State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt. Pratima Mishra on 4 March, 2013
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR(C.G.)
Appeal No.FA/12/492
Instituted on : 12.09.2012
Life Insurance Corporation of India,
Through - Branch Manager,
Jagdalpur Road,
Kanker, District - Kanker (C.G.) ... Appellant.
Vs.
Smt. Pratima Mishra,
W/o Late Shri Hemant Kumar Mishra,
Resident of : Sheetalapara, Near Bajarpara School,
Kondgaon, District - Baster (C.G.) ... Respondent.
PRESENT: ‐
HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT
HON'BLE SMT. VEENA MISRA, MEMBER HON'BLE SHRI V.K.PATIL, MEMBER COUNSEL FOR THE PARTIES: ‐ Shri V. Vijay Rao, for appellant.
Shri Viplav Sharma, for respondent.
ORAL ORDER Dated: 04/03/2013 PER: ‐ HON'BLE JUSTICE SHRI S. C. VYAS, PRESIDENT The Life Insurance Corporation of India (hereinafter called "Insurance Corporation" for short), has felt aggrieved by order dated 13.08.2012 of District Consumer Disputes Redressal Forum, North Baster, Kanker (C.G.) (hereinafter called "District Forum" for short) in Complaint Case No.CC/06/2011 and has preferred this appeal challenging the award of Rs.3,00,000/‐, passed in favour of the // { PAGE \* MERGEFORMAT } // respondent/complainant along with interest @ 7.5% p.a. from the date of repudiation of the claim till date of payment and further direction of payment of cost of litigation Rs.5,000/‐.
2. Undisputedly, Shri Hemant Kumar Mishra, who was husband of the respondent/complainant purchased three insurance policies from the appellant / Insurance Corporation. He died on 16.03.2008, then his wife, the complainant preferred claim of sum assured under all the insurance policies. The appellant has paid sum assured of two insurance policies, but has declined to pay sum assured in respect of insurance policy no.385333282 on the ground that after proposal, when first premium was paid, at that time the deceased insured had already suffered a road accident and was injured and this fact was not notified by him to the Insurance Corporation and therefore a case of suppression of material fact has been made out against him and therefore, the Insurance Corporation, is not liable to make any payment in respect of third insurance policy and claim has been repudiated.
3. Before District Forum, it has been specified by the Insurance Corporation that proposal was made for the insurance cover by the deceased on 23.06.2007 after filling the proposal form and after paying // { PAGE \* MERGEFORMAT } // token amount of Rs.200/‐. Thereafter as the sum assured of all three insurance policies were more than Rs.15,00,000/‐, therefore the matter was referred to Divisional Office, Raipur of the Insurance Corporation from where on 11.12.2007 the local office was granted permission to proceed further with the proposal of insurance cover and in pursuance of this direction of the Divisional Office, Raipur on 13.12.2007, remaining amount of premium i.e. Rs.4,112/‐ was deposited, but in the meantime on 21.08.2007 in an road accident deceased suffered head injuries and was required to take treatment in Ramkrishna Care Hospital, Raipur, where he remained admitted for four days and thereafter was discharged. This fact was not notified by him to the Insurance Corporation and so on account of suppression of material fact, the condition of utmost confidence between the insurer and the insured was broken by the deceased and so the Insurance Corporation was not liable to pay any amount.
4. Learned District Forum did not agree with the defence taken by the Insurance Corporation and allowed the complaint by the impugned order.
5. We have heard arguments advanced by both parties and perused record of the District Forum.
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6. From the record of the District Forum, it appears that proposal form filled by the deceased insured and submitted before the Insurance Corporation, has been brought on record by the appellant/Insurance Corporation. The proposal form is containing a declaration wherein it was agreed by the proposer that "if after the date of submission of the proposal but before the issue of the first Premium Receipt (i) any change in his occupation or any adverse circumstances connected with his financial position or the general health of himself or that of any members of his family occurs or (ii) if a proposal for assurance or an application for revival of a policy on his life made to any office of the Corporation has been withdrawn or dropped, deferred or accepted at an increased premium or subject to lien or on terms other than as proposed he shall forthwith intimate the same to the Corporation in writing to reconsider the terms of acceptance.
7. Thus, it appears that proposer was required to notify to the Insurance Corporation only on the occasion of any change in his occupation or any adverse circumstances connected with his financial position or the general health of himself or that of any members of his family and regarding some circumstances of other insurance cover. It // { PAGE \* MERGEFORMAT } // does not contain any such condition on basis of which it can be presumed that if proposer suffered simple road accident and is admitted in the Hospital for four days and thereafter was discharged, with the medical opinion that he was not suffering from any bony injury or any permanent damage to any limb or vital organ even then he was required to notify to the Insurance Corporation in respect of such accident and admission in hospital for four days. Thus, this proposal form also does not help much to the Insurance Corporation.
8. Even if we presume that the deceased was required to notify anything to the Insurance Corporation as per terms and conditions of the acceptance, as per printed material available in the bottom of receipt of deposit of premium, even then requirement was only this that if there is any change in the occupation of the insured, then it was required to be notified and if there is any adverse circumstances connected with financial position or the general health of the proposer or that of any members of his family then if that circumstance may be very much unimportant, but the same if occurred between the date of proposal and date of this receipt or if on a proposal for assurance or an application for revival of a policy on the life made to any office of the Corporation, then it was required to be notified. Thus, what was // { PAGE \* MERGEFORMAT } // required to be notified was any change in the occupation of the insured or any adverse circumstances affecting the insured or his family members. If deceased insured suffered a road accident, but immediately after treatment it was found that he was not having any bony injury. When no adverse circumstances relating to his health was stated by any of the doctors to the deceased insured, then it was not required for him to notify anything to the Insurance Corporation. Even in the receipt, which was obtained by the deceased after deposit of the premium, only such terms and conditions were printed.
9. Documents in respect of treatment of deceased insured, which have been brought on record by the appellant before the District Forum are photocopies of the treatment of the deceased insured in Ramkrishna Care Hospital, Raipur as well as Chandulal Chandrakar Memorial Hospital, Bhilai. From these documents, it appears that as per noting of Ramkrishna Care Hospital, Raiapur on C.T. Scan, it was found that there was no bony injury and all four limbs could be raised by him. Pupil of both eyes were normal. Thus, nothing substantial was noted by the Hospital for which it can be said that it was a circumstance which had adversely affected the health of the insured and was required to be notified by him to the Insurance Corporation.
// { PAGE \* MERGEFORMAT } // Later on he was treated with Chandulal Chandrakar Memorial Hospital, Bhilai from 15.03.2008, where ultimately he died on 16.03.2008. Thus, from record of the treatment given in Ramkrishna Care Hospital, it appears that it is not containing any such information which can be said to be relating to circumstance adversely affected the health of the deceased insured and was required to be notified by him to the Insurance Corporation.
10. In these circumstances, no case of suppression of material fact against the deceased insured, is made out. The District Forum, has not committed any mistake in passing award against the appellant / Insurance Corporation and so appeal fails and is dismissed. No order as to the cost of this appeal.
(Justice S.C.Vyas) (Smt.Veena Misra) (V.K. Patil)
President Member Member
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