State Consumer Disputes Redressal Commission
Prabhu Lal Vaidiya vs Lic Of India on 10 August, 2010
APPEAL NO: 808/2010 Smt.Sampat w/o late Sh.Ramphool Bairva r/o Naya Gaavn, Markhera Post Gahlod, Tehsil Piploo, at present 36, N.B.S. Colony, Near Imanual School, Tonk. Complainant-appellant Vs. 1. Life Insurance Corporation of India, Jeevan Prakash, Post Box no. 65, Bhawani Singh Road, Jaipur through Manager. 2. Br.Manager, Life Insurance Corporation of India, Tonk. Opposite parties-respondents 10.8.2010 Before: Mr.Justice Sunil Kumar Garg-President Mr.Shashi Kumar Pareek -Member
Mr.Atul Kumar Jain counsel for the appellant Mr.J.P.Sharma counsel for the respondents 2 BY THE STATE COMMISSION This appeal has been filed by the complainant appellant against order dated 29.3.10 passed by the District Forum, Tonk in complaint no. 172/2009 by which the complaint of the complainant appellant was dismissed against the respondents LIC.
2. It arises in the following circumstances-
That the complainant appellant had filed a complaint before the District Forum,Tonk on 30.3.09 inter alia stating that her husband Ramphool now deceased had taken LIC policy from the respondents for a sum of Rs.50,000/- bearing policy no.194778025 on 13.4.05 and the premium of the policy was to be paid half yearly and the policy was for twenty years . It was further stated in the complaint that since the payment of the premium was paid regularly and since the deceased became ill and he was got admitted in the hospital where he had died on 17.4.08 and after the death of the deceased claim was preferred by the complainant respondent being the wife and nominee of the deceased before the office of the respondents but that claim was repudiated by the respondents through letter dated 31.10.08 on the ground that no doubt the policy in question was taken by the deceased on 13.4.05 and the instalments of the premium were not paid regularly, 3 therefore, the policy had become lapsed and the same was revived on 31.10.07 and at the time of revival of the policy the deceased had filled in up a fresh declartion form regarding his health on 31.10.07 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to revival of the policy i.e. on 31.10.07 , the deceased was admitted in the hospital on 23.2.07 where the disease of Pericordial Fluid was diagnosed and he had taken treatment from the hospital and since these facts were not disclosed by the deceased in his fresh declaration form on 31.10.07 at the time of revival of the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the respondents on 15.6.09 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 31.10.08 . Apart from that it was stated in the reply that since the premium for the period September 06 to September 07 had become due and thus the policy had become lapsed one and the same was revived on 3.10.07 and prior to the revival of the policy i.e. on 3.10.07 the deceased was got admitted in Govt. Saadat Hospital, Tonk on 23.2.07 and was discharged from the hospital on 25.2.07 and he was also got operated there and not only this the deceased was got admitted in the SMS Hospital, Jaipur on 12.3.07 and was discharged on 4 15.3.07 and the disease of Pericordial was diagnosed and thus the fact that before revival the deceased was a patient of Pericordial is well established and it was prayed that claim of the complainant was rightly repudiated by the respondents and complaint of the complainant be dismissed After hearing the parties, the District Forum, Tonk through impugned order dated 29.3.10 had dismissed the complaint inter alia holding-
(i) That in this case since the respondents had proved the fact that before filing in up the fresh declaration form on 3.10.07 the deceased was got admitted in the Govt. Saadat Hospital, Tonk on 23.2.07 and was discharged from the hospital on 25.2.07 and he was also got operated there and not only this the deceased was got admitted in the SMS Hospital, Jaipur on 12.3.07 and was discharged on 15.3.07 and the disease of Pericordial was diagnosed and since these facts were not stated in the fresh declartion form dated 3.10.07 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased
(ii) That the respondents were justified in repudiating the claim of the complainant appellant.5
Aggrieved from the said order dated 29.3.10 passed by the District Forum, Tonk this appeal has been filed by the complainant appellant.
3. In this appeal, the main contention of the learned counsel for the complainant appellant is that since the policy in question was taken by the deceased on 13.4.05 and if at the time of revival on 3.10.07 in the fresh declaration form regarding his health he had not mentioned that he was suffering from any kind of disease and further if for the sake of arguments, it was taken for granted that the deceased was admitted in Govt. Saadat Hospital, Tonk, that was only for taking the treatment of Asthma and that was a trivial disease and that would not amount to suppression of material facts regarding health on the part of the deceased and hence, repudiation of claim of the complainant appellant by the respondents was wholly illegal and arbitrary and in view of this the findings of the District Forum dismissing the complaint of the complainant appellant could not be sustained as they suffer from basic infirmity, illegality and perversity and it was prayed that appeal be allowed.
