National Consumer Disputes Redressal
Panni Devi vs L.I.C. And Ors. on 21 May, 2003
Equivalent citations: III(2003)CPJ15(NC)
ORDER
B.K. Taimni, Member
1. Petitioner was the complainant before the District Forum where she had filed a complaint alleging deficiency in service on the part of the respondent LIC & Others.
2. Brief facts of the case are that the complainant's deceased husband had obtained two life policies valued at Rs. 99,000/- and Rs. 3 lakhs respectively on 19.2.1994 and 25.6.1996. When the insured died on 29.1.1997, upon a claim being preferred by the complainant with the respondents it was repudiated by them on the ground of concealment of information at the time of taking policies. It is in these circumstances that the petitioner filed a complaint before the District Forum, who after hearing the parties allowed the complaint with cost. On an appeal filed by the respondent LIC, the State Commission allowed the appeal, set aside the order of the District Forum, and providing liberty to the complainant to seek remedy in Civil Court, if so advised, hence this revision petition.
3. It is the case of the petitioner that before giving policies, the deceased was fully examined by the Doctor-Medical Examiner of the insurer, LIC and nothing adverse was noticed. It is only after such satisfaction that policies were issued. The only basic document relied upon by the respondent is the reported statement of the deceased given to the Anaesthetist that at the pre-anaesthetic stage that he was operated upon 15 years ago. This statement is neither proved nor supported by any other material. Doctor has not been examined. There has been no scar of surgery. The period to which it anti-dates takes us to early 1980's when heart surgery was available only in few hospitals and the poor deceased could hardly afford such a luxury. The District Forum has examined the whole question in correct perspective and had allowed the complaint which must be restricted and upheld. The order of the State Commission is bad both on facts and law and cannot be sustained.
4. On the other hand the case of the respondent is that State Commission has correctly appreciated the material on record and passed a correct order on concealment of information about surgery done to the insured, which he had concealed. The order of the State Commission calls for no interference.
5. We have seen the material on record and heard the arguments. Basic facts of the case are not disputed hence not discussed. We have seen the Medical Examinations Confidential Report. Column 4 reads :
Asceration from the life to be assured whether at any time in the past he/she
(i) has been hospitalised ? No
(ii) was involved in an accident ? No
(iii) has undergone any Radiological, Cardiological, Pathological or any other tests ? No
(iv) is currently under my treatment ? No Then it reads;
If the answer to any of the next 9 Questions (Qn. 5 to Qn. 13) is 'YES', please give full details.
6. The above makes it abundantly clear that doctor is recording what the insured tells him. It is not the result of any test/examination. If a person withholds any information, Doctor would not know it, unless it is visible. Cardiological problem is not visible. In our view what is recorded at the pre-anaesthetic check up is of vital importance when the deceased told the Anaesthetist before surgery that he was operated 15 years back. "Anaesthetist wanted the information for his professional reasons and the deceased gave this information in normal conditions and circumstances. It is not the case of the complainant that he did not go for the surgery or the document is not genuine. Doctor has not been examined but we must give due weight to a statement recorded in the normal course of discharge of one's duties. It cannot be taken but true, leading us to completely agree with the State Commission that the deceased did indeed conceal the information of the surgery at the time of taking the policy - thus violating the very 'good-faith' on which contract of insurance stands. We also see another fact. We see that the second policy is taken on 25.6.1995. As early as 24.1.1996, Dr. Karan Singh Yadav certifies that the insured is suffering from Severe Aortic Reqingitation and Coaractation. He would require Aortic Valve replacement...". This is the certificate produced by the complainant. It is true that this certificate does not antidate the ailment/heart problem, but it is also true that nobody develops heart valve problem overnight. Keeping in view all the material available on record and its very careful analysis, one cannot find fault with the finding of the State Commission that this indeed was a case of concealment of information by the deceased insured and such information was within his knowledge.
We see no ground to interfere in the well-reasoned order passed by the State Commission. Petition is devoid of merit, hence dismissed.
No order as to costs.