Parul Agrawal v. Life Insurance Corporation of India
2024-01-25
ASHWANI KUMAR MISHRA, SYED QAMAR HASAN RIZVI
body2024
DigiLaw.ai
JUDGMENT : Syed Qamar Hasan Rizvi, J. In Re: Order on the Application for condonation of delay: Registry has reported that the present Special Appeal is filed beyond time by 14 days. Sufficient reason is disclosed for the delay, so occasioned. 2. A feeble attempt has been made by the learned Counsel for the respondents to oppose the said Appeal on the ground of delay. 3. This application for condonation of delay is duly supported by an affidavit. 4. Cause of delay in filing of the Appeal has been explained to the satisfaction of the Court. Accordingly, the Application for the condonation of delay in filing of appeal is allowed. Delay is condoned. Special Appeal is treated to have been filed within time. In Re: On the Special Appeal 1. We have heard Sri Rajendra Pratap Singh, learned counsel for the appellant and Sri Udai Shanker Mishra, learned counsel for respondents-Life Insurance Corporation of India (LIC) and perused the materials available on record. 2. With the consent of the learned counsel for the parties, this Court proceeds to decide the present Special Appeal at the admission stage itself. 3. This intra-Court appeal is directed against the judgment and order dated 3.4.2023 passed by the learned Single Judge in Writ-C No. 3149 of 2016 whereby the Writ petition filed by the Appellant has been dismissed. The Writ Court found no good ground to interfere with the impugned order dated 10.9.2015, passed by the Insurance Ombudsman (respondent No. 4), whereby the complaint filed by the appellant against rejection of her claim against the insurance policies Nos. 256487214 and 256487400 were rejected vide order dated 14.3.2014, passed by the authorities of the Life Insurance Corporation (hereinafter referred to as ''LIC''). 4. At the very outset, a preliminary objection has been raised by the learned Counsel for the respondent regarding the maintainability of the present Special Appeal on the ground that adjudication made by the Insurance Ombudsman would be akin of an award, and therefore, a special appeal would not lie against such order. 5. On the issue of the maintainability of the present Special Appeal, it has thus to be seen as to whether the impugned judgment and order passed by learned Single Judge arising out of such order passed by the Insurance Ombudsman could be assailed in special appeal.
5. On the issue of the maintainability of the present Special Appeal, it has thus to be seen as to whether the impugned judgment and order passed by learned Single Judge arising out of such order passed by the Insurance Ombudsman could be assailed in special appeal. Before proceeding further it is imperative to briefly elucidate the law relating to the Special Appeal. 6. Chapter VIII Rule 5 of the Allahabad High Court Rules, 1952 (hereinafter referred to as 'Rules of 1952') provides for the remedy of filing Special Appeal. For a ready reference the same is reproduced hereinafter : ''5. Special appeal : An appeal shall lie to the Court from a judgment (not being a judgment passed in the exercise of appellate jurisdiction) in respect of a decree or order made by a Court subject to the superintendence of the Court and not being an order made in the exercise of revisional jurisdiction or in the exercise of its power of superintendence or in the exercise of criminal jurisdiction 2[or in the exercise of the jurisdiction conferred by Article 226 or Article 227 of the Constitution in respect of any judgment, order or award--(a) of a tribunal, Court or statutory arbitrator made or purported to be made in the exercise or purported exercise of jurisdiction under any Uttar Pradesh Act or under any Central Act, with respect to any of the matters enumerated in the State List or the Concurrent List in the Seventh Schedule to the Constitution, or (b) of the Government or any officer or authority, made or purported to be made in the exercise or purported exercise of appellate or revisional jurisdiction under any such Act of one Judge.'' 7. A perusal of Chapter VIII Rule 5 of the Rules of 1952 would indicate that the first part of the Rule provides for Special Appeal to be maintainable from a judgment passed by a Single Judge of this Court. The subsequent part of the Rule then provides the circumstances and exigencies in which the Special Appeal would not be maintainable. This aspect of the matter has been considered by a Full Bench of this Court in Sheet Gupta v. State of U.P. and others, 2010(1) ADJ 1 (FB).
