State Consumer Disputes Redressal Commission
Lic Of India vs Smt.Godi Bai & Ors. on 23 July, 2009
APPEAL NO: 1812 /2006 1. Life Insurance Corporation of India, through Divisional Manager, Bhawani Singh Road, Jaipur. 2. Br.Manager, LIC of India, Br.office Adarsh Colony, Nimbaheda, Distt. Chittorgarh. Opposite parties -appellants Vs. 1. Smt. Godi Bai w/o Lt.Sh.Srinarayanji 2. Devi Lal s/o Lt.Sh.Srinarayanji both r/o Modji ka Minnana, Teh. Nimbaheda Distt. Chittorgarh. Complainant-respondents Date of judgment 23.7.09 Before: Mr.Justice Sunil Kumar Garg- President Mrs.Vimla Sethia-Member
Mr.J.K.Dhingra counsel for the appellants None present for the respondent BY THE STATE COMMISSION, This appeal has been filed by the appellants LIC against 2 order dated 1.9.06 passed by the District Forum, Chittorgarh in complaint no. 522/2005 by which the complaint of the complainant respondents was allowed in the manner that the appellants were directed to pay the amount of the LIC policy alongwith other benefits within one month and further to pay a sum of Rs. 2500/- as costs of litiation.
2. It arises in the following circumstances-
That the complainant respondents had filed a complaint before the District Forum, Chittorgarh on 1.12.05 inter alia stating that husband of complainant respondent no.1 and father of complainant respondent no. 2 Srinarayan, now deceased had taken a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97. It was further stated in the complaint that the deceased had died on 10.2.02 and after the death of the deceased claim was preferred by the complainant respondent no.1 being the wife and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 29.11.04 on the ground that after taking the policy, the policy was lapsed due to non payment of the premium and the same was revived on 18.3.01 and at the time of revival of the policy in question the deceased had filled in up a fresh declartion form regarding his health on 18.3.01 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to revival of the policy i.e. on 18.3.01 , the deceased was suffering from TB for which he was admitted in the hospital and since these facts were not 3 disclosed by the deceased in his fresh declaration form on 18.3.01 at the time of revival of the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the appellants before the District Forum, Chittorgarh on 6.5.06 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 29.11.04. It was further stated in the reply that the deceased was admitted in the Govt. Hospital, Udaipur in the Deptt. of Chest and TB on 9.1.02 and he was declared dead on 10.1.02 and the cause of death of the deceased was TB and since the disease of TB might be old one, therefore, on the date of revival of the policy i.e. on 18.3.01, it should be presumed that the deceased was a patient of TB and since these facts were not disclosed by the deceased in his fresh declaration form dated 18.3.01 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased and it was prayed that claim was rightly repudiated by the appellants and complaint be dismissed.
After hearing the parties the District Forum, Chittorgarh through impugned order dated 1.9.06 had allowed the complaint inter alia holding that -
(i) That since there is nothing on record to prove the fact that prior to revival of the policy the deceased had taken the treatment from any doctor and had admitted in any hospital for the disease of TB and if the 4 deceased was admitted in the hospital on 9.1.02, that too after revival of the policy i.e. on 18.3.01 , therefore, it was not a case of suppression of material facts regarding health on the part of the deceased.
(ii) That the appellants were not justified in repudiating the claim of the complainant respondent and it had amounted to deficiency in service on the part of the appellants.
Aggrieved from the said order dated 1.9.06 passed by the District Forum, Chittorgarh , this appeal has been filed by the appellants.
3. In this appeal the main contention of the learned counsel for the appellants is that before revival of policy in question, the deceased was suffering from the disease of TB and since these facts were not disclosed by the deceased deliberately in his fresh declaration form on 18.3.01 , therefore, he was guilty of suppression of material facts regarding health and thus on that ground the claim of the complainant respondent was rightly repudiated by the appellants through letter dated 29.11.04 and the District Forum had committed serious error and illegality in decreeing the claim of the complainant respondent. Hence the impugned order could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.
