SUPREME COURT OF INDIA
Dr. Dhananjayay Y. Chandrachud, Indu Malhotra and Indira Banerjee, JJ.
Branch Manager, Bajaj Allianz Life Insurance Company Ltd. – Appellant
Versus
Dalbir Kaur – Respondent
Civil Appeal No. 3397 of 2020
Decided on 09-10-2020
Consumer Protection Act, 1986 -- Ss. 12,15 and 19 -- Insurance Act, 1938 -- S.45 -- Constitution of India -- Art. 142 -- proposal for insurance submitted to appellants -- mother of proposer nominee -- proposer declared in proposal form that he had not undergone any medical treatment -- policy of insurance issued -- within period of one month and seven days from issuance of policy, policy holder died -- claim lodged -- investigation reports indicated that proximate to death deceased suffered stomach ailment and vomiting of blood -- claim repudiated on account of non-disclosure of material facts -- respondent/nominee instituted consumer complaint before District Forum -- District Forum allowed complaint and directed appellants to pay full death claim with interest -- first appeal rejected -- revision before NCDRC also dismissed -- appeal -- contract of insurance is one of utmost good faith -- proposer is duty bound to disclose all material facts -- he failed to disclose vomiting of blood which took place a month prior to issuance of policy -- serious pre-existing medical condition not disclosed to insurer -- judgment of NCDRC does not lay down correct principle of law -- set aside -- during pendency of proceedings, entire claim paid to respondent -- having regard to age of respondent who is seventy years old, directed that no recoveries of amount shall be made from respondent. (2001) 2 SCC 160, (2008) 1 SCC 321, (2009) 8 SCC 316 and (2019) 6 SCC 175 relied on. Civil appeal No. 8245 of 2015 decided on 5.10.2015 distinguished. [Paras 13 & 14
ORDER
Dr. Chandrachud, J
1. Leave granted.
2. This appeal arises from the judgment and order dated 20 March 2020 of the National Consumer Disputes Redressal Commission.
3. On 5 August 2014, a proposal for obtaining a policy of insurance was submitted to the appellants by Kulwant Singh. The proposal form indicated the name of the mother of the proposer, who is the respondent to these proceedings as the nominee. The proposal form contained questions pertaining to the health and medical history of the proposer and required a specific disclosure on whether any ailment, hospitalization or treatment had been undergone by the proposer. Column 22 required a declaration of good health. The proposer answered the queries in the negative, indicating thereby that he had not undergone any medical treatment or hospitalization and was not suffering from any ailment or disease. The declaration under Item 22(c) of the proposal form was in regard to whether any diseases or disorders of the respiratory system such as but not limited to blood in sputum, tuberculosis, asthma, infected respiratory disease or any respiratory system disease including frequent nose bleeding, fever and dyspnoea were involved. This query was also responded to in the negative. Acting on the basis of the proposal submitted by the proposer, a policy of insurance was issued by the appellants on 12 August 2014. Under the policy, the life of the proposer was insured for a sum of Rs. 8.50 lakhs payable on maturity with the death benefit of Rs. 17 lakhs.
4. On 12 September 2014, Kulwant Singh died, following which a claim was lodged on the insurer. The death occurred within a period of one month and seven days from the issuance of the policy. The claim was the subject matter of an independent investigation, during the course of which, the hospital treatment records and medical certificate issued by Baba Budha Ji Charitable Hospital, Bir Sahib, Village Thatha (Tarntaran) were obtained. The records revealed, according to the insurer, that the deceased has been suffering from Hepatitis C. Copies of the investigation report dated 20 December 2014 and 9 January 2015 have been placed on the record. The investigation reports indicate that proximate to the death, the deceased had been suffering from a stomach ailment and from vomiting of blood, as a result of which he had been availing of the treatment at the above hospital. The claim was repudiated on 12 May 2015 on account of the non-disclosure of material facts.
5. The respondent instituted a consumer complaint before the District Consumer Disputes Redressal Forum. The District Forum allowed the complaint and directed the appellants to pay the full death claim together with interest. The first appeal was rejected by the State Consumer Disputes Redressal Commission (hereinafter referred to as “SCDRC”) and the revision before the National Consumer Disputes Redressal Commission (hereinafter referred to as “NCDRC”) has also been dismissed. The NCDRC has relied on the decision of this Court in Sulbha Prakash Motegaonkar & Ors v. Life Insurance Corporation of lndia. [Civil Appeal No 8245/2015 decided on 5.10.2015] According to the NCDRC, a disease has to be distinguished from a mere illness. It held that the death had occurred due to natural causes and there was no reasonable nexus between the cause of death and non-disclosure of disease. Consequently, while affirming the judgment of the SCDRC, the NCDRC imposed costs of Rs. 2 lakhs on the appellants, of which, an amount of Rs. 1 lakh was to be paid to the complainant and Rs. 1 lakh was to be deposited with the Consumer Legal Aid Account of the District Forum.
6. Mr Amol Chitale, learned counsel appearing on behalf of the appellants states that the judgment of the consumer fora in the present case are contrary to the law which has been laid down by this Court in Life Insurance Corporation of India v. Asha Goel. [(2001) 2 SCC 160] P.C. Chacko v. Chairman, Life Insurance Corporation of
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