State Consumer Disputes Redressal Commission
S.B.M.Life Insurance Corporation Of ... vs Bhabagrahi Routray on 29 April, 2008
STATE CONSUMER DISPUTES REDRESSAL COMMISSION:ORISSA:CUTTACK STATE CONSUMER DISPUTES REDRESSAL COMMISSION:ORISSA:CUTTACK C.D. APPEAL NO.390 OF 2004 From an order dated 17.04.2004 passed by the District Consumer Disputes Redressal Forum, Rourkela in C.D. Case No.191 of 2003 1. The Senior Branch Manager, Life Insurance Corporation of India, Sector-19 Branch Office, Rourkela, District- Sundargarh. 2. The Senior Divisional Manager, Life Insurance Corporation of India, Sambalpur Divisional Office, At/P.O- Ainthapalli, Dist- Sambalpur. Appellants. -Versus- Bhabagrahi Routray, Plot No.EE-15, Civil Township, Rourkela-4, Dist- Sundargarh. Respondent. For the Appellants : M/s. G. Kar & Assoc. For the Respondent : M/s. N. Lenka & Assoc. PRESENT : THE HONBLE SMT. BASANTI DEVI, MEMBER A N D SHRI SUBASH MAHTAB, PRESIDENT IN-CHARGE. O R D E R
DATE: - 29TH APRIL, 2008 Smt. Basanti Devi, Member.
This appeal by the opposite parties has been directed against the order dated 17.04.2004 of the District Forum, Sundargarh-II, Rourkela, in C.D. Case No.91 of 2003 dictating opposite parties to pay the insured sum viz. rupees 5,00,000/- to the complainant who is the father and nominee of the assured since dead, against policy No.591450393 with other benefit as per the policy condition within thirty days from the date of receipt of the copy of the order, failing which to pay interest @9% per annum over said amount and to pay cost of litigation rupees 2,000/-.
2. The facts as per the C.D. case in brief is that Mona Routra was serving in R.S. Software (India) Ltd., 234/3A AJC Bose Road at Kolkata being an Engineer in Electronics and Telecommunication. She insured her life with L.I.C. of India through opposite party No.1 for assured sum of rupees 5,00,000/- and submitted proposal form on 09.09.2000. Opposite party No.1 after necessary check-up accepted the proposal form and asked life assured to deposit premium by 18.09.2000. Life assured was examined by the paneled doctor of the opposite party No.1 and deposited quarterly premium rupees 6,419/- on 18.09.2000 and opposite party No.1 issued policy bond (xerox copy is filed) to her on 19.09.2000. Suddenly, life assured suffered from fever and was treated at Ispat General Hospital, in short, I.G.H. Rourkela on 23.09.2000. Unfortunately, on 06.10.2000, when she was checked further in the said hospital, she was found suffering from Carcinama Ovary and was admitted into that hospital. Since there was no improvement, she was admitted in Tata Memorial Hospital, Mumbai for better treatment. But on 28.10.2000 she died in said hospital due to Cardio Respiratory Arrest with Secondary cause of Carcinama Ovary and Renal failure (xerox copy of Death Certificate filed). The complainant thereafter lodged L.I.C. policy claim before the opposite parties. But opposite parties vide their letter dated 05.09.2003 almost after three years, repudiated the claim on the ground of suppression of material facts relating to her health in the proposal for policy and even when the policy was accepted by the opposite parties.
3. The case of the opposite parties as per their written version is that Mona Routra had not disclosed about her acute health condition viz. suffering from lower back ache to the examining Dr. I. Patnaik while submitting the proposal on 09.09.2000. The L.I.C. accepted the proposal in good faith as contract of insurance is based on good faith and issued policy on 19.09.2000. As the death claim has been made only after one month and nine days of the policy, opposite parties made thorough enquiry about authenticity of claim in view of section 45 of the Insurance Act, 1938 and came to know from the admission by the complainant that Mona Routra was treated on 23.09.2000 in the I.G.H. Hospital, Rourkela and as per entry at page 33 of data sheet of the Outdoor health center treatment of the said hospital, Mona had complained Lower Back ache for last eight days. That means, she was suffering from Lower Back ache since 15.09.2000. Therefore, according to the opposite parties, had she disclosed about this suffering when she was examined on 09.09.2000 formally by the L.I.Cs doctor and also when she submitted the proposal on 18.09.2000, they should not have allowed her to enter into such a policy without regular medical check-up. Mona took admission in the I.G.H. hospital on 06.10.2000 and was referred to Tata Memorial Hospital, Mumbai on 10.10.2000 which hospital bears reference of the patient being investigated at Rourkela. Thus, since Mona Routra has knowingly suppressed about her serious illness while entering into the policy, they have repudiated the claim on 05.09.2003 in view of section 45 of the Insurance Act. Accordingly, opposite parties had claimed for dismissal of the C.D. case.
