State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt.Pushpabai Devidas Bansode, on 3 May, 2010
1 F.A.No.:1238/2006
Date of filing :30.06.2006
Date of order :03.05.2010
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL
COMMISSION,MUMBAI, CIRCUIT BENCH AT AURANGABAD.
APPEAL NO. :1238 OF 2006
IN COMPLAINT CASE NO.:25 OF 2004
DISTRICT CONSUMER FORUM :NANDED.
Divisional Manager,
Life Insurance Corporation of India,
Divisional Office,
Air Port Road, LIC building,
Nanded,
Through,
Zonal Manager,
Life Insurance Corporation of India,
Western Zonal Office,
At "Yogakshema", Jeevan Vima Marg,
P.O.Box No.11709, Mumbai 400 021. ...APPELLANT
(Org.Opponent)
VERSUS
1. Smt.Pushpabai Devidas Bansode,
R/at Gautam Nagar, Gaikwad Galli,
Mukhed, Tq.Mukhed, Dist.Nanded.
2. Aniket P.Devidas Bansode,
3. Pallavi P.Devidas Bansode,
4. Koyal P.Devidas Bansode,
R/at Gautam Nagar, Tq.Mukhed,
Dist.Nanded. ...RESPONDENTS
(Org.Complainants)
CORAM : Shri.S.G.Deshmukh, Hon`ble Presiding Judicial Member.
Mrs.Uma S.Bora, Hon`ble Member.
Present : Adv.Shri.S.R.Malani for appellant, Adv.Shri.H.I.Pathan for respondents.
2 F.A.No.:1238/2006O R A L O R D E R Per Shri.S.G.Deshmukh Hon`ble Presiding Judicial Member.
1. The present appeal is filed by L.I.C. of India against the judgment and order dated 17.5.2006 in complaint case No. 25/04 passed by District Consumer Forum, Nanded.
2. Respondents`/org.complainants case before the Forum is that, respondent No.1 is wife and respondent No.2 is the son and respondent No.3 & 4 are daughters of the deceased Devidas Bansode who had obtained policy under Plan & term 88-20 under salary savings scheme for sum assured of Rs.1,00,000/- on 11.3.2001. It is contended that Devidas died on 22.6.2003 due to heart attack. Respondent No.1 informed the appellant about the death of life assured and requested to make payment of policy. It is contended that appellant repudiated the claim on 2.12.2003 on the ground that deceased assured suppressed the fact that he was handicap due to polio.
3. The present appellant appeared before the Forum and resisted the claim. It is contended that deceased assured was handicap due to polio. The said fact was not disclosed by deceased in the proposal. He was suffering from bodily defect or deformity. It is contended that insured did not disclose that he had obtained some other policies at the time of obtaining this policy. Thus they have rightly repudiated the claim.
4. The Forum below after going through the papers and hearing the parties allowed the complaint and directed appellant to pay Rs.1,00,000/- with interest @9% p.a. from 31.3.2004. Forum also directed appellant to pay Rs.1,000/- towards cost.
3 F.A.No.:1238/20065. Being aggrieved by the said judgment and order passed by the District Forum, Nanded, L.I.C. came in appeal.
6. Notices were issued to the appellant as well as respondent. Learned counsel Shri.S.R.Malani appeared on behalf of appellant whereas learned counsel Shri.H.I.Pathan appeared on behalf of respondent. Learned counsel Shri.Malani submitted that life assured was physically handicap due to Polio he did not disclose this fact while submitting the proposal. He stated in proposal form that he was not suffering from any bodily defect or deformity. Learned counsel further submitted that he had suffered from paralytic stroke and had hospitalized for emergency from 30.11.2008 to 14.12.1998. Life assured availed leaves for undergoing treatment for illness which he suppressed. He further submitted that life assured was holding 3 policies in his name at the time of submitting proposal for the said policy. The said fact was not disclosed in the present proposal form. Learned counsel submitted that contract of insurance being contract of utmost goods faith. Proposer is required to disclose all information to the insurer in the proposal for the insurance. It is based on answers to the questions in the proposal which are only within knowledge of proposer. Had the deceased life assured disclosed, in the proposal form about his being handicap and received paralytic attack and he was on medical leave and had obtained three policies the policy would not have been issued without calling further reports. Learned counsel further submitted that though deceased died due to heart attack the cause of death had no relevance to the non-discloser of health at the time of purchase of policy. They have rightly repudiated the claim. He relied on LIC -Vs- Smt.Ayesha reported in Legal Digest July 2006 page 198.
7. On the other hand, learned counsel Shri.Pathan submitted that appellant did not adduce any evidence regarding suppression of material particulars by the deceased while submitting proposal.
4 F.A.No.:1238/2006According to him, Forum has rightly considered all these aspects. Learned counsel submitted that appellant was suffering from paralytic attack can not be accepted in the absence of any evidence in that respect. He relied on 'LIC of India -Vs- Joginder Kaur & Ors' reported in II(2005) CPJ 78(NC). He further submitted that there is no nexus between paralytic attack and cause of death-heart attack and thus he submitted that repudiation is unjustified. Learned counsel in that respect relied on 'Sushilabai Shukla -Vs- LIC of India' reported in I(2005) CPJ 78 (Chhattisgarh State Commission). He also relied on 'Vijaya Lakshmi -Vs- L.I.C. of India' reported in IV(2004) CPJ 612 (A.P.State Commission).
