State Consumer Disputes Redressal Commission
Lic vs Santosh Kumari on 23 September, 2011
PUNJAB STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No.895 of 2006
Date of institution: 12.07.2006
Date of decision : 23.09.2011
1. Life Insurance Corporation of India, Northern Zonal Officer, Jeewan Bharti
Building, 124 Cannaught Circus, New Delhi through its Zonal Manager.
2. Life Insurance Corporation of India through its Senior Divisional Manager,
Sector 17, Chandigarh.
3. Life Insurance Corporation of India, Post Box No.82, Jeevan Parkash,
Model Town Road, Jalandhar through its Divisional Manager.
4. Life Insurance Corporation of India through Branch Office T Giani Zail
Singh Nagar, Tehsil & District Ropar through its Branch Manager.
.....Appellants
Versus
Smt.Santosh Kumari wife of late Sh.Chaman Lal r/o village Rampur Bilron, Tehsil
Garhshankar, District Hoshiarpur at present residing c/o Sh.Amarjit Singh Rana
s/o Sh.Balwant Singh Rana near Gurudwara Katalgarh Sahib, Chamkaur Sahib,
Tehsil and District Ropar.
.....Respondent
First Appeal against the order dated 01.06.2006
passed by the District Consumer Disputes
Redressal Forum, Ropar.
Before:-
Hon'ble Mr.Justice S.N.Aggarwal, President
Mrs.Amarpreet Sharma, Member
Mr.Baldev Singh Sekhon, Member Present:-
For the appellants : Sh.S.K.Mahajan, Advocate For the respondent : Sh.Vishal Gupta, Advocate JUSTICE S.N.AGGARWAL, PRESIDENT VERSION OF THE RESPONDENT Chaman Lal husband of Santosh Kumari respondent had taken the life insurance policy from the appellants for an amount of Rs.50,000/- with commencement date as 15.2.2002. Chaman lal died on 24.3.2006. The insurance claim was lodged with the appellants. It was repudiated by the appellants vide letter dated 19.1.2004. Hence, the First Appeal No.895 of 2006 2 complaint for recovery of the insurance claim along with compensation, interest and costs.
VERSION OF THE APPELLANTS
2. The appellants filed the written reply. The only plea taken by the appellants was that the life assured was suffering from a serious disease. He had suppressed it while filling the proposal form. Therefore, the repudiation was legal and valid. Dismissal of the complaint was prayed. PROCEEDINGS BEFORE THE DISTRICT FORUM
3. The respondent filed her affidavit Ex.CW1. The respondent also filed the affidavit of Vijay Singh as CW2 and the affidavit of Gurpartap Khanna as CW2. The respondent also proved documents Ex.C1 to Ex.C9. On the other hand, the appellants proved documents Ex.R2 to Ex.R87.
4. The learned District Forum accepted the complaint vide impugned judgment dated 1.6.2006 with costs of Rs.1000/-. The appellants were directed to pay the insurance claim with bonus and interest @ 6% per annum.
5. Hence, this appeal.
DISCUSSION :
6. The submission of the learned counsel for the appellants was that the life assured was suffering from serious disease which was kept concealed by him while filling the proposal form. Therefore, the respondent was not entitled to any insurance claim. Hence, it was prayed that the appeal be accepted and the impugned judgment dated 1.6.2006 be set aside.
7. On the other hand, the submission of the learned counsel for the respondent was that there was no merit in the present appeal and the same be dismissed.
8. Record has been perused. Submissions have been considered.
9. The proposal form filled by the life assured has been proved by the appellants as Ex.R83. The life assured had furnished the answers to Question No.11 as under : -
First Appeal No.895 of 2006 3
Questions Answers
"11. (a) During the last five years did you No
consult a Medical Practitioner for
any ailment requiring treatment
for more than a week.
(b) Have you ever been admitted to any No
hospital or nursing home for general
check-up, observation, treatment or
operation.
(c) Have you remained absent from place No
of work on grounds of health during
the last 5 years.
(d) What has been your usual state of Good
health? ''
10. In order to prove that the life assured was suffering from a serious disease, the appellants have proved the discharge certificate as Ex.R37 in which it is shown that the life assured Chaman Lal was admitted in the Civil Hospital on 7.6.2000 and he was discharged on 13.6.2000 and he was suffering from the disease known as COPD. COPD has been defined in the Dorland's Illustrated Medical Dictionary as under : -
"COPD. Chronic Obstructive Pulmonary Disease."
