Sunanda Dhananjay Lahoti vs Metlife India Insurance Co. Ltd. and another

These appeals arise out of single order of State Commission, hence decided by common order. 2. These appeals have been filed by appellant against order dated 13.5.2014 passed by State Commission in Complainant No. 33 of 2011-Smt. Sunanda W/o Dhananjay Lahoti v. The Metlife India Insurance Company Limited & Anr. and Complaint No. 34 of 2011-Smt. Sunanda W/o Dhananjay Lahoti v. The Metlife India Insurance Company Limited & Anr., by which complaints were dismissed. 3. Brief facts of the cases are that the complainant''s husband Dhananjay Lahoti, who expired on 29.6.2010, obtained two insurance policies from the opponent Insurance Company-R-1 having its office at Aurangabad i.e. from opponent No. 2/R-2, the details of which are given as under: Sr. No. Policy No Date of policy proposal Period of Policy Maturity amount Annual premium

20289891 14.3.2010 27.3.2010 to 27.3.2035 60,00,000 Rs. 6,00,000

20353447 26.5.2010 27.5.2010 to 27.5.2020 50,00,000 Rs. 25,953.59

The opponent Insurance Company had issued both these insurance policies in favour of deceased husband after having various fitness tests such as sugar test, kidney function test, lever function test, stress test, Australia and Antigen test i.e. HBsAG, etc. done from its recognised diagnostic center namely "Prabhavati diagnostics, Pune on 23.3.2010. That, as per the test report issued by "Prabhavati diagnostic" the health of her deceased husband, was found normal and he was not suffering from any sort of illness. Thus, the opponent Insurance Company before issuing said insurance policy in favour of her deceased husband, had got satisfied about the good health of her husband. The complainant further submitted that, after the death of her husband she had submitted insurance claim on 11.8.2010 in respect of both the policies with the opponent Insurance Company. However, by its letter dated 9.11.2010 her claim was repudiated with liberty for representation against the said repudiation. Accordingly, by her letter dated 6.12.2010 she submitted her representation for re-examination of the matter regarding her policy claims but the same also came to be rejected by the opponent Insurance Company vide letter dated 17.2.2011. Alleging deficiency on the part of Opposite Parties, the complainant filed two complaints before the State Commission. 4. Opposite Parties resisted the complaints, admitted to have issued the said two insurance policies to the deceased husband of the complainant, but denied other contentions of the complainant. It was submitted that the husband of the complainant i.e. the life assured had given declaration at page 5 of the proposal form whereby he has declared to furnish necessary information correctly and no any information would be with-held etc. However, during the course of evaluation and assessment of the claim the opponents received medical report dated 28.1.2010 as prepared by Sarda Centre for diabetes which clearly indicated that the deceased insured had positive report of HBs AC and that the deceased insured died due to infective hepatitis. It was further submitted that, deceased life insured was availing insurance on his life from other Insurance Company i.e. Kotak Life Insurance and ICICI Prudential Life insurance prior to filling up of the proposal form in respect of the insurance policies under reference. However, the said fact of insurance policies from other insurance companies was not disclosed by the deceased life insured, in part 2(D) of the said proposal form the insured was required to provide the details of policy taken from opponent Life Insurance Company as well as of other Life Insurance Company. However, it is written as " no previous insurance policies." Thus incorrect information was given about his other policies. It was further submitted that, in part 3 on page 3 of the said proposal form the deceased insured has given incorrect information stating as "No" in respect of question "b" i.e. have you undergone ECG, x-ray, blood test or other tests. It was thus contended by the opponent that the complainant has suppressed the material fact about his health and also about other insurance policies which he had availed from other companies. It was also contended that insurance policy is a contract and its terms and conditions are binding upon both the complainant as well as opponent. However, the complainant failed to ad-her to the terms and conditions of the policy. Therefore, both of her claims were rightly repudiated by the opponent Insurance Company, Denying any deficiency on their part in repudiating claim, they prayed for dismissal of complaint. Learned State Commission after hearing both the parties, dismissed complaints against which these appeals have been filed along with applications for condonation of delay. 5. Heard learned Counsel for the parties finally at admission stage and perused the record. 6. As there is delay of only 22 days in filing the appeals on the ground that the appellant is a widow and had no source of income to arrange for expenses for filing appeals, delay stands condoned. 