State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt. Janki Devi on 8 July, 2011
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND
DEHRADUN
FIRST APPEAL NO. 327 / 2010
Life Insurance Corporation of India
Branch Office Ranikhet through Branch Manager
Ranikhet, District Almora
...Appellant / Opposite Party
Versus
Smt. Janki Devi W/o late Sh. Tara Dutt Pandey
R/o Village Gar Ki Chamdoli, Post Office Dhodakhal
District Almora
......Respondent / Complainant
Sh. Deepak Ahluwalia, Learned Counsel for the Appellant
Sh. Lalit Mohan Pandey, Son of the Respondent
Coram: Hon'ble Justice B.C. Kandpal, President
C.C. Pant, Member
Smt. Kusum Lata Sharma, Member
Dated: 08/07/2011
ORDER
(Per: Justice B.C. Kandpal, President):
This is insurer's appeal under Section 15 of the Consumer Protection Act, 1986 against the order dated 13.09.2010 passed by the District Forum, Almora, thereby allowing the consumer complaint No. 01 of 2009 and directing the opposite party - Life Insurance Corporation of India to pay to the complainant insured sum of Rs. 1,00,000/- together with interest @6% p.a. from 26.10.2007, i.e., the date of lodging the claim with the insurance company till the date of actual payment and Rs. 5,000/- as compensation.
2. In brief the facts of the case are that the insured late Sh. Tara Dutt Pandey, the husband of the complainant, purchased a life insurance policy for sum of Rs. 1,00,000/- on 30.03.2007 and the 2 premium of Rs. 20,000/- was paid. The insured was employed as Senior Head Messenger in State Bank of India, Tarikhet, District Almora. The complainant was the nominee under the said policy. On 04.08.2007, the insured felt pain in his heart and he was admitted in Khandelwal Hospital & Urology Centre, New Delhi, where he died. On claim being lodged by the complainant, the same was repudiated by the insurance company on the ground that the insured suppressed the material information in the proposal form. Alleging deficiency in service on the part of the insurance company, the complainant filed a consumer complaint before the District Forum, Almora.
3. The insurance company filed written statement and pleaded that prior to taking the policy in question, the insured had taken certain leave from his office for treatment. The insured was suffering from Chronic Obstructive Pulmonary Disease Coronary Artery L.V. Dysfunction with Cardiogenic Shock, which fact was suppressed by him in the proposal form. It was also pleaded that the claim of the complainant has also been turned down by the Insurance Ombudsman, U.P. & Uttarakhand, Lucknow and it has been held that the life assured suppressed the material information and the decision of the insurance company for repudiating the claim has been upheld. It was also alleged that no deficiency in service has been made by the insurance company in repudiating the claim.
4. The District Forum, on an appreciation of the material on record, allowed the consumer complaint vide order dated 13.09.2010 in the above terms. Aggrieved by the said order, the insurance company has filed this appeal.
35. We have heard learned counsel for the appellant and Sh. Lalit Mohan Pandey, the son of the respondent - complainant and gone through the record.
6. Learned counsel for the insurance company has argued that the policyholder has concealed the true facts with regard to his disease at the time of filling the proposal form, as, in fact, he had already been suffering with the heart disease, but he deliberately concealed this fact and, therefore, the claim was repudiated by the insurance company on valid ground.
