State Consumer Disputes Redressal Commission
Shri Vivek V. Morajkar, vs Life Insurance Corporation Of India, on 14 January, 2010
THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION PANAJI GOA Present: Smt. Sandra Vaz e Correia Presiding Member Smt. Caroline Collasso Member Appeal No. 2 of 2009 Shri Vivek V. Morajkar, R/o Flat No. B-1, Building No.2, Ground Floor, Kenkar Estate, Cabassa, St. Cruz, Ilhas Goa. Appellant (Original complainant) v/s Life Insurance Corporation of India, Goa Division Office, Jeewan Viswas, EDC Complex, Patto, Plot No.2, Panaji-Goa. Respondent (Original opposite party) For the Appellant Shri Rebello, Advocate For the Respondent Shri A.K.P. Moye, Advocate Dated: 14-01-2010 ORDER
[Per Smt. Sandra Vaz e Correia, Presiding Member]
1. This appeal is directed against the order dated 11-11-2008 of the District Forum, North Goa, in complaint No.25/06. The present appellant was the complainant and the respondent herein was the opposite party before the District Forum. For the sake of convenience they will be described as such.
2. Relevant facts of the complaint to decide this appeal are that the complainants wife, since deceased who was working in Goa Medical College as radiographic technician secured a Life Insurance Policy with the opposite party, covering a sum of Rs. One lakh. However, she died on 12-07-1999 the cause of which was diagnosed as Systemic Lupus Erythematsir by Dr. M. B. Agarwal from Mumbai.
3. When the complainant lodged the claim with the opposite party, the same was repudiated by them vide letter dated 04-02-2000 on the ground that the proposal for insurance dated 06-02-1999 was signed by his deceased wife by furnishing false information. They have further stated in the letter that his deceased wife was suffering from various sicknesses such as tube ovarian mass-genital cocks, lapratocmy, ovarian cysts with fibroid uterus. They have further stated that his deceased wife was under treatment for the said sickness by availing medical leave from time to time in Goa Medical College. At the time of payment of the first installment of premium his deceased wife was on medical leave for treatment of pancytopania.
4. It is the case of the complainant that his deceased wife obtained a policy through the LIC agent who filled the form in good faith and stated the health condition of his deceased wife to be good.
5. However, on 09-02-1999 when his deceased wife was admitted to GMC with fever, she was diagnosed to be suffering from malaria spelamonagly anemia and was referred to Tata Memorial Hospital at Mumbai. There it was found that she was having pessytspomia due to malaria. The Tata Memorial Hospital, Mumbai referred her to Dr. M. B. Agrawal, Mumbai who diagnosed her sickness to be that of S.L.E (Systemic Lupus Erythematesir) and she died out of that sickness.
6. The complainant has contended that his wife died on account of S.L.E. and it has nothing to do with other sicknesses mentioned by the Opposite Party such as genital ovarian cysts that should have been suppressed by his deceased wife. There was no malafide intention on the part of his deceased wife as the form was filled by the agent in good faith.
He has filed the present complaint challenging the repudiation of his claim and seeking for the settlement of his claim with compensation.
7. In their written version, the opposite party has stated that since the death of the insured occurred within two years from the date of issue of the policy they carried out investigation pertaining to the health of the policy holder. They secured leave details of the insured from her employer, Goa Medical College and also obtained certificates of employer under their claim form E 3787(E) which was signed by the Director (Administration), Goa Medical College.
8. As per statement of leave provided by her employer for the period from 06-05-1996 to 23-02-1999, she was on leave on ten different occasions and the details of the dates and periods during which she was on leave, the reasons for her leave and whether any medical certificates were provided by her in case of sick leave were also given in the said statement. They have also provided the details of sick leave availed by her on these occasions for the period from 08-05-1996 to 25-02-1999 alongwith the number of days availed and the name of the doctors who issued fitness certificates.
9. It is their case that the deceased had intentionally given wrong answers to the questions under sr. no.2 in the proposal for insurance by giving almost all negative answers therein except answer to Question No.11 (b) wherein she had stated that she had two deliveries.
10. They have further stated that the deceased answered answers in negative to the questionnaire under sr. 11 in the proposal form like whether she consulted a local practitioner for any ailment for more than a week, whether she remained absent on medical grounds from place of work or grounds of health during last five years, whether she is suffering or suffered from diabetes, B.P., T.B. etc. or any disease. She has also stated her usual state of health to be good.
11. However, through the statement of leave and applications for availing medical leave and fitness certificate of the deceased, the opposite party came to the conclusion that the deceased has suppressed material facts. Any concealment of facts or suppression of material information pertaining to the insured would render the contract of insurance invalid.
In case she had disclosed the disease suffered by her, they might not have accepted the risk. They have placed reliance on various decisions of the National Commission in support of their claim. It is their case that they are satisfied in repudiating the claim of the complainant on account of suppression of facts by the policy holder.
12. The District Forum after going through the records and documents, dismissed the complaint vide its order dated 11-11-2008.
13. We have gone through the material on record and considered the written arguments advanced by both the parties.
14. It is by now well settled law that contract of insurance is a contract uberrimae fides and the insured is obliged to disclose all the material facts that are relevant for the Insurance Company to decide on the issuance of policy to the insurer. It is an admitted fact that the insured had suffered an illness as brought on record by the Opposite Party. It has also not been denied that she had been off and on, on medical leave between the period of five years prior to submitting the proposal for insurance. Admittedly, there is non-disclosure of material facts which may be totally unintentional. However, the Opposite Parties were deprived of an opportunity to consider whether to issue the policy or not for the insured. In LIC of India v/s Smt. Ayesha (Revision Petition No.3362/04) the National Commission has categorically stated that ultimate cause of death of insured had no relevance as regards disclosing of information regarding the state of health as required by clause 18 of the proposal form.
15. In view of the above we do not find any merit in the appeal and hence we pass the following:
ORDER Appeal stands dismissed with no order as to costs.
Pronounced.
[Sandra Vaz e Correia] Member [Caroline Collasso] Member