State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt. Geeta Rani on 9 March, 2022
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND
DEHRADUN
FIRST APPEAL NO. 130 / 2019
Life Insurance Corporation of India
Divisional Office, Haridwar Road
Dehradun through its Manager
...... Appellant / Opposite Party
Versus
Smt. Geeta Rani W/o late Sh. Abhay Dass
R/o Village and Post Office Khanjarpur
Tehsil Roorkee, District Haridwar
...... Respondent / Complainant
Smt. Anjali Gusain, Learned Counsel for the Appellant
Sh. Sunil Kumar Singh, Learned Counsel for Respondent
Coram: Hon'ble Mr. Justice D.S. Tripathi, President
Mr. Udai Singh Tolia, Member-II
Dated: 09/03/2022
ORDER
(Per: Justice D.S. Tripathi, President):
This appeal under Section 15 of the Consumer Protection Act, 1986 has been preferred against the impugned judgment and order dated 07.03.2019 passed by the District Consumer Disputes Redressal Commission, Haridwar (in short "The District Commission") in consumer complaint No. 446 of 2015; Smt. Geeta Rani Vs. Branch Manager, Life Insurance Corporation of India, by which the consumer complaint was allowed and the appellant - insurance company was directed to pay the insured amount of Rs. 3,00,000/- to the respondent
- complainant together with interest @6% p.a. from the date of institution of the consumer complaint till payment and Rs. 5,000/- towards costs.2
2. Facts giving rise to this appeal, in brief, are that according to the consumer complaint, late Sh. Abhay Dass, the deceased husband of the complainant - Smt. Geeta Rani, was employed as Lab Assistant in Central Building Research Institute, Roorkee. During his lifetime, he had obtained a life insurance policy from the appellant - insurance company on 03.07.2012 bearing policy No. 273428711 for insured sum of Rs. 3,00,000/-. The amount of premium was used to be deducted from his salary, for remittance to the insurer. The complainant was nominated by the life assured as nominee under the policy. On 11.02.2014, the life assured died on account of heart attack. The complainant lodged a claim with the insurer for payment of the insured amount, which was turned down. Legal notice dated 01.07.2015 was sent by the complainant to the insurer, but to no avail. Hence, consumer complaint was instituted before the District Commission.
3. Written statement was filed by the insurance company, wherein it was averred that at the time of submitting the proposal form for the insurance policy in question, the life assured gave incorrect information with regard to his health and the life assured had obtained the insurance policy by concealment of material facts. At the time of obtaining the insurance policy, the life assured was not hale and hearty. Upon receipt of the claim, investigation was carried out at the instance of the insurer, in which, it was revealed that as per the report of the doctor coupled with other documents, the life assured was suffering from hepato, ascites, thrombosis and alcoholic liver disease with cirrhosis of liver, from before taking the insurance policy. The life assured remained under the treatment of Pal Clinic & Nursing Home, Roorkee for the period from 23.12.2011 to 24.02.2012 in regard to the above disease and he also remained on medical leave from his office from 23.12.2011 to 22.01.2012. On account of the 3 above reasons, the claim was rightly repudiated through letter dated 16.03.2015 and by doing so, no deficiency in service was committed.
4. After giving opportunity of hearing to both the parties, the consumer complaint has been allowed by learned District Commission vide impugned judgment and order dated 07.03.2019, granting the relief in the above terms. Feeling aggrieved, the appellant has preferred the instant appeal.
5. We have heard rival arguments advanced by learned counsel for the parties and perused the record.
6. Learned counsel for the appellant submitted that material facts relating to previous disease of the life assured were concealed by him and the life assured failed to exercise good faith at the time of submitting the proposal form for issuance of insurance policy in question. She further submitted that there was reasonable nexus between the previous disease concealed by the life assured and the cause of his death. Hence, the claim of the complainant has been rightly repudiated by the insurance company and the appeal filed by the insurance company deserves to be allowed and impugned judgment and order passed by learned District Commission is liable to be set aside.
7. Per contra, learned counsel for respondent - complainant submitted that there was no reasonable nexus between the concealment of previous disease by the life assured and the cause of his death. The impugned judgment and order passed by learned District Commission is based on sound reasoning and proper appreciating of evidence on record and the same does not call for any 4 interference. The appeal has no legs to stand and the same is liable to be dismissed.