7. A bare perusal of the record shows that Sh. Tara Dutt Pandey - deceased, in whose favour the policy was issued, died on account of the heart ailment. Our attention has been invited towards Paper Nos. 43 to 44 available on record which is the certificate of hospital treatment and which indicates that Sh. Tara Dutt Pandey, policyholder was admitted in Khandelwal Hospital & Urology Centre, New Delhi on 04.08.2007. The diagnosis arrived at in the hospital also indicates that Sh. Tara Dutt Pandey was suffering with COPD which means Chronic Obstructive Pulmonary Disease. Our attention has further been invited towards Paper No. 66, in which the doctor has suggested that the patient was suffering from COPD. Learned counsel for the insurance company, on the basis of these documents, has vehemently stressed on this aspect of the matter that Sh. Tara Dutt Pandey had been suffering with the heart ailment from before submitting the proposal form and he deliberately concealed this fact in the proposal form. Our attention has also been invited towards other documents whereby the learned counsel for the insurance company has tried to convince us that Sh. Tara Dutt Pandey remained on medical leave on several occasions from 2004 to 2006. According to the learned counsel for the insurance company, this fact further strengthens this 4 aspect that Sh. Tara Dutt Pandey had been suffering with such an ailment which ultimately became fatal to his life and he died on account of this fatal disease. Learned counsel for the insurance company has cited the decisions of the Hon'ble National Commission given in the case of Dineshbhai Chandrana and another Vs. Life Insurance Corporation and another; 2011 (1) CPR 63 (NC), LIC of India Vs. Dalbir Kaur; I (2011) CPJ 83 (NC), Budhiben Pababhai Vs. LIC of India and others; I (2010) CPJ 92 (NC) and Panni Devi Vs. L.I.C. and others; III (2003) CPJ 15 (NC), in order to show that if the policy has been obtained by suppressing the material fact in the proposal form, then the repudiation of the claim is absolutely justified.
8. We have carefully gone through the decisions cited by the learned counsel for the appellant - insurance company and we are of the definite view that these rulings are not going to provide any help to the appellant, for the reason that in the instant case, the appellant could not show that Sh. Tara Dutt Pandey, in fact, had suppressed the material fact with regard to his heart ailment at the time of filling the proposal form.
9. The doctor who attended Sh. Tara Dutt Pandey in the hospital where he died, has indicated that Sh. Tara Dutt Pandey died on account of COPD, CAD, L.V. Dysfunction with Cardiogenic Shock and he also indicated that the deceased had been suffering with this disease from before three days of his death (Paper No. 43 on record). It is worth to mention here that Paper No. 66, on which the reliance has been placed by the learned counsel for the appellant, indicates that one Sh. Ganga Dutt S/o Sh. Girdhari Dutt had been suffering with the disease COPD. Learned counsel for the insurance company has tried to co-relate this document with the disease of the deceased and tried to 5 develop this aspect that the deceased, in fact, suppressed the material fact, but we are of the view that Paper No. 66 which relates to one Sh. Ganga Dutt S/o Sh. Girdhari Dutt, does not have any connection with the disease of the deceased Sh. Tara Dutt Pandey. It is further worth to mention here that the mere fact that Sh. Tara Dutt Pandey remained on leave on account of his ill health before his death, hardly makes any difference, unless it is proved that Sh. Tara Dutt Pandey, in fact, remained on medical leave on account of heart ailment. Paper No. 49 shows that Sh. Tara Dutt Pandey had although remained on leave on several occasions, but he remained on earned leave. The documents on record show that whenever Sh. Tara Dutt Pandey remained on medical leave, he had been suffering either from trauma in right knee or bronchitis, which has got no nexus with the death of the life assured. The trauma in the right knee or bronchitis is not such a disease which may ordinarily cause death and when there is no nexus between the cause of death of the life assured and the disease on account whereof he took leave, then in our opinion, the repudiation of the claim can not be said to be justified. The mere fact that the deceased had taken earned leave on several occasions, does not establish that he suppressed the material fact relating to his disease with which he ultimately died. The burden lies on the insurance company to establish this fact beyond reasonable doubt that the insured suppressed the material fact with regard to his ailment with which he ultimately died. The fact that the insured died within a year of taking the policy, is not sufficient to repudiate the claim. The heart ailment is such a disease which can cause death of any person at any point of time and that too without having any previous symptom of the said disease. We are of the view that there is no evidence available on record which may suggest that the deceased - life assured had been suffering with heart ailment at the time of filling the proposal form and he suppressed this fact in the proposal form. The 6 repudiation of the claim by the insurance company was absolutely against the settled principle of law and can not be said to be justified. The judgment and order passed by the District Forum does not suffer from any illegality or irregularity and the same is fit to be confirmed. The appeal lacks merit and is liable to be dismissed.
10. Appeal is dismissed. No order as to costs.
(SMT. KUSUM LATA SHARMA) (C.C. PANT) (JUSTICE B.C. KANDPAL) K