Delhi

New Delhi

CC/44/2015

Huma Saad - Complainant(s)

Versus

M/S. HDFC Standard Life Insurance Company Ltd. - Opp.Party(s)

19 Nov 2019

ORDER

 

 

 

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI), ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN,

I.P.ESTATE, NEW DELHI-110002.

 

Case No.CC.44/2015                                   Dated:

In the matter of:

                Smt. Huma Saad,

                 W/o Late Sh. Saad Mahmood,

                  R/o 270, IInd Floor,

                 Sukhdev Vihar,

                 New Delhi-110025.

  ….….Complainant

Vs.

 

               HDFC Standard Life  Insurance Company Ltd.

               Having its office at:

              22, Community Centre,

              Opp. New Friends Colony Police Station,

               New Friends Colony,

               New Delhi-110065.  

 

                                                                             ………Opposite Party

   ARUN KUMAR ARYA, PRESIDENT

 

O R D E R

 

 

The complainant has filed the present complaint against the OP under section 12 of Consumer Protection Act, 1986. The brief facts of the present complaint are that in the year 2012, the complainant’s husband(late Sh. Saad Mahmood S/o Late  Mohd. Yusuf) had taken two  Policies  bearing nos.15442789 and 15442799 from the OP.   The premium payable on each policy was Rs.1 lac every year and the premium was payable for a period of five years. OP assured a sum of Rs.7 lacs (each) in case of death of policy holder.  The deceased deposited two premiums on both the policies of Rs.1 lacs each to the OP but unfortunately before the payment of 3^rd premium he died on 21/04/2014 in Escort  Hospital, Friends Colony, Delhi. The complainant was a duly appointed nominee in both the aforesaid policies, therefore she lodged the claim with the OP and submitted all the required documents.  A formal investigation was also carried out by the OP Co. and investigator assured the complainant that sum assured  will be transferred in her account soon.  But  an amount of Rs.4,69,717.66/- (Rs.2,34,858/-each)  was credited in the complainant’s account on 28.7.2014 instead of Rs.14 lacs (Rs. 7 lacs each) sum assured in total against two policies of  DLA It is further submitted that despite her repeated requests, follow up, OP did not consider her balance claim.  On 27.8.2014, through an e-mail, OP informed to the complainant that the balance claim was declined due to non-disclosure of material facts in the proposal form, however an amount of Rs.4,69,717/- was transferred in the complainant’s account as a goodwill gesture. The complainant visited the office of OP on several occasions for balance claim but all in vain. Complainant, therefore, approached this Forums for redressal of her grievance.

2.     OP had filed written statement opposing complaint of the complainant. It was stated that the deceased had given the wrong declaration in the proposal form dt. 14.9.2012 viz. suffering from Anterior Wall Myocardial Infarction and Double Vessel Disease with Hypertension and Diabetes and having consulted doctor for cardiac related problems on 8.11.2008. Thereafter he consulted doctor at Escorts Heart Institute  and  admitted in the same hospital on 8.11.2008, where he undergone coronary angiography and coronary stenting on 10.11.2008 and was discharged on 13.11.2008.  The DLA was diagnosed for cardiac related problems and other diseases as above  mentioned much prior to the issuance of policies, hence, the death claim is liable to be repudiated on this ground alone. Hence, death claim was rightly repudiated in terms of clause 18 of Standard Policy Provision.

 3.    Both the parties filed their evidence by way of affidavits. Parties also filed   written arguments.

4.     We have heard argument advance at the Bar and have perused the record.

5.     Ld. counsel for the OP has contended that Life Assured was suffering from Anterior Wall Myocardial Infarction and Double Vessel Disease with Hypertension and Diabetes and having consulted doctor for cardiac related problems on 8.11.2008. Thereafter he consulted doctor at Escorts Heart Institute  and  admitted in the same hospital on 8.11.2008, where he undergone coronary angiography and coronary stenting on 10.11.2008 and was discharged on 13.11.2008.  for which he was on medication from 2008 prior to the solicitation of the policy. It was argued that the Life Assured had given false replies in the application for insurance as such the policy was obtained by concealment and suppression of material facts. In support of its contention counsel for OP has drawn our attention towards the proposal form as well as the copies of Radiologist report, discharge summary of Escort Heart Institute dt.13.11.2008 as well as the death summary issued by Forties Escort Heart Institute. It was further argued that the claim was rightly repudiated as the policy was obtained by concealment and suppression of material facts.

