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UTTAR PRADESH STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, LUCKNOW
Hon’ble Mr. Justice K.S. Verma, President;
Mr. S.P. Goyal & Mrs. Vidya Sonker, Members
SOHDRDA GUPTA—Complainant
versus
L.I.C.—Opp. Party
Case No. 305/SC of 1991—Decided on 25.6.1993
The Insurance Company is not liable to pay the amount if there is concealment of material facts which have a bearing on the death of the deceased and there is concealment of any matter which has relevance to the cause of death.
Headnote:
Insurance Policy - Claim Dispute - The court held that the Insurance Company is not liable to pay the amount if there is concealment of material facts which have a bearing on the death of the deceased and there is concealment of any matter which has relevance to the cause of death. If the concealed facts have no relevance to the cause of death, the Insurance Company cannot withhold payment of the amount.
Fact of the Case:
The complaint arose from a dispute over an Insurance Policy taken by Smt. Meena Gupta, whose claim was repudiated by the Insurance Company on the grounds of false information provided by the deceased.
Finding of the Court:
The court found that the deceased had taken a Life Insurance Policy, and while there was no dispute about her death during the subsistence of the policy, the only question was whether the claim could be avoided on the ground of concealment of facts. The court held that the Insurance Company is not liable to pay the amount if there is concealment of material facts which have a bearing on the death of the deceased and there is concealment of any matter which has relevance to the cause of death.
Issues: The main issue was whether the claim could be avoided on the ground of concealment of facts as mentioned in the repudiation letter from the Insurance Company.
Ratio Decidendi: The legal position is that the Insurance Company is not liable to pay the amount if there is concealment of material facts which have a bearing on the death of the deceased and there is concealment of any matter which has relevance to the cause of death. If the concealed facts have no relevance to the cause of death, the Insurance Company cannot withhold payment of the amount.
Final Decision: The court allowed the complaint and held that the complainant is entitled to recover a sum of Rs. One lac from the Insurance Company on the basis of the Life Insurance Policy of Meena Gupta.
Mr. Justice K.S. Verma, President — This case arises out of the complaint lodged by complainant on the basis of an Insurance Policy taken by Smt. Meena Gupta for a sum of Rs. 1 lac. Smt. Meena Gupta died on 11.5.88. The husband of Smt. Meena Gupta pre-deceased her and the complainant claims the Insurance Money for Smt. Meena Gupta on the Insurance Policy taken by Smt. Meena Gupta. The complainant put forward the claim that under the Insurance Policy the claim was repudiated by Insurance Company on 31.1.90 on the ground that information sought from Meena Gupta in regard to certain questions put to her were found incorrect. Thus according to the Insurance Company, the claim was repudiated.
2. From a perusal of the letter dated 3.1,1990 it appears that questions were put to Smt. Meena Gupta about the nature of business and she stated that she carries on the business of running Saree Bhandar and her monthly income is Rs. 2000/-. The contention of the Insurance Company is that the deceased was a housewife and had no income.
3. The complainant maintains that the information given by the complainant by the deceased was correct and she is entitled to get Rs. 1 lac under the Insurance Policy after the death of Smt. Meena Gupta.
4. The complaint was opposed by Insurance Company on the ground that Smt. Meena Gupta gave false information to the Insurance Company and hence the complainant is not entitled to the amount under the policy.
5. On this aspect we have heard both the parties. It is to be noticed that deceased Smt. Meena Gupta had taken a Life Insurance Policy for one lac. There is no dispute about the fact that Smt. Meena Gupta died during the subsistence of Insurance Policy. It is also not in dispute that the premium payable in respect of policy has been duly paid. The only question is whether the claim can be avoided on the ground of concealment of facts as mentioned in the letter of repudiation letter dated 31.1.90. The legal position is that Insurance Company is not liable to pay the amount if there is concealment of material facts which have bearing on the death of the deceased and there is concealment of any matter which has relevance to the cause of death. If facts said to have been concealed have no relevance on the cause of death, the Insurance Company cannot withhold payment of amount. In the instant case reply to question which are alleged to be false have no relevance to the cause of the death.
6. For reasons stated above, we allow the complaint and hold that the complainant is entitled to recover a sum of Rs. One lac from the opposite party on the basis of Life Insurance Policy of Meena Gupta. It is however clarified that the complainant will be entitled to Rs. one lac from the Insurance Policy of Smt. Meena Gupta. The Insurance Company shall pay a sum of Rs. one lac to the complainant by 31st August, 1993 failing which the complainant would be entitled @ 12% per annum from 1st September, 1993 to the date of actual payment.
7. The complaint is decided in the manner indicated above.
Complaint allowed.