4. On the other hand, the learned counsel appearing for the respondents has supported the impugned order of the District Forum.
5. We have heard the learned counsel for the appellant as well as for the respondents and have gone through the entire materials available on record.
66. There is no dispute on the point that the deceased LIC policy from the respondents for a sum of Rs.50,000/- bearing policy no.194778025 on 9.3.05 and the same was revived on 3.10.07.
7. There is also no dispute on the point that at the time of revival of the policy a fresh declaration was made by the deceased and in that declaration on 3.10.07 , he had not mentioned that he was suffering from any kind of disease .
8. There is also no dispute on the point that deceased had died on 17.4.08 meaning thereby within one year of revival of the policy.
9. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the respondents through letter dated 31.10.08 on the grounds mentioned therein.
10. On file there is a prescription slip dated 19.2.07 of the Govt. Saadat Hospital, Tonk which shows that the deceased had consulted the doctor who had advised him to admit in the hospital and thereafter the deceased was admitted in the hospital on 23.2.07 and was discharged from the hospital on 25.2.07 and the disease of Pericordial Fluid was diagnosed and in the bed head ticket of the hospital it was also mentioned that the deceased was a patient of Heart, Lungs etc.
11. On file there is a prescription slip dated 12.3.07 of Dr. 7 Sanjeev Devgarha, Asstt.Professor, Deptt. of Cardio Thoracic & Vascular Surgery, SMS Hospital, Jaipur who had advised him to admit in the hospital and the deceased was got admitted in the SMS Hospital, Jaipur on 12.3.07 and was discharged on 15.3.07 and the disease of Pericordial effusion was diagnosed .
12. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint of the complainant appellant was dismissed could be sustained or not and whether the repudiation of the claim of the complainant appellant by the respondents was justified or not.
13. Before proceeding further something should be said about the distinction between Renewal and Revival of the policy.
14. The term " renewal" means renewal of the policy on existing terms and condition of a thing or in other words, extension upon the same terms as the old contract. The renewal of the policy means that the policy is renewed within the stipulated period and in such case, it was in force and it had not lapsed on any of the grounds and further, in cases of renewal of the policy, no further declaration could be sought. But the cases of ' revival' stand on different footings. The case of revival arises only when a policy had lapsed or expired due to many reasons, one of the reasons may be non-payment of premium in time.
815. It may be stated here that since the present case is a case of revival of the policy, the question arises whether revival should be treated as fresh contract or not. After expiry of the policy, if the party chooses to revive the contract of insurance, revival is clearly in law a fresh contract and this Commission has taken the same view in the case of LIC Vs. Munni Bano reported in (2005) 4 CPJ 228 and thus in the present case the revival of the policy would amount to a fresh contract and that is why at the time of revival of the policy i.e. on 3.10.07 , a fresh declaration was given by the deceased regarding his health.
16. It may further be stated here that in the present case there is cogent and reliable evidence on the part of the respondents to show that prior to filling in up the fresh declaration form on 3.10.07 the deceased was got admitted in Govt. Saadat Hospital, Tonk as well as in the SMS Hospital, Jaipur which clearly established that the deceased was a patient of Pericordial Fluid prior to revival of the policy on 3.10.07 and not only this he had taken the treatment from the Deptt. Of Cardio Thoracic & Vascular Surgery, SMS Hospital, Jaipur, meaning thereby he was having some serious problem in the heart and since being aware he had not mentioned this fact in his fresh declartion form regarding health dated 3.10.07 which clearly goes to prove the fact that the deceased had knowingly, fraudulently and intentionally suppressed the disease of Pericordial Fluid and had revived the policy in question by suppressing material facts and therefore, it would amount to suppression of 9 material facts regarding health on the part of the deceased in real sense.
17. It may further be stated here that the well settled law in the field of insurance is that contracts of insurance including the contracts of life assurance are contracts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission and this duty to disclose continues upto the conclusion of the contract and covers any material alteration in the character of the risk which may take place between the proposal and acceptance.