4. We have heard the learned counsel for the appellants and have gone through the entire materials available on record.
5. There is no dispute on the point that the deceased had taken 5 a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97 and the same was revived on 18.3.01.
6. There is also no dispute on the point that at the time of revival of the policy , a fresh declaration was made by the deceased and in that declaration on 18.3.01 , he had not mentioned that he was suffering from any kind of disease or had taken any treatment from any hospital.
7. There is also no dispute on the point that deceased had died on 10.2.02 meaning thereby within two years of the revival of the policy.
8. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the appellants through letter dated 29.11.04 on the grounds mentioned therein.
9. On file there is a bed head ticket of the Govt. Hospital, Udaipur which shows that the deceased was admitted in the hospital for the first time on 9.1.02 and he was declared dead on 10.1.02 and the the deceased was a patient of TB.
10. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint was allowed could be sustained or not and whether the repudiation of the claim of the complainant respondent by the appellants was justified or not.
11. It may be stated here that there is nothing on record to prove the fact that prior to revival of the policy i.e. on 18.3.01, the 6 deceased was admitted in any hospital or had taken the treatment of TB from any doctor , therefore, in absence of that it could not be said that the deceased was aware of the fact that he was a patient of TB and the appellants had failed to prove the fact that the deceased was a patient of TB prior to revival of the policy.
12. Since in the present case there is no documentary proof or evidence available on record to show that the deceased was admitted in any hospital for taking the treatment of TB prior to filling in up the fresh declaration form on 18.3.01 and the policy was revived, it could not be said that the deceased was guilty of suppression of material facts about his health. No doubt in bed head ticket it was mentioned that the deceased was suffering from the disease of TB but to corroborate to prove that entry, no documentary proof or evidence or material has been produced by the appellant showing that the deceased had earlier taken the treatment of TB in any hospital.
13. Thus the appellants had misrably failed to produce any document or paper to show that the deceased had taken the treatment for the disease of TB prior to filling in up the fresh declaration form regarding his health , therefore, it could not be said that it was a case of suppression of material facts regarding health on the part of the deceased.
14. For the reasons stated above, the appellants were not justified in repudiating the claim of the complainants respondents on the ground of suppression of material facts and the appellants have repudiated the claim of the complainants respondents without any basis and on wrong assumption and in an arbitrary manner and in view of this, the findings of the District Forum 7 decreeing the claim of the complainants respondents are liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity, illegality or perversity and this appeal deserves to be dismissed on merits.
On point of compensation
15. In this case it may be stated here that while preferring this appeal the appellants had deposited a sum of Rs. 15,400/- before the District Forum, Chittorgarh on 28.9.06 and in compliance of the order dated 9.1.07 passed by this Commission, the rest amount was also deposited by the appellants and thus a sum of Rs. 25,000/- for which the policy was taken by the deceased had been deposited by the appellants and the appellants had made full compliance of the impugned order dated 1.9.06 passed by the District Forum as the District Forum had not awarded any interest on Rs. 25,000/-.
16. It may be stated here that in para 3 of the impugned order dated 1.9.06 the District Forum, Chittorgarh had observed that the deceased had taken a loan from the appellants and there was a due of Rs.2500/- against the deceased and that amount should be ordered to be recovered from the deceased.
17. In our considered opinion, since no interest has been awarded by the District Forum, therefore, this Commission does not want to deduct the amount of Rs.2500/- from the amount which was ordered to be paid by the appellants to the complainant respondents.
818. Accordingly, the appeal filed by the appellants is dismissed. However, it is made clear that the complainant respondents are free to withdraw the amount deposited by the appellants before the District Forum, Chittorgarh alongwith interest that had accrued on that amount.
