State Consumer Disputes Redressal Commission
L I C vs Smt Chandrawati Devi on 5 February, 2016
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 First Appeal No. A/2005/109 (Arisen out of Order Dated in Case No. of District Lucknow-I) 1. L I C Lucknow ...........Appellant(s) Versus 1. Smt Chandrawati Devi Ballia ...........Respondent(s) BEFORE: HON'BLE MR. Alok Kumar Bose PRESIDING MEMBER HON'BLE MRS. Smt Balkumari MEMBER For the Appellant: For the Respondent: ORDER RESERVED State Consumer Disputes Redressal Commission U.P., Lucknow. Appeal No.109 of 2005 1- Bhartiya Jeevan Bima Nigam through Prabandhak (Vidhi), Mandal Karyalaya, 30, Jeevan Prakash, Hazratganj, Lucknow. 2- Chairman, Bhartiya Jeevan Bima Nigam, Kendriya Karyalaya "Yogakshem", Jeevan Bima Marg, Mumbai (Maharastra) through Prabandhak (Vidhi), 30, Jeevan Prakash, Hazratganj, Lucknow 3- Varishtha Mandal Prabandhak, Bhartiya Jeevan Bima Nigan, Mandal Karyalaya, Jeevan Prakash, B-12/120, Gauriganj, Shahar & District: Varanasi U.P. through Prabandhak (Vidhi), Mandal Karyalaya, 30, Jeevan Prakash, Hazratganj, Lucknow. 4- Varishtha Shakha Prabandhak, Bhartiya Jeevan Bima Nigan, Shakha Karyalaya, Ballia U.P. through Prabandhak (Vidhi), Mandal Karyalaya, 30, Jeevan Prakash, Hazratganj, Lucknow. .Appellants. Versus Smt. Chandrawati Devi aged about 51 years, W/o Late Sri Bharat Prasad Verma, R/o Brij Bihari Singh Marg (Shastri Nagar) presently at Mohalla Tara Nivas Gali, Satni Sarai, Post, Shahar, Pargana & District: Ballia. ...Respondent. Present:- 1- Hon'ble Sri A.K. Bose, Presiding Member. 2- Hon'ble Smt. Bal Kumari, Member. Sri T.C. Seth for the appellant. Sri Sidharth Srinetra for the respondent. Date 29.2.2016 JUDGMENT
Sri A.K. Bose, Member- Aggrieved by the judgment and (2) order dated 7.12.2004, passed by the Ld. DCDRF, Ballia in complaint case No.87 of 2004, the appellants Bhartiya Jeevan Bima Nigam and three others have preferred the instant appeal under Section 15 of the Consumer Protection Act, 1986 (Act 68 of 1986) on the ground that the impugned order is arbitrary, perverse and is bad in the eye of law. It was delivered without proper appreciation of law and/or application of mind on the basis of surmises and conjectures and therefore, it has been prayed that the same be set aside in the interest of justice otherwise the appellants will suffer irreparable loss.
Heard the parties and perused the records. From perusal of the records, it transpires that the husband of the respondent/complainant Sri Bharat Prasad had two Life Insurance Policies bearing no.282588362 under Table and Term 106-15 for a sum assured Rs.25,000.00 and no.282594885 under Table and Term 14-19 for a sum assured Rs.50,000.00 in his name. The first policy commenced from 28.10.1999 whereas the second one commenced from 28.3.2000. The insured replied to all questions in negative relating to status of his health in the proposal forms; and also informed that the general condition of his health had been good all along. The photocopy of the proposal forms are on record. The insured expired on 15.12.2002 due to sudden heart failure and, therefore, two separate claims were filed by his nominee. Since the matter related to early death, therefore, an investigation was conducted into the matter where upon it was revealed that the insured was a known case of (3) Diabetes and was suffering from it for more than 5 years before the proposal. He was also suffering from Tuberculosis and was under treatment for the same for more that a year prior to the filing of the proposal forms. The Case Summary and Discharge Record issued by the Institute of Medical Sciences & S.S. Hospital, B.H.U., Varanasi dated 17.4.2000 are on record which show that the insured had been admitted in the Institute of Medical Sciences & S.S. Hospital, B.H.U., Varanasi on 17.4.2000. He remained there till 22.4.2000 and was under the treatment of Dr. K.K. Tripathi. From perusal of the records, it further transpires that his ailment was diagnosed as CRF (Chronic Renal Failure), DN: Stage-V (Diabetes Nephropathy) with BDR (Background Diabetic Retinopathy). The secondary diagnosis was Pulmonary Edema and Ectopic Left Kidney. The case note of the insured, issued by the Institute of Medical Sciences, BHU, Varanasi also indicates that the patient was detected to have NIDDM (Non-Insulin Dependent Diabetes Mellitus) for 6 years and he had tried various Ayurvedic medicines before approaching the Medical Institute. The admission records of the Institute further indicates that the patient was suffering from NIDDM with Nephropathy and Ectopic Kidney, apart from other ailments. The genuineness of the medical papers, issued by the Institute of Medical Sciences, BHU, Varanasi has neither been challenged nor can be disputed. Thus, it is clear that at the time of admission of the insured on 17.4.2000, he was suffering from Chronic Renal Failure, (4) Diabetes Nephropathy Stage-V with Background Diabetic Retinopathy. He was also suffering from Non-Insulin Dependent Diabetes Mellitus for about 6 years. Chronic Renal Disease is progressive loss in kidney function over a period of months or years. The symptoms of worsening kidney function are never specific and might include feeling generally unwell and experiencing a reduced appetite. Often chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problem, such as those with high blood pressure or diabetes and those with a blood relative with CKD. This disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia, pericarditis or renal osteodystrophy. Chronic Kidney Disease (CKD) is a long-term form of kidney disease; thus, it