National Consumer Disputes Redressal
Prema And Ors. vs Life Insurance Corporation Of India ... on 3 July, 2006
Equivalent citations: IV(2006)CPJ239(NC)
ORDER
S.N. Kapoor, J. (Presiding Member)
1. This order shall dispose of four revision petitions arising from a common order of Karnataka State Consumer Disputes Redressal Commission, Bangalore dated 3.12.99 in Nos. 71 to 74/1997 and 84 to 87/1997. Manjunath the husband of the petitioner Smt. Prema died on 22.2.1991. Late Manjunath had taken four policies, three policies relatable to complaint Nos. 175/93, 177/93 and 178/93 were of the value of Rs, 25,000 each whereas the policy referable to complaint No. 176/93 was of the value of Rs. 60,000.
2. The claim was repudiated by LIC on the ground that the insured deceased had suppressed material facts of his hospitalization due to glossitis, diabetes caused by alcoholic hepatitis for last 20 years to give an opportunity to the LIC to assess his state of health at the relevant point of time, to wit, the answer relevant in the context of the different queries in the proposal forms.
3. By order dated 3.1.1997 District Forum allowed the complaint holding that the petitioner was entitled to sum assured under the respective policies together with interest at the rate of 10% from the date of repudiation.
4. LIC filed appeals for dismissal of the complaint and the complainant filed appeals for enhancement of compensation. All the eight appeals of LIC and the complainants were taken up together by the State Commission and decided by a common order passed by the State Commission dismissing the complaint and accepting the appeals of the LIC holding that the repudiation of the claim was justified.
5. Having heard the parties Counsel and having gone through the record it is evident that it is required to be seen as to whether it is a case of suppression of material facts.
6. We need not say that the Insurance Contracts are 'uberrima fides' and are founded upon utmost good faith. If any party fails to observe this utmost good faith, the contract may be avoided by the other. This legal proposition has been reiterated time and again by the Supreme Court, this Commission as well as by various High Courts.
7. From the statement of Dr. Prabhanna Murigappa Upassi it is evident that he had treated the deceased Manjunath. Dr. P.V. Narendra had referred Manjunath to J.J.M. Medical College Davanagere. Dr. Upassi has filed progress report as Ex. R-10, Temperature chart as Ex. R-11, Doctors treatment chart as Ex. R-12, ECG report as Ex. R-13, Diabetic chart as Ex. R-14, X-ray report as Ex. R-15. He has stated that Manjunath was admitted twice, both times he had treated the deceased. For the first time he treated and examined him on 9.4.90 and admitted on 10.4.90 and discharged him on 16.4.90. Second time he was admitted on 15.2.1991and he died on 22.2.91.He also proved various documents Exs. R-16, R-17 as well as R-18 the admission record. He stated that Manjunath was admitted on the first occasion for fever for six months and also loss of appetite, burning sensations in hands and feet. He was a known alcoholic for 20 years. He had glossitis, all this was due to Alcoholic hepatitus. No doubt in cross-examination he was not able to give the name of the attendant of the patient who gave the history in Ex. P-16 but the facts remain that the primary cause of his death is Cardio Respiratory Arrest. It is evident from the statement of Dr. Upassi as well as other documents on record that the State Commission was absolutely justified in taking the view that there could not be any doubt whatsoever that Manjunath was hospitalized from 10.4.1990 to 16.4.1990 and he was an in patient during the said period. It is not possible to accept that Manjunath was not aware of the decease with which he was suffering from.
8. Insofar as the filing of the proposal forms is concerned, Manjunath was a lineman in K.E.B. at Davangere. As such, the State Commission was justified in taking the view that it was reasonable to believe that he would have the minimum knowledge of these matters. Consequently it could not be believed that he had simply put his signatures on different proposal forms without understanding the contents of the relevant items. Besides, it may be mentioned that in terms of LIC v. M Gowri's Ors., the judgment referred to by the-State Commission the agent who got the proposal form could be an agent of the person seeking insurance policy. The plea that the insured was not aware of the requirement to give correct answer and about contents of the answers given cannot be accepted.
9. In terms of Mithoolal Nayak v. Life Insurance Corporation of India Ltd. , the terms of the policy make it clear that the averments made as to the state of health of the insured in the proposal form and the personal statement were the basis of the contract between the parties and the circumstances that Mahajan Deolal had taken pains to falsify or conceal that he had been treated for a serious ailment by Dr. Lakshmanan only a few months before the policy was taken showed that the falsification or concealment had an important bearing in obtaining the other party's consent. It was observed in Mithoolal Nayak case:
A man who has so acted cannot afterwards turn round and say: 'It could have made no difference if you had known the truth." In our opinion, no question of waiver arises in the circumstances of this case, nor can the appellant take advantage of the Explanation to Section 19 of the Indian Contract Act.
10. In the face of preponderance of evidence it is not possible to accept that the evidence led by the complainant to the effect that he was examined by Medical Assistant was sufficient to counter overwhelming evidence led by the LIC. We have noticed time and again that neither the agent nor the Medical Assistant who examined insured at the time of taking of policy probed the matter in right earnest leaving many loopholes in the system. In any case seeing the well-reasoned judgment passed by the State Commission, we do not feel that there is arty error for taking any view different from the view taken by the State Commission. Consequently all the revision petitions are dismissed. However, in peculiar facts and circumstances parties are left to bear their own cost.