The subsequent part of the Rule then provides the circumstances and exigencies in which the Special Appeal would not be maintainable. This aspect of the matter has been considered by a Full Bench of this Court in Sheet Gupta v. State of U.P. and others, 2010(1) ADJ 1 (FB). Para 18 of the Full Bench judgment is relevant and is extracted hereinafter: ''Having given our anxious consideration to the various plea raised by the learned counsel for the parties, we find that from the perusal of Chapter VIII Rule 5 of the Rules a special appeal shall lie before this Court from the judgment passed by one Judge of the Court. However, such special appeal will not lie in the following circumstances: 1. The judgment passed by one Judge in the exercise of appellate jurisdiction, in respect of a decree or order made by a Court subject to the Superintendence of the Court; 2. the order made by one Judge in the exercise of revisional jurisdiction; 3. the order made by one Judge in the exercise of the power of Superintendence of the High Court; 4. the order made by one Judge in the exercise of criminal jurisdiction; 5. the order made by one Judge in the exercise of jurisdiction conferred by Article 226 or Article 227 of the Constitution of India in respect of any judgment, order or award by (i) the tribunal, (ii) Court or (iii) statutory arbitrator made or purported to be made in the exercise or purported exercise of jurisdiction under any Uttar Pradesh Act or under any Central Act, with respect to any of the matters enumerated in the State List or the Concurrent List in the Seventh Schedule to the Constitution of India; 6. the order made by one Judge in the exercise of jurisdiction conferred by Article 226 or 227 of the Constitution of India in respect of any judgment, order or award of (i) the Government or (ii) any officer or (iii) authority, made or purported to be made in the exercise or purported exercise of appellate or revisional jurisdiction under any such Act, i.e. under any Uttar Pradesh Act or under any Central Act, with respect to any of the matters enumerated in the State List or the Concurrent List in the Seventh Schedule to the Constitution of India.'' 8. 'Insurance' as an entry is contained in List-I at Item 47.
'Insurance' as an entry is contained in List-I at Item 47. The appropriate legislation under which the Insurance Ombudsman is appointed is thus referable to a Central Legislation pursuant to exercise of power by the Parliament under Entry 47 in the List-I, as such the order passed by the Insurance Ombudsman would not fall in any of the exclusionary clauses indicated in para 18 of the Full Bench judgment of this Court in Sheet Gupta (supra). The matter would thus fall in the first part of the rule and an appeal would lie to a Division Bench, from a judgment of Single Judge. Exigencies constituting exclusion would not include judgments, orders or award by the Government or any officer or authority or a tribunal, Court or statutory arbitrator in respect of a Central Act with respect to a matter enumerated in the Union List. 9. Since the instant Special Appeal is arising out of an order passed by the learned Single Judge, wherein the determination by the 'Insurance Ombudsman' is assailed, we find that the special appeal would clearly be maintainable in the light of the judgment passed by the Full Bench of this Court in Sheet Gupta (Supra). Therefore, the preliminary objection regarding the maintainability of the present special appeal as raised by the respondents is turned down. 10. Once, the question of maintainability of the Special Appeal has been decided in affirmative it is apt to delve into the merits of the case. 11. The facts of the case as culled out from the pleadings available on record are that Late Vishal Agarwal, the deceased husband of Smt. Parul Agarwal/Appellant, who unfortunately died on 11.11.2013 was the holder of three insurance policies bearing policy Nos. 224492798, 256487214 and 256487400 that were issued by the LIC. The appellant being the of widow of Vishal Agarwal, preferred the insurance claim against the aforesaid three policies. The claim of the appellant in respect of policy Nos. 256487214 and 256487400 was rejected by the LIC vide order dated 14.3.2014 passed by the Senior Divisional Manager/respondent No. 2 on the ground that the Insured/policy holder, i.e. the husband of the appellant, at the time of entering into the new policies bearing policy Nos. 256487214 and 256487400 did not disclose the material information in the proposal form that he was already holding an insurance policy bearing policy No. 224492798. 12.
