AI Structured Summary
Not yet generated for this judgment
Judgment
Heard Mr. Mohit Beniwal, Advocate, for the complainant and Mr. Joydip Bhattacharya, Advocate, for the opposite party.
Pramod Kumar has filed above complaint for directing the opposite party to (i) pay insurance claim of Rs.1 crore with interest @18% per annum from the date of claim till the date of payment; (ii) pay Rs.5 lakhs, for deficiency in service; (iii) pay Rs.10 lakhs, for mental agony and harassment; (iv) pay Rs.75000/-, towards litigation costs; and (v) any other relief which is deemed fit and proper in the facts of the case.
The complainant stated that he was the brother and nominee of the deceased life insured Pradip Kumar, who had obtained Life Insurance Policy No.16957808 dated 14.07.2014 from the opposite party, valid for 30 years. Pradip Kumar was admitted in Jeevan Nursing Home due to chest pain on 21.07.2015 around 22:00 hours, where he died on 21.07.2015 at 23:00 hours. Premium of the policy was due on 04.08.2015, which could not be paid due to the death of the insured. The nominee of the insured filed insurance claim with the opposite party, who, vide letter dated 05.03.2016, repudiated the claim on the ground that in the proposal form the insured had given wrong information regarding his income and occupation. The agent of the opposite party had obtained the signature of the insured on the blank application form and the insured had not filled up the proposal form in his hand writing. The deceased life insured supplied the requisite documents sought by the opposite party including copy of the ITR. After satisfaction with the deceased life insured’s occupation, income and other particulars, the opposite party issued the insurance policy in question. The deceased life insured had not suppressed any material fact nor misrepresented the opposite party. Incorrect information in the application, if any, is unintentional and due to negligence of the agent of the opposite party. The insured was having good income, which is clear from the ITR annexed alongwith the application form. The Insured also started his business as a commission agent with Fair Trade Commodity Broking Pvt. Ltd., Bhiwani. He was also having ancestral agricultural land having annual income of Rs.4 lakhs. All these information/documents were supplied to the opposite party. Moreover, wrong information about the occupation is not such a serious in nature, which can affect the root conditions of the policy. The deceased life insured did not conceal the material fact relating to health condition or any medical related information. The complainant had no reason to conceal any fact relating to his occupation when he had sufficient income. At the time of taking the policy, the insured worked in “Fairtrade Commodity Broking Pvt. Ltd.” and the complainant was the Managing Director of the said Company. In the proposal form the agent/staff of the opposite party wrote the name of the Company as “Fairtred.” No such document was provided either to the agent or staff of the opposite party of above company. Aforesaid wrong information filled in the proposal form was due to the negligence on the part of the opposite party and its representative. There was no suppression of material fact by the complainant. The opposite party illegally repudiated the claim, vide letter dated 05.03.2016.
The Insurer filed its written reply on 03.04.2017 and contested the complaint. The Insurer stated that the deceased life insured (hereinafter referred to as “DLA”) had obtained the insurance policy by supressing the material fact relating to annual income and violated the principle of uberrima fides i.e. utmost good faith. The DLA had provided incorrect information in respect of his occupation, income and marital status in the proposal form. In part-II of the proposal form, the DLA stated that he was the owner of Fair Trade Commodity Pvt. Ltd. having annual income of Rs.450000/-. Income Tax Returns for the assessment year 2012-13 and 2013-14 did not reflect that the DLA was the owner of the Fair Trade Commodity Pvt. Ltd. Clause 10 of the policy provided that the policy is issued on the basis of application and declaration made by the applicant. The claim of the complainant was rightly repudiated in view of clause 10 of the terms & conditions of the insurance policy. If there has been false disclosure of material fact then the insurance company may treat the policy as void from inception and no benefits will be payable by the insurer. As the DLA supressed the material facts regarding marital status, occupation and income, the insurance company was justified in repudiating the claim in view of clause 10 of the policy and the complainant is not entitled to any benefit under the