is differentiated from acute kidney disease. Diabetic Nephropathy: Stage-V (or Diabetic Kidney Disease) is a progressive kidney disease caused by damage to the capillaries in the kidneys' glomeruli. It is characterized by nephritic syndrome and diffuse scarring of the glomeruli. It is due to long standing diabetes mellitus, and is a prime reason for dialysis in many developed countries. It is classified as a small blood vessel complication of diabetes. There are five stages of CKD with Stage-I being the mildest and usually causing few symptoms and stage 5 being a severe illness with poor life expectancy if untreated. Stage 5 CKD is often called End Stage Kidney disease, end-stage renal disease, or end stage kidney failure and is largely (5) synonymous with the now outdated terms chronic renal failure or chronic kidney failure; and usually means the patient requires renal replacement therapy, which may involve a form of dialysis but ideally constitutes a kidney transplant. The insured was also suffering from Background Diabetic Retinopathy also known as diabetic eye disease. It is a stage when damage occurs in the retina due to diabetes. It can eventually lead to blindness. It is an ocular manifestation of diabetes, a systemic disease which affects up to 80 percent of all patients who have had diabetes for 20 years or more. Background diabetic retinopathy or BDR is named appropriately because it sits in the background, not itself a danger to vision, but is instead a warning sign that serious damage may starting. Directly above the white arrows in the picture are two small flame shaped haemorrhages with tiny microaneurisms seen along either side of the vessel between the arrows. This warning sign is difficult to interpret, about 80% of people who have had diabetes for over 20 years have some BDR but only about 1 out of every 4 or 5 of those with BDR will eventually suffer measurable vision impairment. The insured was also having NIDDM (Non-Insulin Dependent Diabetes Mellitus) with Nephropathy and Ectopic Kidney. Diabetes Mellitus is a long term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained (6) weight loss. Symptoms may also include increased hunger, feeling tired and sores that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure and poor blood flow in the limbs which may lead to amputations. Of the various types of Diabetes Mellitus, Non-Insulin-Dependent Diabetes is, by far, the most common and is ever increasing. It is a heterogeneous disorder, characterized by a genetic predisposition and interaction between insulin resistance and decreased pancreatic bet-cell function. There is a strong association between the presence of obesity and low levels of physical exercise and the development of NIDDM. However, NIDDM may also develop in lean individuals and the incidence increased significantly with increasing age. The insured was also a patient of Tuberculosis and Chronic Renal Disease with Pulmonary Edima and Ectopic Left Kidney. The insured, however, concealed these facts relating to the status of his health in the proposal. In Maya Devi vs. LIC of India, III (2011)CPJ 43 (NC), it has been held that the case history given in certificate of Doctor can not be disbelieved. It is immaterial whether the insured was declared medically fit by the Penal Doctor of the LIC at the time of his medical examination or not. In Smt. Shashikala Vijaykumar Bohra vs. LIC of India, Legal Digest 2010 pg. 134, it has been held that examination by Penal Doctors of the LIC does not absolve life insured of his duty to disclose the factum of ailment.
(7)It was argued by the Ld. Counsel for the respondent that the Attending Doctor has not filed his Affidavit and, therefore, these Prescriptions can not be read in evidence. This argument has no force in view of ruling laid down in Pushpa Chauhan vs. LIC of India, II (2011) CPJ 44 (NC) in which it has been held that the affidavit of the Doctor is not required. It may also be observed here that the Hon'ble Apex Court in P.C. Chacko & Anr. vs LIC of India, (2001) SCC 321, has been pleased to hold that:
"the purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bone fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiate in law."
A similar view was also taken by the Hon'ble National Commission in LIC of India vs. Shahida Khatoon & Anr. Legal Digest (2013) 294 (NC). Thus, in view of the discussions made and the rulings cited hereinabove, we are of the considered opinion that in the instant matter, the insured Sri Bharat Prasad concealed the material information regarding the status of his health in (8) the proposal forms. As such, repudiation of the claims on ground of concealment of previous ailments in the proposal forms was justified. The insured obtained the policy in gross breach of principles of Uberrimae fide. The Forum below failed to appreciate the law on the point and delivered the judgment without considering the factum of concealment and ruling laid down by the Hon'ble Apex Court and the Hon'ble National Commission. As such, the judgment suffers from material irregularity and illegality and, therefore, can not be allowed to sustain. Consequently, the appeal deserves to be allowed.
ORDER The appeal is allowed and the judgment and order dated 7.12.2004, passed by the Ld. DCDRF, Ballia in complaint case No.87 of 2004 is set aside.
No order as to costs. Certified copy of the judgment be provided to the parties in accordance with rules.
(A.K. Bose) (Bal Kumari) Presiding Member Member Jafri PA II Court No.3 [HON'BLE MR. Alok Kumar Bose] PRESIDING MEMBER [HON'BLE MRS. Smt Balkumari] MEMBER