18. Taking into consideration that aspect also when the answer in the fresh declaration form dated 3.10.07 was given in negative by the deceased and when there is ample evidence to prove the fact that the deceased was a patient of Pericordial Fluid prior to filling in up the fresh declaration form dated 3.10.07 regarding his health, therefore, from every point of view the present case would be a case of suppression of material facts regarding health on the part of the deceased.
19. For the reasons stated above, it is held that repudiation of claim of complainant appellant by the respondents through letter dated 31.10.08 on ground of suppression of material facts regarding health by the deceased was justified and no illegality or irregularity has been committed by the respondents in repudiating the claim of complainant appellant and in view of this the findings of the District Forum dismissing the complaint of the complainant appellant are 10 liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity,illegality or perversity and this appeal deserves to be dismissed.
Accordingly the appeal filed by the appellant is dismissed.
Member President
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APPEAL
NO: 823/2010
Prabhu
Lal Vaidiya s/o Kishan Bairva
r/o
Plot no. 36, N.B.S. Colony,
Near
Immanuel School,
Tonk.
Complainant-appellant
Vs.
1.
Life Insurance Corporation of India,
Jeevan
Prakash, Post Box no. 65,
Bhawani
Singh Road, Jaipur
through
Manager.
2. Br.Manager,
Life
Insurance Corporation of India,
Tonk.
Opposite
parties-respondents
10.8.2010
Before:
Mr.Justice
Sunil Kumar Garg-President
Mr.Shashi
Kumar Pareek -Member
Mr.Atul
Kumar Jain counsel for the appellant
Mr.J.P.Sharma
counsel for the respondents
2
BY
THE STATE COMMISSION
This
appeal has been filed by the complainant appellant against order dated 29.3.10 passed by the District Forum, Tonk in complaint no. 181/2009 by which the complaint of the complainant appellant was dismissed against the respondents LIC.
2. It arises in the following circumstances-
That the complainant appellant had filed a complaint before the District Forum,Tonk on 30.3.09 inter alia stating that his brother Ramphool now deceased had taken LIC policy from the respondents for a sum of Rs.1 lac bearing policy no.196805039 on 27.10.07 and the premium of the policy was to be paid yearly and the policy was for twenty years . It was further stated in the complaint that the deceased became ill and he was got admitted in the hospital where he had died on 17.4.08 and after the death of the deceased claim was preferred by the complainant respondent being the brother and nominee of the deceased before the office of the respondents but that claim was repudiated by the respondents through letter dated 1.9.08 on the ground that at the time of taking the policy the deceased had filled in up a declartion form regarding his health on 26.10.07 in which he had not mentioned that he was suffering from any kind of 3 disease but they had the sufficient proof to prove the fact that prior to 8 months before the deceased was admitted in the hospital on 23.2.07 where the disease of Pericordial Fluid and Asthama & C/O SOB was diagnosed and he had taken treatment from the hospital and since these facts were not disclosed by the deceased in his declaration form on 26.10.07 at the time of taking the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the respondents on 15.6.09 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 1.9.08 . Apart from that it was stated in the reply that prior to taking the policy i.e. on 26.10.07 the deceased was got admitted in Govt. Saadat Hospital, Tonk on 23.2.07 and was discharged from the hospital on 25.2.07 and he was also got operated there and not only this the deceased was got admitted in the SMS Hospital, Jaipur on 12.3.07 and was discharged on 15.3.07 and the disease of Pericordial was diagnosed and thus the fact that before taking the policy in question the deceased was a patient of Pericordial is well established and it was prayed that claim of the complainant was rightly repudiated by the respondents and complaint of the complainant be dismissed After hearing the parties, the District Forum, Tonk 4 through impugned order dated 29.3.10 had dismissed the complaint inter alia holding-
(i) That in this case since the respondents had proved the fact that before filing in up the declaration form on 26.10.07 the deceased was got admitted in the Govt. Saadat Hospital, Tonk on 23.2.07 and was discharged from the hospital on 25.2.07 and he was also got operated there and not only this the deceased was got admitted in the SMS Hospital, Jaipur on 12.3.07 and was discharged on 15.3.07 and the disease of Pericordial was diagnosed and since these facts were not stated in the declartion form dated 26.10.07 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased
(ii) That the respondents were justified in repudiating the claim of the complainant appellant.
Aggrieved from the said order dated 29.3.10 passed by the District Forum, Tonk this appeal has been filed by the complainant appellant.
