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Sunita & Another v/s HDFC Standard Life Insurance Co. Ltd.

    Revision Petition No. 3178 of 2013

    Decided On, 09 November 2020

    At, National Consumer Disputes Redressal Commission NCDRC

    By, THE HONOURABLE MR. PREM NARAIN
    By, PRESIDING MEMBER & THE HONOURABLE MR. C. VISWANATH
    By, MEMBER

    For the Appearing Parties: Gurudatta Ankolekar, Joydeep Bhattacharya, Advocates.



Judgment Text

C. Viswanath, Member

The present Revision Petition is filed by the Petitioners under Section 21(b) of the Consumer Protection Act, 1986 against Order passed by the Karnataka State Consumer Disputes Redressal Commission, Bangalore (hereinafter referred to as the "State Commission") in First Appeal No.1977/2007 dated 27.05.2013.

2. Petitioners are the children of the insured Tulsa Bai Kamalapur. The insured had taken HDFC Children's Double Benefit Policy bearing Nos.143275 and 143262 for a sum of Rs.1,00,000/- each, Policies commencing from 11.03.2003. Tulsa Bai Kamalapur expired on 17.02.2006. Father/guardian of the Petitioners submitted insurance death claim with the Respondent/Insurance Company, which repudiated the claim on the ground that the insured had suppressed material facts in the proposal form. Aggrieved by repudiation of the claim, Complainants filed Consumer Complaint before the District Forum with the following prayer: -

"i). To pay Rs.2,00,000/- alongwith bonus and benefits and on that amount interest @ 18% from 17.02.2006 till the date of realization in respect of Petitioner No.2.

ii) To pay Rs.2,00,000/- alongwith bonus and benefits and on that amount of interest @ 18% from 17.02.2006 till the date of realization in respect of Petitioner No.2.

iii) To pay Rs.1,00,000/- towards mental agony to each petitioner.

iv) To pay the cost of the instant proceedings."

3. Opposite Party/Insurance Company resisted the claim on the ground that the insured Tulsa Bai Kamalapur suppressed the material fact that she was suffering from diseases relating to "disorder of liver." It was further submitted that the insured had violated the doctrine of utmost good faith which would enable the Insurance Company to take decision about grant of insurance. Death certificate issued by Care Hospital, Hyderabad admitted the death to HBV related cirrhosis of liver with portal hypertension and Hepato Renal Syndrome. In addition, Department of Gastroenterology of Care Hospital had given the past history as "known case of HBV related cirrhosis of liver with portal hypertension since 4 to 5 years." Tulsa Bai Kamalpur had taken the Policy in March 2003 and before that date she was suffering from cirrhosis of liver, which is a life threatening disease. The disease cirrhosis of liver is long drawn and is usually fatal. It was further submitted that the Policy had been obtained fraudulently with the intention to make undue pecuniary gain. The District Forum, after hearing both the parties and appreciating the evidence led by them as well as based the record of the case, rejected the contention of the Opposite Party/Insurance Company and allowed the Complaint as follows: -

"Complaint is allowed. Guardian of the complainants i.e. Subhashchandra Kamalapur is entitled to recover a sum of Rs.2,00,000/- towards payment of death claim with regard to the policy No.143262 pertaining to Sunita with interest @ 6% per annum from the date of filing of this complaint till the date of realization from O.P. Further he is also entitled to recover a sum of Rs.2,00,000/- towards payment of death claim with regard to the policy No.143275 pertaining to the Mahesh with interest @ 6% per annum from the date of filing of this complaint till the date of realization from O.P. Further he is also entitled to recover a sum of Rs.2,000/- towards mental agony and cost of this proceedings from O.P. Complainants' father Subhashchandra who is natural guardian of complainant No.1 and 2 is directed to deposit the said amount in the name of complainant No.1 and 2 in any nationalized bank till they attain the majority since Tulasabai died leaving behind her children. However, Subhashchandra Kamalapur who is natural guardian of complainant No.1 and 2 is directed to withdraw the interest on the said amount for the purpose of their education etc. Further O.P. is directed to pay the said amount within one month from the date of this order."

