Judicial Analysis Court Copy Headnote Facts Arguments Court observation

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
AVM J. Rajendra, AVSM VSM (Retd.), Presiding Member
Abdul Mannan S/o Late Abdul Majid – Petitioner
versus
Branch Manager, L.I.C. of India – Respondent
Revision Petition No.1971 of 2015
(Against the Order dated 21/04/2015 in Appeal No. 24/2011 of the State Commission Jharkhand)
Decided on 3.7.2024

Advocates:
Counsel for the Parties:
For the Petitioner:Mr. Sanjeev Kumar Verma, Advocate
For the Respondent:Mr. Rajesh K. Gupta, Advocate

IMPORTANT POINTS
(1) Proposal form – In filling up the proposal form, the agent normally, ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from the insurer to write the answers in the proposal form.
(2) Untruth – If an agent nevertheless does that, he becomes merely the amanuensis of the insured, and his knowledge of the untruth or inaccuracy of any statement contained in the form of proposal does not become the knowledge of the insurer.

Headnote:
Consumer Protection Act, 1986 – Section 21(b) [Consumer Protection Act, 2019 – Section 58(1)(b)] – Revision – Services – Insurance – Repudiation of Claim – Death claim – It is also an admitted position that the insured was diagnosed various ailments and had undergone treatment for same before taking the insurance policy in question. While the Complainant asserted that the deceased insured did not conceal about the previous illness, however, the proposal form filled by the deceased insured reveals that she had not mentioned any previous illness, which she was otherwise aware – Further retreated, now it is clear that a person who affixes his signature to a proposal which contains a statement which is not true, cannot ordinarily escape from the consequence arising therefrom by pleading that he chose to sign the proposal containing such statement without either reading or understanding it, besides, in filling up the proposal form, the agent normally, ceases to act as agent of the insurer but becomes the agent of the insured and no agent can be assumed to have authority from the insurer to write the answers in the proposal form – If an agent nevertheless does that, he becomes merely the amanuensis of the insured, and his knowledge of the untruth or inaccuracy of any statement contained in the form of proposal does not become the knowledge of the insurer – On facts, Petition dismissed, order upheld. [Paras 10 to 16].
Result: Petition dismissed.

ORDER

The present Revision Petition has been filed by the Petitioner under Section 21(b) of the Consumer Protection Act, 1986 (the “Act”) against impugned order dated 21.04.2015, passed by the learned Jharkhand State Consumer Disputes Redressal Commission, Ranchi, (‘the State Commission’) in First Appeal No. 24/2011 wherein the State Commission allowed the Appeal filed by the Respondent/OP against the order dated 07.12.2010 passed by the learned District Consumer Disputes Redressal Forum, Dhanbad, (‘the District Forum’) wherein the District Forum had allowed the complaint filed by the Petitioner/Complainant.

2. For convenience, the parties are referred to as placed in the original Complaint filed before the District Forum.

3. Brief facts of the case, as per the Complainant, are that his wife took a policy on 8.11.2005 under ‘Jeevan Anand (With profits) (With Benefit) Accidental Policy for Rs. 5 Lakhs form LIC with the yearly premium of Rs.41,930/-. His wife suddenly fell ill and died on 19.11.2008 due to “Cardio Respiratory Failure.” He intimated the LIC and lodged his insurance claim but it was repudiated by dated 29.1.2010 against which he preferred appeal before the Zonal Office of LIC vide letter dated 4.3.2010 but as nothing was done, he filed complaint petition on 25.5.2010. According to him – “all detailed information was given except that my wife was suffering from diabetes and got treatment at Vellore Hospital in the year, 2005 before taking the policy but it is also clear that she must have been examined by the Doctor of the Opposite Party, when the policy was taken”. Aggrieved, he filed a complaint seeking directions to OP to pay the policy amount of Rs.5,00,000/- along with Rs.50,000/- as compensation on account of mental agony, pain and harassment together with Rs.10,000/- as litigation expenses.

4. In reply, the Respondent/OP admitted the issue of policy and receipt of the claim and contended that, while taking the policy, the Deceased Life Insured (DLI) had hidden material information about her disease and treatment and deliberately did not disclose the facts. This amounts to suppression of material facts and giving misstatements with ulterior intention to obtain the insurance policies. OPs came to know during investigation that the DLI was a patient of ‘Diabetes Mellitus II’ and other ailments for which she took treatment at Vellore Hospital in July 2005, when the proposal for the policy was filed on 31.10.2005. Thus, OP rightly repudiated the claim for non-disclosure of the material facts in the proposal form of the policy. The decision to repudiate the claim was taken in good faith based on an inquiry. Being considered repudiation, no deficiency is involved.

5. The learned District Forum vide Order dated 07.12.2010 allowed the complaint and granted the following observations:-

“Now the points for consideration are

(1) Is the complainant entitled for the relief as claimed?

(2) Is the case maintainable?

Findings

Both points being interlinked are taken together for its consideration. After going the case records, documents filed by the parties and points of oral arguments, it is clear that the Policy was taken in the year 2005 which continued till 2008 and Annual Premium was paid. It is said that it was again revived in the year 2008, but the old policy continued from year 2005. All detail information was given except that she was suffering from diabetes and got treatment at Vellore Hospital in the year 2005 before taking the Policy. But it is also clear that she must have been examined by the Doctor of the O.P. which report has not been brought on record by thee O.P. It is also pointed out by the complainant side that diabetes now a days has become very common disease and a large number of our population is suffering from one or other form of diabetes, and in the present case death of the D.LA. took place by falling and subsequently due to “Cardiac Respiratory Failure”, which was certainly not due to