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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Rekha Gupta, Presiding Member and Anup K. Thakur, Member
Savneet Singh Sobti —Petitioner
versus
Aviva Life Insurance Co. India Pvt. Ltd. and Ors. —Respondents
Revision Petition No.3998 of 2014
(Against Order dated 5.9.2012 in First Appeal No.1548 of 2011 of Haryana State Consumer Disputes Redressal Commission, Panchkula)
Decided on 9.9.2016
Counsel for the Parties:
For the Petitioner:Mr. Aditya Verma, Advocate
For the Respondents:Mr. Joydeep Bhattacharya, Advocate
IMPORTANT POINT
Claim for insurance cannot sustain on grounds of non-disclosure of material information and on principle of insurance being a contract of utmost good faith.
Headnote:Consumer Protection Act, 1986—Sections 15, 17, 19 and 21—Insurance—Repudiation of death claim ground of non-disclosure of pre-existing medical ailment in proposal form—Complaint dismissed by Fora below—Death claim investigation report carried out at instance of Insurance Company confirms that death was due to heart attack when she was sleeping—Investigation report further gives an account of various enquires made with medical stores, various doctors, neighbours etc. and reports that she was quite healthy and not apparently suffering from any illness—Two neighbours interviewed reported her to be healthy and never in an ill condition—All this does seem to point to fact that she was leading a normal healthy and unremarkable life—However, Investigator also reported that she had taken 15 days medical leave and cause of leave for taking leave was hypertension and that leave was availed before commencement of policy On the basis of these facts, two Fora below have come to finding that claim for insurance cannot sustain on grounds of non-disclosure of material information and on principle of insurance being a contract of utmost good faith—Revision petition dismissed. (Paras 10 and 11)
Result: Revision Petition dismissed.
Anup K. Thakur, Member—This revision petition has been filed by the petitioner/complainant-Shri Savneet Singh Sobti, nephew of late Shri Jatinder Paul Kaur, holder of a life insurance policy with Aviva Life Insurance Co., India Ltd. against the order dated 5.9.2012 in First Appeal No. 1364 of 2013 passed by Haryana State Consumer Disputes Redressal Commission, Panchkula (in short ‘State Commission’).
2. The petitioner’s prayer before the commission is that the State Commission has misconstrued the facts, have not given a speaking order and therefore their order is illegal, perverse and bad in law.
3. The facts of the case in brief are that Ms. Jatinder Paul Kaur bought a Aviva Life Insurance Policy (Life Saver plus) No. LSP 1720283 w.e.f. 16.10.2007. The premium was Rs. 50,000 per annum and had been paid regularly i.e. two premia amounting to Rs. 1 lakh had been paid till the intervening night of 11/12th February 2009 when she passed away in her sleep at home. The death was considered to be natural and as such she was cremated subsequently without any medical examination, etc. The petitioner thereafter filed a request letter to the respondent/insurance Company claiming her insurance. They responded on 1.9.2009, seeking necessary documents etc. for processing the insurance claim. They also appointed an investigator on 20.11.2009 who submitted their report on 30.11.2009.
4. The complaint is that despite submission of all documents required by the Insurance Company and without suppressing any fact, the respondent/insurance Company repudiated the claim vide their letter dated 25.11.2009 on the ground of “non-disclosure of pre-existing medical ailment in the proposal form”. The complainant’s case is that since the insurance policy had been obtained in the first place on the basis of a medical checkup by a panel of doctors of the Insurance Company, the ground of “non-disclosure” was invalid and unjust.
5. The respondent/insurance Company has strongly contested this, pleading that the petitioner had not come with clean hands. Late Ms. Kaur had been suffering from hypertension, a condition corroborated by the fact of her taking medical leave from 14.5.2007 to 26.5.2007 on the basis of a medical certificate issued by Dr. Har Parkash Sharma dated 14.5.2007. Yet this important information was withheld by her at the time of making a proposal for life insurance. They have also cited several judgments in similar cases to support their main argument that a contract of insurance is a contract of utmost good faith in which the insurer has to disclose all facts known to be true, without withholding any information, as asked for in the proposal form. In particular, they have highlighted the response of the insured to the Section on PERSONAL DETAILS, Column 2-Health and Activity Section. In Section A, she was asked if she was “currently receiving any medical treatment or awaiting medical or surgical consultation, test or investigation? Her answer was “No”. In Section B, she was specifically asked whether she ever had any medical or surgical treatment including investigations, tests, scan or x-ray for any of the following illness or medical conditions viz high blood pressure, angina, heart attack, stroke or any other disorder of heart or circulations? To this also, she had replied in the negative. In fact, the entire series of question under Section B had been answered in the negative. The case of the Insurance Company is therefore, that this amounted to non-disclosure of material information which would have had a bearing on how the company handled treated her application for insurance.
6. The District Forum, on an appraisal of the facts viz. the complainant accepting that the deceased had taken leave on grounds of hypertension for 15 days to take rest under medical advice from 14.5.2007 to 26.5.2007, and that the proposal for contracting the insurance policy was submitted on 8.10.2007, i.e., after medical leave, and thereafter the non-disc