4. Going through the case of both parties, the District Forum vide its aforesaid orders has observed that the treatment record of passed three years does not disclose the Mona was suffering from serious disease or the disease for which she died. That, there is no proof that while submitting proposal for policy, Mona was suffering from any disease or the disease, for which she died. The District Forum also observed that life assured complained about lower back ache on 23.09.2000 before the Doctor, I.G.H. which does not mean that she knew the disease on such date. Moreover, even if life assured had suffered from lower back ache while submitting the proposal, it cannot be said that she knew at that time that she was suffering for Carcinoma Ovary. Therefore, the aforesaid disease was diagnoside and detected after the said policy was accepted by the opposite parties. Further, there is no evidence to show that insured was suffering from this particular disease prior to the policy was accepted. In these end of the view, according to the District Forum, complainant has not made suppression of material fact viz. relating to suffering of aforesaid disease until the proposal was accepted, for which repudiation of claim of the complainant by the opposite parties is unjustified and arbitrary. So, the impugned order was passed.
5. We went through the case of both parties and perused the xerox copies of documents filed by the parties.
6. As per the appeal memo as well as before us appellants have seriously challenged the aforesaid findings of the District Forum in not holding Mona to have suppressed about suffering from lower back ache which was found later on in the worst case, a symptom of a dangerous disease viz. Carcinoma Ovary which resulted to her death. According to them, though Mona was duty bound to disclose about lower back ache before the proposal for the policy was accepted, she has knowingly and deliberately suppressed material facts which is clear from the fact that after the proposal was accepted on 18.09.2000, she had consulted with the doctor on 23.09.2000 in respect to her lower back ache during last eight days that means since 15.09.2000 and took admission in the hospital on 06.10.2000 and was referred to the Tata Memorial Hospital on 10.10.2000. In this end of the view, as has been held by the Honble Apex Court in a decision reported in AIR 1962 Supreme Court at Page 814 (V. 49C 117) Mona is guilty for fraudulent suppression of material facts.
7. Now, therefore, the sole question arises as to whether Mona the insured, knowingly and fraudulently suppressed material facts relating to suffering from lower back ache while submitting the proposal for and entering into the L.I.C. policy.
8. In the decision referred to above, the Honble Apex Court has arrived into a finding that where the policy holder has suppressed material facts, which he is required to disclose, fraudulently, knowingly and deliberately and he is making false statements relating to material facts, a policy is vitiated.
9. But it is noticed from the xerox copies of the record of treatment (13 sheets) filed along with xerox copies of the L.I.C. policy and death certificate of Municipal Corporation of Greater, Mumbai that prior to 1993, the life assured was constantly being treated for ill health by Health Center and was under
medication until 26.07.2000 and was also treated on 23.09.2000 at 11.40 A.M. where there was problem in the ovary and multiple tumor deposits in marrow imprint etc. and the treatment as per this record of treatment was until
10.10.2000. Thus when this record of treatment shows that life assured is found suffering from disease prior to 1993, when she made statement regarding her good health in the proposal form, definitely, she has made false statements knowing fully well that she is suffering from diseases which were not being cured. This is nothing but suppression of material fact with fraudulent intention. Moreover, there is no dispute about it that lower back ache of the life assured was diagnosed as Carcinoma Ovary ultimately for which disease, life assured met with her death on 28.10.2000. The contract of insurance is based on good faith, whereas the life assured has given false statement as per the proposal form very cunningly which the District Forum has lost sight of it and made the aforesaid finding vide orders dated 17.04.2004 which order cannot sustain. Therefore, we find the Life Insurance Corporation through opposite parties has rightly repudiated the claim of the complainant on the ground of suppression of material fact.
10. In view of our observation, we find there is merit in the appeal.
11. Therefore, the appeal is allowed on contest without cost taking into consideration the circumstance of the case. The impugned order dated 17.04.2004 of the District Forum in C.D. Case No.191 of 2003 is hereby dismissed.
Records received from the District Forum may be sent back forthwith.