256487214 and 256487400 did not disclose the material information in the proposal form that he was already holding an insurance policy bearing policy No. 224492798. 12. After rejection of her claim regarding the aforesaid two insurance policies, the appellant filed a review application before the Zonal Manager, respondent No. 3 that went in vain. Thereafter, she filed an application/complaint before the Insurance Ombudsman (respondent No. 4) on 1.11.2014. However, the said application/complaint of the appellant was rejected vide order dated 10.9.2015 passed by the Insurance Ombudsman (respondent No. 4). 13. Assailing the aforesaid orders dated 14.3.2014 and 10.9.2015, the appellant preferred the Writ petition bearing WRIT-C No. 3149 of 2016 before the Writ Court. The learned Single Judge by means of a detailed judgment and order dated 3.4.2023 dismissed the said writ petition. 14. The contention of the learned counsel appearing for the appellant-petitioner is that the impugned order dated 14.3.2014 passed by the authorities of the corporation is totally baseless and unsustainable on the ground that although they allowed the claim in respect of one policy but rejected the claim in respect of two policies bearing Nos. 256487214 and 256487400. It has been vehemently argued by the learned counsel that no fraud/misrepresentation/concealment was made by the insured and moreover the proposal form was filled up by the agents of the insurance company themselves and in case there was something left blank in 'Column No. 9', the appellant-petitioner cannot be non-suited on such a ground rather the fault, if any, would be on the part of the insurance company whose agent had filled up the form and left something blank. It was the duty of the agent of the corporation to make specific queries from the insured while filling up the form and if any such query was made and something was left blank in the form, the same would not constitute a ground to deny the claim of the appellant-petitioner. In support of his contention, he relied upon the judgment passed by the Hon'ble Supreme Court in the case of Manmohan Nanda v. United India Assurance Co. Ltd. and another, (2022) 4 SCC 582 . 15. Learned counsel for the appellant-petitioner drew the attention of this Court to the provisions of Insurance Regulatory and Development Authority (Protection of Policyholders' Interests) Regulation-2002 (hereinafter referred to as Regulation-2002).
Ltd. and another, (2022) 4 SCC 582 . 15. Learned counsel for the appellant-petitioner drew the attention of this Court to the provisions of Insurance Regulatory and Development Authority (Protection of Policyholders' Interests) Regulation-2002 (hereinafter referred to as Regulation-2002). The explanation to Regulation 2(d) defining 'Proposal Form' throws light on term 'material information'. For ready reference, Regulation 2(d) is reproduced as under: ''2. Definitions. :In these regulations, unless the context otherwise requires: (d) ''Proposal Form'' means a form to be filled in by the proposer for insurance, for furnishing all material information required by the insurer in respect of a risk, in order to enable the insurer to decide whether to accept or decline, to undertake the risk, and in the event of acceptance of the risk, to determine the rates, terms and conditions of a cover to be granted.'' 16. It has also been contended on behalf of the appellant-petitioner that there is no concealment of the material information in the proposal form. For the fault on the part of the agent of the LIC, the appellants have been illegally deprived of their lawful claim. 17. Per contra, learned counsel appearing on behalf of the respondent corporation refuting the submissions made on behalf of the appellant-petitioner submitted that from a bare perusal of the Column No. 9 of the proposal form, it is evident that the insured despite having full knowledge of the policies did not disclose the previous policy No. 22449279 in the proposal forms of the subsequent policies. Disclosure of only one policy bearing No. 256487214 was made in one of the forms whereas in another form, the words ' dksbZ ugh is mentioned. The non disclosure of the information regarding the earlier policies prevented the corporation from conducting certain additional checks and precaution especially with respect to the medical condition of the insured such as ECG, FBS, RUA, Hb% and Elisa etc. Further, learned counsel for the corporation has contended that in the matter of insurance, parties must act in utmost good faith and the insured is under solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. In support of his contention, he has relied upon the judgment passed by the Hon'ble Supreme Court in the case of Satwant Kaur Sandhu v. New India Assurance Company Limited, (2009) 8 SCC 316 . 18.
