National Consumer Disputes Redressal
Smt. Komal Sharma & Ors. vs Lic Of India & Ors. on 11 February, 2013
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 317 OF 2013 (From order dated 26.10.2012 in First Appeal No. 523 of 2009 of the State Consumer Disputes Redressal Commission, Punjab, Chandigarh) 1. Smt. Komal Sharma, Widow 2. Deepak Sharma, minor son 3. Priyanka Sharma, minor daughter Of Late Sh.Rajeshwar Kumar Sharma C/o Shamsher Singh, H.No.6036 Near Jain Bhawan, Mata Rani Gali Bhatinda Petitioners Versus 1. Life Insurance Corporation of India Divisional Office Urban Estate Phase-I, Dugri, Ludhiana Through its Sr.Divisional Manager 2. Life Insurance Corporation of India Branch Office, Jeevan Jyoti Building Bibi Wala Road, Bhatinda Through its Branch Manager 3. Punjab Water Supply & Sewerage Division Bhatinda Through its Executive Engineer & Ors. Respondents REVISION PETITION NO. 318 OF 2013 (From order dated 26.10.2012 in First Appeal No. 643 of 2009 of the State Consumer Disputes Redressal Commission, Punjab, Chandigarh) Deepak Kumar Sharma Minor son of late Sh.Rajeshwar Kumar Sharma Through natural guardian & mother Smt.Komal Sharma W/o Late Sh. Rajeshwar Kumar Sharma C/o Shamsher Singh, H.No. 6036, Near Jain Bhawan Mata Rani Gali, Bathinda Petitioner Versus 1. Life Insurance Corporation of India Divisional Office Urban Estate Phase-I, Dugri, Ludhiana Through its Sr.Divisional Manager 2. Life Insurance Corporation of India Branch Office, Jeevan Jyoti Building Bibi Wala Road, Bhatinda Through its Branch Manager Respondents AND REVISION PETITION NO. 319 OF 2013 (From order dated 26.10.2012 in First Appeal No. 644 of 2009 of the State Consumer Disputes Redressal Commission, Punjab, Chandigarh) 1. Smt. Komal Sharma, Widow 2. Deepak Sharma, minor son 3. Priyanka Sharma, minor daughter Of Late Sh.Rajeshwar Kumar Sharma C/o Shamsher Singh, H.No.6036 Near Jain Bhawan, Mata Rani Gali Bhatinda Petitioners Versus 1. Life Insurance Corporation of India Divisional Office Urban Estate Phase-I, Dugri, Ludhiana Through its Sr.Divisional Manager 2. Life Insurance Corporation of India Branch Office, Jeevan Jyoti Building Bibi Wala Road, Bhatinda Through its Branch Manager Respondents BEFORE: HONBLE MR.JUSTICE J. M. MALIK , PRESIDING MEMBER HONBLE MR. VINAY KUMAR, MEMBER For the Petitioners in all cases : Mrs. Mridula Ray Bharadwaj, Advocate Pronounced on 11.02.2013 O R D E R JUSTICE J.M. MALIK 1. This order shall decide three revision petitions detailed above. Rajeshwar Kumar Sharma, since deceased who was employed with Punjab Water Supply and Sewerage Division, Bhatinda, OP3, secured two insurance policies in the sum of Rs.1,00,000/- for the period 28.12.2004 to 28.12.2015 and Rs.50,000/- for the period 28.06.1999 to 28.06.2014, respectively, from the Life Insurance Corporation, OPs 1 & 2. Smt. Komal Sharma, the complainant was appointed as a nominee. Unfortunately, the insured expired on 01.08.2006 due to disease of Auto Immune Hepatitis with cirrhosis liver (pneumonia). In all the three cases, the complainants are his widow and minor children who are his only Legal Representatives. Thereafter, the complainant Smt. Komal Sharma made claims of the above said policies in her own capacity and in the capacity of her minor children. The insurance company repudiated their claim on the ground that the deceased had not disclosed the factum of his admission in hospital from 04.09.1996 to 16.09.1996 due to stomach distress, hypertension and lower limb problems. It was also averred that the deceased was suffering from said diseases since 1996 and remained under the treatment in Delhi Nursing Home, Bhatinda and PGI, Chandigarh. Thereafter, Smt.Komal Sharma filed complaints in the capacity of nominee appointed by the deceased and as guardian of their minor children. It is surprising to note that Sh.Pritam Singh Dhanoa, President of District Forum passed both orders dated 24.02.2009. He directed LIC to pay a sum of Rs.1,50,000/- to the complainant in equal shares along with interest @ 9% p.a. vide order dated 02.04.2009. But in another case, vide order dated 09.04.2009, he upheld the repudiation letter and it may be mentioned here that the first order pertains to Smt.Komal Sharma & Ors. and the second order dated 09.04.2009 pertains to the complaint filed by Smt.Komal Sharma & Ors and Deepak Kumar Sharma. 2. All the three complainants preferred appeals before the State Commission. It dismissed the Appeal filed by Smt.Komal Sharma & Ors., in respect of order dated 09.04.2009 and accepted the Appeals filed by LIC against order dated 24.02.2009 meaning thereby he dismissed the complaints. 