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2014 DIGILAW 223 (UTT)

SUDARSHAN SHARMA v. BIRLA SUN LIFE INSURANCE CO. LTD.

2014-05-20

B.C.KANDPAL, C.C.PANT

body2014
ORDER (Per: Mr. C.C. Pant, Member): Smt. Sudarshan Sharma W/o Late Sh. Gopal Sharma, R/o 157, Raipur, Dehradun (hereinafter referred as “complainant”) has filed this consumer complaint under Section 18 read with Section 12 of the Consumer Protection Act, 1986 against Birla Sun Life Insurance Co. Ltd. (through its Managing Director/Chairman) Registered office, 6th Floor, Vaman Centre Makhwana Road, Off Andheri – Kurla Road, Near Marol Naka, Andheri (E), Mumbai–400059 (hereinafter referred as “opposite party”), alleging deficiency in service on the part of the opposite party and praying for the following reliefs:- (a) The opposite party be directed to pay a sum of Rs. 50,00,000/- of assured sum covered under two insurance policies taken by the complainant’s husband Sh. Gopal Sharma. (b) The opposite party be directed to pay a sum of Rs. 25,00,000/- for mental agony, physical discomfort and inconvenience, pecuniary loss, loss of earning etc. (c) The opposite party be directed to pay an interest @ 18% per annum on the assured sum from the date of death of complainant’s husband. (d) The opposite party be directed the cost of the consumer complaint. (e) Any other relief that this Commission thinks fit to be granted under the facts and circumstances of the case. 2. The facts of the case, in brief, are that during his life time the complainant’s deceased husband Sh. Gopal Sharma had taken two insurance policies on 28.12.2007 (bearing No. 001362164 and 001363025) from the opposite party covering a risk of Rs. 25,00,000/- under each policy. However, the assured expired on 16.03.2008. The complainant, who was nominated by the assured as his nominee, submitted a claim for the assured sum, but opposite party repudiated the same on the ground of concealment of material facts about his health by the assured and misrepresentation. The complainant made a representation to the insurance authorities for re-consideration on their decision of repudiation of the claim, but the same was also turned down. This led the complainant to file a consumer complaint before this Commission on 11.06.2009 against the opposite party and praying for the reliefs, as stated above. 3. Notices were served on the parties. The complainant appointed Sh. Ashutosh Sharma, Advocate as her counsel. After some time, she changed the advocate and engaged Sh. Mohd. Muzammil, Advocate as her counsel. Again, she changed her counsel and engaged Sh. 3. Notices were served on the parties. The complainant appointed Sh. Ashutosh Sharma, Advocate as her counsel. After some time, she changed the advocate and engaged Sh. Mohd. Muzammil, Advocate as her counsel. Again, she changed her counsel and engaged Sh. R.S. Bharti as her counsel, who was also changed by the complainant after some time and Sh. Devesh Ghildyal, Advocate was appointed by the complainant as her counsel. The opposite party engaged Mrs. Anjali Gusain, Advocate as its counsel. 4. The opposite party filed the written statement and pleaded that it has not committed any deficiency in service because the life assured-Sh. Gopal Sharma had concealed the material facts about his health in the application for insurance dated 13.12.2007 and had also given false information about his business, annual income and income tax returns. Since the insurance contracts are based on the doctrine of Uberrimae fides, the opposite party issued the said two policies to Sh. Gopal Sharma-complainant’s husband. Further, the policies were issued on 28.12.2007 and the life assured expired on 16.03.2008. Therefore, as provided under Section 45 of the Insurance Act, 1938, the insurer has a right to deny the claim, if it finds that the assured has failed to disclose a material fact, which may influence the Insurer’s decision as to whether the application / proposal should be accepted or not. The opposite party has also stated that the medical certificate dated 23.05.2008 submitted by Dr. Bhim Pandhi reveals that the life assured was suffering from Hypertension and Hypothyroidism since 2001, much before applying for the said policies. It has also been stated by the opposite party that on investigation, it was found that the life assured Sh. Gopal Sharma did not have any proprietary firm in the name and style of M/s Gopal Sharma & Co. with an annual turnover of Rs. 18.00 lacs. 5. The complainant adduced the following evidence in support of her case:- (1) Affidavit dated 10.05.2009 of Mrs. Sudarshan Sharma–complainant (Paper No. 8) (2) Pathological reports which were issued by Dr. Savita Goyal on the reference made by the opposite party (Paper Nos. 9 to 12) (3) First proposal form for insurance (Paper Nos. 14 to 21) (4) Second proposal form for insurance (Paper Nos. 22 to 29) (5) Sterss Test Report (Paper Nos. 30 to 31) (6) Receipts of premiums (Paper Nos. 46 to 47) (7) Dr. Savita Goyal on the reference made by the opposite party (Paper Nos. 9 to 12) (3) First proposal form for insurance (Paper Nos. 14 to 21) (4) Second proposal form for insurance (Paper Nos. 22 to 29) (5) Sterss Test Report (Paper Nos. 30 to 31) (6) Receipts of premiums (Paper Nos. 46 to 47) (7) Dr. Bhim S. Pandhi’s treatment papers (Paper Nos. 48 to 49) 4 (8) Dr. Ahujas’ pathological report (Paper Nos. 50 to 52) (9) Blood examination report (Paper No. 53) (10) Discharge slip of Sun Flag Hospital & Research Centre (Paper Nos. 74 to 75) (11) Death certificate of assured (Paper No. 76) (12) Repudiation letter dated 19.09.2008 (Paper Nos. 96 to 97) 6. The opposite party has adduced evidence in the form of affidavit of Smt. Sreemaya Athikkat, Authorized Representative of Birla Sun Life Insurance Co. Ltd., which is at Paper Nos. 152 to 157. 