National Consumer Disputes Redressal
Lic Of India vs Pratima Mishra on 17 December, 2015
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 2306 OF 2013 (Against the Order dated 04/03/2013 in Appeal No. 492/2012 of the State Commission Chhattisgarh) 1. LIC OF INDIA THROUGH ITS ASSITANT SECRETARY, (LEGAL CELL) H-39 1ST FLOOR, NEW ASIATIC BUILDING, CONNAUGHT PLACE, NEW DELHI - 01 ...........Petitioner(s) Versus 1. PRATIMA MISHRA W/O LATE SH HEMANT KUMAR ISHRA, R/O SHEETALAPARA, NEAR BALAPARA SCHOOL, KONDAGAON BASTER C.G ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE V.B. GUPTA, PRESIDING MEMBER HON'BLE MR. PREM NARAIN, MEMBER For the Petitioner : Mr. U.C. Mittal, Advocate with Mr. Ajay Kumar, Divisional Manager, Of Petitioner's Corp. in person For the Respondent :
Dated : 17 Dec 2015 ORDER
1. Life Insurance Corporation of India has filed this revision petition against the order dated 04.03.2013 of the State Consumer Disputes Redressal Commission, Chhattisgarh, (in short 'the State Commission') passed in Appeal No.FA/12/492 filed by the petitioner against the order dated 13.08.2012 of the District Consumer Dispute Redressal Forum, North Baster Kanker (in short 'the District Forum'), wherein the complaint of the respondent has been allowed.
2. We heard the learned counsel for the petitioner and perused records carefully.
3. Learned counsel for the petitioner stated that the respondent had submitted a proposal on 25.6.2007 for his life insurance cover for a sum assured of Rs.3,00,000/-. The petitioner accepted the proposal and issued the insurance policy No.385333282 valid from 13.12.2007. The insured died on 16.3.2008 at Chandu Lal Chandrakar Hospital Bhilai. In the medical attendance certificate issued by the hospital, there is a mention of old case of head injury against the column relating to the history of deceased. It was found out that the insured had an accident on 21.8.2007 and was admitted in Ramkrishna Care Hospital, Raipur from 22.08.2007 to 26.8.2007 for treatment of head injury. As the policy started from 13.12.2007 and the insured had not declared this disease in his proposal form, nor even afterwards, petitioner repudiated the claim vide its letter dated 27.12.2010 on the basis that Section 45 of Insurance Act, 1938 has been clearly violated. In fact the insured had taken three polices and the payment of two policies had already been made as they started before the accident of the deceased on 21.08.2007. The respondent/insured was duty bound to send information to the insurer about his accident as this altered the health status of the insured. Both the fora below have erred in not appreciating these provisions of the Insurance Act and have wrongly allowed the insurance claim. Learned counsel for the petitioner also mentioned the following judgments in support of his arguments:-
"(i). Life Insurance Corporation of India Vs. Raja Vasireddy Komalavalli Kamba, (1984) 2 SCC, 719, wherein it has been observed that delay in approving the proposal of insurance does not vitiate the terms and conditions of the policy.
(ii). Life Insurance Corporation of India, Ahmedabad Divisional Office Vs. Bhoomikaben M. Modi & Ors. (through their natural Guardian), 2011, 1 CPR (NC) 293, holding that the contract of insurance is complete when the proposal is accepted."
4. We find that both the fora below have examined the issue of payment of insurance amount to the respondent in the special circumstances of the case in detail. From the facts narrated by the learned counsel for the petitioner, it is clear that the proposal form was submitted on 25.6.2007 and the accident took place on 21.8.2007. Hence, it is not possible that the insured could have given the information about the accident in the proposal form, which was submitted much before the accident. When the Insurance Company took about six months to approve the proposal form, they should have re-inquired about the status of the health of complainant either from their agent or from the complainant himself. This has not been done. It is certain that the proposal form was correctly filled and there was no suppression of fact on the date of submission of the proposal form. The two judgements mentioned by the learned counsel are not directly applicable in the present case. Section 45 of the Insurance Act, 1938 reads as follows:-
"Policy not to be called in question on ground of mis-statement after two years- No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement [was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made] by the policy-holder and that the policy-holder knew at the time of making it that the statement was false [or that it suppressed facts which it was material to disclose]:
[Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.]"
5. From the above, it is clear that there is no obligation under this section on the part of the insured to give subsequent statement after the proposal form has been filled. Thus, we find no illegality or material irregularity in the order of the fora below. Accordingly, the revision petition having no merits is hereby dismissed in limine.
......................J V.B. GUPTA PRESIDING MEMBER ...................... PREM NARAIN MEMBER