Tata Aia Life Insurance Company Ltd vs Alpona Mukhapadhyay

THIS case swirls around the question whether late Shri Mrinal Kanti Mukhopadhyay was suffering from pre -existing disease. This is strange country when the doctors warn the patient that his death is imminent, the patient has no other business but to approach the insurance company for getting the insurance policy. He has no qualms about telling the untruth before the insurance company.

IN this case, the deceased, Shri Mrinal Kanti Mukhopadhyay obtained insurance policy on 17.2.2010. He was aged about 54 -55 years. He was being treated by Dr. Samir Bhattacharya. The certificate issued by Dr. Bhattacharya dated 25.11.2010 is reproduced as under: "To Whom it may concern This is to certify that Lt. Mrinal Kanti Mukhopadhyay aged 55 S/o Lt. Mrityunjoy Mukhopadhyay at Officers'' Colony P.O. Muluk, P. S. Bolpur was under my treatment since 17.3.2008 for poor controlled Hypertension and diabetes Mellitus, which was controlled on 07.01.2010 after taking some below pressure medicines and insulin injection."

ON 17.3.2008, he was given prescription, which shows that his BP was 160/100. On 27.7.2008, he was given the prescription and this is pertinent to note that his BP was recorded as 210/100 and he was advised to stop smoking. He continued medical treatment on 12.7.2009. The medical prescriptions are there. Above all, the admission of his pre -existing disease comes out from the horses'' mouth itself. His son Kishan Raj Mokhopadhyay in a written letter admits: " As a company employee I hereby also informed you that the claim investigation has already done and the investigation teams are not found any pre existing disease of my father though my father was suffering from Hypertension and diabetes since 17.3.2008 and my father was under treatment of Dr. Samir Bhattacharya and my was also treated by Dr. A. Chatterjee since 10.02.2010 and as per advise of Dr. A. Chatterjee my father was admitted at Bankure Sewa Niketan. On 17.02.2010 at 7.00 a.m. to 24.02.2010 and also he admitted 25.02.2010 to 25.03.2010 to 05.00.2010 and advice to take rest. I hereby also declare that the policy premium amount deposited on "10.02.2010" by D/D and before 10.02.2010 my father was not suffering from any critical illness except DM and HTM. This is to inform you that we are not lodging any fraud claim by intentionally but a humanly ground. I informed the all true matter as a company employee. Prescription of Dr. Samir Bhattacharya and other relevant document submitted to you by your authorized representative."

LASTLY , there is report dated 18.11.2010 of Banerjee Associates and its para 2 runs as under: "2. We have also met with three workmates, whose are Mr. Mihir Maji (Mob. No. 9474559922), Mr. Shantanu Ghosh (Mob. No. 9474734295) and Mr. Ranjit Sardar (9474456118) and as per verbal discussion with them that the deceased was good healthy and very cheerful person till his last working date (15.02.2010) but three months back he had a stroke in duty hours and admitted at Seva Niketan Nursing Home and after fifteen days later he joined his duty which was continue upto 15.02.2010."

IT is clear that he has suppressed all these facts. The fora below have not considered all these facts. This view dovetails neatly with the Supreme Court Authority in Satwant Kaur Sandhu vs. New India Assurance Co. Ltd., civil appeal No. 2776 of 2002 decided on 10.7.2009 wherein it was held: In Carter v. Boehm (1558 -1774) All ER Rep. 183 Lord Mansfield had succinctly summarized the principles necessitating a duty of disclosure by the assured, in the following words: "Insurance is a contract of speculation. The special facts upon which the contingent chance is to be computed lie most commonly in the knowledge of the assured only; the underwriter trusts his representation, and proceeds upon confidence that he does not keep back any circumstance in his knowledge to mislead the underwriter into a belief that the circumstance does not exist. The keeping back of such circumstance is a fraud, and therefore the policy is void. Although, the suppression should happen through mistake, without any fraudulent intention, yet still the underwriter is deceived, and the policy is void; because the risque run is really different from the risque understood and intended to be run at the time of the agreement .. The policy would be equally void against the underwriter if he concealed . Good faith forbids either party, by concealing what he privately knows, to draw the other into a bargain from his ignorance of the fact, and his believing the contrary."

There can be no conflictions on the point that insurance is a contract of Uberrimae fidei, meaning a contract of utmost good faith on the part of the both the parties. It is a fundamental principle of insurance law that utmost faith must be observed by the contracting parties. Good faith forbids either party from non -disclosure of the facts which the party privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary.

IN Oriental Insurance Co. Ltd. vs. Sony Cheriyan, 1999 6 SCC 451 in para 17, it was held: "The insurance policy between the insurer and the insured represents a contract between the parties. Since the insurer undertakes to compensate the loss suffered by the insured on account of risks covered by the insurance policy, the terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more that what is covered by the insurance policy. That being so, the insured has also to act strictly in accordance with the statutory limitations or terms of the policy expressly set out therein."

CONSEQUENTLY , we accept the revision petition and dismiss the complaint. The bank is also discharged.