4. Aggrieved by the order passed by the District Forum, Respondent/Insurance Company preferred an Appeal before the State Commission. State Commission dismissed the Appeal and confirmed the order passed by the District Forum. Against the order of the State Commission, the Opposite Party/Insurance Company preferred Revision Petition No.4279/2007 before this Commission. This Commission, vide order dated 05.03.3012, set aside the impugned order and remanded the matter to the State Commission to decide the case afresh, in accordance with law, after taking into consideration the entire evidence including Ex. R-6, R-8 and R-9. State Commission, vide impugned order dated 27.05.2013 set aside the order passed by the District Forum and allowed the Appeal. Hence, the present Revision Petition has been filed by the Complainants.

5. Heard the Learned Counsel for the Petitioners as well as Respondent and also carefully perused the evidence placed on record.

6. Learned Counsel for the Petitioners contended that the Opposite Party, without following due procedure and arbitrarily on false and baseless grounds, rejected the Complainants' insurance claim on the ground that the insured had supressed material facts in the Proposal Form. State Commission, while passing the impugned order, failed to appreciate the absence of any independent corroboration. The District Forum rightly granted relief on the ground that the authors of the aforementioned documents were not examined. Death summary report dated 17.02.2006 and Doctor's report dated 26.05.2006 relied upon by the Respondent were insufficient to prove that the deceased policy holder had a history of liver infection, when it is the admitted case that she had been admitted to the hospital only on 12.02.2006 i.e. 5 days before her death. It was further contended by Learned Counsel the Petitioners that the State Commission failed to consider the documents showing that the deceased policy holder was not suffering from any liver problem at the time of submission of Policy application, as evidenced from the Consultant Confidential Report dated 09.03.2003 prepared by Mr. Sandeep Jawalkar, an employee of the Respondent Insurance Company, who specifically stated that the general appearance of the policy holder was normal and that there was nothing unusual about her death. As per Section 45 of the Insurance Act, 1938, no Policy of Life Insurance, after the expiry of 2 years from the date of commencement of the Policy, can be called into question by the insurer on the ground that statements made in the proposal form or in any report of the Medical Officer were inaccurate or false. He contended that the Opposite Party, in rejecting the insurance claim of the Complainants, acted illegally and thus committed deficiency in service.

7. Learned Counsel for the Respondent contended that there was no infirmity in the impugned order of the State Commission and that the Commission had rightly held that the Complainant had not denied the contents of the documents, namely the claim form, Death Report, Death Summary and Doctor's Certificate and that the burden of proof strictly shifts on the Complainants to prove that DLA was not suffering from any pre-existing disease prior to filing of the Proposal Form dated 09.03.2003. He further contended that the State Commission appreciated the fact that in the column of "Past History" of the death summary it was duly stated that the DLA was a known case of "HBV related cirrhosis of liver with portal hypertension since 4-5 years" and the cause of death was also due to the aforesaid ailment, which was never disclosed by the DLA at the time of filing the Proposal Form. The insured had supressed information regarding a very serious ailment while taking the Insurance Policy. The Complainants' claims for insurance were rejected as the Policy was obtained fraudulently, with an intention to obtain undue pecuniary gain.

8. The Petitioners in the present case are the daughter and son of Tulsa Bai Kamalapur who was working as a teacher in a government school. She had taken HDFC Children's Double Benefit Policy bearing Nos.143262 and 143275 for Rs.1,00,000/- each, commencing from 11.03.2003 and the Petitioners were the nominees of the said Policies. The mother of the Petitioners died on 17.02.2006 at Care Hospital, Hyderabad and subsequently the father and legal guardian of the Petitioners' submitted the insurance claim form on 21.04.2006 which was duly received by the Respondent on 28.04.2006. However, the said insurance claim was repudiated by the Insurance Company, vide its letter dated 16.06.2006, on the ground that the information on "LA being known case of HBV related cirrhosis of liver with portal hypertension since 4-5 years and edema was persistent since 1999" was not disclosed in the Applications submitted to the Respondent. Being aggrieved by the repudiation, the Petitioners filed CC No.13 of 2007 before District Forum, Gulbarga.

