State Consumer Disputes Redressal Commission
Lic Of India vs Kaushalya Devi on 14 June, 2007
H H.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, SHIMLA CAMP AT MANDI. Appeal No. 300/2005. Date of Decision 14.06.2007. Life Insurance Corporation of India, through its Senior Divisional Manager, Divisional Office, Kasumpti Shimla 171 009, . Appellant. Versus Kaushalya Devi Wd/o late Sh. Bakshi Ram aged 43 years, R/o Vill. Jukain (Gharwan) Illaqua Suranga, PO Nobahi, Tehsil Sarkaghat, Distt. Mandi, 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 Appellant. S/Sh. Bimal Kumar Sharma and Pushap Raj Sharma, Advocates. For the Respondent. Sh. A. S. Chandel, Advocate. O R D E R:
Justice Arun Kumar Goel (Retd.) President (Oral) Appellant has filed this appeal against the order of District Forum Mandi, in Consumer Complaint No. 6/2005, dated 13.9.2005. By means of impugned order it has been directed to pay Rs. 50,000/- to the complainant, alongwith interest @ 6% per annum from the date of repudiation of claim i.e. 31.1.2004 till the entire amount was realized and cost of Rs 1000/-.
2. Deceased husband of the respondent having got himself insured for Rs. 50,000/- on 28.2.2003 and also having paid the premium of Rs. 1627/- is not in dispute. He however, died on 10.8.2003. Respondent submitted the requisite information/documents and asked for payment of the sum insured which was declined while repudiating her claim on the ground that the deceased had concealed material facts regarding his pre-existing ill state of health. Deceased was also on medical leave during the period 3.2.2001 to 10.8.2003 in different spells. Deceased was further alleged to be suffering from Duodenal Ulcer and Coronary Artery Disease, (QLD) Myocardial Cardiology Infarction. These facts were not disclosed by the deceased in the proposal form. Thus the appellant justified repudiation of claim.
3. This resulted in filing of the complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the Act), wherein aforesaid directions have been issued.
4. At the time of hearing learned counsel for the appellant laid great emphasis on Annexure R-VI and R-VII the fitness certificates issued by the medical officers of Indira Gandhi Medical College and Associate Hospitals. In Annexure R-VI deceased is shown to have relapse duodenal ulcer. In Annexure R-VII Professor & Head, Department of Cardiology had given the deceased CAD old H.I. LV days. Emphasis is also laid on Annexure R-I the proposal form and Annexure R-V, Form No. 3787 issued by the employer of the deceased. As per this form deceased had gone on earned leave on one occasion on account of marriage of son and on other occasions during different spells, On two occasions on medical ground, whereas on third occasion medical certificate was not produced.
5. On the basis of these documents it was urged that the contract of insurance is based on utmost good faith and bonafide on the principal of uberrima fides as such the insured is required to state true and correct facts including those relating to his state of health while obtaining insurance. Mis-statement as well as withholding of such facts constitutes fraud, and death having taken place within less than six months, District Forum below fell into error while ignoring these vital facts. Thus a prayer was made to allow this appeal while setting aside the impugned order with costs.
6. Who had filled in the proposal form there is nothing on record. Further there is nothing to suggest that it was filled in by the deceased himself. As such the best person to establish as to what is filled in the proposal form was the agent/development officer, who had undertaken the insurance, besides the doctor who had certified that the statements contained in the proposal form were made by the deceased. There is no evidence worth the name either of the doctor or of the development officer/agent. Why no such evidence was produced learned counsel for the appellant had no answer. As such no advantage can be taken by the appellant from what is contained in the proposal form Annexure R-I. Now coming to the medical certificates Annexures R-VI and R-VII. Affidavits of the doctors were required to be filed by the appellant and in case they declined then they should have been summoned for examination. It is the case of the appellant that the doctor refused to file their affidavits and or it made any attempt to summon them in the witness box. As such no advantage can be obtained by the appellant from these two documents.
7. Annexure R-V is form No. 3787 issued by the employer of the deceased. It only shows that on three occasions he was on medical leave on medical grounds. What was the nature of ailment, there is nothing on record. Moreover to take advantage of this document appellant was duty bound to have placed something in the shape of affidavits of the doctor who had attended upon the deceased, as also show what was nature of his ailment.
8. Assuming for the sake of argument that some advantage can be obtained by the appellant from these documents, then it was further necessary as well as incumbent upon it to have shown that the so-called disease had direct nexus with the cause of his death. Again this evidence is lacking.
9. We are further of the view that every suppression of information and or withholding thereof does not always constitute a ground to decline the claim in the event of death, as was urged on behalf of the appellant. Since death has taken place within 2 years therefore, appellant in law could challenge the statements made in the proposal form. However, plea based on it i.e. the proposal form had already been rejected. Similarly fraud had to be established as a question of fact by the appellant in view of Section 45 of the Insurance Act, 1938. It has not discharged this onus.
10. 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 interim orders passed from time to time in this appeal shall stand vacated forthwith.
Office will also make available a copy of this order to the parties free of costs as per rules.
Mandi 14th June, 2007. (Justice Arun Kumar Goel) Retd.
President.
(Narinder Singh Thakur), Member.
(Saroj Sharma), Karan* Member.