Member President APPEAL NO: 1812 /2006 1. Life Insurance Corporation of India, through Divisional Manager, Bhawani Singh Road, Jaipur. 2. Br.Manager, LIC of India, Br.office Adarsh Colony, Nimbaheda, Distt. Chittorgarh. Opposite parties -appellants Vs. 1. Smt. Godi Bai w/o Lt.Sh.Srinarayanji 2. Devi Lal s/o Lt.Sh.Srinarayanji both r/o Modji ka Minnana, Teh. Nimbaheda Distt. Chittorgarh. Complainant-respondents Date of judgment 23.7.09 Before: Mr.Justice Sunil Kumar Garg- President Mrs.Vimla Sethia-Member Mr.J.K.Dhingra counsel for the appellants None present for the respondent BY THE STATE COMMISSION, This
appeal has been filed by the appellants LIC against 2 order dated 1.9.06 passed by the District Forum, Chittorgarh in complaint no. 522/2005 by which the complaint of the complainant respondents was allowed in the manner that the appellants were directed to pay the amount of the LIC policy alongwith other benefits within one month and further to pay a sum of Rs. 2500/- as costs of litiation.
2. It arises in the following circumstances-
That the complainant respondents had filed a complaint before the District Forum, Chittorgarh on 1.12.05 inter alia stating that husband of complainant respondent no.1 and father of complainant respondent no. 2 Srinarayan, now deceased had taken a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97. It was further stated in the complaint that the deceased had died on 10.2.02 and after the death of the deceased claim was preferred by the complainant respondent no.1 being the wife and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 29.11.04 on the ground that after taking the policy, the policy was lapsed due to non payment of the premium and the same was revived on 18.3.01 and at the time of revival of the policy in question the deceased had filled in up a fresh declartion form regarding his health on 18.3.01 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to revival of the policy i.e. on 18.3.01 , the deceased was suffering from TB for which he was admitted in the hospital and since these facts were not 3 disclosed by the deceased in his fresh declaration form on 18.3.01 at the time of revival of the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the appellants before the District Forum, Chittorgarh on 6.5.06 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 29.11.04. It was further stated in the reply that the deceased was admitted in the Govt. Hospital, Udaipur in the Deptt. of Chest and TB on 9.1.02 and he was declared dead on 10.1.02 and the cause of death of the deceased was TB and since the disease of TB might be old one, therefore, on the date of revival of the policy i.e. on 18.3.01, it should be presumed that the deceased was a patient of TB and since these facts were not disclosed by the deceased in his fresh declaration form dated 18.3.01 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased and it was prayed that claim was rightly repudiated by the appellants and complaint be dismissed.
After hearing the parties the District Forum, Chittorgarh through impugned order dated 1.9.06 had allowed the complaint inter alia holding that -
(i) That since there is nothing on record to prove the fact that prior to revival of the policy the deceased had taken the treatment from any doctor and had admitted in any hospital for the disease of TB and if the 4 deceased was admitted in the hospital on 9.1.02, that too after revival of the policy i.e. on 18.3.01 , therefore, it was not a case of suppression of material facts regarding health on the part of the deceased.
(ii) That the appellants were not justified in repudiating the claim of the complainant respondent and it had amounted to deficiency in service on the part of the appellants.
Aggrieved from the said order dated 1.9.06 passed by the District Forum, Chittorgarh , this appeal has been filed by the appellants.
3. In this appeal the main contention of the learned counsel for the appellants is that before revival of policy in question, the deceased was suffering from the disease of TB and since these facts were not disclosed by the deceased deliberately in his fresh declaration form on 18.3.01 , therefore, he was guilty of suppression of material facts regarding health and thus on that ground the claim of the complainant respondent was rightly repudiated by the appellants through letter dated 29.11.04 and the District Forum had committed serious error and illegality in decreeing the claim of the complainant respondent. Hence the impugned order could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.
4. We have heard the learned counsel for the appellants and have gone through the entire materials available on record.
5. There is no dispute on the point that the deceased had taken 5 a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97 and the same was revived on 18.3.01.