9. District Forum, Gulbarga, vide order dated 04.08.2007, allowed the Complaint and directed the Respondent to pay a sum of Rs.2,00,000/- each towards the respective policies of Petitioner Nos. 1 and 2, alongwith interest @ 6% p.a. from the date of filing of the Complaint till realization, as well as Rs.2000/- towards compensation. The Respondent challenged the said order of the District forum before the State Commission, Bangalore which was dismissed, vide order dated 25.10.2007. Being aggrieved by the said order dated 25.10.2007, the Respondent preferred Revision Petition bearing No.4279 of 2007 before this Commission, which set aside the order of the State Commission directing it to decide the case afresh, taking into account the entire evidence including the Claim Forms, Death Summary and the Doctor's Report. Thereafter, the State Commission, vide impugned order dated 27.05.2013, allowed the Appeal of the Respondent on remand and set aside the order of the District Forum. The present Revision Petition has been filed challenging the impugned order of the State Commission dated 27.05.2013 whereby the State Commission allowed the Appeal filed by the Respondent and set aside the order of the District Forum dated 04.08.2007.

10. The main issue that arises in the present case is taking on record the three exhibits R-6, R-8 and R-9 i.e. Claim Forms, Death Summary and the Doctor's Report and the applicability of the exception provided under Section 45 of the Insurance Act, 1938. District Forum while admitting the Complaint of the Petitioners, granted relief on the ground that to prove the veracity of the aforementioned documents, the Respondents ought to have examined the authors of the documents. Proceedings contemplated under the Consumer Protection Act, 1986 are summary in nature. It is for the Tribunals to receive and place on record all the necessary, relevant cogent and acceptable facts, though strictly not in accordance with the Evidence Act. There is, therefore, no need to examine the authors of the documents produced by the parties in such cases and therefore, the District Forum erred in rejecting the case of the Respondent solely on the ground of non-examination of important and relevant documents. The State Commission rightly observed that the Petitioners have themselves not disputed the contents of the aforementioned documents and when once prima-facie evidence is placed by marking Xerox copy of the documents with consent, it cannot, therefore, be contended that such documents are concocted. It is now a settled law that if a document is mentioned as exhibit on consent reservation, the contents are not only evidence but are taken as admitted. Further, the Petitioners' reliance on the Consultant Confidential Report dated 09.03.2003 is of no value, as the author of the said report only knew the deceased policy holder for a period of one month and merely stated that during the course of the said month the general appearance and state of health of the deceased policy holder was normal. However, the said report offers no insight into the medical condition of the deceased at the time the life Insurance Policy was taken.

11. The State Commission, vide order dated 27.05.2013, rightly considered the relevant documents and material placed on record i.e. Exhibits 6 to 9 a

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nd appreciated them. In the Death Summary, it is clearly stated that the insured was suffering from liver problem since 4 to 5 years. Even the Doctor's Hospital Certificate mentioned that she was suffering with Hepatitis B infection chronic with partial hypertension since January, 2003. The Policies, however, were taken in March, 2003 i.e. 3 years before her death. Death of the DLA was due to liver cirrhosis. The DLA being aware of the ailment, before taking the Policies, has not disclosed the same information in the Proposal Forms. Based on the aforementioned documents viz the Death Summary, the Death Report and the Doctor's report, it is clear that the policy holder had furnished incorrect information in the Insurance Policy Proposal Forms. 12. It is seen from the record that the Petitioners suppressed information regarding her medical condition, which is material information as far as Policies of Insurance are considered and as such the case of the Petitioners falls within the exception provided in Section 45 of the Insurance Act, 1938. The Petitioners cannot, therefore, avail the benefit of Section 45 of the Act. 13. In view of the above discussion, we are of the opinion that the State Commission has rightly appreciated the evidence and its order dismissing the Complaint cannot be faulted. Revision Petition is, therefore, dismissed.
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