State Consumer Disputes Redressal Commission
The Branch Manager,Lic Of India & ... vs Smt. Ranjita Parida. on 6 December, 2022
(,
STAI'tr CONSIJMIIl{ I)l SI'}{.J'l'liS I{L.l)l{ESSAL COMMISSION,
ODISI"lA. CTJI-'IACK
FIRSTAI'}l'}EAL N0. 33 of 2012
(Irrom :rn order clated 0B.l I .2011 passed by the District
Consunrer I)ispr-rlcs Itedressal Forum, Jharsuguda in
Consumcr C'omplaint No. 13612010)
1) The Branch Managcr, LIC ol'lndia, Branch
Office, Atll']o/l)i st. Phu I ban i.
2) The Branch Managcr, LIC o1- Inciia, l]ranch
Office, Jharsuguda, I)ist. Jharsuguda
3) Divisional Managcr, LICI of India, t)ivisional
Office, Jecvan l)raka sh, I(hoclasing,
Berhampur(G.M)750010
4) The Divisional Marragcr, t,lC of India,
Sambalpur Division, Sarlbalpur,Ocli sha.
Appellants.
-VcrsLr s-
Smt.Ranjita l)aricia, W/o. Latc l]tiuy Kumar
Panda, IVo. S.ll.l.ltoad, ntlPO-/PS-
G.Udaygiri, Dist- I(anclhatnal, Phr-rlbani, At
present:-At- Purrunabasti, , PO/PS/Dist-
Jharsuguda.
Ilespondent.
Counsel lor the Appcllants- Sri Rohini Kanta Pattnaik &
Associates,
Counscl lbr thc ltcsponclcnt- Sri Aclhikari C.R.Das & Associates,
-z-
PITESENT :- Sri I)illip Kumar Mohapatra, Member.
Sri Prarnode Kutnar Prusty. Mentber.
DATE, OF HI.,ARIN(; -3{1.08.2022 DATE OF OttDElL- 06.12.2022 Sri IlK.PrusS.Member OITDEII 't'his appcal ariscs or,rt ol'order dt. 0U.11.2011 passed ir-r Consurr-rcr (bn-rplaint No 130/2010 by lcarncd [)istrict (]onsumer I)isputes l{cdrcssal liorut"r-t, JharsugLrda.
'l'l-rc bricl' lact of thc casc is tl-rat thc cor-nplainant is the wife of the deceascd late llijay I(urnar Pandur who was working as Head Master in Lingagada l{igh School in tl-rc District of Kandhmal. L,atc lliiay Kumar Panda was having fivc numbers of insurance policies which were undcr salary savir-rgs scheme. 'l'he prerniun-r amourrts werc bcing dcductcd fiom thc salary ol- dcceascd assurcd and wcrc paid to LIC of' India by thc school aurthority. 'l'hc complair-rant allcges that out o{'five policies, lbur policies have been settled by the insurance oompany but one policy bearing No.570319855 1or the sutl assurcd of Rs.1,00,000/- was repudiated by thc insurancc colxpany. She r-nadc rcprcsentation to the Zonal Managcr, t.l(l of India trt rcconsidcr thc clz.tirn burt hcr claim was turned down lbr which shc filcd thc cortsurrcr cornplainl case bclbrc thc learnr:r1 I)islric1 Fonrrn- .lharsua.ud lbr navment of insurance -3- amount with compensatiot-t.
On receipt ol- notice, the Opposite Parties LIC of India filed their written versiorr statir"rg that the deceased life assured had suppressed the material Iact oI hospitalisation and treatment for his ill health. Ijrom thc trcatmcnt rccord dt.6.3 .2005 issued by Santiniketan Mcnlal I Icalth Ccntrc, Yiz.ag it revealed that the life assured had adrlitted in the said hospital on 12.2.2005 for treatment of his mental deprcssion and was discharged or-r 6.3.2005. f)uring the said period of hospitalisertion hc was absent from his duty and that was prior to the date of colrlmcnccmcnt of the policy which was not mentioned in thc proposal lbmr as pcr the rules but the life assured suppressed thosc matcrial inlbrn-ration to the O.I'}s which leads to violation of the terms and cor-rditions of the policy. The repudition of claim of the cornplainaltt wzts t-tot malafide but on genuine ground.
The learnecl lbrun-r bclow after hearing the parties passed the impugned orrJer clircctir-rg thc O.Ps, LIC of India to pay to the complainant a sum of I{s.1,00,000/- thc assured amount with interest @10%p.a I'ron-r thc datc of rcpLrdiation i.e. 15.1.2008 till the date of actual payment. l'hc O.Ps were also directed to pay Rs.1000/- towards cost of the case/litigation.
