State Consumer Disputes Redressal Commission
Lic Of India vs Narendra Singh on 25 February, 2009
BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR APPEAL NO: 701/2006 Life Insurance Corporation of India, through Sr.Divisional Manager, Ajmer. throuh Manager (Legal ) Jaipur. Opposite party-appellant Vs. Sh.Narendra Singh, Beawar Distt. Ajmer Complainant-respondent Date of judgment 25.2.09 Before: Mr.Justice Sunil Kumar Garg- President Mrs.Vimla Sethia-Member Mr.Ram Kalyan Sharma counsel for the appellants Mr. D.M.Mathur counsel for the respondent JUDGMENT
BY THE STATE COMMISSION ( PER HON. MR.JUSTICE SUNIL KUMAR GARG, PRESIDENT ) This appeal has been filed by the appellants LIC against order dated 20.3.06 passed by the District Forum, Ajmer in complaint no. 260/2005 by which the complaint of the complainant was allowed in the manner that the appellants were directed to pay a sum of Rs.1 lac the amount of the LIC policy alongwith interest @ 9% p.a. w.e.f. 28.5.04 and further to pay a sum of Rs.1000/- as costs.
22. It arises in the following circumstances-
That the deceased complainant respondent had filed a complaint before the District Forum, Ajmer on 12.9.06 inter alia stating that his wife Smt. Pramila, now deceased had taken a life insurance policy for a sum of Rs. 1 lac from the appellants on 15.2.04 bearing policy no.0184948417 and that policy was to come into force w.e.f. 28.11.03. It was further stated in the complaint that on 28.5.04 the deceased had died suddenly and after the death of the deceased claim was preferred by the complainant respondent being the husband and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 9.11.04 on the ground that at the time of taking the policy in question on 15.2.04 the deceased had filled in up a declartion form regarding her health in which she had not mentioned that she was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to that , the deceased was suffering from Hypertension Shock and had consulted the medical man and had taken the treatment from him and since these facts were not disclosed by the deceased in her declaration form on 15.2.04 at the time of taking the policy, therefore, the deceased was guilty of suppression of material facts regarding her health. Thereafter the present complaint was filed.
A reply was filed by the appellants on 7.2.06 and they have taken the same pleas which were taken by them in the repudiation letter dated 9.11.04 It was further stated in 3 the reply that since a specific question was asked by the appellants at the time of filling in up the declartion form on 15.2.04 whether she was a patient of hypertension etc. and since she had given the answer of these questions in negative but from the record of the Govt. Hospital, Beawar it is very much clear that the deceased was admitted in that hospital on 2.1.04 and the diagnosis which was made by the doctors was hypertension and when the deceased was admitted in the hospital, it was found that she was feeling difficulty in speach and further she was suffering from vertigo and on clinical examination it was found that it was a known case of hypertension and further on the same day the deceased had left the hospital against the medical advise of the doctors , therefore, it was a case of suppression of material facts regarding health on the part of the deceased and it was prayed that claim was rightly repudiated by the appellants and complaint be dismissed.
After hearing the parties the District Forum, Ajmer through impugned order dated 20.3.06 had allowed the complaint inter alia holding that -
(i) That since the deceased was admitted in the Govt.
Hospital, Beawar on 2.1.04 only for the purpose of investigation and since there is nothing on record to prove the fact that prior to filling in up the declartion form regarding her health on 15.2.04 , the deceased had ever taken treatment from any hospital therefore, it was not a case of suppression of material facts regarding health on the part of the deceased.
4(ii) That the appellants were not justified in repudiating the claim of the complainant respondent and it had amounted to deficiency in service on the part of the appellants.
Aggrieved from that order dated 20.3.06 passed by the District Forum, Ajmer , this appeal has been filed by the appellants.
3. In this appeal the main contention of the learned counsel for the appellants is that before issuance of policy in question, the deceased was suffering from the disease of Hypertension, stroke and dysphasia for which she took medical treatment from the doctor and since these facts were not disclosed by the deceased deliberately in her declaration form on 15.2.04 , therefore, she was guilty of suppression of material facts regarding health and thus on that ground the claim of the complainant respondent was rightly repudiated by the appellants through letter dated 9.11.04 and the District Forum had committed serious error and illegality in decreeing the claim of the complainant respondent. Hence the impugned order could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.