7. Both the parties have also submitted their written arguments. The learned counsel for opposite party also placed oral arguments, but none appeared on behalf of the complainant. 8. In the written arguments, the complainant has submitted that the opposite party has repudiated a genuine claim because Hypothyroidism and mild Hypertension are trivial ailments and the same could not be construed as fraudulent suppression of material fact. These ailments have no bearing or relevance on the cause of the death of the insured. Further, it has also been submitted that the insured had furnished true account of his annual income and business pursuits to the insurance agent. The discrepancies in the annual income and designation vis-a-vis the business pursuits of the insured have either crept in due to inadvertent mistake of the concerned insurance agent or the same have crept in as a result of forgery committed at the benefit of opposite party after the submission of proposal form. 9. The learned counsel for the opposite party submitted that the last attending physician’s certificate issued by Dr. V.P. Choudhry of Sun Flag Hospital & Research Centre, Faridabad (Haryana), shows that the assured was admitted in the hospital on 14.03.2008 with bleeding mouth and gums and fever and he died on 16.03.2008 in the hospital itself. However, it was confirmed that the assured was suffering from Hypothyroidism and Hypertension and the assured had developed high blood pressure in the year 1998, for which he was taking Tenchor 25. However, it was confirmed that the assured was suffering from Hypothyroidism and Hypertension and the assured had developed high blood pressure in the year 1998, for which he was taking Tenchor 25. The assured developed Hypothyroidism in the year 2001, for which he was taking Eltrocin 0.1 mg OD. The learned counsel also submitted that during investigation, it revealed that there were two death certificates of the assured, one from Sun Flag Hospital & Research Centre, Faridabad (Haryana) and second from Dehradun. Further, on investigation, it was found that no firm in the name and style of M/s Gopal Sharma & Co. was in existence. The assured had shown his annual income as Rs. 18.00 lacs, but no proof of filing income tax return came into light. 10. We considered these submissions. The complainant has made grave allegations against the opposite party that the details of the proposal forms were altered by the opposite party for its benefit. We cannot believe it because the deceased appears to be well literate and he was going to take two high-value insurance policies. The complainant has also failed to establish that the deceased was not a patient of Hypothyroidism and Blood Pressure. It is immaterial whether these ailments are trivial or not, but it is a fact that the deceased had not disclosed his state of health truly and correctly. Further, the investigations made by the opposite party in respect of annual income of the assured, his business etc. have not been controverted by the complainant. Two high-value insurance policies were taken in December, 2007 and the assured died after three months, which shows that the said policies were taken for wrongful gain from the opposite party by furnishing false details and concealing the material facts. 11. have not been controverted by the complainant. Two high-value insurance policies were taken in December, 2007 and the assured died after three months, which shows that the said policies were taken for wrongful gain from the opposite party by furnishing false details and concealing the material facts. 11. In the light of the following judgments, which have been cited by the learned counsel for the opposite party, we are of the view that the opposite party has not committed any deficiency in service by repudiating the complainant’s claim:- (i) Hon’ble National Commission’s judgment dated 25.10.2005 in Revision Petition No. 3362 of 2004; L.I.C. of India vs. Smt. Ayesha (ii) Hon’ble National Commission’s judgment dated 23.01.2006 in Revision Petition No. 1935 of 1999; L.I.C. of India vs. Krishan Chander Sharma (iii) Hon’ble Gujrat National Commission’s judgment dated 09.02.2011 in Revision Petition No. 781 of 2007; Panchal Ramabhai Motibhai vs. L.I.C. of India (iv) Life Insurance Corporation of India & Ors. Vs. Nita Bhardwaj; I (2014) CPJ 409 (NC) (v) Manjinder Kaur vs. Life Insurance Corporation & Anr.; I (2014) CPJ 3 (NC) (vi) Neetu Namdhari vs. Life Insurance Corporation of India & Ors.; I (2014) CPJ 442 (NC) (vii) Shyni Valsan Pombally vs. State Bank of India & Anr.; I (2014) CPJ 387 (NC) 12. Thus, this consumer complaint has no force and the same is liable to be dismissed. 13. The consumer complaint is dismissed. No order as to cost.