when he filled up the proposal form. The concealment of material facts by the life assured vitiated the contract of insurance. The complaint was also contested on the above-referred concealment material facts even on preliminary objections by the answering OPs by averring that contract of insurance is based on "UBERRIMA FIDES" and life assured Sukhdev Singh suppressed the material facts regarding his health. OP No.1 and 2 also relied upon Section 45 of the Insurance Act, 1938  in this regard. It was further averred on merits by OP no.1 and 2  that risk on the life of Sukhdev Singh assured was accepted by OPs on the basis of information supplied by him in the proposal form regarding his good health. The fact of taking the insurance policy by him was not disputed. The claim of the complainant was contested mainly on the ground that life assured gave wrong answers in the proposal form and suppressed the material fact of his pre-existing ailment. OP no.1 and 2 prayed for dismissal of the complaint.

7.      To counter this evidence, OPs tendered in evidence affidavit of Rajinder Singh Kalsi Zonal Legal Manager Bajaj Allianz Life Insurance Company Ltd Ex.RW-A. He stated in his affidavit that Sukhdev Singh life assured was not keeping good health during his lifetime and he concealed the material fact of his pre-existing disease regarding his health. He gave wrong answers in the proposal form, despite the fact that he was already suffering from diabetes, COPD, CAD, aortic valve disorder before the date of proposal for insurance dated 20.08.2008. Dr. Neel Patel (Hospital of the University of Pennsylvania) also provided a certificate of hospital treatment, which was produced by the complainant, wherein the date of first time treatment as an outpatient has been mentioned as 28.08.07 for diabetes, COPD. The life assured expired on 29,03.2009, which indicated that the deceased life assured had dishonestly, willfully and malafidely concealed the material information regarding his health and the contract of insurance stood repudiated on that basis. He reiterated the averments of OP No.1 and 2, as pleaded in the written reply filed by them. Ex.R-1 is proposal form filled in by Sukhdev Singh deceased life assured. From perusal of proposal form Ex.R-1, we find that life assured gave negative answers to the following questionnaire in the proposal           form :-

l) In the last 5 years, have you ever had, or been advised to have, or are likely within the next 30 days to undergo medical examination or any investigations such as but not limited to blood test, urine test, x-ray, ECG or biopsy, CT scan or test by any other special instrument?
m) Injured, sick, operated, given a medical consultation, given a medical advice on health, care in any hospital?

The submission of OPs is that life assured gave wrong answers to the above-referred questionnaire, despite the fact that he was already suffering from cardio vascular system disorder (supra). Ex.R-3 is death claim (claimant's statement), Ex.R-4 is scanned document by OPs dated 24.12.09, the policy extract for death claim investigation is contained in it. Ex.R-5 is certificate from Usual/Family Doctor of Sukhdev Singh. The main emphasis of the OPs is on Ex.R-5, which is photocopy of scheme Usual Family Doctor. The date of first consultation and cause is 28.08.2007 regarding diabetes, COPD, CAD, aortic valve disorder. We have to examine Ex.R-6 the Medical Attendant Certificate, wherein primary cause of death is malignant neoplasus of lung. The history reported at the time of his earlier consultation was diabetes, COPD, CAD, aortic valve disorder and it was issued, in fact, on 03.02.2010 by the concerned doctor. Ex.R-7 is copy of letter regarding repudiation of insurance claim of the complainant. Ex.R-8 is rejection of death claim under policy no.106641783. Ex.R-9 is requirement of the medical documents under policy from complainant. Ex.R-10 is letter addressed to complainant regarding requirement of treatment record for processing the claim.

9.      From evaluation of above-referred evidence on the record, we have come to the conclusion that documents issued by Hospital of the University of Pennsylvania U.S.A cannot be presumed to be  false documents. They have clearly proved it on the record, vide Ex.R-5 certificate from usual/family doctor that Sukhdev Singh life assured firstly consulted on 28.08.07 for Diabetes, COPD, CAD, artic valve disorder in Dr. Neel Patel Hospital. Ex.R-6 medical attendant certificate has further proved that Sukhdev Singh life assured knew the diseases of Diabetes, COPD, CAD, artic valve disorder. This document has, thus, proved that Sukhdev Singh had gone to doctor in regard to above consultation since August 2007 of the above diseases. We find no ground to ignore the document Ex.R-5 issued by usual/family doctor and medical attendance certificate Ex.R-6 issued originally by the above doctor of Neel Patel Hospital in America of deceased. The life assured suffered from last stage of cancer, as per affidavit of Sukhbir Singh on the record. The life assured gave wrong answers to proposal form with regard to his health, which was filled up by him on 20.08.08. The life assured, thus, already knew that he was suffering from material diseases, but he fraudulently gave the wrong answers stating "No" to such diseases. We have, thus, come to the conclusion that life assured knew that he was suffering from above diseases, as detailed in his family doctor certificate on the record, when he took the insurance policy. The contract of insurance is based on "UBERRIMA FIDES", bonafide and correct information is required to be given at the time of taking up the contract of insurance by the proposer, where the decision of the insurance company depends upon information provided by the life assured and if life assured knowingly and fraudulently provided wrong information then it renders contract of insurance void. We find that life assured suppressed the material facts from their disclosure fraudulently and he knew at the time of making statement that the information supplied by him was false and he suppressed the facts, which were material for him to disclose. We refer to law laid down in Mithoolal Nayak vs. LIC reported in AIR 1962 Page 814 by Supreme Court on this point. Reference may also be given in Satwant Kaur Sandhu vs. New India Assurance  Company Ltd, reported in 2009CTJ 956 (Supreme Court) (CP)  and "P.C Chacko and another Vs. Chairman Life Insurance Corporation of India and other" reported in 2007(VI) CLT 2009 (SC) decided on 20.11.2007.