4. On the other hand, the learned counsel appearing for the respondent has supported the impugned order of the District Forum .
5. We have heard the learned counsel for the appellants as well as for the respondent and gone through the entire materials available on record.
56. There is no dispute on the point that the deceased had taken a life insurance policy for a sum of Rs. 1 lac from the appellants on 15.2.04 bearing policy no.0184948417 and that policy was to come into force w.e.f. 28.11.03.
7. There is also no dispute on the point that at the time of taking insurance policy , a declaration was made by the deceased and in that declaration on 15.2.04 , he had not mentioned that he was suffering from any kind of disease or had taken any treatment from any hospital.
8. There is also no dispute on the point that deceased had died on 28.5.04 meaning thereby within four months 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 appellants through letter dated 9.11.04 on the grounds mentioned therein.
10. On file there is a record of Govt. Hospital, Beawar which shows that the deceased was admitted in the hospital on 2.1.04 and at the time of admission the disease which was diagnosed by the doctors of the hospital was hypertension and the complaints which were made by the deceased at the time of admission were difficulty in speach, vertigo and she was found known case of hypertension and the final diagnosis which was made by the doctors was Dysphasis.
11. There is no dispute on the point that on the same i.e. 2.1.04 the deceased had left the hospital against the medical advice and further on the back of the bed head ticket of the hospital, it was 6 mentioned by the complainant respondent in his own writing that he is taking his wife ( the deceased ) to Ajmer for the purpose of geting CT Scan.
12. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum could be sustained or not and whether the repudiation of the claim of the complainant respondent by the appellants was justified or not.
13. It may be stated here that since in this case there is a record of the hospital that prior to taking the policy in question i.e. on 15.2.04 the deceased was admitted in the Govt. Hospital, Beawar on 2.1.04 and Hypertension, vertigo, stroke and dysphasia diseases were diagnosed by the doctors and since at the time of filling in up the declaration form on 15.2.04 regarding health on the part of the deceased, she had not mentioned that she was suffering from above mentioned diseases, therefore, it would certainly amount to suppression of material facts regarding health on the part of the deceased.
14. It may further be stated here that the present case is not a simple case of hypertension only but it is a case of stroke as well as of Dysphasia. The word " Dysphasia" means -
" Dysphasia or aphasis, is impairment in communication. It's caused by damage to the part of the left side of the brain, which is responsible for language and communication."
15. Similarly the word " Stroke " means-
7"A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood supply to the brain. This can be due to ischemia ( lack of blood supply ) caused by thrombosis or embolism or due to a hemorrhage. As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech or inability to see one side of the visual field."
16. It may be stated here that the brain damage that results in dysphasia is often caused by a stroke, when the blood supply to the brain is interrupted and ultimately it leads to the heart attack.
17. Thus, if the deceased was a patient of Dysphasia prior to taking the policy and if that fact was not mentioned by the deceased at the time of filling in up the declaration form rearding her health on 15.2.04, therefore, it would certainly amount to suppression of material facts regarding health on the part of the deceased because it is a very serious disease affecting left part of the brain.
18. Further the learned counsel for the complainant has argued that since the cause of death of the deceased was not the disease of dysphasia and therefore, there was no nexus between the cause of death of the deceased and thus the findings recorded by the District Forum should be upheld.
19. In our considered opinion, this argument does not carry any weight because of the fact that when there is disease known as dysphasia, it would certainly result in stroke as the blood supply to the brain is interrupted and when it being so, the deceased has 8 nexus with the cause of death of the deceased i.e. heart attack.
20. In view of the discussion made above, it is held that repudiation of claim of complainant respondent by the appellants through letter dated 9.11.04 on ground of suppression of material facts regarding health by the deceased was justified and no illegality or irregularity has been committed by the appellants in repudiating the claim of complainant respondent and in view of this, the findings of the District Forum decreeing the claim of the complainant respondent could not be sustained and the same are liable to quashed and set aside as they are wholly illegal, erroneous and perverse one and the appeal deserves to be allowed.
Accordingly, the appeal filed by the appellants LIC is allowed and the impugned order dated 20.3.06 passed by the District Forum, Ajmer is quashed and set aside and the complaint of the complainant respondent is dismissed.
Member President