National Consumer Disputes Redressal
Lic Of India And Ors. vs Smt. Shashi Bala on 12 September, 2003
ORDER
B.K. Taimni, Member
1. Appellant was the Opposite Party before the State Commission.
2. Brief facts of the case are the Respondent/Complainant's late husband, who was a Revenue Village Patwari, had obtained a life Insurance 'twenty year' policy for Rs. 5 lakh commencing Feb. 1996 for which the first half yearly premium of Rs. 16,458/- was paid. Insured died in June 1997. When, on a claim being preferred by the widow/nominee, the claim was repudiated on the ground of concealment of information about the deceased suffering from Diabetes Mellitus, the Complainant filed a complaint before the State Commission alleging deficiency in service on the part of the Appellant. After hearing the parties, the State Commission allowed the complaint - hence this appeal.
3. We heard the learned counsels for the parties and perused the material on record.
4. Basic facts are not disputed hence not being recounted. The only point of controversy is whether there was a concealment of information on the part of the deceased/insured at the time of getting life insurance policy?
5. We have on record the proposal from where in Para 11(c) against the Question "Have you ever suffered from diabetes, TB, BP ..... or any other disease?"
Answer is 'No'.
6. Whereas at the time of claim Enquiry conducted by the Sr. Branch Manager of the Appellant, his enquiry revealed that the deceased was suffering from diabetes and was on oral insulin. His enquiry led him to Doctor Arora, the treating doctor of the deceased, who issued a certificate, which repeatedly states about the deceased having diabetes. He was brought in the witness box and was cross examined by the Learned Counsel of the Complainant. Certificate obtained by the Appellants from the Doctor was issued at the behest of the complainant and in the presence of herself, her brother and officers of the Appellant. Certificate issued by the Doctor and the cross examination only reiterate the fact that the deceased indeed was suffering from diabetes for the last 3 years or so. The only point raised by the learned counsel for the Respondent/Complainant was that the report of the complainant cannot be relied upon as it is not backed by any record of the patient kept by the Doctor. Admittedly there is no record of the patient available but in his cross-examination two points are made by the Doctor. Had the complainant and her brother given the dates of admission, he could have produced the record; since they could not give out the period - record could not be produced. The second point we note is that the deceased was a village Patwari and quite a prominent personage of the village. On that knowledge, Doctor could say that the deceased had come to him and the deceased was having diabetes.
7. In our view there is enough evidence on record to show that the deceased indeed was having diabetes and he was aware of this. We see no contradiction in the report of the Sr. Manager who conducted the claim-enquiry. It is true that Urine Reports were not produced. We are not looking into a case of medical negligence, what we are looking into is the veracity of the entries made by the deceased in the Proposal Form at the time of getting Life Insurance Policy. Doctors in a small place know the patients personally and in this case this is what Dr. Arora has to say in his cross examination.
"As the patient was Patwari by profession of that area and he and his family were well known to me, and on the basis of that I filled the form to the best of my knowledge."
8. In our view the State Commission seriously erred in not only not relying upon the certificate and evidence of Dr. Arora hut also going on to say that 'Diabetes Mellitus is no such a serious ailment which was necessary for the insured to bring it to the noticing of the Corporation at the time of taking the Policy'. No one should forget that 'Policy' is issued on trust and in good faith. It is for both the parties to maintain this well laid principle.
9. Nexus between Diabetes Mellitus and heart attack is too well established in the medical literature to be reiterated here by us.
10. In our view the State Commission went wrong in analysing the fats on record and law laid down on good faith by the Apex Court. We are unable to sustain the order of the State Commission. We, however, in passing would like a observe as pointed out by the learned counsel for the Appellant that the lowest Revenue Functionary,obtained a Policy for Rs. 5 lakh, showing his income as Rs. 1 lakh p.a. and paying a premium of over Rs. 33,000/- as annual premium. All this also appears to have gone unnoticed by the State Commission.
11. In view of discussion on the subject as above, we see no merit in the order passed by the State commission which is set aside - Appeal is allowed. Complaint is dismissed.
12. No order as to costs.