Back
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
J.M. MALIK, PRESIDING MEMBER, S.M. KANTIKAR, MEMBER
Renu Gangwar - Complainant
Versus
Aviva Life Insurance Company India Ltd. – Respondent
Consumer Complaint No.125 of 2013
Decided on : 10-10-2014
Advocate Appeared:
For the Appellant :Mr. Hemant Verma, Advocate.
The importance of credible evidence and full disclosure in supporting an insurance claim.
Headnote:
Insurance Claim - Validity of Repudiation - Insurance Act, 1938, Section 45 - Summary
Fact of the Case:
The complainant's husband passed away during the subsistence of an insurance policy. The complainant filed a claim with the insurance company, which was repudiated on the grounds of alleged fraud and non-disclosure of previous insurance policies. The complainant approached the Commission seeking release of the insurance claim, compensation, and litigation costs.
Finding of the Court:
The court found that the evidence presented by the complainant was not sufficient to prove the cause of death of the insured. The court also noted discrepancies in the documents submitted and dismissed the complaint.
Issues: Validity of the insurance claim repudiation, sufficiency of evidence to prove cause of death, non-disclosure of previous insurance policies.
Ratio Decidendi: The court emphasized the importance of credible evidence to support an insurance claim and highlighted the significance of full disclosure of relevant information in insurance proposals.
Final Decision: The complaint was dismissed, and no costs were awarded.
ORDER :
Mr. Justice J.M. Malik, Presiding Member-The main controversy in this case revolves round the question, “Whether, repudiation of the claim made by Smt. Renu Gangwar, the complainant, with Aviva Life Insurance Co. India Ltd., the OP, is valid?”.
2. Sh. Pankaj Kumar Gangwar, the husband of the complainant, expired during the subsistence of the insurance policy, “Aviva Life Shield Plus”, issued by the OP. As per the policy, the life of the complainant’s husband was assured for a sum of Rs. 50.00 lakh only, along with an additional Accidental Death Benefit of an amount of Rs. 50.00 lakh. The said policy has been placed on record as Annexure C-1.
3. In April, 2011, the insured went to Bareilly, Uttar Pradesh. On 23.4.2011, he slipped and fell down at Railway Station, due to which, he got injured. The insured was taken to District Hospital, namely, Maharana Pratap Jila Sanyukt Chikitsalay”, where, he was examined by Emergency Medical Officer, vide copy of OPD ticket, dated 23.4.2011, is appended with the complaint as Annexure C-2. The insured got himself treated till 2.5.2011 by Dr. Rakesh Kumar, at Bareilly. The said Doctor issued Fitness Certificate, vide Annexure. C-3, dated 2.5.2011. On 3.5.2011, the deceased got himself examined at Swastit Hospital. He was advised to take further medicines, vide Annexure C-4. On 6.5.2011, the deceased arrived at Delhi and got himself examined at Dean Dayal Hospital, in Emergency Department. The medical prescription dated 6.5.2011 is annexed with the complaint as Annexure C-5.
4. Unfortunately, the insured, passed away, in the night of 7.5.2011. His cremation took place at Kacchla, Badaun, on 8.5.2011. Copy of the Death Certificate, marked as Annexure C-6, has been placed on record.
5. Thereafter, the relatives of the deceased came back to Delhi and Renu Gangwar, his wife, filed the claim before the OP, which was repudiated vide Annexure C-8. It is stated that the deceased had paid the premiums regularly. The present complaint petition was filed before this Commission, on 2.5.2013, with the following prayers:
“1. Direct the opposite party to release the insurance claim in favour of complainant amounted to Rs. 1,00,00,000 (Rupees one crore only) along with interest of 24% per annum from the date of claim, till the realization of claim amount.
2. Pass an order of compensation in favour of complainant and against the opposite party for physical and mental harassment amounted to Rs. 10,00,000.
3. Grant the cost of present litigation in favour of complainant and against the opposite party amounted to Rs. 50,000.
4. Pass any other order as this Hon’ble Commission may deem fit according to facts and circumstances of the present case.”
6. Notice was issued to the OP, vide order dated 18.11.2013, for 5.5.2014. The A/D Card was received back. On 5.5.2014, none appeared on behalf of OP, till 12.45 pm. Consequently, the OP was directed to be proceeded against ex parte, on the said date. The final arguments were heard on 7.10.2014. OP has not approached this Commission, till the pronouncement of this judgment.
7. We have heard the Counsel for the complainant. The repudiation letter is crucial. The relevant portion of which runs, as follows:
“As per the information procured by us during the course of claim evaluation, we have noted that the Cremation Certificate submitted by you, on the basis of which, Death Certificate has been issued, is forged. Also, we have noted that the Income Tax Return as per Article 9(c) of the standard terms and conditions :
Fraud : If the policy holder or the insured or the nominee or anyone acting for any of the or at their knowledge makes or advances any claim knowing it to be misleading, false, dishonest or fraudulent, in any respect, then, this policy shall be void and any benefit actually paid or potentially payable, shall be forfeited. Further, as per the information procured by us, during the course of claim evaluation, the deceased life assured had previous life insurance polic
