State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt. Shanti Rajbhar on 27 November, 2008
D R A F T State Consumer Disputes Redressal Commission West Bengal BHABANI BHAVAN (GROUND FLOOR) 31, BELVEDERE ROAD, ALIPORE KOLKATA 700 027 S.C. CASE NO. : FA/08/301 DATE OF FILING : 04.08.2008 DATE OF FINAL ORDER: 27.11.2008 APPELLANTS 1. The Branch Manager Life Insurance Corporation of India Cooch Behar Branch P.O., P.S. & Dist. Cooch Behar West Bengal. 2. The Divisional Manager Life Insurance Corporation of India Jalpaiguri Division P.O., P.S. & Dist. Jalpaiguri West Bengal. RESPONDENT Smt. Shanti Rajbhar Wife of Late Jhapsi Rajbhar Vivekananda Street P.O., P.S. & Dist. Cooch Behar. BEFORE : MEMBER : MR. S.COARI MEMBER : MRS. S.MAJUMDER FOR THE PETITIONER / APPELLANT : Ms Sumita Roy Chowdhury, Advocate FOR THE RESPONDENT / O.P.S.: Ms Suman Sehanabis, Advocate : O R D E R :
MR. S.COARI, HONBLE MEMBER The present Appeal has been directed against the judgement and order dt. 4.7.08 passed by the Cooch Behar District Consumer Forum in Case No. DF 43/2006 wherein the Ld. District Forum allowed the complaint in favour of the complainant.
The complainants case before the Ld. District Forum, in brief, was that one Jhapashi Rajbhar during his lifetime obtained a Life Insurance Policy from the Appellants concerned and during the continuance of such LIC policy he died on 28.9.03. The complainant is the nominee and wife of the deceased who preferred a claim before the Insurance Co. and the claim was deferred by the company on some pretext or other and ultimately the same was repudiated on the ground of withholding of some material information about the condition of health of the deceased at the time of inception of the insurance policy. Being aggrieved and dissatisfied with such repudiation the complainant preferred the complaint before the Ld. District Forum.
The Appellants/Ops contested the complaint case contending inter alia that the deceased intentionally withheld some material information about the condition of his health namely that he was suffering from various ailments including cirrhosis of liver which has ultimately caused his untimely death and that such withholding of material information has actually vitiated the contract between the parties and as such, there was nothing wrong on the part of the Insurance Co. to repudiate the claim of the complainant.
The Ld. District Forum after considering the respective parties case has observed that the plea taken by the Appellants/Ops to the effect that there was material suppression of facts in respect of the health condition of the insured was not acceptable and accordingly rejected the plea and upheld the claim of the complainant.
The only moot question that revolves round the present Appeal is as to whether the Ld. District Forum was justified in disposing of the complaint petition in the manner as discussed above.
DECISION WITH REASONS At the time of hearing the Ld. Advocate on behalf of the Appellants has submitted before us that there was positive withholding of information at the instance of the insured so far as it relates to his health condition inasmuch as he was suffering from various ailments at the time of inception of the insurance policy, which has ultimately caused his untimely death. According to the Ld. Counsel, the repudiation of claim was genuine as the Appellants took information from the employer of the deceased wherefrom it could be gathered that the deceased obtained medical leave for a long period due to various ailments. But for some obvious reasons this fact of suffering from various ailments were intentionally suppressed by the insured at the time of inception of the insurance policy as it would be evident from the filled up form of the insurance policy in question wherein there was specific questionnaire to that effect to which the insured has answered No. While elaborating her submission on this point the Ld. Advocate on behalf of the Appellant has also submitted to us that there no denial of the fact that the insured has died due to cirrhosis of liver and there was no disclosure of earlier ailments of the insured and on these grounds the repudiation of claim at the instance of the Appellants was proper and justified. According to the Ld. Advocate, the adverse inference drawn by the Ld. District Forum is not supported by materials on record. In this connection, the Ld. Advocate has also submitted that the contract of insurance is based on utmost good faith.
But it is extremely unfortunate that the insured did not observe this condition of good faith at the time of inception of the insurance policy under consideration and accordingly the contractual agreement between the Appellant and the insured is vitiated under the provisions of the Indian Contract Act. While concluding her submission the Ld. Advocate for the Appellants has submitted that had there been proper disclosure, the Appellants would certainly not have entered into any agreement with the insured as claimed by the Respondent and that the Appeal should be allowed after considering the fact that the Respondent/Complainant did not come with clean hands before the Ld. District Forum.
We have duly considered the submissions put forward by the Ld. Advocate on behalf of the Appellants and have also gone through the pleadings of the parties and materials on record and find that in the written objection before the Ld. District Forum the Appellant took the plea that the deceased was suffering from various ailments like UTI, Bronchitis, Typhoid etc. before the inception of the insurance policy.
However, we do not find any material on record so as to come to a conclusion that the insured was suffering from cirrhosis of liver prior to inception of the insurance policy. In this regard we find that the observation of the Ld. District Forum in this respect is just and proper, according to whom there was no positive material for a legal presumption that the deceased was suffering from cirrhosis of liver prior to taking of the policy or that there was intentional suppression of material facts at the relevant point of time.
We have also considered the decision referred to on behalf of the Appellants reported in III (2002) CPJ 10 (NC) and find that the facts of the cited decision is not similar to the instant one inasmuch as in the cited decision it was an admitted position that the insured was suffering from cancer, took treatment in the hospital which was not disclosed. The other decision, i.e. CPJ 2008 78 is also not applicable to the instant case as we find that the insured did not inform the hospitalization four years prior to the date of proposal of the policy. But in the instant case we find that there was no such non-disclosure of material ailments of the deceased. We do not find it out of place to mention that it is not uncommon on the part of an employee in general to take leave on medical grounds for some obvious reasons and that the leave so taken on medical ground will not certainly indicate that the concerned employee was actually ill on those dates for which the medical leave was obtained. Considering the present Appeal in the light of above observation we do not find any merit in the present Appeal and the same is liable to be dismissed. In the result, the Appeal fails.
Hence, ORDERED that the Appeal be dismissed on contest without cost. The judgment of the Forum below dt. 4.7.08 be affirmed.
MEMBER(L) MEMBER