AI Structured Summary
Not yet generated for this judgment
Judgment
Dinesh Singh, J
Heard learned counsel for the complainants and learned counsel for the opposite party - insurance co., and perused the material on record.
The dispute relates to repudiation of life insurance claim by the insurance co. on the death of the insured.
Brief facts, shorn of unnecessary detail, are that Ajay Gupta (insured; husband of complainant no. 1 - nominee) obtained an insurance policy from the opposite party insurance co. on 24.04.2009. The sum assured was Rs. 5 crore. Payment of premium; the insurance policy being valid and in place on the date of death; and the date of death (01.12.2010) of the insured, are not disputed. The insurance claim was lodged on 24.06.2011 by the complainant no. 1 (Manisha Gupta - nominee - wife of the insured Ajay Gupta). The insurance claim was repudiated vide the insurance co.'s letter dated 12.01.2012.
The insurance co. vide its repudiation letter dated 12.01.2012 declined the insurance claim principally on the ground of intentional non-disclosure and suppression of material information and untrue statements:
BY RPAD
12/01/2012
Mrs. Manisha Gupta
I/C/5 B
Ashok Vihar
Phase-III
Delhi-110052
Sub: Claim Repudiation
Re: Policy No. 01557506 [Proposer / Life Insured: Mr. Ajay Gupta]
Dear Mrs. Manisha Gupta,
We, at Kotak Mahindra Old Mutual Life Insurance Ltd., herein referred to as "the Company" are very sorry and deeply mourn the said demise of Mr. Ajay Gupta. Please accept our deep condolences in this sad moment.
We refer to:
The Proposal No. 01557506 dated 27/03/2009 and Policy No. 01557506;
Your claim intimation form dated 24/06/2011 received in our office on 21/07/2011;
The Death Certificate issued by the Municipal Corporation of Delhi, Government of National Capital Territory of Delhi, India issued under section 17 of the Registration of Births and Deaths Act, 1969 bearing registration no. MCDOLIR-0210-004310051 received in our office on 21/07/2011.
The FIR Report form District North West Delhi, Police Station: Adarsh Nagar, bearing FIR no. 294 dated 02/12/2010 received in our office on 13/12/2011;
The Post Mortem report from Department of Forensic Medicine, Deen Dayal Upadhyay Hospital, bearing PM no. 1407/10 dated 2/12/2010;
The report from Department of Forensic Medicine, Deen Dayal Upadhyay Hospital, Govt. of N.C.T. of Delhi, dated 31/05/2011 received in our office on 13/12/2011;
The Description of Parcels from Forensic Science Laboratory, Govt. of NCT of Delhi dated 19/04/2011 bearing report no. FSL.2010/C-5515 received in our office on 13/12/2011;
Inner Case Diary in case no. 294/10 u/s 304/379/711/201/34;
Letters to all Insurance companies by Brij Pal Singh Inspector, Special Staff, North West District, Delhi; u/s 91 Cr. P.C.;
Letters received from your end regarding details of Insurance Policies And Loans received in our office on 21/11/2011;
The Policy of Birla Sun Life bearing policy no. 1431826 dated 28/03/2008;
The Policy of Metlife bearing policy no. 1200400054561 dated 21/08/2004;
The Policy of HDFC bearing policy no. 10183956 dated 04/02/2005;
The Policy of HDFC bearing policy no. 10183958 dated 04/02/2005;
The Policy of SBI Life bearing policy no. 19004387401 dated 24/05/2006;
The Policy of SBI Life bearing policy no. 19004235210 dated 18/05/2006;
The Policy of SBI Life bearing policy no. 19003568902 dated 13/04/2006;
The Policy of Bajaj Allianze bearing policy no. 55475117 dated 24/07/2007;
The Policy of LIC bearing policy no. 121295762 dated 28/10/1999;
The Policy of LIC bearing policy no.121677925 dated 28/03/2001;
The Policy of LIC bearing policy no.122268767 dated 28/01/2003;
The Policy of LIC bearing policy no. 122268763 dated 28/01/2003;
The Policy of LIC bearing policy no. 122268765 dated 28/01/2003;
The Policy of LIC bearing policy no. 122275026 dated 25/07/2003;
The Policy of LIC bearing policy no. 121181233 dated 28/06/1988;
The Policy of LIC bearing policy no. 120813824 dated 28/06/1998;
The Policy of LIC bearing policy no. 121686477 dated 15/12/2001;
The Policy of LIC bearing policy no. 122275027 dated 25/07/2003;
The Policy of LIC bearing policy no. 110332533 dated 28/12/1988;
The Policy of LIC bearing policy no. 120813825 dated 28/06/1998;
The Policy of Bharati Axa bearing policy no. 5002130465 dated 31/10/2008;
