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J. RAJENDRA, ANOOP KUMAR MENDIRATTA
Manager (Claims) Life Insurance Corporation of India – Appellant
Versus
Chanda Devi – Respondent
JUDGMENT :
AVM J. Rajendra, AVSM, VSM (Retd.).—The present First Appeal has been filed under Section 51 of the Consumer Protection Act, 2019 (“the Act”) against the Order dated 23.11.2021 passed by the State Consumer Disputes Redressal Commission, Delhi (“the State Commission”) in Consumer Complaint No. 551 of 2016, whereby the Complaint was allowed.
2. There is 15 days delay in filing the present First Appeal. In view of the facts and circumstances of the case, the delay is condoned.
3. For convenience, the parties are being referred to as they were before the State Commission. “Smt. Chanda Devi,” the wife and nominee of the Life Assured Shri Ram (since deceased), is the Complainant/Respondent. The “Life Insurance Corporation of India” (LIC) is Appellant/Opposite Party/Insurer.
4. Brief facts of the case, as per the complaint, are that the husband of the Complainant Shri Ram (“Deceased Life Assured” or “DLA”) had obtained a Life Insurance - Jeevan Mitra Policy No. 125804443 under Table and Term 133-21-21 for a sum assured of Rs.8,00,000. The policy commenced on 28.08.2011, with the risk coverage period from 22.11.2011 to 28.08.2032. The first annual premium of Rs.64,462 was paid at
(1) The “Three-Year Rule” (Section 45) – Under the amended Section 45, a policy cannot be questioned after three years from issuance or risk commencement on any ground.(2) Agent’s Responsibility – Th....
(1) Contract of Insurance – A contract of insurance is one of utmost good faith. A proposer who seeks to obtain a policy of life insurance is duty bound to disclose all material facts bearing upon th....
(1) Full Knowledge – DLA had the full knowledge of pre-existing ailments at the time of filling the proposal form and there was a nexus with preexisting disease and the cause(s) of death.(2) Proposal....
(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 ....
Law imposes duty of uberrima fides [utmost good faith], on Proposer to disclose material facts truthfully in order to enable Insurer to exercise discretion to enter into contract of insurance.
1) Per Sec. 45 of Insurance Act, claim can be repudiated, if it is proved that the assured knowingly and fraudulently suppressed the material facts.2) Contractual duty so imposed on the Insured is su....
(1) Medical condition – There is a good possibility that the DLA was not aware of his medical condition prior to filling the Proposal Form and OP has not established anything to the contrary.(2) Duty....
(1) Burden of proof – Insurance is a contract of utmost good faith, but the burden of proving that the insured suppressed material facts lies strictly on the Insurer. Exclusionary clauses and allegat....
Insurance – Materiality of a certain fact is to be determined on a case-to-case basis – However, burden of proving fact which excludes liability of Insurer to pay compensation lies on Insurer alone a....
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