6. There is also no dispute on the point that at the time of revival of the policy , a fresh declaration was made by the deceased and in that declaration on 18.3.01 , he had not mentioned that he was suffering from any kind of disease or had taken any treatment from any hospital.
7. There is also no dispute on the point that deceased had died on 10.2.02 meaning thereby within two years of the revival of the policy.
8. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the appellants through letter dated 29.11.04 on the grounds mentioned therein.
9. On file there is a bed head ticket of the Govt. Hospital, Udaipur which shows that the deceased was admitted in the hospital for the first time on 9.1.02 and he was declared dead on 10.1.02 and the the deceased was a patient of TB.
10. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint was allowed could be sustained or not and whether the repudiation of the claim of the complainant respondent by the appellants was justified or not.
11. It may be stated here that there is nothing on record to prove the fact that prior to revival of the policy i.e. on 18.3.01, the 6 deceased was admitted in any hospital or had taken the treatment of TB from any doctor , therefore, in absence of that it could not be said that the deceased was aware of the fact that he was a patient of TB and the appellants had failed to prove the fact that the deceased was a patient of TB prior to revival of the policy.
12. Since in the present case there is no documentary proof or evidence available on record to show that the deceased was admitted in any hospital for taking the treatment of TB prior to filling in up the fresh declaration form on 18.3.01 and the policy was revived, it could not be said that the deceased was guilty of suppression of material facts about his health. No doubt in bed head ticket it was mentioned that the deceased was suffering from the disease of TB but to corroborate to prove that entry, no documentary proof or evidence or material has been produced by the appellant showing that the deceased had earlier taken the treatment of TB in any hospital.
13. Thus the appellants had misrably failed to produce any document or paper to show that the deceased had taken the treatment for the disease of TB prior to filling in up the fresh declaration form regarding his health , therefore, it could not be said that it was a case of suppression of material facts regarding health on the part of the deceased.
14. For the reasons stated above, the appellants were not justified in repudiating the claim of the complainants respondents on the ground of suppression of material facts and the appellants have repudiated the claim of the complainants respondents without any basis and on wrong assumption and in an arbitrary manner and in view of this, the findings of the District Forum 7 decreeing the claim of the complainants respondents are liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity, illegality or perversity and this appeal deserves to be dismissed on merits.
On point of compensation
15. In this case it may be stated here that while preferring this appeal the appellants had deposited a sum of Rs. 15,400/- before the District Forum, Chittorgarh on 28.9.06 and in compliance of the order dated 9.1.07 passed by this Commission, the rest amount was also deposited by the appellants and thus a sum of Rs. 25,000/- for which the policy was taken by the deceased had been deposited by the appellants and the appellants had made full compliance of the impugned order dated 1.9.06 passed by the District Forum as the District Forum had not awarded any interest on Rs. 25,000/-.
16. It may be stated here that in para 3 of the impugned order dated 1.9.06 the District Forum, Chittorgarh had observed that the deceased had taken a loan from the appellants and there was a due of Rs.2500/- against the deceased and that amount should be ordered to be recovered from the deceased.
17. In our considered opinion, since no interest has been awarded by the District Forum, therefore, this Commission does not want to deduct the amount of Rs.2500/- from the amount which was ordered to be paid by the appellants to the complainant respondents.
818. Accordingly, the appeal filed by the appellants is dismissed. However, it is made clear that the complainant respondents are free to withdraw the amount deposited by the appellants before the District Forum, Chittorgarh alongwith interest that had accrued on that amount.