The Policy of Reliance Life Ins. Co. bearing policy no. 10847252;
The Indian Income Tax Return Acknowledgement from the Assessment Year 2007-2008 bearing PAN no. AALPG0624R;
The Indian Income Tax Return Acknowledgement from the Assessment Year 2008-2009 bearing PAN no. AALPG0624R;
The Indian Income Tax Return Acknowledgement from the Assessment Year 2009-2010 bearing PAN no. AALPG0624R;
The letter from Ms. Richa Rastogi, Assistant Commissioner of Income Tax, New Delhi, to The Manager, Claims Department, Birla Sun Life Insurance Company LTD. In accordance to recovery proceeding u/s 226 (3) of the IT Act, 1961 in the case of Late Sh. Ajay Gupta (Prop. M/s. Ethik Enterprises) bearing F. No. ACIT/C-38(1)/226(3)/2011-12/A74 dated 19/05/2011 received in our office on 13/12/2011;
The Notice Under Section 226(3) of the Income Tax Act, 1961, Income Tax Office dated 19/05/2011 received in our office on 13/12/2011;
The letter from the Directorate General of Works, Central Public Works Department, New Delhi in accordance to Extension of Revalidation/Enlistment period of contractors in class I (Elect) category bearing office order no. 390 dated 03/08/2008 received in our office on 13/12/2011;
The Letter to the D.G.P., Anti-Corruption Department, Jaipur from Ajay Gupta Director, Ethik Enterprises (P) Ltd. dated 16/09/2010 received in our office on 13/12/2011;
The newspaper report printed in Times of India dated 03/12/2010 received in our office on 13/12/2011;
The newspaper report printed in Hindustan Times dated 12/12/2010 received in our office on 13/12/2011;
The newspaper report printed in Indian Express dated 12/12/2010 received in our office on 13/12/2011;
The newspaper report printed in DNA dated 11/12/2010 received in our office on 13/12/2011;
The letter written by Manisha Gupta to Investigation officer in reply to notice u/s 91 Cr. P.C. In case FIR no. 294/10 PS Adarsh Nagar;
We have duly processed your application for claim under the said policy, having due regard to all the aforesaid documents and other documents available with us in this respect. Based on our assessment of the said death claim, with regard to all the relevant factors, declared or mentioned in any of the supporting documents submitted either by the Life Insured and/ or yourself, we regret to inform you that Kotak Mahindra Old Life Insurance Ltd. (called hereinafter as 'the company') has decided to decline your claim under the said policy on the grounds of non-disclosure and suppression of material information.
The information, now available in our possession, reveals that Life insured:
Had not disclosed policy proposal for 6.62 crore with other insurance companies prior to procuring the said policy with the company. It would not be out of place to mention here that the life insured has not disclosed the life insurance policies that he had already procured from the following companies.
The Policy of Birla Sun Life bearing policy no. 1431826
The Policy of Metlifebearing policy no. 1200400054561
The Policy of HDFC bearing policy no. 10183956
The Policy of HDFC bearing policy no. 10183958
The Policy of SBI Life bearing policy no. 19004387401
The Policy of SBI Life bearing policy no. 19004235210
The Policy of SBI Life bearing policy no. 19003568902
The Policy of Bajaj Allianze bearing policy no. 55475117
The Policy of LIC bearing policy no. 121295762
The Policy of LIC bearing policy no.121677925
The Policy of LIC bearing policy no.122268767
The Policy of LIC bearing policy no. 122268763
The Policy of LIC bearing policy no. 122268765
The Policy of LIC bearing policy no. 122275026
The Policy of LIC bearing policy no. 121181233
The Policy of LIC bearing policy no. 120813824
The Policy of LIC bearing policy no. 121686477
The Policy of LIC bearing policy no. 122275027
The Policy of LIC bearing policy no. 110332533
The Policy of LIC bearing policy no. 120813825;
The Policy of Bharati Axa bearing policy no. 5002130465
In addition to the above, we reproduce, hereunder, Question from the Proposal Form in response to which there has been material non-disclosure by the Life Insured. All these questions have been replied / responded to in the negative.
Under Clause 8.1 of Proposal Form:
Do you have any existing life insurance policies with Kotak Life Insurance or other companies?