7. Learned Counsel for appellant submitted that in spite of no wilful suppression of any facts, learned State Commission committed error in dismissing the complaints on assumptions, hence appeals be allowed, impugned order be set aside and claim be allowed. On the other hand learned Counsel for the respondents submitted that order passed by the State Commission is in accordance with law, hence, appeals be dismissed. 8. It is not disputed that complainant''s husband obtained two policies vide proposal form dated 14.3.2010 and 26.5.2010 from Opposite Party. It is also not disputed that complainant''s husband died on 29.6.2010, within the short span after obtaining policies. 9. The core question to be decided is whether insured suppressed material facts regarding earlier policies and about state of his health or not? 10. Perusal of proposal forms for both the policies reveals that in Section D of the proposal form, where he was supposed to disclose about other Life Insurance Policies taken from the Opposite Party or any other Insurance Company, he mentioned "No Previous Insurance Policies". One column requires information regarding Insurance Policies in force/lapsed/in case of revival, date of revival/pending and just after this another column, requires information whether proposal accepted/postponed/declined etc. 11. Perusal of record reveals that insured was having one policy with Kotak Life Insurance and for its revival Kotak Life Insurance by letter dated 26.12.2009, asked insured to submit medical reports by their Penal Doctors for review. Letter dated 28.12.2009, issued by ICICI Prudential Life Insurance, reveals that on the request of reinstatement of policy, insured was asked to submit medical reports. Thus, it becomes clear that insured was having two policies in lapsed condition at the time of filling proposal forms for both disputed policies. But insured purposely filled wrong information stating that there was no previous insurance policy, whereas he was supposed to mention that policies were either lapsed or in revival process. Thus, there was material suppression regarding earlier policies. Perusal of impugned order further reveals that insured was having another policy obtained from Bajaj Allianz General Insurance, which was in force during 3.4.2010 to 2.4.2011 and insured also did not disclose details of this policy. Thus, this was a clear case of suppression of information regarding earlier policies. 12. Insured in the Clause 3 of proposal form regarding medical details replied in negative to the questions, by which he was required to disclose whether he has undergone ECG, X-ray, Blood test or other tests in last five years. It is also not disputed that in pursuance to letter dated 26.12.2009, issued by Kotak Life Insurance, insured got his blood tested from Sarda Centre for Diabetes & Self Care and HbsAg Test was found positive, which ought to have been disclosed in the proposal forms. Learned Counsel for appellant submitted that firstly he did not receive test report issued by Sarda Centre for Diabetes & Self Care and secondly, medical test conducted by Prabhavati Diagnostics on the request of OP, opined HBsAG as negative, so there was no question of giving false reply to medical queries. No doubt, prabhavati Diagnostics opined negative report regarding HBsAG but it is not disputed that insured died on 29.6.2010 and his cause of death was Terminal Candiorespiratory arrest in a case of infective hepatitis (Hepatitis-B positive) with Hepatic encephalopathy with hepatorenal syndrome. It suggests that opinion given by Sarda Centre for Diabetes & Self Care regarding HbsAg Test was correct. No doubt, OP cannot deny report of Prabhavati Diagnostics but at the same time, report of Sarda Centre for Diazbetes & Self Care is also to be considered and it appears that as this report was received by insured, he did not approach Kotak Life Insurance as well as ICICI Prudential Insurance, for revival of his earlier policies and it cannot be believed that he did not receive blood test report, issued by Sarda Centre for Diabetes & Self Care, As he suppressed vital information and gave false answers regarding his health and blood test, OP has not committed any error in repudiating claim. 13. As complainant suppressed material information regarding his earlier Insurance Policies, and gave false information regarding his health and medical tests, learned State Commission after elaborate discussion has not committed any error in dismissing complaints on the basis of judgments of Hon''ble Apex Court in IV (2007) ACC 773 (SC) = IX (2007) SLT 533 = III (2008) CPJ 78 (SC) = AIR 2008 Supreme Court 424, P.C. Chacko & Anr. v. Chairman of LIC of India, and judgment in Civil Appeal No. 2776 of 2002, Satwant Kaur Sandhu v. New India Assurance Company Ltd., VI (2009) SLT 338 = IV (2009) CPJ 8 (SC) and I do not find any illegality in the impugned order and appeals are liable to be dismissed. 14. Consequently, both appeals filed by appellant are dismissed with no order as to costs. Appeals dismissed.