Member President APPEAL NO: 1812 /2006 1. Life Insurance Corporation of India, through Divisional Manager, Bhawani Singh Road, Jaipur. 2. Br.Manager, LIC of India, Br.office Adarsh Colony, Nimbaheda, Distt. Chittorgarh. Opposite parties -appellants Vs. 1. Smt. Godi Bai w/o Lt.Sh.Srinarayanji 2. Devi Lal s/o Lt.Sh.Srinarayanji both r/o Modji ka Minnana, Teh. Nimbaheda Distt. Chittorgarh. Complainant-respondents Date of judgment 23.7.09 Before: Mr.Justice Sunil Kumar Garg- President Mrs.Vimla Sethia-Member Mr.J.K.Dhingra counsel for the appellants None present for the respondent BY THE STATE COMMISSION, This
appeal has been filed by the appellants LIC against 2 order dated 1.9.06 passed by the District Forum, Chittorgarh in complaint no. 522/2005 by which the complaint of the complainant respondents was allowed in the manner that the appellants were directed to pay the amount of the LIC policy alongwith other benefits within one month and further to pay a sum of Rs. 2500/- as costs of litiation.
2. It arises in the following circumstances-
That the complainant respondents had filed a complaint before the District Forum, Chittorgarh on 1.12.05 inter alia stating that husband of complainant respondent no.1 and father of complainant respondent no. 2 Srinarayan, now deceased had taken a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97. It was further stated in the complaint that the deceased had died on 10.2.02 and after the death of the deceased claim was preferred by the complainant respondent no.1 being the wife and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 29.11.04 on the ground that after taking the policy, the policy was lapsed due to non payment of the premium and the same was revived on 18.3.01 and at the time of revival of the policy in question the deceased had filled in up a fresh declartion form regarding his health on 18.3.01 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to revival of the policy i.e. on 18.3.01 , the deceased was suffering from TB for which he was admitted in the hospital and since these facts were not 3 disclosed by the deceased in his fresh declaration form on 18.3.01 at the time of revival of the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the appellants before the District Forum, Chittorgarh on 6.5.06 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 29.11.04. It was further stated in the reply that the deceased was admitted in the Govt. Hospital, Udaipur in the Deptt. of Chest and TB on 9.1.02 and he was declared dead on 10.1.02 and the cause of death of the deceased was TB and since the disease of TB might be old one, therefore, on the date of revival of the policy i.e. on 18.3.01, it should be presumed that the deceased was a patient of TB and since these facts were not disclosed by the deceased in his fresh declaration form dated 18.3.01 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased and it was prayed that claim was rightly repudiated by the appellants and complaint be dismissed.
After hearing the parties the District Forum, Chittorgarh through impugned order dated 1.9.06 had allowed the complaint inter alia holding that -
(i) That since there is nothing on record to prove the fact that prior to revival of the policy the deceased had taken the treatment from any doctor and had admitted in any hospital for the disease of TB and if the 4 deceased was admitted in the hospital on 9.1.02, that too after revival of the policy i.e. on 18.3.01 , therefore, it was not a case of suppression of material facts regarding health on the part of the deceased.
(ii) That the appellants were not justified in repudiating the claim of the complainant respondent and it had amounted to deficiency in service on the part of the appellants.
Aggrieved from the said order dated 1.9.06 passed by the District Forum, Chittorgarh , this appeal has been filed by the appellants.
3. In this appeal the main contention of the learned counsel for the appellants is that before revival of policy in question, the deceased was suffering from the disease of TB and since these facts were not disclosed by the deceased deliberately in his fresh declaration form on 18.3.01 , therefore, he was guilty of suppression of material facts regarding health and thus on that ground the claim of the complainant respondent was rightly repudiated by the appellants through letter dated 29.11.04 and the District Forum had committed serious error and illegality in decreeing the claim of the complainant respondent. Hence the impugned order could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.
4. We have heard the learned counsel for the appellants and have gone through the entire materials available on record.
5. There is no dispute on the point that the deceased had taken 5 a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97 and the same was revived on 18.3.01.
6. There is also no dispute on the point that at the time of revival of the policy , a fresh declaration was made by the deceased and in that declaration on 18.3.01 , he had not mentioned that he was suffering from any kind of disease or had taken any treatment from any hospital.