Under Clause 8.1 of Proposal Form:
If 'Yes' or 'At the Proposal stage', please gives the following details:
Policy/
Proposal No.
Company Name (Including Kotak Life Insurance)
Sum Assured
Acceptance Terms (Std. / With Extra / Postponed / Declined/ Not Completed)
In Force / Lapsed (Mention year of Lapse / Revival applied for)
On Death
OnAccidental Death
On Disability
On Critical Illness
From the above, it is evident that in spite of having the complete information of the other Life Insurances procured, the Life Insured intentionally withheld the material information from the Company and chose not to disclose true and correct facts In the proposal form despite there been specific questions asked in the proposal form.
Had all the above information revealed to us in a truthful manner, the insurance policy would not have been offered to him at the terms and conditions offered thereon.
As the material information as detailed above, was not disclosed, by the Life Insured at the point of submission of the said Proposal, the Company was not able to correctly assess the risk that it was asked to undertake under the said proposal. Had the Life Insured disclosed the above facts, then the Company would not have accepted the proposal for insurance at that point of time.
We wish to state that the information now available with the company reveals that the Life Insured also had debts amounting to a large sum at the time of proposing for the said life insurance policy with the company. The life insured was further under obligation to pay income tax dues to the tune of Rs. 23.16 lakhs in 2004-05, 65.83 lakhs in 2005-06, 1.99 lakhs in 2006-07 and 29.17 lakhs in 2007-08.
It would further not be out of place to mention here that the property of the Life Insured at the proposal stage was mortgaged and the insured was in Debts for total loans amounting to 1060 lakhs with SBI and with Federal Bank amounting to 3.41 lakhs prior to the date of proposal.
We state that all the aforementioned information coupled with the fact that the life insured had procured death cover to the tune of Rs. 6.62 crores within a short span of around 3 years indicates that the said investments were made by concealing the material information from the company only with an intention to wipe out the debts that the life insured had. It is further important to mention here that the aforesaid information is critical for the insurance company to evaluate the financial risk and the moral hazards involved in the proposal and allows the insurance company to take a prudent decision.
We further wish to bring it to your kind attention that the contract of insurance is a contract of good faith and the proposer / life insured is under a bounden obligation to reveal all the material information categorically asked in the proposal form. Deliberate concealment of material information and furnishing of tweaked facts and figures on the part of the life insured has lead to the denial of opportunity to the insurer to assess the risk under the said proposal in a prudent manner.
In view of the foregoing and based on:-
The grounds of intentional non-disclosure of material facts, untrue statements contained in the said Proposal Form, which forms the basis of the afore referred policy.
The declaration given under clause 12 of the said Proposal, duly signed and accepted by the Life Insured on 27/3/2009.
Kotak Mahindra Old Mutual Life Insurance Ltd. has decided to decline your claim under the said policy.
In case, you need any further clarification in this respect, you can contact our Claims Department at Mumbai on +91-(022)-6605 7292 / 7293 or you can email us at [email protected].
Thanking you and assuring you of our best services at all times.
Yours Sincerely,
Sd/-
Ganesh Iyer
Vice President
Claims Department
Encl: List of Ombudsman & Endorsed policy document
C.C
Mr Suresh Agarwal : National Sales Head
Mr Yog Raj Sharma : Zonal Manager
Ms Ms. Shruti Oberoi : Branch Office Executive
Ms Rekha Kumari : Life Advisor
(emphasis supplied)
Here, we refer to the following:
(i) Clause 8, clause 8.1, clause 8.2 and clause 12 of the filled-up Proposal Form that was duly signed by the insured:
DETAILS OF LIFE INSURANCE POLICIES HELD / PROPOSALS APPLIED FOR BY THE LIFE TO BE INSURED.
8.1 Do you have any existing life insurance polices with Kotak Life Insurance or other companies? Yes
< > At the proposal stage
Policy/
Proposal No.
Company Name
(Including Kotak Life Insurance)
Sum Assured
Acceptance Terms (Std. / With Extra / Postponed / Declined/ Not Completed)
In Force / Lapsed (Mention year of Lapse / Revival applied for)
On Death
On Accidental Death
On Disability
On Critical Illness
----------- N / A ------------
DECLARATION BY THE LIFE TO BE INSURED, PROPOSER AND IN CASE OF MINOR BY HIS / HER LEGAL GUARDIAN
I / We confirm that I / we am / are submitting this Proposal form after having read and understood the product features, benefits & risk factors, structure of charges, terms and conditions of the proposal plan as set forth in the related brochure(s) and I / we submit the duly acknowledge unreadable confirming my / our understanding of the plan for which Proposal Form is being submitted.