policy. Clause 11 of “Protection of Policyholder’s Interests Regulations, 2002” mandates the requirement of disclosure of material information, which applies to both, the insurer and the insured. Annexure G filed by the complainant is letter of appointment dated 31.03.2014, which makes it clear that the DLA was not the owner of Fair Trade Commodity Pvt. Ltd. but an employee in the said Company. After receiving the claim form, the opposite party made investigation of the claim, wherein it was found that the DLA had provided incorrect information regarding his occupation, income and marital status. From the aforesaid income tax returns, it could not be inferred that the DLA was an employee in Fair Trade Commodity Pvt. Ltd. In the appointment letter dated 31.03.2014 the date of commencement of employment is stated 01.07.2014, which is 8 days prior to filling up the proposal form. There is every likelihood that the DLA had obtained the appointment letter to deceive the opposite party for having exorbitant sum insured of Rs.1 crores. The claim of the complainant was rightly repudiated as per terms & conditions of the policy and in light of the settled judgments of Supreme Court and this Commission. The opposite party relied on the judgment of this Commission in Rakesh Patel vs. LIC & Anr. (RP No.408 of 2013), justifying the repudiation of claim wherein the DLA had provided incorrect information regarding her qualification, employment and income. Supreme Court in LIC vs. Smt. Asha Goel & Anr. (2001) 2 SCC 160. There is no deficiency in service on the part of the opposite party and the complaint deserves to be dismissed.
The complainant filed Rejoinder Reply reiterating the averments made in the complaint that the DLA signed on the blank application form, which was filled by the agent of the opposite party. In fact, the deceased was unmarried that is why his brother was the nominee and this fact was duly communicated to the agent. The complainant filed Affidavit of Evidence of Pramod Kumar. The opposite party filed Affidavit of Evidence of Ankush Saini. Both the parties have filed their written synopsis.
We have considered the arguments of the counsel for the parties and examined the record. The claim was repudiated vide letter dated 05.03.2016, on the ground that income and occupation detail of the DLA as disclosed in the application form were found to be false. In the proposal form date of birth of the DLA was mentioned as 15.07.1979. On the date of insurance, the DLA was below 35 years. The counsel for the opposite party produced a copy of Guide Lines for insurance company, showing that for the age group of 18 years to 35 years, insurance coverage would be 25 times of annual income. In the proposal form, annual income was shown as Rs.450000/- and occupation was shown as the owner of Fairtred Group. In paragraph-3 of the complaint, it is admitted that Pramod Kumar, the complainant was Managing Director of the company “Fairtrade”. In paragraph-12 of the complaint, it has been stated that before June, 2014, Pradip Kumar (the DLA) was doing his personal security trading with Fair Wealth Commodities Broking Pvt. Ltd. In June, 2014, the DLA started his business as commission agent with Fair Trade Commodities Broking Pvt. Ltd. and he was having an income of approximately Rs.4/- lacs per year. As such information in respect of occupation as mentioned in proposal form was admitted incorrect. Downloaded information from internet relating to Fair Wealth Commodities Broking Pvt. Ltd. shows that it was incorporated on 23.06.2014. The appointment letter of the DLA shows that he was appointed on 01.07.2014. Proposal form for insurance policy was filled up on 08.07.2014. Therefore, from this employment, the deceased did not have any income at the time of filling proposal form. In paragraph-12 of the complaint, it has been stated that before June, 2014, Pradip Kumar (the DLA) was doing his personal security trading with Fair Wealth Commodities Broking Pvt. Ltd. but no evidence in this respect was produced. In Income Tax Return for assessment year 2012-13 and 2013-14, gross income of Rs.275300/- and Rs.404500/- have been shown. Both these returns were filed on 31.03.2014, which itself creates doubts in respect of its credibility. From aforesaid discussions it is proved that there was material concealment of the fact and the Insurer is justified in repudiating the claim. Supreme Court in Reliance Life Insurance Company Limited Vs. Rekhaben Nareshbhai Rathod, (2019) 6 SCC 175, held that the facts which were required to be disclosed in proposal form are material facts. After signing the proposal form, no one can say that he had signed the blank form.
ORDER
In view of the aforesaid discussions, the complaint is dismissed.