7. There is also no dispute on the point that deceased had died on 10.2.02 meaning thereby within two years of the revival of the policy.
8. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the appellants through letter dated 29.11.04 on the grounds mentioned therein.
9. On file there is a bed head ticket of the Govt. Hospital, Udaipur which shows that the deceased was admitted in the hospital for the first time on 9.1.02 and he was declared dead on 10.1.02 and the the deceased was a patient of TB.
10. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint was allowed could be sustained or not and whether the repudiation of the claim of the complainant respondent by the appellants was justified or not.
11. It may be stated here that there is nothing on record to prove the fact that prior to revival of the policy i.e. on 18.3.01, the 6 deceased was admitted in any hospital or had taken the treatment of TB from any doctor , therefore, in absence of that it could not be said that the deceased was aware of the fact that he was a patient of TB and the appellants had failed to prove the fact that the deceased was a patient of TB prior to revival of the policy.
12. Since in the present case there is no documentary proof or evidence available on record to show that the deceased was admitted in any hospital for taking the treatment of TB prior to filling in up the fresh declaration form on 18.3.01 and the policy was revived, it could not be said that the deceased was guilty of suppression of material facts about his health. No doubt in bed head ticket it was mentioned that the deceased was suffering from the disease of TB but to corroborate to prove that entry, no documentary proof or evidence or material has been produced by the appellant showing that the deceased had earlier taken the treatment of TB in any hospital.
13. Thus the appellants had misrably failed to produce any document or paper to show that the deceased had taken the treatment for the disease of TB prior to filling in up the fresh declaration form regarding his health , therefore, it could not be said that it was a case of suppression of material facts regarding health on the part of the deceased.
14. For the reasons stated above, the appellants were not justified in repudiating the claim of the complainants respondents on the ground of suppression of material facts and the appellants have repudiated the claim of the complainants respondents without any basis and on wrong assumption and in an arbitrary manner and in view of this, the findings of the District Forum 7 decreeing the claim of the complainants respondents are liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity, illegality or perversity and this appeal deserves to be dismissed on merits.
On point of compensation
15. In this case it may be stated here that while preferring this appeal the appellants had deposited a sum of Rs. 15,400/- before the District Forum, Chittorgarh on 28.9.06 and in compliance of the order dated 9.1.07 passed by this Commission, the rest amount was also deposited by the appellants and thus a sum of Rs. 25,000/- for which the policy was taken by the deceased had been deposited by the appellants and the appellants had made full compliance of the impugned order dated 1.9.06 passed by the District Forum as the District Forum had not awarded any interest on Rs. 25,000/-.
16. It may be stated here that in para 3 of the impugned order dated 1.9.06 the District Forum, Chittorgarh had observed that the deceased had taken a loan from the appellants and there was a due of Rs.2500/- against the deceased and that amount should be ordered to be recovered from the deceased.
17. In our considered opinion, since no interest has been awarded by the District Forum, therefore, this Commission does not want to deduct the amount of Rs.2500/- from the amount which was ordered to be paid by the appellants to the complainant respondents.
818. Accordingly, the appeal filed by the appellants is dismissed. However, it is made clear that the complainant respondents are free to withdraw the amount deposited by the appellants before the District Forum, Chittorgarh alongwith interest that had accrued on that amount.
Member President APPEAL NO: 1812 /2006 1. Life Insurance Corporation of India, through Divisional Manager, Bhawani Singh Road, Jaipur. 2. Br.Manager, LIC of India, Br.office Adarsh Colony, Nimbaheda, Distt. Chittorgarh. Opposite parties -appellants Vs. 1. Smt. Godi Bai w/o Lt.Sh.Srinarayanji 2. Devi Lal s/o Lt.Sh.Srinarayanji both r/o Modji ka Minnana, Teh. Nimbaheda Distt. Chittorgarh. Complainant-respondents Date of judgment 23.7.09 Before: Mr.Justice Sunil Kumar Garg- President Mrs.Vimla Sethia-Member Mr.J.K.Dhingra counsel for the appellants None present for the respondent BY THE STATE COMMISSION, This
appeal has been filed by the appellants LIC against 2 order dated 1.9.06 passed by the District Forum, Chittorgarh in complaint no. 522/2005 by which the complaint of the complainant respondents was allowed in the manner that the appellants were directed to pay the amount of the LIC policy alongwith other benefits within one month and further to pay a sum of Rs. 2500/- as costs of litiation.
