Decided on June 05,2014

Aviva Life Insurance, Claim Department And Ors. Appellant


J.S.Klar, Presiding Member (J) - (1.) THE instant appeal has been preferred by the appellants, who were opposite parties in the original proceedings in the complaint (hereinafter referred to as "the opposite parties") against the impugned order dated 10.6.2010 passed by the District Consumer Disputes Redressal Forum, Amritsar (in short, "the District Forum"). The brief facts of the complaint are that respondent of this appeal, who is complainant, to be referred as such hereinafter, filed a complaint under Section 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the opposite parties, on the allegations that Joginder Singh Jakkar, since deceased, husband of the complainant procured a life insurance policy vide No. LSP1638372 from the opposite parties in the year 2007 and total sum assured was Rs. 5 lacs. First premium of said policy of Rs. 50,000 was duly paid by late husband of the complainant (the insured in this case) and complainant was appointed as nominee therein. Husband of complainant died on 15.3.2008 at Amritsar and he was self -employed person and he was earning his livelihood by way of self -employment at the time of his demise. Husband of complainant had good health at the time of filling the proposal form for insurance policy. Husband of the complainant also prepared policy for his wife in the year 2006 for a sum of Rs. 5 lacs and premium of Rs. 50,000 thereon was to be paid annually to the opposite parties in the year 2006. After the death of her husband, complainant being nominee of her husband lodged the claim with the opposite parties by supplying the necessary documents like death certificate, hospital discharge certificate in original to them. The complainant is an aged lady and her children are dependent upon her. The opposite parties repudiated the genuine claim of the complainant, necessitating the filing of the present complaint. The complainant has prayed in this case that a direction be issued to the opposite parties to pay an amount of Rs. 5 lacs for which the policy was taken, along with interest @ 18% p.a., besides payment of Rs. 11,000 as litigation expenses and Rs. 1 lac as compensation for mental harassment.
(2.) THE brief written reply of the opposite parties is that the insured was suffering from hypertension and he concealed this fact from the opposite parties at the time of filling up his proposal form for taking the insurance policy. On account of concealment of this fact of hypertension ailment by the insured, the insurance claim was rightly repudiated by the opposite parties. The false statement made in the proposal by the insured form renders the contract of insurance null and void. The insured has failed to disclose the material facts in the proposal form at the time of taking the policy. In the column of questionnaire to the effect, if the proposer was suffering from high blood pressure, angina, heart attack, stroke or any other disorder of heart or circulation, the insured replied in the negative. This was the material concealment of fact by the insured from the opposite parties which led to the repudiation of this contract of insurance between the two. It was denied that the total sum insured was Rs. 5 lacs, rather the total sum insured was Rs. 2.50 under the policy. The policy holder died on 15.3.2008. Since the insured was suffering from the disorder of hypertension when he took the policy, he concealed this fact by suppressing it, therefore, it led to repudiation of the claim of insurance by the opposite parties. The opposite parties prayed for dismissal of the complaint on these points. The complainant tendered in evidence her own affidavit Ex. C -1 along with letter issued by opposite party dated 26.12.2008 Ex. C -2, certificate issued by the hospital Ex. C -3, Medical Examiner's report of doctor of opposite parties supplied by the opposite parties in the column Ex. C -4 to Ex. C -9, renewal premium receipts Ex. C -10 and Ex. C -11. In rebuttal of it, the opposite parties tendered in evidence affidavit of Pankaj Saini, Asstt. Manager Ex. R -1, Ex. R -2 copy of insurance policy, Ex. R -3 policy schedule, Ex. R -4 checklist of documents submitted by the claimant, Ex. R -4 is also marked in duplicate which is UTI Mutual Fund produced by the opposite parties along with medical record of insured, Ex. R -5 history sheet of the insured, Ex. R -6 is the requisition of certain documents by the opposite parties from the complainant, Ex. R -7 the documents of the complainant supplying some information. Ex. R -7 is the hypertension disorder questionnaire produced by the opposite parties and Ex. R -8 is the letter of repudiation of claim. On conclusion of evidence and arguments, the District Forum accepted the complaint of the complainant by virtue of impugned order and directed the opposite parties to pay the amount of Rs. 5 lacs along with interest @ 6% p.a. to the complainant along with Rs. 2,000 as litigation expenses. Aggrieved by the impugned order, the opposite parties have preferred the present appeal.
(3.) WE have heard learned Counsel for the parties at considerable length and have also examined the record of the case. The factum of taking insurance policy by the husband of the complainant being insured from the opposite parties is an indisputable fact in this case. Similarly, the fact that an amount of Rs. 50,000 was paid as premium by insured is not disputed. The point of complainant being nominee of her husband's insurance policy is also an admitted fact. The point for adjudication as canvassed by the Counsel for appellants in the appeal is that the insured was suffering from health disorder of hypertension for the last 8 years and he has suppressed this fact at the time of taking up the policy. The insured answered it as Nil in the questionnaire when asked, he was suffering from hypertension, angina or heart ailment or any other disorder of blood circulation. History sheet of policy holder was taken from Hartej Maternity and Nursing Home where he was admitted and it is shown that he was suffering from hypertension for the last 8 years. Even the certificate issued by Dr. Rakesh Arora dated 24.8.2008 has recorded that the insured was suffering from hypertension before his death. This material fact has been suppressed by not disclosing it by the insured in the insurance policy and hence, it rendered the contract of insurance null and void. It was also submitted that the coverage for the insurance was for Rs. 2.50 lacs and not Rs. 5 lacs.;

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