Challcr-rging thc impugncd order of the learned forum below, this appeal has bccn filcd by thc appellant.
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During the cor-rrse of hearing, the learned counsel for the appellant contended that the lil-c zrssurecl was sr-rffering from different ailments and hacl undcrgor"rc hospitalization in Shantiniketan Mental Health Centre, Vishakhapatnam and l-rc had also availed medical leave for the said discase pcriod. tlut thc said lact had not bccn disclosed by the life assurcd in thc proposal l"orm. [Jecause of such non-disclosure of material fact and dclibcrate suppressiotr of fact, the contract of insurance was being vitiatccl dr-rc to breach of good faith which is the 'l'he Appellants in support of its cardinal principlc of insurancc law.
plea have filcd documcnary cvidcncc, but the lcarned llorum below without considcrir-rg thc malcrial cvidcncc availablc ir-r record has came to a finding that thc Appcllants/Opposite Parties have not produced any documentary cvidence with the written version to substantiate their plca although doocutnentary evidence were filed before the learncd llorum bclow, as such tl-rc impugned order is liable to be set aside.
T'he counscl lor thc l{cspondent submitted that the Opp.Party/ Appcllants hars not poduccd any documentary evidence in support of their writter-r staterrent. No single document has been produced by the Opp.l']arty/Appellar-rts to make tl-reir plea to believable and in absencc of Dischargc Ocrtil'rcatc issued by l-lealth Centre as well in absclce ol- 1py cvidcncc cithcr oral or documenary, the 9- learned District lrorum has rightly passed the impugned order.
The oounscl o{' I{cspondcnt/ Cornplainant cited the following decisionsto substzrntiatc thc casc. (1991) I SCC 357, in case of LIC of Inclia Vrs Smt. (i.M.Channabasamma, wherein the Hon'ble Apex Court hcld that "We, thereJbre, ugree with the High Court that the cleJbndont Corporotion hus foiled to discharge the burtlen of provirtg the defbnce story obor.tt the serious illness of the insurerl ut the time o/'tuking out the insurunce policies and knou,ingl.y suppressing the moterial information." Hon'ble Apcx (lor-rrt clisrnissccl the appeal of Life Insurance Corporation as it coulcl not provc thc c1c['crrcc story abor,rt serious illness of the insured at thc tirlc o1-taking or-rt thc il-tsurance policics.
Decision of Ilon'blc Apcx Court in case ol' Sulbha Prakash Motegaonkar Vrs Lile Insr-rrance Corporation, decided on 5tr' October 2015. Relevant portion o1'said.ir-rdgrncnt is cluotcd here under "l(e ure oJ the opinion that the National Comntissittn u,us in error in denying to the oppellonts the insurunce cloim und uccepting the repudiation of the claim by the respondent. T'he deoth of the insured due to ischemic hearf disetrse ttnrl ntltttcardiul infurction hud nothing to do with ltis lumbur spondilitis tttith PID with sciuticet In our considered opirtittrt, since the ulleged concenlntent wos not of such u nctture us n,oulrl disentitle the deceosed from getting his life insurerl, the repudiutiotr of the cloint wss incorrect und not justified.
Accorrlingly, we set osicle the order pussed by the
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IYotional Commissiotr und ullow the appeol. The respondent will accept the cloint made by the oppellants within u period of .four weeks.fi'om todoy ond moke the elue payment'"
l'he decision ol- Apcx C-'ourt in case of Manmohan Nanda Vrs United lndia Assurance ('o. Ltcl & other, decided on 6'r' Decernber 2021, where in Hon'ble Apex (lor-rrt lield that "lfe find considerable ./brce in tlte orgument morle on behrt![_! the _uppellant. This is because while cliohetes mellitus-ll is tr risk fuctor for t curdi, person, it is ntot u hurtl ond f ost t'Lle thot every pers eliabetes mellitus-It would necessarily s cliseuse. Cont,erselv, et lterson who does not suffer from diobetes mellitus-ll cun ulso sl(ffer froru o cardisc silment. Tltus, whot the uppellunt hod knowledge of was the existence of fliobetes mellitus-ll,.for which he was uncler treatment. In order to disclose the slulus oJ' the soid diseuse he hud submitted his I:CG report, btood ancl urine test reports which shov,ed nornml results. The ./irct thot ECG report showed normul purometers ntoultl indicute that the oppellant hod no corfliac diseuse. The prescription of stotins to the appellunt wos only 11.r 0 precotttion to prevent u possible cardiac ailruent.from rleveloping in the.future os diobetes mellitus-Il is et risk fuctor ./br such u tliseuse. But by that, it csnnot be lecluced or infbrred thut becouse the appellant hud t cardiac ailment or hltperlipiduemio, he wos prescribed stotins."
