PUSHPADEVI YADAV vs L.I.C.

THIS appeal under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 31.10.2001 in complaint No. 7/2000 by the District Consumer Disputes Redressal Forum, Durg (hereinafter called the "Distt. Forum" for short), dismissing the claim of the complainant/appellant regarding life insurance policy No. 381076039 for assures sum of Rs. 16,000/- and policy No. 380530654 for assured sum of Rs. 12,000/- obtained by the insured Janaklal Yadav, the husband of the complainant/appellant.

UNDISPUTABLY, the husband of the complainant Janaklal Yadav obtained three life insurance policies, Policy No. 381071429 was for an assured sum of Rs. 25,000/-. The other two policies as detailed above were also obtained by the deceased in the month of July, 1997 and August, 1997. It is also not in dispute that the insured Janaklal Yadav met with a road accident in July, 1997 and ultimately died on 23.1.1998 due to injuries sustained in the said accident. After the death of the deceased insured Janaklal Yadav, the complainant/appellant being the nominee under the said policies, laid claim with the respondent insurer for payment of the amount under the policies. The claim of the complainant/appellant was however repudiated by the insurer/respondent. The complainant, therefore, preferred the complaint before the Distt. Forum seeking payment under all the three policies as above. The complaint was resisted by the insurer/respondent. It was averred that the insured has suppressed material facts at the time of submitting proposal forms regarding policy No. 381076039 and policy No. 380530654. Therefore, the complainant could not get the benefit of the said policies.

The Distt. Forum though allowed the complaint, so far as policy No. 381071429 is concerned. However, the complaint was dismissed for the other two policies as mentioned above.

IN this appeal, the complainant/appellant has challenged the dismissal of her complaint regarding policy Nos. 381076039 and 380530654. It was submitted by the learned Counsel for the complainant/appellant that the repudiation of the claim of the appellant by the respondent/insurer was not justified and she was entitled to get the benefit under the aforesaid two policies. It has to be considered as to whether the repudiation by the insurer respondent of the complainant's claim under the aforesaid two policies was justified?

IT may be noticed that complainant's claim under policy No. 380530654 was repudiated by the respondent insurer by their letter dated 15.1.1999 on the ground that the insured had suffered head injury in the road accident prior to submission of proposal form. He also remained admitted in the hospital from 15.8.1997 to 21.8.1997 for the treatment of the said injuries. However, he has suppressed the material fact as above, in his proposal form. Regarding policy No. 381076039, the claim was repudiated by the respondent/insurer by their letter dated 15.1.1999 on the ground that before acceptance of the proposal form on 28.8.1997, the insured had already suffered injury and was admitted in the hospital from 15.8.1997 to 21.8.1997. He was, therefore, obliged to intimate of the said ailment in terms mentioned in the proposal form. However, as he failed to do so, the policy stood cancelled as was specifically stipulated in the proposal form. It is not in dispute that the proposal form for policy No. 380530654 was submitted by the insured on 23rd August, 1997. It is also not in dispute that prior to the submission of the proposal form as above, the insured Janaklal had already suffered head injury and was under treatment an indoor patient in the hospital of Bhilai Steel Plant, as evidenced by the copy of the medical certificate on the record of Distt. Forum. However, in the proposal form, the above facts were suppressed by the insured and the answer regarding queries in the said proposal regarding ailment, treatment, admission in the hospital, etc. have been replied in the negative, by the insured and his general health was stated to be good by him. Obviously the information given in the proposal form, as above was false as the insured Janaklal had already met with an accident, recently and was actually remained admitted in the hospital for treatment of his injuries including on the head. Such a suppression was clearly breach of faith due to which the agreement of insurance stood vitiated. Therefore, the nominee under the said policy No. 380530654 cannot get any benefit under the said policy. Her claim was rightly repudiated by the insurer/respondents. So far as policy No. 381076039 is concerned, the proposal form therefor was filled up on 30th July, 1997. The said policy was accepted on 28.8.1997 and the coverage of risk from 28.7.1997 to 28.8.2007. It is also not in dispute that before the acceptance of the proposal and issuance of the policy as above, the complainant had suffered from head injuries on account of road accident in July, 1997 and was admitted in the hospital. However he did not intimate the respondent Life Insurance Corporation about the said accident and injuries suffered by him. It may be noticed that as per terms of the proposal and declaration filled up by the insured the disclosure as above was necessary and it was stipulated that failure on his part would result in cancellation of the policy.

IN view of the above, it is clear that the other policy No. 38107639 also stood cancelled, due to non-disclosure of the material fact as above by the insured. The repudiation of the complainant's claim under the said policy was, therefore, also justified.

THE Distt. Forum has, therefore, correctly come to the conclusion that the complainant's claim under the said two policies cannot be accepted. We affirm the said finding. This appeal has no merit. It is accordingly dismissed. Appeal dismissed.