8. We find from the record that the question with regard to his health was put to the life assured at the time of submitting the proposal form for the policy. The question was "Whether during last 5 years did you consult a medical practitioner for any ailment requiring treatment for more than a week?" The aforesaid question was answered by the life assured in negative. Accordingly, the life assured replied that he did not consult a medical practitioner for any ailment requiring treatment for more than a week, during the last 5 years'. Learned counsel for the appellant submitted that there is evidence on record to establish that the life assured had consulted a medical practitioner in regard to his ailment before issuance of the insurance policy in question. Accordingly, she submitted that the life assured failed to exercise good faith at the time of submitting the proposal form for issuance of the insurance policy. In support of her contention, she has relied upon certain documents available on record. Learned counsel for the appellant has cited judgment dated 09.10.2020 rendered by Hon'ble Apex Court in Civil Appeal No. 3397 of 2020; Branch Manager, Bajaj Allianz Life Insurance Company Limited and others Vs. Dalbir Kaur, in which the law laid by Hon'ble Apex Court in Life Insurance Corporation of India Vs. Asha Goel reported in (2001) 2 SCC 160; P.C. Chacko Vs. Chairman, Life Insurance Corporation of India reported in (2008) 1 SCC 321 and Satwant Kaur Sandhu Vs. New India Assurance Company Limited reported in (2009) 8 SCC 316, have been referred. Relying upon the aforesaid judgments rendered by Hon'ble Apex Court, learned counsel for the appellant submitted that a policy of insurance is governed by the principle of utmost good faith and suppression of any material fact by the life assured / insured entitles 5 the insurance company to repudiate the policy under Section 45 of the Insurance Act, 1938.
9. We have perused the documents relied upon by learned counsel for the appellant. Medical certificate dated 23.01.2012 has been issued by Dr. Rajendra Pal (M.D.) of Pal Clinic & Nursing Home, Roorkee, certifying therein that the life assured remained under his treatment and he requires rest for a period of 19 days', i.e., for the period from 23.01.2012 to 10.02.2012. Another certificate dated 18.01.2012 has been issued by the same doctor, i.e., Dr. Rajendra Pal (M.D.), thereby certifying that the life assured requires further rest from 11.02.2012 to 24.02.2012 (14 days'). We also find from the record that the life assured had applied for medical leave from his office for the period from 23.12.2011 to 22.01.2012, on the ground that on account of his ill health, he is not able to come to the office. Perusal of aforesaid medical certificates issued by the medical practitioner shows that the disease suffered by the life assured mentioned by the medical practitioner in the certificates is illegible. The insurance company could have contacted the above-mentioned medical practitioner through its investigator to make it clear as to from which disease, the life assured was actually suffering from and what medical treatment was provided by the medical practitioner to the life assured, but there is no evidence available on record that the investigator appointed by the insurance company had collected any evidence from the above-mentioned medical practitioner to make it clear what treatment was provided by him to the life assured and in relation to which disease.
10. Another medical certificate dated 10.11.2013 issued by Dr. Ravi Kumar Jain of Vardhman Hospital, Roorkee is on record, according to which, the life assured was suffering from hepato, 6 ascites, thrombosis and alcoholic liver disease with cirrhosis of liver, regarding which the life assured was treated as an OPD patient from 21.10.2013 onwards and he was advised rest from 21.10.2013 to 10.11.2013. The said certificate does not provide any help to the insurance company, as the same pertains to the period after the issuance of insurance policy.
11. The evidence available on record clearly indicate that the life assured was treated for some disease before commencement of insurance policy, which he did not disclose at the time of submitting the proposal form. The question to be decided in the instant appeal is whether the previous disease of the life assured was related to the cause of his death or not. Learned counsel for the appellant has relied upon the medical certificate dated 10.11.2013 issued by Dr. Ravi Kumar Jain. Her submission is that the life assured died due to heart attack and he was suffering from the disease known as liver cirrhosis. Liver cirrhosis is a life-threatening disease and the same is co-related with the cause of death of the life assured, hence this material fact was suppressed by the life assured and the insurance company was fully justified in repudiating the claim, but the aforesaid medical certificate dated 10.11.2013 is after the date of commencement of insurance policy, i.e., 03.07.2012. Learned counsel for respondent submitted that the life assured could not have imagined at the time of submitting the proposal form for issuance of insurance policy that he may develop a life-threatening disease like liver cirrhosis in future. We find from the record that there is no evidence on record to prove that the life assured was hospitalized before commencement of the insurance policy for the treatment of liver cirrhosis, nor there is any evidence of taking treatment relating to liver cirrhosis.
712. Thus, evidence available on record clearly indicate that the life assured was treated for the disease of liver cirrhosis after the commencement of insurance policy, which is not material in the given facts and circumstances of this case. No doubt that the life assured had concealed about some disease, for which he was treated by the medical practitioner and rest was advised to him, but the treatment of the life assured for the life-threatening disease (liver cirrhosis) before submission of the proposal form for the insurance policy in question, is not borne out from the record. Hence, it can not be said that there was concealment of pre-existing life-threatening disease by the life assured at the time of submitting the proposal form. Thus, it is not established from evidence available on record that concealment of pre-existing disease by the life assured was co-related to his cause of death.
13. For the foregoing reasons, we are of the considered opinion that the impugned judgment and order passed by learned District Commission does not call for any interference by this Commission. The appeal being bereft of any merit, warrants dismissal.
14. Appeal is dismissed. No order as to costs.
(U.S. TOLIA) (JUSTICE D.S. TRIPATHI)
Member-II President
K