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Judgment
This revision petition has been filed by the petitioner/complainant-Shri Savneet Singh Sobti, nephew of late Shri Jatinder Paul Kaur, holder of a life insurance policy with Aviva Life Insurance Co., India Ltd. against the order dated 5.9.2012 in First Appeal No. 1364 of 2013 passed by Haryana State Consumer Disputes Redressal Commission, Panchkula (in short ''State Commission'').
The petitioner''s prayer before the commission is that the State Commission has misconstrued the facts, have not given a speaking order and therefore their order is illegal, perverse and bad in law.
The facts of the case in brief are that Ms. Jatinder Paul Kaur bought a Aviva Life Insurance Policy (Life Saver plus) No. LSP 1720283 w.e.f. 16.10.2007. The premium was Rs. 50,000 per annum and had been paid regularly i.e. two premia amounting to Rs. 1 lakh had been paid till the intervening night of 11/12th February 2009 when she passed away in her sleep at home. The death was considered to be natural and as such she was cremated subsequently without any medical examination, etc. The petitioner thereafter filed a request letter to the respondent/insurance Company claiming her insurance. They responded on 1.9.2009, seeking necessary documents etc. for processing the insurance claim. They also appointed an investigator on 20.11.2009 who submitted their report on 30.11.2009.
The complaint is that despite submission of all documents required by the Insurance Company and without suppressing any fact, the respondent/insurance Company repudiated the claim vide their letter dated 25.11.2009 on the ground of "non-disclosure of pre-existing medical ailment in the proposal form". The complainant''s case is that since the insurance policy had been obtained in the first place on the basis of a medical checkup by a panel of doctors of the Insurance Company, the ground of "non-disclosure" was invalid and unjust.
The respondent/insurance Company has strongly contested this, pleading that the petitioner had not come with clean hands. Late Ms. Kaur had been suffering from hypertension, a condition corroborated by the fact of her taking medical leave from 14.5.2007 to 26.5.2007 on the basis of a medical certificate issued by Dr. Har Parkash Sharma dated 14.5.2007. Yet this important information was withheld by her at the time of making a proposal for life insurance. They have also cited several judgments in similar cases to support their main argument that a contract of insurance is a contract of utmost good faith in which the insurer has to disclose all facts known to be true, without withholding any information, as asked for in the proposal form. In particular, they have highlighted the response of the insured to the Section on PERSONAL DETAILS, Column 2-Health and Activity Section. In Section A, she was asked if she was "currently receiving any medical treatment or awaiting medical or surgical consultation, test or investigation? Her answer was "No". In Section B, she was specifically asked whether she ever had any medical or surgical treatment including investigations, tests, scan or x-ray for any of the following illness or medical conditions viz high blood pressure, angina, heart attack, stroke or any other disorder of heart or circulations? To this also, she had replied in the negative. In fact, the entire series of question under Section B had been answered in the negative. The case of the Insurance Company is therefore, that this amounted to non-disclosure of material information which would have had a bearing on how the company handled treated her application for insurance.
The District Forum, on an appraisal of the facts viz. the complainant accepting that the deceased had taken leave on grounds of hypertension for 15 days to take rest under medical advice from 14.5.2007 to 26.5.2007, and that the proposal for contracting the insurance policy was submitted on 8.10.2007, i.e., after medical leave, and thereafter the non-disclosure in the proposal form, concluded that this amounted to withholding relevant information while entering into a contract of insurance. This along with the fact that the life assured died within the period of two years, led the forum to dismiss the complaint as being devoid of any merit.
The State Commission came to the same conclusion from the same facts viz. that the life assured was suffering from hypertension prior to obtaining the insurance policy and that she did not disclose this in the proposal form signed by her on 16.10.2007. Citing thereafter, the well settled principle of law that the contract of insurance is a contract uberrimafides, i.e. "utmost good faith" they held that the insured had violated the terms and conditions of the policy and hence was not entitled to insurable benefits. Accordingly, they found no case for interference with the order of the District Forum and dismissed the appeal.
Thereafter, the petitioner has approached this Commission with RP No. 3998 of 2014 with the prayer that the order of the State Commission in FA No. 1548 of 2011 and the order of the District Forum dated 12.10.2011 in CC No. 74 of 2010 may be set aside and the respondent be directed to pay jointly and severally to the revisionist being the appointed nominee, the entire benefits accruing from the insurance policy No. LSP 1720283 along with interest as well as pay an exemplary fine on account of deficient services and mental agony and harassment in addition to legal cost and expenses and such other relief the Commission may deem fit.
We have heard the Counsels, the petitioner, and also carefully gone through the pleadings in the revision petition, the facts of the case as brought out before the District Forum by both the complainant and the opposite parties, and all the documents that were submitted in support of their respective contentions.
Facts not in dispute are that Late Ms. Kaur had purchased an insurance policy on the basis of a proposal form duly signed by her in which she had answered all the questions relating to "Health and activity Section", in the negative. She passed away peacefully in the night of 11/12.2.2009 and there being no grounds for believing otherwise, was cremated as per customary rites and rituals without any further investigation. The death certificate was also issued in due course, recording the date of death as 12.2.2009. On asking the petitioner why the reason for death was not recorded, he replied that since the death occurred in a natural way at home, the cremation took place in a normal, routine manner and as such, there was requirement of a medical certificate of death.
A perusal of the death claim investigation report carried out at the instance of the Insurance Company confirms that the death was due to heart attack when she was sleeping. The investigation report further gives an account of various enquires made with medical stores, various doctors, neighbours etc. and reports that she was quite healthy and not apparently suffering from any illness. Two medical stores that were approached did not know who she was. Similarly, none of the hospital or doctor approached her knew her. The two neighbours interviewed reported her to be healthy and never in an ill condition. All this does seem to point to the fact that she was leading a normal healthy and unremarkable life. However, the investigator also reported that she had taken 15 days medical leave from 14.5.2007 to 26.5.2007, and that the cause of leave for taking leave was "hypertension" and that the leave was availed before the commencement of the policy. On this ground, the investigator had recommended repudiation of the claim. This is what the Insurance Company seems to have accepted, repudiating the claim vide its letter dated 25.11.2009. A review of this decision by the company''s claims review committee also did not go in the petitioner''s favour.
As would be clear from the discussions above, the facts of the case are not controversial nor in dispute. On the basis of these facts, the two Fora below have come to finding that the claim for the insurance cannot sustain, on grounds of non-disclosure of material information and on the principle of insurance being a contract of utmost good faith. Since, there has been no error apparent either of fact or law, in the order of the State Commission, we see no reason to interfere with the same, in any manner. Accordingly, this Revision Petition is dismissed on merit and therefore, the order of the District Forum is upheld. No order as to cost. Revision Petition dismissed.