3. In this appeal, the main contention of the learned counsel for the complainant appellant is that since the policy in question was taken by the deceased on 26.10.07 and 5 if in the declaration form regarding his health he had not mentioned that he was suffering from any kind of disease and further if for the sake of arguments, it was taken for granted that the deceased was admitted in Govt. Saadat Hospital, Tonk, that was only for taking the treatment of Asthma and that was a trivial disease and that would not amount to suppression of material facts regarding health on the part of the deceased and hence, repudiation of claim of the complainant appellant by the respondents was wholly illegal and arbitrary and in view of this the findings of the District Forum dismissing the complaint of the complainant appellant could not be sustained as they suffer from basic infirmity, illegality and perversity and it was prayed that appeal be allowed.
4. On the other hand, the learned counsel appearing for the respondents has supported the impugned order of the District Forum.
5. We have heard the learned counsel for the appellant as well as for the respondents and have gone through the entire materials available on record.
6. There is no dispute on the point that the deceased had taken LIC policy from the respondents for a sum of Rs.1 lac bearing policy no.196805039 on 27.10.07 and the premium of the policy was to be paid yearly and the policy was for twenty years .
67. There is also no dispute on the point that at the time of taking the policy a declaration was made by the deceased and in that declaration on 26.10.07 , he had not mentioned that he was suffering from any kind of disease .
8. There is also no dispute on the point that deceased had died on 17.4.08 meaning thereby within one year of issuance of the policy.
9. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the respondents through letter dated 1.9.08 on the grounds mentioned therein.
10. On file there is a prescription slip dated 19.2.07 of the Govt. Saadat Hospital, Tonk which shows that the deceased had consulted the doctor who had advised him to admit in the hospital and thereafter the deceased was admitted in the hospital on 23.2.07 and was discharged from the hospital on 25.2.07 and the disease of Pericordial Fluid was diagnosed and in the bed head ticket of the hospital it was also mentioned that the deceased was a patient of Heart, Lungs etc.
11. On file there is a prescription slip dated 12.3.07 of Dr. Sanjeev Devgarha, Asstt.Professor, Deptt. Of Cardio Thoracic & Vascular Surgery, SMS Hospital, Jaipur who had advised him to admit in the hospital and the deceased was got admitted in the SMS Hospital, Jaipur on 12.3.07 and was 7 discharged on 15.3.07 and the disease of Pericordial effusion was diagnosed .
12. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint of the complainant appellant was dismissed could be sustained or not and whether the repudiation of the claim of the complainant appellant by the respondents was justified or not.
13. It may be stated here that in the present case there is cogent and reliable evidence on the part of the respondents LIC to show that prior to filling in up the declaration form on 26.10.07 the deceased was got admitted in the Govt. Saadat Hospital, Tonk as well as in the SMS Hospital, Jaipur which clearly established that the deceased was a patient of Pericordial Fluid prior to taking the policy on 26.10.07 and not only this he had taken the treatment from the Deptt. of Cardio Thoracic & Vascular Surgery, SMS Hospital, Jaipur, meaning thereby he was having some serious problem in the heart and since being aware he had not mentioned this fact in his declartion form regarding health dated 26.10.07 which clearly goes to prove the fact that the deceased had knowingly, fraudulently and intentionally suppressed the disease of Pericordial Fluid and had taken the policy in question by suppressing material facts and therefore, it would amount to suppression of material facts regarding health on the part of the deceased in real sense.
814. It may further be stated here that the well settled law in the field of insurance is that contracts of insurance including the contracts of life assurance are contracts uberrima fides and every fact of materiality must be disclosed otherwise there is good ground for rescission. And this duty to disclose continues upto the conclusion of the contract and covers any material alteration in the character of the risk which may take place between the proposal and acceptance.
15. Taking into consideration that aspect also when the answer was given in negative and when there is ample evidence to prove the fact that the deceased had taken the treatment of Pericardial fluid prior to filling in up the declaration form dated 26.10.07 regarding his health, therefore, from every point of view the present case would be a case of suppression of material facts regarding health on the part of the deceased.
16. For the reasons stated above, it is held that repudiation of claim of complainant appellant by the respondents through letter dated 1.9.08 on ground of suppression of material facts regarding health by the deceased was justified and no illegality or irregularity has been committed by the respondents in repudiating the claim of complainant appellant and in view of this the findings of the District Forum dismissing the complaint of the complainant appellant are liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on 9 record and they do not suffer from any basic infirmity,illegality or perversity and this appeal deserves to be dismissed.
Accordingly the appeal filed by the appellant is dismissed.
Member President nm