Insurance Act, Section 45  - Material fact - Suffering from diabetes, hypertension etc. and getting treatment for ARF was a material fact which must be within the knowledge of the deceased policy holder -  It was, therefore, the bound duty of the deceased to have disclosed these facts and for his failure to do so, he cannot take advantage of section 45 of Insurance Act, on the ground that the death took place after two years of obtaining the policy in question -  Even after the lapse of two years of taking the policy, it was necessary to disclose information about the material facts before the Insurance Company.    NCDRC ON LIFE INSURANCE 2017 ...95

Material concealment - Fact about his intake of alcohol in the proposal form  - Medical documents after his death, he was reported to be a chronic alcoholic with hypertension, ALD, Cirrhosis etc., but there is no material to establish that any of these conditions were occurring at the time of issuance of the policy - It has also been stated in the said documents that the deceased was suffering from hypertension for the last one year -  However, any basis for mentioning this period of one year, has not been indicated - A perusal of the proposal form indicates that the insured disclosed in the same that he used to take 100 ml of alcohol per week for the last 15 years - It has not been clarified anywhere if such an intake shall qualify him to be called a ‘chronic alcoholic’-  In any case, the deceased disclosed the fact about his intake of alcohol in the proposal form and hence, it was upon the Insurance Company to decide whether to issue the policy to him or not -  The insured could not be accused of providing any misinformation.   NCDRC ON LIFE INSURANCE 2017 ...148

Material concealment – In the Proposal form the deceased insured inter-alia maintained that he had not been admitted to any hospital or Nursing home for general observation, treatment or operation -   He had also denied having taken alcoholic drinks -   Statement of wife of the deceased insured wherein she inter-alia stated that her husband was a habitual drinker even before her marriage - Statement recorded on 19.9.2005 would show that the marriage happened about five years ago, meaning thereby it happened sometime in the year 2010 -  Therefore, the deceased insured obviously made a false statement in the proposal form when he denied consuming liquor.  Held, 7.      On merits, the learned counsel for the petitioner Corporation  has drawn my attention to the proposal form dated 16.12.2004, wherein the deceased insured inter-alia maintained that he had not been admitted to any hospital or Nursing home for general observation, treatment or operation.  He had also denied having taken alcoholic drinks.  He has drawn my attention to the statement of Smt. A.R. Sudha, wife of the deceased insured wherein she inter-alia stated that her husband was a habitual drinker even before her marriage.  The statement recorded on 19.9.2005 would show that the marriage happened about five years ago, meaning thereby it happened sometime in the year 2010.  Therefore, the deceased insured obviously made a false statement in the proposal form when he denied consuming liquor. 9.      The learned counsel for the petitioner has also drawn my attention to additional affidavit filed by the petitioner Corporation.  In the said affidavit, it is stated that as per the new business underwriting guidelines which were being followed during the relevant period, in the case of an occasionalConsumer consuming alcohol, the would have obtained physicians report, besides investigations such as SGOT, SGPT and GGTP.  All the aforesaid investigations pertain to the state of health of the liver.  Had the petitioner disclosed in the proposal form that he had been taking liquor he would have been subjected to physical examination by a physician and would also have been investigated for ascertaining the state of his liver by undergoing investigations such as SGOT, SGTP and GGTP.   It is therefore evident that the deceased had made a material concealment from the petitioner Corporation with respect to the state of his health which influenced advantage of the insurer on the question as to whether the proposal for insurance should be accepted or not.  On this ground also, the repudiation of the claim was fully justified.   NCDRC ON LIFE INSURANCE 2017 ...45

Material concealment – In the Proposal form the deceased insured inter-alia maintained that he had not been admitted to any hospital or Nursing home for general observation, treatment or operation -  The record from National Institute of Mental Health and Neuro Sciences Bangalore would show that the deceased had sustained injury of LS spine and had taken treatment for the said injury in the aforesaid hospital -   Therefore, it is obvious that a false answer was given by him in the proposal form when he denied having been admitted to any hospital for treatment or operation – Claim rightly repudiated. Held,      The learned counsel for the petitioner has also drawn my attention to additional affidavit filed by the petitioner Corporation.  In the said affidavit, it is stated that as per the new business underwriting guidelines which were being followed during the relevant period, in the case of an occasionalConsumer consuming alcohol, the would have obtained physicians report, besides investigations such as SGOT, SGPT and GGTP.  All the aforesaid investigations pertain to the state of health of the liver.  Had the petitioner disclosed in the proposal form that he had been taking liquor he would have been subjected to physical examination by a physician and would also have been investigated for ascertaining the state of his liver by undergoing investigations such as SGOT, SGTP and GGTP.   It is therefore evident that the deceased had made a material concealment from the petitioner Corporation with respect to the state of his health which influenced advantage of the insurer on the question as to whether the proposal for insurance should be accepted or not.  On this ground also, the repudiation of the claim was fully justified.   NCDRC ON LIFE INSURANCE 2017 ...45

Material fact  - An information which would influence the decision of the insurer as to whether it should accept the proposal or not and whether it should grant the insurance policy or not, would be a material fact, which a person seeking to obtain an insurance policy must necessarily disclose to the insurer that he had undergone a surgery in April 2005 -   Had he disclosed the said information, the insurer might or might not have accepted the proposal submitted by him -  The insurer might also have asked him to undergo additional investigations in order to verify the state of his health and the risk to his life on account of the surgery he had undergone in April 2005 -  It could also have asked for a higher premium, on account of the insured having undergone the aforesaid surgery -  Since the insured withheld the aforesaid material fact from the insurer while applying for the insurance policy, the insurer was fully justified in rejecting the claim on account of the aforesaid concealment.   NCDRC ON LIFE INSURANCE 2017 ...196

Material fact -  Concealment  - The contention taken by the complainant that the proposal form was filled by an agent, does not provide him any benefit, because it has not been denied that the said form was submitted by the life assured under his own signatures.   NCDRC ON LIFE INSURANCE 2017 ...190

Material fact -  Pension  -  Proposal form submitted by the father of the complainant, Mahabir Singh before the OP Insurance Company shows that he had mentioned in the column, ‘nature of duties’ that he was a pensioner and his source of income was pension and that he was getting Rs. 65,000/- per annum as pension -   On the other hand, it is amply made clear that Mahabir Singh was retired from the Haryana Roadways in the year 2008, because of his weak eyesight and that he was not drawing any pension -   Complainant had nowhere contradicted the version given by the OP Insurance Company that the life assured was not a pensioner -  It is evident, therefore, that it was the duty of the life assured to provide truthful and correct information to the Insurance Company at the time of filling up the proposal form -  The contention taken by the complainant that the form was filled by an agent, does not provide him any benefit, because it has not been denied that the said form was submitted by the life assured under his own signatures.   NCDRC ON LIFE INSURANCE 2017 ...190

 

Material fact concealment  -  Not proved  - Proposal form filled by the complainant on 28th March, 2012 wherein the complainant in response to the questionnaire pertaining to his health, particularly regarding heath ailment and diabetes mellitus has answered in the negative - Hospital record of 11.4.2013 wherein the concerned doctor has recorded that the complainant visited his clinic with history of pain in chest and uneasiness and that the patient was advised ECG which showed some changes - There is also a mention about diabetes mellitus-2 -  This document, is of no avail to the insurance company because the document is of the date after the submission of the proposal form -  Counsel for the petitioner has failed to show any evidence which could lead us to the conclusion that prior to 28.3.2012 the complainant was found suffering from any heart ailment or diabetes mellitus.    NCDRC ON LIFE INSURANCE 2017 ...56