At, National Consumer Disputes Redressal Commission NCDRC
By, THE HONOURABLE MR. JUSTICE V.K. JAIN
By, PRESIDING MEMBER
For the Petitioner: Sounak S. Das, Advocate. For the Respondent: -------
Late Smt. Tabunisha wife of the petitioner/complainant obtained three separate insurance policies from the respondent. On her death, claims under the aforesaid insurance policies were lodged by the complainant/petitioner with the respondent company. The claims, however, were rejected vide letter dated 28.8.2014 on the following grounds:-
“The information available with us
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reveals the following:
The Life Insured was suffering from Tuberculosis, prior to the date of signing the proposal and the Risk Commencement date.
The Income details of the Life to be Insured were found to be grossly discrepant as against the information provided in the proposal form.
In addition to the above, we refer, hereunder, Questions from the Proposal Form in response to which there has been material non-disclosure by the Life Insured.
Under Clause 1.9 of Proposal Form:
Gross Annual Income (In Rs. Per Annum)
“The Annual income of the insured mentioned in the proposal form was found to be untrue at claims stage.”
All the below questions have been replied/respondent to in the negative.”
2. Being aggrieved from the rejection of the claim, the complainant/petitioner approached the concerned District Forum by way of three separate consumer complaints seeking payment in terms of the insurance policies taken by his deceased wife. The complaints were resisted by the insurer primarily on the grounds on which the claims had been repudiated.
3. The District Forum having ruled out in favour of the complainant/petitioner, the respondent approached the concerned State Commission by way of three separate appeals. The appeals were allowed and the complaints were dismissed primarily on the ground that while taking the insurance policies, the deceased wife of the complainant had concealed that she was suffering from Tuberculosis. Being aggrieved from the dismissal of the complaints, the petitioner/complainant is before this Commission.
4. The main contention of the learned counsel for the petitioner/complainant is that the deceased did not die on account of Tuberculosis but had died a natural death. It is, however, not disputed that she was suffering from Tuberculosis at the time the insurance policies were taken. In terms of clause 11.1 of the proposal form, the deceased insured was required to disclose whether she had suffered from any respiratory disease/disorders like asthma, bronchitis, pulmonary TB, lung ailment, etc. and whether she had received any advice for the aforesaid ailments. The insured answered in negative to the aforesaid question, meaning thereby that she represented to the insurer that she was not suffering from Tuberculosis nor she had received any medical advice for the said illness. The aforesaid information was false since she was actually suffering from Tuberculosis. It is, therefore, evident that the deceased insured had concealed information on a material fact which influenced the decision of the insurer in the matter of granting the insurance policies. Obviously either the proposal for insurance would have been rejected or the deceased would have been subjected to further investigation, had she disclosed that she was suffering from Tuberculosis. The insurance policies, therefore, was obtained by acting concealment of a material information thereby playing a fraud upon the insurer. The respondent insurer, therefore, was fully justified in repudiating the claim on the aforesaid ground. The order passed by the State Commission, therefore, does not call for any interference by this Commission in the exercise of its revisional jurisdiction.
5. There is delay of one year in filing the revision petitions. The applications seeking condonation of the said delay have been filed. However, since the petitioner does not succeed on merit, I need not consider those applications. The revision petitions as well as the accompanying applications seeking condonation of delay in filing the revision petitions are, therefore, dismissed.