In support of his contention, he has relied upon the judgment passed by the Hon'ble Supreme Court in the case of Satwant Kaur Sandhu v. New India Assurance Company Limited, (2009) 8 SCC 316 . 18. We have heard the submissions advanced by the learned counsel for the appellant and the respondent-corporation and perused the records. 19. It is an admitted fact by the parties that the husband of the appellant-petitioner was holding three insurance policies having policy Nos. 224492798, 256487214 and 256487400. After the death of her husband, the appellant presented her claim for the said policies, however, the claim in respect of the policy No. 224492798 was accepted by the respondent-LIC, while the claim in respect of the remaining two policies Nos. 256487214 and 256487400 were rejected. The dispute revolves against the issue whether non disclosure of the earlier two policies in Column No. 9 of the proposal forms were such that makes the appellant-petitioners disentitle to her claims. 20. The Hon'ble Supreme Court in the case of Manmohan Nanda (supra) has been pleased to hold that it is the duty of the insured to disclose all material facts. The insurer must also inform the insured about the terms and conditions of the policy that is going to be issued to him and must strictly confirm to the statements in the proposal form or prospectors or themselves made through his agents. Further, the principle of utmost good faith imposes meaningful reciprocal duties owed by the insured to the insurer and vice-versa. It has also been held that the duty of the insured to observe utmost good faith is enforced by requiring him to respond to a proposal form which is so framed to seek all relevant information to be incorporated in the policy and to make it the basis of a contract. The contractual duty so imposed is that in suppression or falsity in the statements in the proposal forms would result in a breach of duty of good faith and would render the policy voidable and consequently repudiate it at the instance of the insurer. 21.
The contractual duty so imposed is that in suppression or falsity in the statements in the proposal forms would result in a breach of duty of good faith and would render the policy voidable and consequently repudiate it at the instance of the insurer. 21. In the case of Satwant Kaur Sandhu (supra), a similar view has been taken by the Hon'ble Supreme Court to the effect that in the matter of insurance, parties must act in good faith and the insured is under solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. 22. Another aspect of the matter that has been appropriately appreciated by the learned Single Judge is that the declaration which has been signed by the insured (Vishal Agarwal, husband of the appellant) very categorically makes an statement that he did not withheld any information and in case if any untrue averment is found in the said contract, in that event, the same shall be held a nullity and the money paid in respect thereof shall stand forfeited to the corporation. The said categorical declaration made by the Insured repels the contention of the learned counsel for the petitioner that since the forms are filled up by the agent/officers of the corporation, anything omitted would not constitute a ground for repudiation/rejection of the claim and could be attributed to the agent of the corporation, who filled the form. Further the contract of insurance between the insurer and the insured would certainly bind insured's legal representative i.e. appellant-petitioner and, therefore if, on account of any incorrect declaration or concealment made by the deceased, the claim of the appellant-petitioner can be rightly rejected by the respondent corporation. 23. The learned Single Judge after taking into consideration the facts of the case as well as the legality of the impugned orders dismissed the writ petition filed by the petitioner and drew the following conclusions, that are extracted below: ''Conclusion-I 31. Considering the aforesaid provisions in the light of the material available on record, particularly the proposal form, I find that existence of two policies bearing Nos.
Considering the aforesaid provisions in the light of the material available on record, particularly the proposal form, I find that existence of two policies bearing Nos. 256487214 and 224492798 was in special knowledge of the insured Vishal Agarwal but only existence of policy No. 256487214 was disclosed in one form and the policy bearing No. 224492798 was not disclosed in either of the proposal forms and, therefore, by invoking the principle of adverse inference and estoppel, respectively contained in Section 114(g) and Section 115 of the Act-1872, which would apply to the representative of the deceased Vishal Agarwal, i.e. the petitioner herein, no advantage of non-disclosure can be given to the petitioner so as to claim any relief regarding the two policies repudiated under the impugned orders. 32. The contention of the learned counsel for the petitioner to the effect that insurance company accepted the premium and, therefore, it was unjustified in dislodging the claim, is of no consequence in view of the fact that the proposal forms were filled in the year 2012 and Vishal Agarwal died in the year 2013 due to cardiao-respiratory failure and payment might have been made only once during this period. Even otherwise, mere payment of premium would not estop the insurance company from repudiating the claim as it is well within its rights to repudiate or reject the claim on the ground of non-disclosure of existence of previous policies at the time of taking any fresh policy as there are various factors, administrative, medical as well as financial which need to be analyzed by the Corporation, while issuing any fresh insurance policy to a person who was already insured. 33. Regarding the principles of insurance law with respect to action in good faith, the Apex Court in the Case of Satwant Kaur Sandhu (supra), relied upon by learned counsel for the Corporation, has held that insurance policy is a contract of insurance falling in the category of contract uberrimae fidei, meaning a contract of utmost good faith on the part of the assured. Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge.
Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. It is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not. Of course, the obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known. The obligation to disclose necessarily depends upon the knowledge one possesses. His opinion of the materiality of that knowledge is of no moment. {See: Joel v. Law Union & Crown Ins. Co. (1908) 2KB 863 (CA)}. 34. In United India Insurance Co. Ltd. v. M.K.J. Corporation, (1996) 6 SCC 428 , the Supreme Court has observed that it is a fundamental principle of insurance law that utmost faith must be observed by the contracting parties. Good faith forbids either party from non-disclosure of the facts which the party privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. (Also see: Modern Insulators Ltd. v. Oriental Insurance Co. Ltd., (2002) 2 SCC 734). 35. MacGillivray on Insurance Law (10th Edition) has summarised the assured's duty to disclose stating that the assured must disclose to the insurer all facts material to an insurer's appraisal of the risk which are known or deemed to be known by the assured but neither known nor deemed to be known by the insurer. Breach of this duty by the assured entitles the insurer to avoid the contract of insurance so long as he can show that the non-disclosure induced the making of the contract on the relevant terms. 36. In Carter v. Boehm, (1558-1774) ALL ER Rep 183: (1766) 3 Burr 1905, Lord Mansfield had succinctly summarised the principles necessitating a duty of disclosure by the assured by stating that insurance is a contract of speculation. The special facts upon which the contingent chance is to be computed lie most commonly in the knowledge of the assured only; the underwriter trusts his representation, and proceeds upon confidence that he does not keep back any circumstance in his knowledge to mislead the underwriter into a belief that the circumstance does not exist.
The special facts upon which the contingent chance is to be computed lie most commonly in the knowledge of the assured only; the underwriter trusts his representation, and proceeds upon confidence that he does not keep back any circumstance in his knowledge to mislead the underwriter into a belief that the circumstance does not exist. The keeping back of such circumstance is a fraud, and therefore the policy is void. Although the suppression should happen through mistake, without any fraudulent intention, yet still the underwriter is deceived, and the policy is void; because the risque run is really different from the risque understood and intended to be run at the time of the agreement...The policy would be equally void against the underwriter if he concealed...Good faith forbids either party, by concealing what he privately knows, to draw the other into a bargain from his ignorance of the fact, and his believing the contrary. 37. The term ''material fact'' is not defined in the Act and, therefore, it has been understood and explained by the Courts in general terms to mean as any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether he would like to accept the risk. Any fact which goes to the root of the Contract of Insurance and has a bearing on the risk involved would be ''material''. As stated in Pollock and Mulla's Indian Contract and Specific Reliefs Acts, any fact the knowledge or ignorance of which would materially influence an insurer in making the contract or in estimating the degree and character of risks in fixing the rate of premium is a material fact. Conclusion-II 38. In the present case, the declaration made by the insured at the bottom of the proposal form and signed by him contains clear stipulation to the effect that he has not withheld any information and that the statements made by him in the said declaration shall be the basis of ''contract of insurance' between him and the Corporation and, if any, untrue averment be contained therein, the contract shall be absolutely null and void and the money which shall have been paid in respect thereof, shall stand forfeited.
In the aforesaid facts and circumstances, the contention of the petitioner to the effect that since forms are filled up by the agents/officers of the Corporation, anything omitted would not consitute a ground for repudiation/rejection of the claim, cannot be accepted. Contrarily, the stand taken by the Corporation justifying the orders impugned has substance in the light of entire material available on record.'' 24. We are in agreement with the conclusions drawn by the learned Single Judge and find no good ground to interfere with the judgment and order dated 3.4.2023 passed by the learned Single Judge. 25. The Special Appeal is liable to be dismissed and is, accordingly, dismissed. No order is passed as to costs.