'I'he counscl ol' ILcsponclent/Complainant cited a decision repofted in Manu/OR/04 1()l20)g in case o1- Kunilata Sahoo Vrs Senior Divisional Managcr, I-lC o1- [nclia and others,(decided on 06-08-2009) where in Hon'ble Odisha IIigh Court has held that, *T^ "In the present cose, the decessed insured was suffering.fittrrr Gustritis with superficiol Stomuch (Jlcer and wus under medicution .fbr some time, as would be evident .from the l)octor's report (Annexure-K) to the Counter Affittartit. Admittedl.y, the deceased insured died of Wral Encephalitis und ('urdioc Respirutor arrest and suffired ./rom the sonte onl.y ten hours beJbre his death, as would be evident .fiom the Medical Attenclant Certificate (Annexure-4 scries) to the Writ Petition.
Irr view e/' the principles of low os discussed ubove, we ora o.f the crtnsidered view thot tts the deceused insurerl wus su.ffbring.fittrtt minor ollments like Gostritis with superficiol Stomuch (Jlcer, which is not u serious disease huvirtg on-y heorinyg ott the risk underloken by the L.I.C, the non-rlisclosure o.f the sunte cunnot he said to be material, especiull.y n,hcn the some dirl not t4ffict the lifb expectancy of the deceased insurerl. Moreover os the couse of death of the insured wts uclmitterl due to Virul Encepholitis coupled with Cardio Respirutory {trrest, which had no nexus with the previous olinrents o/'the deceosed insured, the repucliation of the polic.y unrl re.jectiort o./'the cloim by the L.I.C. Wus not proper ond .j ustified. "
The counscl o['ltcrspondcnt/C)omplainant cited the order passed in First Appcal No.91ll20ol by this Clornrnission in case of Chairman, LIC of India and another vrs. l)raclccp I(urnar Agarwal. In the said appeal this Commission has rciectccl thc appcal ol'l.lC ol-lndia Ltd. holding that:
^b^ " c-Ycept .filing soirl Medicol Attendant's Certificote und Medicol Exuminer's Confidential RePort t\t.30.10.200-1, rtppellunts have relied upon no other tlocuments. Ilut both these documents do not show tltut life assured x,us st(fbring.fronr epilepsy since 3 to 5 months prior to submission o.l'proposal./ornt- In these end of the view the life ussurerl cort not he soid to huve supressed sbout sufJbring o.f epileps.f irr the proposul .form- Therefore, the oppellonts hova reltudioted the death cloim of the contpluinurrt tyhile dischurging their aulhority in highly irresponsibIe munner. In these end of'the view we Jind no nrcrit in lha u1tPeul."
'l-he learnecl coLrnscl lor tl-re ILespondent sLrbrnitted that the Opp.Parties/ Appcllanrs l-iavc not pmc.luccd any clocumenary cvidence in support of thcir writtcn vc:rsion ancl ir-r arbscncc of Dischargcd Cerificate issued by l{ealth Ccntcr as wcll ers in abscncc ol-any evidcncc cither oral or documentary thc lcanrccl liglttlr bclow has rightly passed thc impugned order.
IT the appcllattt, il-tsurancc colrpany to prove its case that the insured was sLrli-cring 1r'ont anY clisease which leads to his death. The appcllalt has alsg lailcd to provc that thc insured was suffering fiom thc mYocarclial inlarction zrt thc timc o1'submission of proposal form rathcr ll'orll thc M cclical Attcndance Certi frcate(Claim -1- Fornr-[]) it clearly rcveals that thc insured was e xpired on 12.12.2006 due to acute pain ar-rd breathlcsslless.
