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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
S.M. Kantikar, Dinesh Singh, Members
MANISHA GUPTA AND OTHERS - Appellant
Vs.
KOTAK MAHINDRA OLD MUTUAL LIFE INSURANCE LTD. - Respondent
Consumer Case No. 293 of 2012
Decided On : 09-05-2019
Insurance Claim - Life Insurance - Clause 8, clause 8.1, clause 8.2 and clause 12 of the filled-up Proposal Form - [Clause 8, Clause 8.1, Clause 8.2, Clause 12]
Fact of the Case:
The insured obtained a life insurance policy for Rs. 5 crore, and the claim was repudiated by the insurance company on the grounds of intentional non-disclosure and suppression of material information. The insured had 21 pre-existing life insurance policies totaling Rs. 6.62 crore, which were not disclosed in the Proposal Form. The insured's death was found to be accidental due to unnatural factors.
Finding of the Court:
The court dismissed the complaint, stating that the insured willfully suppressed material facts by not disclosing the pre-existing life insurance policies, and imposed a cost of Rs. 1.00 lakh on the complainant no. 1.
Issues: Intentional non-disclosure of pre-existing life insurance policies, Accidental death of the insured, Consumer protection
Ratio Decidendi: An insurance contract requires utmost good faith, and the insured's failure to disclose pre-existing life insurance policies led to the repudiation of the claim. The court imposed a cost on the complainant for attempting to obtain wrongful gains through consumer protection fora.
Final Decision: The complaint was dismissed, and a cost of Rs. 1.00 lakh was imposed on the complainant no. 1.
JUDGMENT/ORDER :
Dinesh Singh, Member - Heard learned counsel for the complainants and learned counsel for the opposite party insurance co., and perused the material on record.
2. The dispute relates to repudiation of life insurance claim by the insurance co. on the death of the insured.
3. Brief facts, shorn of unnecessary detail, are that Ajay Gupta (insured; husband of complainant no. 1 nominee) obtained an insurance policy from the opposite party insurance co. on 24.04.2009. The sum assured was Rs. 5 crore. Payment of premium; the insurance policy being valid and in place on the date of death; and the date of death (01.12.2010) of the insured, are not disputed. The insurance claim was lodged on 24.06.2011 by the complainant no. 1 (Manisha Gupta nominee wife of the insured Ajay Gupta). The insurance claim was repudiated vide the insurance co.'s letter dated 12.01.2012.
4. The insurance co. vide its repudiation letter dated 12.01.2012 declined the insurance claim principally on the ground of intentional non-disclosure and suppression of material information and untrue statements:
| BY RPAD |
| 12/01/2012 |
| Mrs. Manisha Gupta |
| I/C/5 B |
| Ashok Vihar |
| Phase-III |
| Delhi-110052 |
| Sub: Claim Repudiation |
| Re: Policy No. 01557506 [Proposer / Life Insured: Mr. Ajay Gupta] |
| Dear Mrs. Manisha Gupta, |
| We, at Kotak Mahindra Old Mutual Life Insurance Ltd., herein referred to as "the Company" are very sorry and deeply mourn the said demise of Mr. Ajay Gupta. Please accept our deep condolences in this sad moment. |
| We refer to: |
| 1. The Proposal No. 01557506 dated 27/03/2009 and Policy No. 01557506; |
| 2. Your claim intimation form dated 24/06/2011 received in our office on 21/07/2011; |
| 3. The Death Certificate issued by the Municipal Corporation of Delhi, Government of National Capital Territory of Delhi, India issued under section 17 of the Registration of Births and Deaths Act, 1969 bearing registration no. MCDOLIR-0210-004310051 received in our office on 21/07/2011. |
| 4. The FIR Report form District North West Delhi, Police Station: Adarsh Nagar, bearing FIR no. 294 dated 02/12/2010 received in our office on 13/12/2011; |
| 5. The Post Mortem report from Department of Forensic Medicine, Deen Dayal Upadhyay Hospital, bearing PM no. 1407/10 dated 2/12/2010; |
| 6. The report from Department of Forensic Medicine, Deen Dayal Upadhyay Hospital, Govt. of N.C.T. of Delhi, dated 31/05/2011 received in our office on 13/12/2011; |
| 7. The Description of Parcels from Forensic Science Laboratory, Govt. of NCT of Delhi dated 19/04/2011 bearing report no. FSL.2010/C-5515 received in our office on 13/12/2011; |
| 8. Inner Case Diary in case no. 294/10 u/s 304/379/711/201/34; |
| 9. Letters to all Insurance companies by Brij Pal Singh Inspector, Special Staff, North West District, Delhi; u/s 91 Cr. P.C.; |
| 10. Letters received from your end regarding details of Insurance Policies And Loans received in our office on 21/11/2011; |
| 11. The Policy of Birla Sun Life bearing policy no. 1431826 dated 28/03/2008; |
| 12. The Policy of Metlife bearing policy no. 1200400054561 dated 21/08/2004; |
| 13. The Policy of HDFC bearing policy no. 10183956 dated 04/02/2005; |
| 14. The Policy of HDFC bearing policy no. 10183958 dated 04/02/2005; |
| 15. The Policy of SBI Life bearing policy no. 19004387401 dated 24/05/2006; |
| 16. The Policy of SBI Life bearing policy no. 19004235210 dated 18/05/2006; |
| 17. The Policy of SBI Life bearing policy no. 19003568902 dated 13/04/2006; |
| 18. The Policy of Bajaj Allianze bearing policy no. 55475117 dated 24/07/2007; |
| 19. The Policy of LIC bearing policy no. 121295762 dated 28/10/1999; |
| 20. The Policy of LIC bearing policy no.121677925 dated 28/03/2001; |
| 21. The |
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