2. It arises in the following circumstances-
That the complainant respondents had filed a complaint before the District Forum, Chittorgarh on 1.12.05 inter alia stating that husband of complainant respondent no.1 and father of complainant respondent no. 2 Srinarayan, now deceased had taken a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97. It was further stated in the complaint that the deceased had died on 10.2.02 and after the death of the deceased claim was preferred by the complainant respondent no.1 being the wife and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 29.11.04 on the ground that after taking the policy, the policy was lapsed due to non payment of the premium and the same was revived on 18.3.01 and at the time of revival of the policy in question the deceased had filled in up a fresh declartion form regarding his health on 18.3.01 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to revival of the policy i.e. on 18.3.01 , the deceased was suffering from TB for which he was admitted in the hospital and since these facts were not 3 disclosed by the deceased in his fresh declaration form on 18.3.01 at the time of revival of the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the appellants before the District Forum, Chittorgarh on 6.5.06 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 29.11.04. It was further stated in the reply that the deceased was admitted in the Govt. Hospital, Udaipur in the Deptt. of Chest and TB on 9.1.02 and he was declared dead on 10.1.02 and the cause of death of the deceased was TB and since the disease of TB might be old one, therefore, on the date of revival of the policy i.e. on 18.3.01, it should be presumed that the deceased was a patient of TB and since these facts were not disclosed by the deceased in his fresh declaration form dated 18.3.01 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased and it was prayed that claim was rightly repudiated by the appellants and complaint be dismissed.
After hearing the parties the District Forum, Chittorgarh through impugned order dated 1.9.06 had allowed the complaint inter alia holding that -
(i) That since there is nothing on record to prove the fact that prior to revival of the policy the deceased had taken the treatment from any doctor and had admitted in any hospital for the disease of TB and if the 4 deceased was admitted in the hospital on 9.1.02, that too after revival of the policy i.e. on 18.3.01 , therefore, it was not a case of suppression of material facts regarding health on the part of the deceased.
(ii) That the appellants were not justified in repudiating the claim of the complainant respondent and it had amounted to deficiency in service on the part of the appellants.
Aggrieved from the said order dated 1.9.06 passed by the District Forum, Chittorgarh , this appeal has been filed by the appellants.
3. In this appeal the main contention of the learned counsel for the appellants is that before revival of policy in question, the deceased was suffering from the disease of TB and since these facts were not disclosed by the deceased deliberately in his fresh declaration form on 18.3.01 , therefore, he was guilty of suppression of material facts regarding health and thus on that ground the claim of the complainant respondent was rightly repudiated by the appellants through letter dated 29.11.04 and the District Forum had committed serious error and illegality in decreeing the claim of the complainant respondent. Hence the impugned order could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.
4. We have heard the learned counsel for the appellants and have gone through the entire materials available on record.
5. There is no dispute on the point that the deceased had taken 5 a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97 and the same was revived on 18.3.01.
6. There is also no dispute on the point that at the time of revival of the policy , a fresh declaration was made by the deceased and in that declaration on 18.3.01 , he had not mentioned that he was suffering from any kind of disease or had taken any treatment from any hospital.
7. There is also no dispute on the point that deceased had died on 10.2.02 meaning thereby within two years of the revival of the policy.
8. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the appellants through letter dated 29.11.04 on the grounds mentioned therein.