I / We declared that I / we have answered the questions in the Proposal Form after having fully understood the nature of the questions and the importance of disclosing all information while answering such questions. I / We also hereby declare that the answers given by me / us to all the questions in the proposal form are true and complete in every respect and that I / We have not withheld any material information or suppressed any fact. I / We undertake to notify Kotak Mahindra Old Mutual Life Insurance Ltd. ("the Company") of any change in the state of health of the life to be insured or as to his / her occupation or any decisions about his / her existing policies or proposals subsequent to the signing of this proposal form and before the acceptance of the risk by the Company. I / We hereby consent to the Company seeking information and any reports from any doctor(s) including hospital who at any time may have attended me / us concerning anything, which affects my / our physical or mental health.
I also hereby authorize my employer, to divulge to the Company any information required by it in connection with this proposal form and the policy contract that may be issued pursuant to the proposal. I agree to undergo all medical tests required by the Company for obtaining the policy further I understand that in the event of my being physically examined, the answers given by me to the medical examiner acting on behalf of the Company, shall be deemed to be duly incorporated in this Proposal Form. In event of this proposal not being converted into a policy the Company reserves the right to recover from me administration charges and medical expenses incurred by the Company.
I / We further declare that the statements / submissions made by me / us in this Proposal Form [including any addendum(s) thereto / all declarations, affidavits and other statements] and / or any information sought for by the Company from any person authorized by me to provide such information, relied upon by the Company to assess the risk on my life under this Proposal Form shall form a base of the contract of insurance between me / us and the Company. And if any untrue statement is contained in the Proposal Form [including any addendum(s) thereto / any of the above documents or statements], or there has been a nondisclosure of a material fact the Company shall have the right to vary the benefits / treat the policy as void and all premiums under the policy may be forfeited by the Company.
I / We understand that the contract will be governed by the provisions of Insurance Act, 1938, the IRDA Act, 1999 and the Regulations framed there under and that the contract will not commence until the Company's written acceptance of this Proposal Form is received. In case of the life to be insured being a minor, I further declare and affirm that this proposal of insurance is for the benefit of the life to be insured.
I / We hereby confirm that all premiums will be paid from bonafide sources and no premiums have / will be paid out of proceeds of crime related to any of the offence listed in Prevention of Money Laundering Act, 2002.
(Applicable for non tobacco users opting for Kotak Preferred Term Plan or Kotak Preferred Term Benefit)
I hereby declare, that I have not consumed tobacco in any form (smoking, chewing etc.) during the past 12 months and do not have any intention of consuming tobacco in any form in the future. I am aware that any false statement regarding my use of tobacco would render the contract void and lead to loss insurance cover.
Photograph of Ajay Gupta affixed
Sd/- (Ajay Gupta)
Place NEW DELHI
Date 27 03 2009
(emphasis supplied)
(ii) The Post Mortem Report dated 02.12.2010 of the insured Ajay Gupta:
Government of National Capital Territory of Delhi
DEEN DAYAL UPADHYAY HOSPITAL
GOVT. OF N.C.T. OF DELHI
HARI NAGAR, NEW DELHI - 110064
(Department of Forensic Medicine)
POST MORTEM REPORT
No of Pages:- 03
PM No. : 1407/10 Dated : 02.12.2010
DD No. : 5-A Dated : 01.12.2010 PS : - Khyala
(1) Dead body of : Ajay Gupta Age 46 years, Sex Male, S/o Late Sh. Balkishan Gupta
Address : C-I-5B, Ashok Vihar Phase-III, New Delhi
Physique : Obese Height : 5' 5"
(2) Body sent by : SI Dharampal and Ct. Shri Kant 2443/W
(3) Body is identified by : Mr. Sanjay Gupta (Brother) and Mr. Tarun Gupta (cousin brother)
(4) Date & Hour of Receipt of inquest papers : 02.12.2010 at 02:15 PM
(5) Date & Hour of Starting Autopsy : - 02.12.2010 at 02:30 PM
(6) Autopsy completed at :- 02.12.2010 at 03:30 PM
BRIEF HISTORY (As per inquest Papers): Alleged history of male person found near ganda na Khyala gas godam on 01.12.2010 at 12:20 AM and brought to the casualty of DDU Hospital unconscious state and declared brought dead as per MLC No. 21357/10.
(emphasis supplied)
(iii) The Forensic Science Laboratory's Report dated 19.04.2011:
Forensic Science Laboratory
Govt. of NCT of Delhi
Sector-14, Rohini, Delhi-110085.