11. The word 'Pulmonary' has been defined in the aforesaid Medical Dictionary as under : -
"Pulmonary.1. Pertaining to the lungs. Called also pneumonic and pulmonic 2. Pulmonic (def. 2)."
12. This disease, therefore, relating to the lungs was a serious problem in itself. It was very material.
13. The Hon'ble Supreme Court in the judgment reported as "Satwant Kaur Sandhu v. New India Assurance Company Ltd." 2009 CTJ 956 (Supreme Court) (CP) was pleased to observe as under:-
"17. The terms "material fact" is not defined in the Act and, therefore, it has been understood and explained by the Courts in general terms to mean as any fact which First Appeal No.895 of 2006 4 would influence the judgment of a prudent insurer in fixing the premium or determining whether he would like to accept the risk. Any fact which goes to the root of the Contract of Insurance and has a bearing on the risk involved would be "material'.
14. The law has been settled by the Hon'ble Supreme Court in a number of judgments that the contract of insurance is a contract of Uberrima fides and the parties are bound to disclose the material facts to each other. Reference can be made to the judgment reported as Mithoolal Nayak v. Life Insurance Corporation of India, AIR 1962 Supreme Court 814. It was held in this judgment that if the life insured suppressed the material facts with fraudulent intention then the insurer would be at liberty to repudiate the insurance claim.
15. This dictum of law was reiterated by the Hon'ble Supreme Court in the subsequent judgment reported as "Life Insurance Corpn. Of India & Ors. v. Asha Goel (Smt.) & Anr., I (2001) SLT 89 = (2001) 2 SCC 160" in which it was observed as under : -
"The contracts of insurance including the contract of life assurance are contracts uberimma fides and every fact of material (sic material fact) must be disclosed, otherwise, there is good ground for rescission of the contract. The duty to disclose material facts continues right up to the conclusion of the contract and also implies any material alteration in the character of the risk which may take place between the proposal and its acceptance. If there are any misstatements or suppression of material facts, the policy can be called into question. For determination of the question whether there has been suppression of any material facts it may be necessary to also examine whether the First Appeal No.895 of 2006 5 suppression relates to a fact which is in the exclusive knowledge of the person intending to take the policy and it could not be ascertained by reasonable enquiry by a prudent person."
16. This view of law has been approvably reiterated by the Hon'ble Supreme Court in the judgment reported as "P.C.Chacko & Anr v. Chairman, Life Insurance Corporation of India & Ors. III (2008) CPJ 78 (SC)."
17. The appellants have proved the medical record that the life assured was suffering from CPOD in as early as in the year 2000. It has been held by the Hon'ble Supreme Court in the judgment reported as "Satwant Kaur Sandhu's case (supra) as under:-
".................We do not find any substance in the contention of learned counsel for the appellant that reliance could not be placed on the certificate obtained by the respondent from the hospital, where the insured was treated. Apart from the fact that at no stage the appellant had pleaded that the insured was not treated at Vijaya Health Centre at Chennai, where he ultimately died. It is more than clear from the said certificate that information about the medical history of the deceased must have been supplied by his family members at the time of admission in the hospital, a normal practice in any hospital. Significantly, even the declaration in the proposal form by the proposer authorizes the insurer to seek information from any hospital he had attended or may attend concerning any disease or illness which may affect his health." First Appeal No.895 of 2006 6
18. Keeping in view the discussions held above, it is clearly proved that the life assured had suppressed material facts while filling the proposal form and, therefore, the respondent is not entitled to any insurance claim.
19. Accordingly, this appeal is accepted and the impugned judgment dated 1.6.2006 is set aside.
20. The appellants had deposited an amount of Rs.25,000/- with this Commission at the time of filing of the appeal on 12.7.2006. This amount of Rs.25,000/- with interest accrued thereon, if any, be refunded by the registry to the appellants by way of a crossed cheque/demand draft after the expiry of 45 days.
21. The arguments in this appeal were heard on 9.9.2011 and the order was reserved. Now the order be communicated to the parties.
22. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(JUSTICE S.N.AGGARWAL) PRESIDENT (AMARPREET SHARMA) MEMBER (BALDEV SINGH SEKHON) MEMBER September 23, 2011.
Paritosh