Relevant portion of Iiorm-I) is quoted here under:
a) Datc of [)eath - 12.12.2006
b) Placc ol-l)calh - SUt [{oad,(i.tJdaygiri 4- a) What wars thc cxacl caLlsc o1-dcath Prir-nary cause - Myocardial Inlarction
b) Was it ascertairtcd by exatriuation alier deatl-t or inlbrred lrom sympton'rs and appearance o1'his hcalth- lirom symPtoms
c) Ilow long had hc bccr-r sull'cring lrorn this cliscasc belore his dcath- tlould no1 bc asccrtained
d) What werc symptoms of illness- acute pain, brcathlessness
e) when were they first observed by the deccased- 12.12.2006 fl What was the datc on which you wcre first consultcd during the illness - 12J2.2006
g) I)id you attcnd hirn durir-rg thc wholc of its coursc? l1-not slatc during what pcriod- Whole of its period I,'r()|x tlre ab(.t',,,e rliscrlosrrre((.'lainr [rtrtr Il). it reveals that the insured complair-red about accute pain and breathlessness oll 12.12.2996 ancl consulted thc doctor on 12.12.2006 and expired on the same clay i.e. t>n 12.12.2006. I"ur1her, affidavit dt.20.09.2011 filed by
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complainant clearly staling that tl'rc O.Ps, LIC of tpdia aocepted the above policy ald assurccl the lifc of the cleceased or-rly after getting him examinecl througl'r thcir own cloctor w'l-ro lound thc life assured Brjaya Kumar Panda was llt at thc rclcvant til"nc' wc havc pen-rsccl thc rccords, appcal mclno, DFI{, written submissions lllcd op behall-o{'both thc partics and citations filed by Respondent/Corr-rpletir-rant. We llnd the Appellants/ O'Ps have not filed any docutlelrtary cviclencc in support of their stand taken in written version regarclir-rg trcatrncut of complainant at Shantiniketan Mental Health (lcnter, Visakhapattlanl ancl to sl-row/prove the deceased life assured supprcssccl u-ratcriell inlormatiot-t to O.Ps ar-rd on the other hand, the contplainant has I-rlccl xcrox copics of thc letter of authorisation, rcpr-rcliation lettcr clt. 15.1 .2008 and her letter dt' 10.2.2008 alongwitl'r hcr' own eviclence in sl-rape ol affidavit dt' In the
20.g.2011 i1 support of hcr clairn as per thc cornplaint petition' absence of tl-rc Dischargc Cerillcatc dt. 6.3.2005 issued by Ytzag oral or Health Centrc as wcll as it-r absct1cc ol' any cvidcnce citl'rer documentary , wc arc u,ablc to bclicvc thc ctltrtcntions lnade in the
-l'he O.l)s havc r-rot filccl documenary evidencel written versio,.
except materials on the basis o1'rvhic[ thc death claim was replrdited, Mental mentioning abor-rt treatmcr-rt ol'con-rplainar-rt at Shantiniketar"r has been Health Centrc, Visakhapatnant, cvcll not a single documenl
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produced by L.I.C/Appellants to make their plea believable .
We have gonc through the averrments of the complaint , the repudiatior-r lctter dt. 15.1.2008 ar-rd thc cvidencc in shape o1- al'fidavit Illcd by thc cotnplainar-rl dt. 29.9.2011. We havc also perused the copy of thc Mcdical Attcndant's Clcrtillcatc dl. 2.1.2001 duly prepared/issucd by thc Mcdical Atlendant, whcreir-r it is slatcd that the dcceased/lif-e assured died on 12.12.2006 near S.U.l.Road Udaygiri due to Myocardial lr-rfarction, in this situation in absence ol any proof placcd by thc O.Ps, wc du rrot hcsitate to hold that the repudialion ol'thc claim is urniustillcd basclcss and without any valid rcason.
Wc lor-rnd lcan-rcd liourn-t bclow has claborately discussed the matter and rightly held that the Opp.Parties/ L.l.C has l-ailed to prove by satisf-actory ev'ider-rce that thc ir-rsured/deceased ever with held correct inlorn'ration rcgarding his clcath and mcdical lcavc at the time ol- signir-rg ol'proposal lirrm and hcld thc complainar-rt is dcscrved to gct thc full assurcd amount ol'thc policy ol-hcr husband, ::.. ln our considcrcd opinion, thc cor-nplainar-r1 is cntitlcd to get the I'ull assured amorrnl ol'thc pollgy of her lrusband and learrlecl Ilorum below has rightly passed the impr-rgned order.
In vicw of thc abovc lacts, wc conllrn-r thc irlpugl-rcd order passccl by thc learncd lrttrum below.
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Appeal sans rlerit, hence is disrnissed-
No cos1s.
lircc copy ol'thc ordcr bc supplicd to thc rcspcctivc parties or they n"ray clown load samc ll'orl thc conlorrct or wcbsite o['this Commission to trcat thc samc as copy o1-ordcr rcccivcd liom this C'ommissiot-t.
Send back the DFR.
[)ue to non-coltstitution of Bench, the order is delivered today i.c. 06. .12.2022.
,'h-,..-. \--{g-b\r'-
D.K.IIIoh-apatra ) (llK.Prusrlf
Member Mcmber