3. We have heard the counsel for the petitioners. She argued that the question of concealment of ailments of the deceased does not arise because before accepting the policies, the deceased was examined by a panel of doctors of the respondent, LIC of India. She vehemently argued that the deceased died due to pneumonia and as such suppression of ailment does not arise. 4. Instead of touching the heart of the problem, the learned counsel for the petitioners just skirted it. The State Commission has mentioned that documents Ex.R7 to R13 of PGI, Chandigarh clearly go to reveal that the deceased was diagnosed by the doctors and he was suffering from cirrhosis of liver. There is ultra sound report, Ex.R-14 which also shows that he was suffering from cirrhosis of liver, ascites and portal hypertension. The State Commission also observed that Ex.R-15 issued by PGI, Chandigarh, dated 28.08.1996 mentions Test indicates the absence of antibodies to HCV core antigen and proteins NS-3 and NS-4 were detected in the test. The respondent also placed Ex.R-18 to R-29 of the PGI regarding the treatment. 5. Again, Dr.Rupinder Singh Sidhu of Malwa Super Specialty Hospital, Bhatinda, examined the patient and issued certificates Ex.R-36 and R-37 showing that the deceased was treated for cirrhosis of liver from 12.06.2006 to 30.06.2006 and 01.07.2006 to 31.07.2006. Form No.3816, Ex.R-38 which depicts that all ailments of deceased clearly go to show that he was suffering from Auto Immune Hepatitis for the last 10 years and he died due to Cardio Respiratory Arrest, Auto Immune Hepatitis and due to pneumonia. The deceased also remained under treatment of Dr.Rupinder Singh Sidhu and later died in his hospital. 6. In his proposal form, the petitioner denied that during the last five years, he had consulted a Medical Practitioner for any ailment requiring treatment for more than a week. He also denied that he was admitted to any hospital or Nursing Home for general check-up. He also denied that he had ever suffered from ailments pertaining to liver, stomach, heart, lungs, brain or nervous system. 7. The respondent produced record from the Delhi Nursing Home, Bhatinda, Ex.R-3, and PGI, Chandigarh, Ex.R-4 and Ex.R-29, to prove that the insured deceased had taken treatment from the above said hospitals in the year 1996. While dismissing the appeals filed by the complainants, the learned State Commission placed reliance on various authorities. 8. When confronted with such a situation, the learned counsel for the petitioner could not explain. As a matter of fact, she had no answer. The Honble Apex Court in Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd., reported in IV (2009) CPJ 8 (SC), held as under:- 12. .A medi-claim policy is a non-life insurance policy meant to assure the policy holder in respect of certain expenses pertaining to injury, accidents or hospitalisations. Nonetheless, it is a contract of insurance falling in the category of contract uberrimae fidei, meaning, a contract of utmost good faith, on the part of the assured. Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. It is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not. Of course, obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known. The obligation to disclose necessarily depends upon the knowledge one possesses. His opinion of the materiality of that knowledge is of no moment. (See: Joel Vs. Law Union & Crown Ins. Co. [1908] 2 K.B. 863). 13. In United India Insurance Co. Ltd. Vs. M.K.J. Corporation, III (1996) CPJ 8 (SC)=(1996) 6 SCC 428, this Court has observed that it is a fundamental principle of insurance law that utmost faith must be observed by the contracting parties. Good faith forbids either party from non-disclosure of the facts which the party privately knows, to draw the other into a bargain, from his ignorance of that fact and his believing the contrary. (Also see: Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd., II (2000) SLT 323 = I (2000) CPJ 1 (SC) = (2000) 2 SCC 734). 17. The term material fact is not defined in the Act and, therefore, it has been understood and explained by the courts in general terms to mean as any fact which would influence the judgment of a prudent insurer in fixing the premium or determining whether he would like to accept the risk. Any fact which goes to the root of the Contract of Insurance and has a bearing on the risk involved would be material. 18. As stated in Pollock and Mullas Indian Contract and Specific Relief Acts, any fact the knowledge or ignorance of which would materially influence an insurer in making the contract or in estimating the degree and character of risks in fixing the rate of premium is a material fact. 8. Consequently, all the revision petitions are without any force and the same are dismissed. ...
(J. M. MALIK,J.) PRESIDING MEMBER ...
(VINAY KUMAR) MEMBER dd/14,15&16