Tel.: 011-27555811, Fax: 011-27555890
Accredited by the National Accreditation Board for Testing and Calibration Laboratories (NABL)
REPORT No. FSL.2010/C-5515 Dated 19.4.11
The Station House Office
PS: Khyala
Delhi
Your letter No. 9454/SHO/Khyala Dated 15.12.10 regarding 3 parcels in connection with case DD No. 5A dated 01.12.10 U/S 174 Cr. P.C. PS Khyala duly received in this office on 5.12.10 through SI Dharampal, NO. D-4848.
DESCRIPTION OF PARCEL(S)
Sealed polythene bags : 02 (two)
Sealed cloth parcel : 01 (one)
Total : 03 (three)
Three sealed parcels marked as '1', '2' & '3'. Seals were intact and tallied with the specimen seal as per forwarding letter (FSL FORM).
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
RESULTS OF EXAMINATION
On chemical microscopic, TLC & GC-HS examination, (i) Exhibits '1A', '1B' & '1C' were found to contain Ethyl Alcohol.
(ii) Exhibit '1C' was found to contain 'Ethyl Alcohol' 10.3 mg per 100 ml of blood.
(iii) Metallic poisons, ethyl and methyl alcohol, cyanide, phosphide, alkaloids, barbiturates, tranquilizers and pesticides could not be detected in exhibits '2' & '3'.
NOTE: Case exhibits / Remnants of Exhibits sent to this laboratory for examination have been sealed with the seal of "KLV FSL DELHI".
Sd/-
(DR. KANAK LATA VERMA)
Senior Scientific Officer(Chemistry)
Forensic Science Laboratory, Delhi
cum-Ex Officio Chemical Examiner to the
Govt. of National Capital Territory of Delhi
(emphasis supplied)
(iv) The Subsequent Opinion regarding final cause of death of insured Ajay Gupta dated 31.05.2011 of the Department of Forensic Medicine, Deen Dayal Upadhyay Hospital:
DEEN DAYAL UPADHYAY HOSPITAL
GOVT. OF N.C.T. OF DELHI
HARI NAGAR, NEW DELHI - 110064
(Department of Forensic Medicine)
(011-25494401 - 08)
Dated: 31.05.2011
FIR No. 294/10
PS: Adarsh Nagar
US 304, 379, 411, 34 IPC
Subsequent Opinion regarding final cause of death of deceased Ajay Gupta S/o Late Bal Kishan Gupta Vide PM No. 1407/10 dated 02.12.2010
On dated 31.05.2011 Insp. Brij Pal Singh Special Staff North West Distt. Pitam Pura, New Delhi moved an application along with PM report, FSL report and photo copies of all inquest papers.
The post mortem examination of the above mentioned deceased was conducted by Dr. Sabreena Majid who has left the hospital and service, and case marked to me by HOD, Forensic Medicine for subsequent opinion.
After seeing the FSL report No. FSL.2010/C-5515 dated 19.04.2011 and same was clarified on dated 25.05.2011 it is mentioned that the exhibits "C" contained ethyl alcohol level of 10.3 mg/100 ml of blood. After going through PM report findings observed and noted (in PM report no. 1407/10) that no any external / internal injuries was found on the body of the deceased. However internal findings (congestion of multiple internal organs) are supportive / consistent to death caused by asphyxia. The lumen of trachea was found congested and contained semi digested food up to the bifurcation of the trachea. Such complete obstruction of upper respiratory passage was sufficient to cause death in ordinary course of nature by manner of suffocation. In usual course the out come of aspiration of vomits / bronchial secretion takes place under the altered sensorium like unconsciousness caused by head injuries, stage of intoxication or many other pathological conditions. But in this case all above mentioned conditions were not associated as mentioned in PM report. The ethyl alcohol level in blood was 10.3 mg / 100 ml, which was very negligible concentration and was insufficient to change the mental or physical conditions of the body. It is very clear that the cause of death was due to asphyxia caused by obstruction of upper respiratory as a resultant of aspiration of gastric contents under the stage of altered sensorium. The changing of consciousness (altered sensorium) is determined by internal stimulus (causing factors) or external stimulus. As per PM report findings nothing is suggestive of existing any internal factors and external factors like grave and sudden threatening / frightening can not be ruled out. The manner of death is accidental caused by some unnatural factors / circumstances.
