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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Dr. S.M. Kantikar, Presiding Member
Vandana Pathak —Petitioner
versus
HDFC Life Insurance
Company Ltd. —Respondent
Revision Petition No.201 of 2017
(Against the Order dated 08/07/2016 in Appeal No. 1231/2013 of the State Commission Uttar Pradesh)
Decided on 7.6.2018
Counsel for the Parties:
For the Petitioner:Mr. Ashish Anand, Advocate
For the Respondent:Mr. Joydip Bhattacharya, Advocate
IMPORTANT POINT
Concealment of actual health status while filing proposal form is a valid ground to repudiate death claim.
Headnote:Consumer Protection Act, 1986—Sections 15, 17, 19 and 21—Insurance—HDFC SL Crest Plan Insurance Policy—Repudiation of death claim on ground that deceased life assured had concealed his actual health status while filing proposal form—District Forum allowed complaint ex parte and directed OP to pay Rs. 5 lakhs as insured amount and Rs. 2,000/- as cost of litigation—However, complaint dismissed by State Commission in appeal—Prima facie, instant case is of concealment of material facts—Deceased life assured has not disclosed about his recent hospitalization but filled proposal form after three months and got policy—If deceased life assured had disclosed his previous illness and treatment, company would have declined to offer insurance cover—However, forfeiture of entire premium of Rs.50,000/- paid by deceased life assured towards first premium, is not justified—Policy was issued without carrying any medical tests of deceased life assured which would have helped insurance company to diagnose previous ailments—OP/insurance company shall refund premium amount of Rs.50,000/- to complainant—OP shall refund Rs.50,000/- to complainant. (Paras 10 to 12)
Result: Revision Petition Partly allowed.
Dr. S.M. Kantikar, Presiding Member—This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 against the order dated 8.7.2016 passed in appeal No. 1231 of 2013 by U.P. State Consumer Disputes Redressal Commission, Lucknow (for short, ‘State Commission’) whereby the appeal of the insurance company was allowed and the order dated 7.9.2012 of the District Forum was set aside.
2. Brief facts are that the complainant’s husband, Sanjeev Pathak (since deceased-insured) obtained HDFC SL Crest Plan Insurance Policy from the OP for a sum of Rs. 5,00,000/- on 16.4.2011. However, he expired after 26 days on 12-5-2011 in K. K. Hospital, Bareilly, due to acute Pancreatitis with Septicemia. The cause of death was given as cardio-respiratory failure. Thereafter, his wife as nominee had filed the death claim before the OP for the payment of the insured amount, but it was repudiated on the ground that the deceased life assured (DLA) had concealed his actual health status while filing the sproposal form. Being aggrieved by the conduct of the OP/Insurance Co., the complainant filed a complainant before the District Consumer Dispute Redressal Forum, Bareilly (herein after referred to as “District Forum”) and prayed for payment of the insured sum of Rs.5,00,000/- along with Rs.25,000/- towards mental harassment.
3. Before District Forum, OP did not file any reply even after receiving the notice. Therefore, District Forum allowed the complaint, ex parte and directed the OP to pay Rs. 5 lakh as the insured amount and Rs.2,000/- as cost for litigation.
4. Being aggrieved by the order of District Forum, first appeal was preferred by OP before the State Commission, U.P. (for short, State Commission’). The State Commission held that the DLA had concealed his previous treatment and hospitalization in K.K Hospital, Bareilly for one week i.e. from 14.01.2011 to 20.01.2011. The complainant filled the proposal form on 11.04.2011, without disclosing about his hospitalization. The State Commission vide order dated 29.06.2005 allowed the appeal and set aside the order of the District Forum.
5. Being aggrieved by the impugned order, the complainant filed the present revision petition.
6. Heard learned counsel for both the parties. There is delay of 85 days in filing the revision petition. For the reasons stated in the application for condonation of delay, the delay of 85 days is condoned.
7. Learned counsel for the complainant submitted that at the time of filling up the proposal, DLA was healthy. On 7.5.2011, he was admitted in K. K. Hospital for acute pancreatitis with septicemia and died due to cardiac respiratory arrest on 12.05.2011. There was no co-relation with the previous disease and the cause of death.
8. Learned counsel for the OP submitted that before taking the policy, the DLA was admitted in K. K. Hospital during 14.1.2011 to 20.1.2011 and he was treated for Septicemia with Rt. Pneumonitis and Encephalopathy with Dyselectrolylaemia. After treatment, he was discharged in a stable condition. The counsel submitted that the DLA had answered in ‘Negative for the questions in the proposal form related to suffering of any disease of the Liver, Kidneys etc. The counsel contended that the Insurance Co. was justified in repudiating the claim as the DLA had not disclosed the fact of his hospitalization while filling the proposal form.
9. I have perused the proposal form, the medical record of K. K. Hospital, the laboratory test reports, other relevant documents and given thoughtful consideration to the arguments from both the parties. The discharge summary dated 20.01.2011 of K. K. Hospital, revealed that the DLA was admitted in K. K. Hospital from 14.1.2011 to 20.1.2011 and treated for Septicemia due to Pneumonitis with Encephalopathy. There was dyselectrolytemia also. It is pertinent to note that, after three months only, i.e. on 16.04.2011, the DLA had filled the proposal form and the policy was issued by OP. The DLA answ