6.     On the other hand, ld. counsel for the complainant has contended that there is no concealment of material facts by the Life Assured, in fact the DLA has declared his health condition to the agent and it is the agent who had filled the proposal form and intentionally not mentioned the health status of the DLA  in the same for getting the business/premium for OP and prayed that the relief claims be granted.

7.     It is admitted position that the Life Assured had taken two  insurance policies, wherein total sum assured was Rs.14 lacs from the OP in the year 2012. The Life Assured had died on 21.4.2014, the balance claim has been repudiated by the OP on the ground that the Life Assured was suffering from  Anterior Wall Myocardial Infarction and Double Vessel Disease with Hypertension and Diabetes and having consulted doctor for cardiac related problems on 8.11.2008. Thereafter he consulted doctor at Escorts Heart Institute  and  admitted in the same hospital on 8.11.2008, where he undergone coronary angiography and coronary stenting on 10.11.2008 and was discharged on 13.11.2008 for which he was on medication since 2008  i.e. prior to the solicitation of the policy.  It was alleged by OP that  the Life Assured had given false replies in the application for insurance as such the policy was obtained by concealment and suppression of material facts. Whereas it was argued on behalf of complainant that the proposal form was filled by the agent and only the signature was made by the DLA on the proposal form, hence, the allegation of the  suppression of material facts was vague and frivolous. On the issue of signing the document, we are guided by Hon’ble Supreme Court in Civil Appeal No.5994-2014 titled as Grasim Industries Ltd. & Anr. Vs. Agarwal Steel with Civil Appeal No.7477/2004 and 1733/2005 in which the Hon’ble Apex Court has held as under:

“When a person signed a document, there is a presumption, unless there is proof of force or fraud, that he has read the document properly and understood it and then only he has affixed his signature thereon, otherwise, no signature on a document can ever be accepted”.

 

 8.    In the present case, there is no allegation  regarding obtaining the signature on the proposal form by force and fraud against the OP,  hence,  in such a circumstances we are inclined to hold that the DLA had signed the proposal form only after understanding it properly.   The stand of the complainant that DLA had disclosed to the agent about his health status and agent has intentionally did not mention the same in the proposal form is not sustainable in view of judgment of Hon’ble Supreme Court cited above.

9.     On the other hand, to prove its stand, OP has relied upon the queries answered by the Life Assured in the proposal form. The relevant portion of the same is reproduced as under:

2A	Have you ever suffered from or received treatment for, any symptoms of medical condition to any of the following?
1.	Chest pain or heart attack or any other heart disease or problem or hypertension	No
2.	Stroke or paralysis	No
3.	Cancer tumor, growth or cyst of any kind	No
4.	Diabetes or high blood sugar/sugar in urine	No
5.	Kidney problem(excluding kidney stone) or disease of the reproductive organs	No
6.	Liver problem excluding jaundice or hepatitis B or C	No
7.	Musco skeletal disorder	No
8.	Gestro intestinal disorders	No
9.	Nervous psychiatric or mental disorder	No
10.	Respiratory disease (excluding Asthma and bronchitis)	No
3.	Apart from minor ailment such as cold and flu, have your received any treatment from any doctor or specialist or been hospitalized or undergone hospital treatment in the last five years.	No

 

