HARYANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, CHANDIGARH
Hon’ble Mr. Justice S.S. Sandhawalia, President;
Mr. S. Kulwant Singh, Member
POONAM MITTAL & OTHERS—Complainants
versus
THE LIFE INSURANCE COMPANY—Opposite Party
Complaint Case No. 9 of 1992—Decided on 20.7.1992
INSURANCE - LIFE INSURANCE - REPUDIATION OF CLAIM - MISREPRESENTATION AND SUPPRESSION OF MATERIAL FACTS - CONSUMER DISPUTE - DEFICIENCY IN SERVICE - SCOPE OF ENQUIRY.
Fact of the Case:
The complainant, Smt. Poonam Mittal, and her two children filed a complaint against the Life Insurance Corporation (LIC) for repudiating their claims under three life insurance policies taken out by her deceased husband, Shri Roshan Lai. The complainants alleged that the LIC had repudiated the claims on the ground that the deceased had misrepresented and suppressed material facts about his health in the proposal forms.
Finding of the Court:
The court found that the deceased had a long history of alcohol dependence syndrome, alcoholic cirrhosis, and other related maladies. This information was not disclosed in the proposal forms, which constituted a material suppression vitiating the contract of insurance. The court also found that the cause of the deceased's death was shrouded in mystery, as no police report was lodged or post-mortem conducted.
Issues: 1. Whether the deceased had misrepresented or suppressed material facts about his health in the proposal forms. 2. Whether the LIC was justified in repudiating the claims based on the misrepresentation and suppression of material facts. 3. Whether the matter falls within the scope of consumer dispute and whether there was any deficiency in service on the part of the LIC.
Ratio Decidendi: 1. The court held that the deceased had indeed misrepresented and suppressed material facts about his health in the proposal forms. This was evident from the discharge and follow-up card of the PGI, which showed that the deceased had been admitted as an in-door patient for treatment of alcohol dependence syndrome and other related maladies. 2. The court held that the LIC was justified in repudiating the claims based on the misrepresentation and suppression of material facts. The contract of insurance is one of utmost good faith, and any material misrepresentation or suppression of facts vitiates the contract. 3. The court held that the matter did not fall within the scope of consumer dispute. The scope of enquiry in a consumer dispute is limited to whether there has been any deficiency in the services undertaken to be rendered by the service provider. In this case, the LIC had conducted a detailed enquiry and had come to the conclusion that the deceased had made material suppressions vitiating the contract of insurance. This decision was taken in good faith and after due application of mind. Therefore, there was no deficiency in service on the part of the LIC.
Final Decision: The court dismissed the complaint and left the parties to their basic civil remedies.
Mr. Justice S.S. Sandhawalia, President — For the limited purpose of this order relegating the complainant to her remedy in a Civil Court, it is unnecessary to delve too deeply into the facts and the merits.
2. The complainant Smt. Poonam Mittal and her two children are the widow and off-springs of Shri Roshan Lai (hereinafter called the deceased) who died on the 24th of May, 1989. In this joint complaint, it is the case that on the 15th July, 1987 the deceased had submitted a proposal of Life Insurance Policy of Rs. 50,000/- with a double accident benefit which was accepted on the 9th of September, 1987 and Policy No. 170075473 was issued with regard thereto. In this policy, complainant No. 1 was the nominee. Again on the 15th December, 1988 the deceased made another proposal for a Life Insurance of Rs. 50,000/- with double accident benefit which was also accepted on the 31st of December, 1988 and relevant policy document was issued, wherein complainant No. 2 was the nominee. Curiously on the same aforesaid date i.e. 15th day of December, the deceased made a third proposal for life insurance of Rs. 50,000/- with double accident benefit which was also accepted and policy document was issued, in which complainant No. 3 was the nominee.
3. It is the case of the complainants that when all the aforesaid policies were, taken out the deceased was hale and hearty and was only 33 years of age. He paid the installments and the premier on the said policies. However, on 24th of May, 1989, he suffered a fall in the bath-room and died due to brain hemorrhage. Consequent thereto the complainants as. the nominees made their claims with the Life Insurance Corporation (hereinafter called the L.I.C.), in reply to which certain information’s were sought with regard to the deceased having taken treatment from the Post Graduate Institute of Medical Research & Education (hereinafter called the P.G.I.). To this communication, the complainant gave reply alongwith the Card issued by the P.G.I. which indicated that he was admitted as an indoor patient on the 11th of April, 1989 and was discharged after a month’s treatment on the 10th of May, 1989 with some improvement in his condition. Though the complainants completed the other formalities of their claims yet on the 5th of March, 1990, the L.I.C. in a detailed communication repudiated the liability on all the policies on the ground that the deceased had suffered from indigestion, diarrhoea, nausea and alcohol dependence, long before the time of the proposals and these maladies were deliberately suppressed by the deceased and instead he gave false answers about the condition of his health. The complainants thereafter made representations against the said repudiation but the L.I.C. stuck to its guns, compelling the complainant to knock at the door of this Commission on the 5th March, 1992. A relief to the tune of Rs. 3 Lacs alongwith interest @ 18 per cent per annum is claimed. Reliance was placed on the relevant documents of the proposals and the policies issued.
4. The complaint has been strenuously opposed on behalf of the L.I.C. whilst the broad factual matrix of the basic facts with regard to the three Insurance proposals have been admitted, the core of the defense is that the impeccable hospital record of the deceased policy-holder established that he had a long history of alcohol dependence resulting in a complete damage of his liver and other serious complications. It was the case that this information was fraudulently suppressed when making the proposal, and the contract of insurance being one of utmost good faith stood vitiated by such a suppression. It was the defence that if the correct information about the state of health had been disclosed, the opposite party would never have accepted the risk with such a past medical history. It was stated that even on the question of age there was a mis-statement by the proposer. In particular, it had been averred that the cause of death of the deceas
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