State Consumer Disputes Redressal Commission
Lic Of India & Anr. vs Smt. Bimla Devi on 5 April, 2007
H H.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, SHIMLA. Appeal No. 29/2006. Date of Decision 05.04.2007. 1. Life Insurance Corporation of India, Branch Office Hamirpur, H.P. through its Branch Manager, 2. Life Insurance Corporation of India, Divisional Office, Block No. 14 & 15, SDA Complex, Kasumpti, Shimla 171 009 through its Divisional Manager, 3. Life Insurance Corporation of India, Northern Zonal Office, Jeevan Bharti P.B. No.630, Cannaught Circus, New Delhi through its Zonal Manager. . Appellants. Versus Smt. Bimla Devi W/o late Sh. Amar Nath Kapil, R/o Vill. Kotlu, PO Uttap, Tehsil Nadaun, District Hamirpur, H.P. . Respondent. Honble Mr. Justice Arun Kumar Goel, President. Honble Mr. Narinder Singh Thakur, Member. Honble Mrs. Saroj Sharma, Member. Whether Approved for reporting? No. For the Appellants. Mr. Varinder Tajta, Advocate. For the Respondent. Mr. K.S. Banyal, Advocate. O R D E R:
Justice Arun Kumar Goel (Retd.) President, (Oral) Heard learned counsel for the parties. Admitted facts of this case are that deceased Shri Amar Nath Kapil was the husband of respondent and was insured in the sum of Rs. 1 lac. Policy Annexure R-1 was issued in this behalf, its date of commencement is 19.3.1999 and mode of payment of premium was yearly. He died on 28.1.2001. He had paid the last premium in the month of March, 2000, and next premium was due in the same month of 2001, Respondent was nominated as his nominee by the deceased in the policy Annexure R-1.
Whether Reporters of Local Papers may be allowed to see the Order? Yes.
2. After the death of her husband being the nominee, respondent approached the authorities of the appellant-Insurance Company for settlement of the claim and payment to her. Needful was not done, therefore, this resulted in filing of the complaint under Section 12 of the Consumer Protection Act, 1986, (hereinafter to referred as the Act). This complaint was resisted on the sole ground that the deceased withheld material information regarding his health at the time of effecting the insurance with the appellants, as also regarding his suffering from enteric fever and pain in epigastric region, as also having availed medical leave for 52 days. These facts were not disclosed by him in the proposal/personal statement. To the contrary, he gave false answers and in this behalf great emphasis was laid on different clauses of para 11 of the proposal form. This is what was conveyed to her vide Annexure C-8, and this is also the sum and substance of the reply field by the appellants to the complaint. Reliance is also placed on Form No. 3787 purported to have issued by Divisional Manager, Forest Division Working, Hamirpur and on Form No. 3816 purported to have been issued by Dr.V. Sudhakar, Senior Resident in Surgery, PGIMER, Chandigarh besides, Annexure R-5 dated 8.7.1996 purported to have been issued by Thakur Surgical & Maternity Nursing Home, Hamirpur. District Forum below after conclusion of the proceedings has ordered the appellants to pay Rs. 1 lac to the complainant within 30 days from the date of its order alongwith interest @ 9% per annum from the date of filing of the complaint, i.e., 7.1.2003 as also litigation expenses of Rs. 2000/-, hence this appeal.
3. At the time of hearing learned counsel for the appellants, Mr. Tajta submitted that the contract of insurance is based on utmost bonafide and good faith. Therefore, it was required of the deceased to have given full as well as correct information regarding his state of health including his having availed medical leave for 52 days and the ailments referred to Annexure C-8. Omission to do so being writ large in this case, makes the policy void and thus his clients stood absolved of their liability if any. And due to lack of good faith and bonafides on the part of the deceased, he urged that this appeal deserves to be allowed. With a view to support his submissions, he laid great emphasis on Form No. 3787, 3816 as well as certificate issued by Thakur Surgical & Maternity Nursing Home, Hamirpur. All these pleas were contested by Mr. Banyal learned counsel for the respondent. He stated that no misstatement of fact any whatsoever was made by the deceased. Alternatively and without conceding, he further submitted that, admitting the averments of the appellants, unless it is also established by cogent, as well as legally acceptable evidence that the suppression of information was fraudulent, mere withholding of the information in question is of no benefit to the appellants. According to him, fraud being a question of fact onus was upon the appellants to have proved it like any question of fact and there being no evidence, the appeal deserves to be dismissed. He further stated that no benefit can be derived by the appellants from Form Nos. 3787 and 3816, as well as from the certificate issued by the Thakur Surgical & Maternity Nursing Home, Hamirpur, i.e., Annexures C-3 to C-5 respectively.
4. After having heard learned counsel for the parties and having examined the record of this case, we are of the view that this appeal has no merit and is liable to be dismissed for the reasons to be recorded hereinafter.
5. We will first take up Annexures R-3 to R-5.
First is Form No. 3787 which shows that the deceased was on medical leave that too in the year 1996 in the months of May, 1996 to July 1996 on medical grounds. In its column No. 3 there is a clear cut mention that the deceased had produced the medical leave certificate. So far Form No. 3816 is concerned, it purports to have been filled in by the doctor who attended upon the deceased at PGIMER, Chandigarh. Again Annexure R-5 issued by Dr. Prem Thakur on 8.7.1996 shows that the deceased was seen in his hospital on 10th June, 1996 and 21st June, 1996 as on 8th July, 1996 as an out patient, complaining of pain in the epigastric region. He was given treatment and was recovering then. Affidavit of none of these persons who had issued these documents have been placed on record, nothing prevented the appellants to have made an endeavour to obtain affidavits who had issued these Annexures and in case they refused to get them summoned through the process of law, i.e., Section 13 of the Consumer Protection Act, 1986. In these circumstances, these documents are of no consequence so as to advance the case of the appellants in any manner whatsoever.
6. Unless misstatement/withholding of information as set out by the appellants in this case is also established as a question of fact to be fraudulent, no benefit can be derived by the appellants in view of Section 45 of the Insurance Act 1938. Admittedly except Annexures R-3 to R-5 there is no other material placed on record by the appellants. On this count also this appeal must fail.
7. Proposal Form Annexure R-2 had been placed on record it is signed by Dr. D.D. Sharma. It is not understood as to what is the significance of this proposal form. Because the Insurance Company on one hand takes up the defence of suppression of fact, whereas this certificate under Section 41 of the Insurance Act, 1938 at the end of this proposal form is signed by the doctor, for what purpose we are unable to appreciate. When specifically questioned Mr. Tajta learned counsel for the appellants pointed out that in certain cases the insured is not got medically examined depending upon the amount for which he is assured. And in certain cases assured person is got medically examined. We are unable to appreciate this submission of Mr. Tajta. Reading of the certificate of the doctor at the end of the proposal Form Annexure R-2, shows that he has only certified as to what is mentioned by the insured being correct before him. We are unable to understand the significance, as well as the relevance of getting such certificate when the life assured is not to be medically examined by a doctor.
8. No other point is urged.
In view of the aforesaid discussion there is no merit in this appeal which is accordingly dismissed, leaving the parties to bear their own costs.
All interims orders passed from time to time shall stand vacated forthwith.
Office will make available a copy of this order to the parties free of costs as per rules.
Shimla.
5th April, 2007. (Justice Arun Kumar Goel) Retd.
President.
(Narinder Singh Thakur), Member.
(Saroj Sharma), Karan* Member.