10.    We have gone through the proposal form as well as copies of Radiologist report, discharge summary of Escort Heart Institute dt.13.11.2008 and the death summary issued by Fortis Escort Heart Institute  placed on record by the OP.  Perusal of the same shows that the  Life Assured was suffering  from hypertension and diabetes mellitus, as well as from heart disease since 2008 for  which he was on medication  since 2008  prior to the solicitation of the policy.  The DLA in his proposal form in section C(2) sought medical questionnaire for health details of Life Assured  Answered in negative, whereas as per the Radiologist report, discharge summary of Escort Heart Institute dt.13.11.2008 and the death summary issued by Fortis Escort Heart Institute it was clear that he was suffering from ACS, Atrial, fibrillation with FVR, old AWMI, DVD (10.11.2008), HTN, DM Type II, dyslipidemia.   The material on record clearly shows that the Life Assured had not given correct answers and had obtained the policy by suppressing material facts.

11.    The Non-Disclosure” of the true and correct facts pertaining to the medical history at the proposal stage by the DLA amounts to misleading the OP Insurance Co., resulting in the violation and infringement of the terms of contract between the parties, hence the repudiation is justified. 

12.    The contracts of insurance are contracts of uberrima fides and every material fact is required to be disclosed. In United India Page 11 of 13 Insurance Co. Ltd. v. M.K.J. Corpn., III (1996) CPJ 8 (SC), a two Judge Bench of Hon‟ble Supreme Court has observed: “It is a fundamental principle of Insurance law that utmost good faith must be observed by the contracting parties. Good faith forbids either party from concealing (non-disclosure) what he privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. Just as the insured has a duty to disclose, „similarly, it is the duty of the insurers and their agents to disclose all material facts within their knowledge, since obligation of good faith applies to them equally with the assured‟.”

13.    In Satwant Kaur Sandhu v New India Assurance Company reported in IV (2009) CPJ 8 (SC), Hon‟ble Supreme Court has observed that in a contract of insurance, the expression “material fact” is to be understood in general terms, to mean as any fact which would influence the mind of a prudent Insurer, in deciding whether to accept the risk or not. If the proposer has knowledge of such fact, he is obliged to disclose it, particularly while answering questions in the proposal form. Any inaccurate answer will entitle the Insurer to repudiate its liability because there is clear presumption that any information sought for in the proposal form is material for the purpose of entering into a contract of insurance, which is based on the principle of utmost faith– uberrimae fidei. Good faith forbids either party from non-disclosure of the facts which the party privately knows, to draw the other into a bargain, from his ignorance of that Page 12 of 13 fact and his believing the contrary. It has also been emphasized that it is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not.

14.    In PC Chacko and Anr. v. Chairman, Life Insurance Corporation of India & Ors. (2008) 1 SCC 321, the Hon‟ble Supreme Court has upheld the repudiation of the contract of insurance on the ground of non-disclosure and mis-statement in the proposal form to the various questions to which the answers were given by the insured.

15.    In the present case, the material on record discussed above clearly establishes that the Life Assured had concealed material facts about his health as well as life style in the proposal form. The Life Assured had failed to disclose that he was suffering from ACS, Atrial, fibrillation with FVR, old AWMI, DVD (10.11.2008), HTN, DM Type II, dyslipidemia, which was clearly mentioned in death summary issued by Fortis Escort Heart Institute dt. 21.4.2014. Further, when the application for insurance was filled up by Life Assured he had replied questions in respect of aforesaid ailments in negative. There is clear suppression of material facts in relation to diseases suffered by him prior to date of application for insurance. Material on record  proves that policy was obtained by concealment of material facts. In the facts and circumstances of the present case, we are of the  considered view that the OP was justified in repudiating the claim.  

16.    In view of the above discussion, we find not merits in the present compliant, same is hereby dismissed.

A copy of this order each be sent to both the parties free of cost by post. This final order be sent to server (www.confonet.nic.in ). File be consigned to Record Room.

Announced in open Forum on 19/11/2019.

 

 

(ARUN KUMAR ARYA)

          PRESIDENT

 

                  (NIPUR CHANDNA)                                                  (H M VYAS)

                          MEMBER                                                                MEMBER