DELHI STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, NEW DELHI
Mr. Justice A.P. Chowdhri, President; Ms. S. Brar &
Mr. Desh Bandhu, Members
JAIPALI—Appellant
versus
CHAIRMAN, L.I.C. & ORS.—Respondents
Case No. A-422 of 1994—Decided on 2.8.1996
The insured's fraudulent suppression of material information can justify the repudiation of an insurance claim.
Headnote:
Insurance - Claim Repudiation - Fraudulent Suppression of Information
Fact of the Case:
The insured took two insurance policies and nominated his wife as the nominee. After his death, the wife filed a complaint stating that the payment under the first two policies had not been made, while the payment under the third policy had been made. The claim was repudiated based on the insured's fraudulent suppression of material information regarding his health.
Finding of the Court:
The complaint was dismissed, and the plea of the opposite party was accepted. The appeal was also dismissed due to the fraudulent suppression of material information by the insured.
Issues: The issues included the fraudulent suppression of material information by the insured, the validity of the claim, and the reliance on one-sided affidavit filed on behalf of the respondent.
Ratio Decidendi: The court found that the insured had suppressed significant facts regarding his health in the personal statement, and the respondent was justified in repudiating the claim based on the investigation. The court also emphasized that the deceased being illiterate did not absolve him from the responsibility of the information provided in the questionnaire.
Final Decision: The appeal was dismissed, and there was no order as to costs.
Mr. Justice A.P. Chowdhri, President— Facts necessary for the disposal of this appeal are that one Brahm Prakash working as a fitter in the Kelvinator India Ltd. took two insurance policies of Rs. 25,000/- each effective from 28.3.89. He nominated his wife Smt. Jaipali as nominee. The aforesaid insured died on 29.7.90. In the complaint filed by Smt. Jaipali it was stated that her late husband had also secured a third policy No. PN/1891 /611 for Rs. 10,000/- effective from 20.3.89 from the Life Insurance Corporation. It was further stated that while the payment of Rs. 10,000/- had been made by the opposite party under the third policy, the payment under the first two policies had not been made. The complaint was contested. It was pleaded that the insured was guilty of fraudulent suppression of material information. The investigations made in connection with the claim revealed that in July, 88 the insured was operated for cancer of gall bladder. This significant fact was suppressed in the personal statement of the insured dated 28.2.89. It was also found that the insured had been on long period of leave in connection with his aforesaid ailment during the years 1988-89. Based on the result of investigation the claim was repudiated by letter dated 16.9.92. On a consideration of the matter the complaint was dismissed. The plea of the opposite party was accepted.
2. None appeared for the appellant. On behalf of the respondent an application was made for adjournment. In the absence of any compelling reasons, we declined the prayer for adjournment. We have carefully gone through the records and proceed to dispose of the appeal.
3. In the grounds of appeal a new ground has been taken that the deceased was thoroughly examined by a panel of doctors. Firstly no such case was set out in the complaint and the aforesaid fact cannot be permitted to be pleaded for the fist time in the appeal. It has next been stated that the District Forum erred in placing reliance on one sided affidavit filed on behalf of the respondent. We fail to understand what is one sided affidavit. There cannot be any dispute that in the proceedings before the FORA affidavits have been made admissible to enable expeditious disposal of the matters in a time bound frame. The affidavits are scrutinised with the care they deserve and there is no infirmity in the order simply because the matter has been decided on the basis of evidence in the form of affidavit and the affidavit filed on behalf of the opposite party has been accepted.
4. The next ground mentioned is, that payment of Rs. 10,000/- made by cheque in respect of the third policy and there is no reason why similar action was not taken in respect of the remaining two policies. There is no merit in this contention. The respondent has denied having issued any such cheque for Rs. 10,000/-. In any case assuming that payment of Rs. 10,000/- relating to the stated third policy has been made, the respondent is not estopped from repudiating the claim on the basis of investigation made in connection with the claim of the complainant. It has been established on record that deceased insured underwent operation of cancer of gall bladder in Batra Hospital and he remained on leave and these important facts wee suppressed in the personal statement of the deceased dated 28.2.89. We find no merit in the plea put forward in the grounds of appeal that the deceased was illiterate and he merely put his signatures on the personal statement while replying to the questionnaire with regard to various ailments etc. Assuming that the insured was illiterate, he must have taken the assistance of a literate person and what was stated in the questionnaire was prima-facie binding on the maker unless a clear case of fraud etc. had been pleaded and proved.
5. For these reasons, we find no merit in the appeal. It is, accordingly, dismissed. There will be no order as to costs. A copy of this order be communicated to both the parties as well as Distri