Bajaj Alliance Life Insurance … vs A.G.Lalithabhai on 26 August, 2009

       

  

  

 
 
  IN THE HIGH COURT OF KERALA AT ERNAKULAM

WP(C).No. 24479 of 2009(D)


1. BAJAJ ALLIANCE LIFE INSURANCE CO.LTD.,
                      ...  Petitioner

                        Vs



1. A.G.LALITHABHAI, PEECHENKURICHIL HOUSE,
                       ...       Respondent

2. THE INSURANCE OMBUDSMAN, KOCHI,

                For Petitioner  :SRI.JOMY GEORGE

                For Respondent  : No Appearance

The Hon'ble MR. Justice V.GIRI

 Dated :26/08/2009

 O R D E R
                           V.GIRI, J
                        .......................
                      W.P.(C).24479/2009
                        .......................
            Dated this the 26th day of August, 2009

                         JUDGMENT

Petitioner challenges Ext.P14 order passed by the

Insurance Ombudsman. Ext.P14 came to be passed on a

complaint filed by the 1st respondent, the legal representative

of one P.D.Sivakumar who had taken a capital unit gain policy

for an assured sum of Rs.1 Lakh at an annual premium of

Rs.10,000/- by submitting a proposal on 10.1.2007. Sivakumar

died on 30.4.2008 due to Toxi Epidermal Necrolysis followed

by acute renal failure, while employed as a technician in VTT

Technology Services Ltd.

2. A claim made by the 1st respondent, the legal

representative, was repudiated on the ground that Sivakumar

was suffering from Psoriasis three years prior to the date of

his admission in the hospital, that therefore, he must have

been suffering from Psoriasis when he submitted the proposal

for a policy, but this was not disclosed in the proposal. The

contract of Insurance is one of good faith and therefore, the

Insurance Company is entitled to repudiate the same.

W.P.(C).24479/09
2

3. Documentary evidence was submitted by both sides.

The Insurance Ombudsman referred to the note submitted on

behalf of the Insurance Company which affirms the

repudiation by stating that the deceased was suffering from

Psoriasis for three years. Other documents produced by the

Insurance Company were also referred to by the Insurance

Ombudsman and it was found that the repudiation was on the

ground that the Insured has suppressed the material facts.

The Ombudsman considered whether the fact in question was

suppressed.

4. The Ombudsman referred to clause 14 of the proposal

form containing a query whether the Insurer has been treated

similarly for any way of the conditions which are mentioned

therein. Answer given is in the negative. Apparently there

was no specific query in addition to any skin disease.

Reference was made to the certificate produced by the

Insurance Company, produced and marked as Ext.P9 in the

writ petition wherein the doctor, who treated the insured who

was admitted in the Co-operative Medical College, certified

W.P.(C).24479/09
3

that the deceased was admitted with Toxi Epidermal

Necrolysis and Renal failure. It was further certified that he

did not have a lesion of Psoriasis. But he gave a past history

of Psoriasis. Duration of the said disease was not mentioned

in the said certificate and Ombudsman took note of this

materials and found that there is no material to come to the

conclusion that the deceased was aware of his affliction,

even at the time when he had submitted a proposal in January

2007. It was found that thus, there is no material to show

that there was a wilful suppression of material facts by the

insured when he had submitted the proposal in January 2007.

Nor is there any material to clearly establish any nexus

between the condition of Psoriasis and the cause of death or

any other material to indicate that the condition would

definitely have been revealed to the deceased when he had

submitted the proposal for insurance on 22.1.2007.

5. I am in agreement with the conclusions arrived at in this

regard by the Ombudsman. Even otherwise the grounds for

interference with the finding of the fact by an authority like

W.P.(C).24479/09
4

Insurance Ombudsman are limited. This Court does not

exercise any appellate jurisdiction. On judicial review, I do

not find any grounds for interference with Ext.P14.

6. The claim was only for an amount of Rs.1 Lakh. Even

otherwise, I am of the view that the repudiation of the policy

in the circumstances, was not justified. For all these reasons,

I find that the writ petition is bereft of merit and hence the

same is dismissed.

V.GIRI,
Judge

mrcs