8. We perused the papers and gave our anxious thoughts to the arguments advanced by both the counsels and citations relied by them. There is no dispute that deceased had obtained policy under term-plan 88-20 on 11.3.2001. It is the contention of appellant that deceased did not disclose about paralytic attack and availment of leaves on medical ground and earlier policies obtained by him Policy in question is taken on 11.3.2001 and deceased expired on 22.3.2003 due to heart attack. Admittedly there is no nexus between heart attack and paralytic attack which is alleged to have been suffered by deceased.
9. In LIC & others vs. Asha Goal and Anr. AIR 2001 S.C. 549. Hon'ble Apex Court held that, Insurance Act (4 of 1938) S.45--Life Insurance Corporation Act (31 of 1956) S. 303--Repudiation of claim by insured-- Merely on grounds that deceased had withheld correct information regarding his health at time of effecting insurance with corporation--Not proper--Matter of repudiation of policy should not be dealt with in a mechanical and routine manner but should be one of extreme care and caution.
5 F.A.No.:1238/200610. In LIC vs. Smt. Teja Ben Kananbhai Patel reported in 2007 (I) CPR pg. 248 (NC). The Hon'ble National Commission held that, "the hospitalization for fever, rigour pain in throat and difficulty in swallowing eight month before death of insured due to heart attack could not be said to be suppression of material fact by insured so as to disentitle to claim under Life Insurance Policy."
11. In Smt. Alia Begum Vs. LIC reported in 1997 (III) CPR- 60 (NC), The Hon'ble National Commission has held "that, in order to discharge its onus it was for insurance company to place material on the record to show that the deceased suppressed the facts which it was material to disclose, whether a fact is material depends upon the circumstances of a particular case. The test to determine materiality is whether the fact has any bearing on the risk under taken by the insurer. If the fact has any bearing on the risk it is a material fact, if not it is immaterial."
12. In LIC vs. Nishar Khan decided on 08.03.2006 reported in 2006 NCJ 713 (NC). The Hon'ble National Commission held that, Life Insurance - Claim for - Allowed - Sustainability of - Appreciation of evidence - Death due to rupture of appendicitis - Repudiation on the ground that fact of pregnancy not shown - Consideration of - Held - No nexus between cause of death and alleged pregnancy - Repudiation unjustified - Dismissed revision petition.
13. In L.I.C. of India -Vs- Patel Ganesh Bhai Ramji Bhai reported in S.C. & N.C.Consumer Law cases(2005-2008) 32, the National Commission has held that;
Insurance claim-Repudiation-Suppression of material fact- Suffering from T.B.-History record filed by doctor and relied upon by the appellant neither supported by any corroborative evidence in the form 6 F.A.No.:1238/2006 of affidavit nor does it prove that the said treatment has any nexus to the cause of death-The panel doctor of the appellant could have easily noticed from the x-ray that insured was suffering from T.B. which he did not do-Held that there is no suppression of material fact as alleged by the appellant-The documents filed are unreliable to prove the contentions taken by the appellant-No ground to interfere with the well reason order of the State Commission allowing the complaint.
14. In LIC -Vs- Harish Joshi, reported in III 2003 CPJ 743 the Hon`ble National Commission relying on the Hon`ble Supreme Court case Life Insurance Corporation of India -Vs-
Smt.G.M.Chennabasamma, reported in (1991) 1 SSC 357 held "that, Life Insurance Corporation of India was not justified in repudiating the complainant`s case merely on the basis of certificate of hospital treatment without any corroborative evidence especially in view of the fact that the burden of proving that the insured had made false representation and suppressed material facts lay on the LIC of India and if the latter failed to discharge the said burden the repudiation of the claim of the policy holder was unjustified and amounted to deficiency in service on the part of LIC of India".
15. In the instant case, it is the contention of appellant that deceased had availed leave on medical ground. Appellant did not adduce evidence in that respect even appellant did not adduce evidence to show deceased was suffering from paralysis and he had paralytic attack. Appellant simply produced the certificate of concern doctor. Affidavit of doctor is not brought on record. Further it is to be noted that there is no evidence to show that deceased was knowing that non-discloser of earlier policies will help him in obtaining present policy. It was necessary for the appellant to bring on record the evidence showing that because of non-discloser of earlier policies deceased is getting benefit in issuing policy in question. Deceased died due to heart attack. He was said to have suppressed the deformity 7 F.A.No.:1238/2006 and paralytic attack. There is no nexus between cause of death and the alleged suppression of material particular. Forum has considered all these aspects in right perspective and rightly allowed the complaint. We are not inclined to interfere the order passed by the Forum. We pass the following order.
O R D E R 1. Appeal is dismissed. 2. No order as to cost.
3. Copies of the judgment be issued to both the parties.
Mrs.Uma S.Bora S.G.Deshmukh
Member Presiding Judicial Member.
Mane