BEFORE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CIRCUIT BENCH (COURT No. 2), RAJASTHAN, JAIPUR
Appeal No. 1543/2009
Life Insurance Corporation of India Ltd., through its Manager (LHPF), Divisional Office: ‘Jeevan Prakash’, B.S. Road, Jaipur.
..Appellant-Non-applicants 1-3
VS
Smt. Radha Devi W/o Late Shri Bhanwar Singh Choudhary, R/o Jalsu Nanak, Post Ren, Tehsil Degana, Distt. Nagaur (Raj.)
..Respondent-Complainant
Before:
Mr. G.S. Hora, Presiding Member
Smt. Vimla Sethiya, Member
Present:
Mr. Vizzy Agarwal, counsel for the Appellant
Mr. Amit Kudi, counsel for the Respondent
ORDER Dated: 17.03.2011
PER Mr. G.S. HORA, PRESIDING MEMBER
This appeal arises out of order dated 28.10.2009 passed by the District Consumer Forum (DCF), Nagaur whereby the Appellant Insurance Co. has been directed to pay to the Complainant a sum of Rs. 7,50,000/- along with interest @ 9% per annum from 20.7.2009 to the date of payment besides Rs. 2,000/- as cost of litigation.
The Life Assured (LA) was Late Shri Bhanwar Singh Choudhary who had obtained three policies by filling the proposal forms on 25.5.2006, 15.3.2007 and 30.3.2007. The policy amount was Rs. 3,50,000/-, Rs. 2,00,000/- and Rs. 2,00,000/- respectively. The policy holder died on 24.11.2007. A claim was filed by Smt. Radha Devi being the nominee but the claim for all the three policies were repudiated vide separate letters dated 7.4.2008 on the ground that the LA before submitting proposal forms had suffered from Kidney stone for which an operation was performed but he did not disclose this fact while taking the insurance policies, rather he gave false information.
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The question for consideration is whether the repudiation by the Insurance Corporation on the aforesaid grounds was justified.
Record of Bhandari Hospital & Research Centre (BHRC) has been placed on record which goes to show that the insured Shri Choudhary was admitted in this hospital on 9.12.2002 for the treatment of renal calculi. An operation was performed and the stone was removed. The insured was discharged from the hospital on 13.12.2002. No record of subsequent period has been placed on record, which indicates that the insured must have been cured fully. We have also called for the instructions of the Insurance Corporation wherein the minimum waiting period has been prescribed for various diseases during which life policies are not issued. For stone in kidney, the minimum waiting period is 12 months after cure or six months after operation. When the policies were obtained by the LA, both these periods had expired. As has been said that no record of subsequent period has been produced and therefore we can presume that the patient must have been cured fully. The next question for consideration is whether this was a material fact which was required of the insured to have disclosed in the proposal forms. In Satwant Kaur Sandhu vs New India Assurance Co. Ltd. 2009 (IV) CPJ 8, Hon’ble the Supreme Court has held that the term material fact is not defined in the Act and therefore it has been understood in general terms to mean as any fact which would influence the judgement of a prudent insurer in fixing the premium or determining whether he would like to accept the risk. In this judgement, Regulation 2(1)(d) of the Insurance Regulatory & Development Authority (Protection of Policy Holders Interest) Regulation, 2002 has been referred which defines the word material to mean and include all important, essential and relevant information in the context of guiding the insurer to decide whether to undertake the risk or not. In this particular case, the insured had been treated for renal stone and was discharged from the hospital on 13.12.2002. The policies were obtained in the year 2006 and 2007. Long period had passed after insured was cured. Withholding of such information will not deprive the Complainant from receiving the payment of insured amount.
The learned counsel for the Appellant further argued that this is a case where the LA died because of heart attack. Record of BHRC goes to show that he was treated for heart ailment also. It was recorded in 2002 that he was a known case of IHD (Ischemic Heart Disease). In this regard, opinion of the Cardiologist was also obtained. We regret that such argument cannot be entertained at the appellate stage as this plea was not taken while repudiating the claim
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of the Complainant nor was taken while submitting reply before the learned DCF. A new case cannot be allowed to be introduced at the appellate stage simply on the basis of verbal submission.
For the foregoing reasons, we find no force in this appeal and the same is dismissed.
Member Presiding Member
Hira Lal