Back
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Ajit Bharihoke, Presiding Member
Max New York Life Insurance
Co. Ltd. —Appellant
versus
Gitaben Rajeshbhai Kanparia —Respondent
First Appeal No.140 of 2018
(Against the Order dated 10/10/2017 in Complaint No. 57/2012 of the State Commission Gujarat)
Decided on 5.2.2018
Held: Now the question is whether or not the concealment by the life assured about his foreign travels and his stay at Zimbabwe is a material fact which could have bearing on the decision of the insurance company to accept or not the accept the insurance proposal or to grant insurance cover on a higher premium. 11. The State Commission has dealt with this issue in detail. Relevant observations of the State Commission are reproduced as under: -
“Complainant’s husband has done foreign visits within five years but given negative answer and not declared true information regarding trips. But the question arises that the same is covered under hiding important information or case of cheating? Legally the fact reveals that the policy contract is made with good faith .Policy contract is like uberrima fides. In the proposal form, insurer has to provide true and important information. Regarding the same, opponents have submitted decision given by Supreme Court 4 (2009) CPJ 8 (SC) between Satwant Kaur Sandhu vs. New India Assurance Co. Ltd. in presented judgment, court has declared that insurer has to provide all important information in proposal form.
In the given decision, it was also disclosed that what is the important information? Important information are those which can decide whether to accept risk of the proposer and if accepted then how much premium should be collected. Any information can decide the above are called as important information. Insurance proposer has to declare this kind of information. In the current case, complainant’s husband has done many foreign trips within 5 years and this information comes under important information whether the insurer able to get the policy or not? Complainant’s husband has not disclosed the same. He has not declared previous foreign trips and also not asked about premium difference in case of foreign trips. Opponent insurance company has not declared that if complainant’s husband has declared about foreign trips then what effect occurred about providing insurance policy.
In proposal form part ‘C” item 1 has question about other insurance policies. Hon’ble National Commission has declared in revision petition No.3139/2015 (NC) between Bajaj Allianz Life Insurance Co. Ltd. vs. Paramjit Kaur that non-disclosure of other company’s insurance policies in proposal form is not covered under hiding important information. Any questions asked in proposal form and if true answer was not given then it cannot be declared that the policy was taken with intention to cheat. It is responsibility of opponent insurance company to inform the proposer about important information to decide giving policy or not. Opponent has argued that complainant’s husband has visited Zimbabwe, Sierra Leone, Guinee, Israel, South Africa and Mozambican which are decline/negative countries and this is beyond the terms and conditions.
But in proposal form, list of decline/negative countries was not given. In part ‘A’ item 22 of proposal form, the question asked about dangerous working schedule in country or outside country for visiting? Regarding the same there is nothing declared in proposal form that which parts of the country or outside country are dangerous. In proposal form, nowhere information that visiting of country like Zimbabwe, Sierra Leone etc. are beyond the policy conditions. So, opponent’s argument about visiting countries like Zimbabwe, Sierra Leone, Guinee, South Africa, Israel and Mozambique is beyond policy conditions, is totally baseless and seems to produce by them intensely repudiating the claim.”
From the above observation, it appears that it was pleaded before the State Commission that the countries which were visited by the life assured prior to filling up of the proposal form and Zimbabwe, where the life assured died because of Cardiac Pulmonary Arrest were in negative list of countries. However, on perusal of proposal form, it is seen that although information about foreign travel by the proposer life assured has been sought in the proposal form but it is not clarified as to why the said information has been sought and no information about list of negative countries is there in the proposal form. Therefore, I find no fault with the impugned order of the State Commission holding that non furnishing of information about foreign travel amounts to concealment of material fact. Thus, I find no reason to interfere with the well-reasoned order of the State Commission. Appeal is accordingly dismissed.
As the appeal has been dismissed on merits, no finding on application for condonation of delay is required. (Paras 10, 12 and 13)
Result: Appeal has been dismissed.
Ajit Bharihoke, Presiding Member—This appeal is directed against the order of the State Commission, Gujarat dated 10th October, 2017 in CC/57/2012 whereby the State Commission partly accepted the complaint filed by the respondent and directed as under:-
“1. Complaint’s complaint No.57/2012 is partly accepted.
2. Order is given to opponents to pay amount of Rs.33,91,185/- (Rupees Thirty Three Lacs Ninety One Thousand One Hundred Fifty Eighty Five) to complainant, with interest of 8% from the date of complaint.
3. Order is given to opponents to pay compensation of Rs.5000/- (Rupees Five Thousand) to complainant to giving mental stress and harassment and amount of Rs.2000/- (Rupees Two Thousand) for complaint cost.
4. Opponents have to bear expenses by self.
5. Copies of this order are given to parties free of cost. Above order is given on today dated 10-10-2017.”
2. Briefly put, facts relevant for the disposal of the appeal are that husband of the respondent purchased a life insurance policy for sum of Rs.33,91,185/- from the appellant insurance company. The police commenced w.e.f. 24.5.2010. During the subsistence of the insurance policy the life assured died due to Cardiac Pulmonary Arrest in Zimbabwe. The complainant being the nominee in the insurance policy as also the legal heir filed insurance claim. The insurance claim, however, was repudiated on the ground that the life assured prior to filling up of the proposal form had visited four to five countries and he had a plan to visit a foreign country in near future.
3. Being aggrieved of the repudiation of the insurance claim, the respondent filed a consumer complaint in the State Commission, Gujarat. The appellant/opposite party contested the complaint, main plank of the contest being that the insurance policy was obtained by concealing material fact.
4. The State Commission on consideration of pleadings and the evidence did not find justification in repudiation of the insurance claim by the appellant.
Accordingly holding the appellant guilty of deficiency in service, the State Commission allowed the complaint and directed the appellant as stated above.
5. Being aggrieved of the order of the State Commission, insurance company has approached this Commission in appeal. It is pertinent to note that the appeal, however, has been filed after the expiry of 30 days period of limitation from the date of receipt of free copy of the impugned order, with a delay of 73 days. The appellant has, therefore, moved application seeking condonation of delay in filing of appeal.
6. So far as the merit of the case is concerned, learned counsel for the appellant has contended that the State Commission has fallen in error by failing to appreciate that the insurance policy was obtained by the life assured by concealing material facts pertaining to his earlier visits to the foreign country or his plan to visit countries in the near future. It is contended that had the complainant disclosed that earlier to submission of the proposal form he made several visits to foreign countries and even after the issue of the insurance policy he intended to visit Zimbabwe, where he expired, the insurance company would not have issued insurance policy. In support of the contention, learned counsel has drawn my attention to the copy to the proposal form particularly question No.9 in part-4 of the proposal form, which deals with the foreign travel. The said column requires the proposer to answer the following questions:
“Have you in the last 5 years, or do you intend within a year, to travel or reside abroad other than on holiday? If yes, please give full details including all countries involved and duration of stay.”
7. It is submitted that although the life assured had visited foreign countries on several occasions during last five years and he was staying in Zimmabwe at the time of filing of proposal form, the life assured, however, answered the question in negative which clearly indicates that the
SupremeToday
An indispensable Tool for Legal Professionals, Endorsed by Various High Court and Judicial Officers
Please visit our Training & Support
Center or Contact Us for assistance
Scan Me!
India’s Legal research and Law Firm App, Download now!
For Daily Legal Updates, Join us on :
Back to top