Dated : 31.05.2011 Sd/-
(Dr. B.N. MISHRA)
Medical Officer
Deptt. Of Forensic Medicine
DDU Hospital, Hari Nagar, New Delhi
(emphasis supplied)
We note that:
(i) The insured Ajay Gupta had taken 21 life insurance policies for a total assured amount of Rs. 6.62 crore before he duly signed the filled-up Proposal Form and took the subject policy from the opposite party - insurance co.
(ii) In the Proposal Form, on an explicit, categorical, unambiguous and material question, that "Do you have any existing life insurance polices with Kotak Life Insurance or other companies?", he replied "No". In the next question, "If 'Yes' or 'At the proposal stage', please give the following details", he replied "N / A", that is, 'Not Applicable'.
(iii) The subject insurance policy was for an assured amount of Rs. 5.00 crore.
(iv) The insured had duly affixed his signatures on the filled-up Proposal Form.
(v) The insured was a post-graduate self-employed contractor (that is, he was educationally well-qualified, and could read and understand what he was signing).
(vi) The premium for the subject policy was Rs. 1,25,000/- per quarter. It is inter alia stated in the repudiation letter dated 12.01.2012 that "- - - the Life Insured also had debts - - -"; "- - - was further under obligation to pay income tax dues to the tune of Rs. 23.16 lakhs in 2004-05, 65.83 lakhs in 2005-06, 1.99 lakhs in 2006-07 and 29.17 lakhs in 2007-08.- - -"; "- - - the property of the Life Insured at the proposal stage was mortgaged and the insured was in Debts for total loans amounting to 1060 lakhs with SBI and with Federal Bank amounting to 3.41 lakhs prior to the date of proposal.- - -" and "- - - aforementioned information coupled with the fact that the life insured had procured death cover to the tune of Rs. 6.62 crores within a short span of around 3 years - - -". These averments of the insurance co. have not been commented upon or rebutted by the complainants in any manner, including in their complaint and in their evidence by way of affidavit.
(vii) The Post Mortem Report dated 02.12.2010 inter alia states his death to be an MLC, that is, Medico Legal Case.
(viii) The Forensic Science Laboratory report dated 19.04.2011 inter alia states "- - - On chemical microscopic, TLC & GC-HS examination, (i) Exhibits '1A', '1B' & '1C' were found to contain Ethyl Alcohol.- - -" and "- - - (ii) Exhibit '1C' was found to contain 'Ethyl Alcohol' 10.3 mg per 100 ml of blood. - - -".
(ix) The Subsequent Opinion dated 31.05.2011 regarding final cause of death of the insured Ajay Gupta inter alia states "- - - exhibits "C" contained ethyl alcohol level of 10.3 mg/100 ml of blood. - - -"; "- - - It is very clear that the cause of death was due to asphyxia caused by obstruction of upper respiratory as a resultant of aspiration of gastric contents under the stage of altered sensorium.- - -" and "- - - The manner of death is accidental caused by some unnatural factors / circumstances.- - -".
(x) The fundamental facts, as such, stated in sub-para (i) to sub-para (ix) above, are not disputed by either side.
An insurance contract has to be in utmost good faith, by both sides. And in a life insurance contract, existence of earlier life insurance policies is a relevant and material question, necessarily required to be answered truthfully and unambiguously.
In the instant case, the insured suppressed the pre-existence of not one (1), or two (2), but twenty-one (21) life insurance policies, when suppression of even one (1) pre-existing life insurance policy was sufficient to arrive at a conclusive finding of willful and intentional suppression of material facts. And there is no mitigating factor. The insured was a post-graduate self-employed contractor. It is reasonable and appropriate to say that he knew what he was signing, he knew the significance of the questions, he knew that they were relevant and material.
The repudiation letter dated 12.01.2012 is a self-contained and reasoned communication, wherein the facts and reasons for repudiation of the claim have been explicitly and categorically stated. It cannot be faulted.
The complaint, being patently misconceived and totally devoid of merit, is dismissed.
Attempting to obtain wrong gains in such facts and in such manner through the consumer protection fora is not viewed favourably. In the totality of this case, we find it just and appropriate to impose a cost of Rs. 1.00 lakh on the complainant no. 1 (Manisha Gupta; nominee - wife of the insured Ajay Gupta), to be deposited in the Consumer Legal Aid Account of this Commission within 4 weeks of the date of pronouncement of this Order.
The Joint Registrar of this Commission is requested to monitor compliance of para 11 above, and to report the status of compliance to this bench on the case-file on the immediately next working day after the expiry of 4 weeks of pronouncement of this Order.