9. On file there is a bed head ticket of the Govt. Hospital, Udaipur which shows that the deceased was admitted in the hospital for the first time on 9.1.02 and he was declared dead on 10.1.02 and the the deceased was a patient of TB.
10. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint was allowed could be sustained or not and whether the repudiation of the claim of the complainant respondent by the appellants was justified or not.
11. It may be stated here that there is nothing on record to prove the fact that prior to revival of the policy i.e. on 18.3.01, the 6 deceased was admitted in any hospital or had taken the treatment of TB from any doctor , therefore, in absence of that it could not be said that the deceased was aware of the fact that he was a patient of TB and the appellants had failed to prove the fact that the deceased was a patient of TB prior to revival of the policy.
12. Since in the present case there is no documentary proof or evidence available on record to show that the deceased was admitted in any hospital for taking the treatment of TB prior to filling in up the fresh declaration form on 18.3.01 and the policy was revived, it could not be said that the deceased was guilty of suppression of material facts about his health. No doubt in bed head ticket it was mentioned that the deceased was suffering from the disease of TB but to corroborate to prove that entry, no documentary proof or evidence or material has been produced by the appellant showing that the deceased had earlier taken the treatment of TB in any hospital.
13. Thus the appellants had misrably failed to produce any document or paper to show that the deceased had taken the treatment for the disease of TB prior to filling in up the fresh declaration form regarding his health , therefore, it could not be said that it was a case of suppression of material facts regarding health on the part of the deceased.
14. For the reasons stated above, the appellants were not justified in repudiating the claim of the complainants respondents on the ground of suppression of material facts and the appellants have repudiated the claim of the complainants respondents without any basis and on wrong assumption and in an arbitrary manner and in view of this, the findings of the District Forum 7 decreeing the claim of the complainants respondents are liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity, illegality or perversity and this appeal deserves to be dismissed on merits.
On point of compensation
15. In this case it may be stated here that while preferring this appeal the appellants had deposited a sum of Rs. 15,400/- before the District Forum, Chittorgarh on 28.9.06 and in compliance of the order dated 9.1.07 passed by this Commission, the rest amount was also deposited by the appellants and thus a sum of Rs. 25,000/- for which the policy was taken by the deceased had been deposited by the appellants and the appellants had made full compliance of the impugned order dated 1.9.06 passed by the District Forum as the District Forum had not awarded any interest on Rs. 25,000/-.
16. It may be stated here that in para 3 of the impugned order dated 1.9.06 the District Forum, Chittorgarh had observed that the deceased had taken a loan from the appellants and there was a due of Rs.2500/- against the deceased and that amount should be ordered to be recovered from the deceased.
17. In our considered opinion, since no interest has been awarded by the District Forum, therefore, this Commission does not want to deduct the amount of Rs.2500/- from the amount which was ordered to be paid by the appellants to the complainant respondents.
818. Accordingly, the appeal filed by the appellants is dismissed. However, it is made clear that the complainant respondents are free to withdraw the amount deposited by the appellants before the District Forum, Chittorgarh alongwith interest that had accrued on that amount.
Member President APPEAL NO: 1812 /2006 1. Life Insurance Corporation of India, through Divisional Manager, Bhawani Singh Road, Jaipur. 2. Br.Manager, LIC of India, Br.office Adarsh Colony, Nimbaheda, Distt. Chittorgarh. Opposite parties -appellants Vs. 1. Smt. Godi Bai w/o Lt.Sh.Srinarayanji 2. Devi Lal s/o Lt.Sh.Srinarayanji both r/o Modji ka Minnana, Teh. Nimbaheda Distt. Chittorgarh. Complainant-respondents Date of judgment 23.7.09 Before: Mr.Justice Sunil Kumar Garg- President Mrs.Vimla Sethia-Member Mr.J.K.Dhingra counsel for the appellants None present for the respondent BY THE STATE COMMISSION, This
appeal has been filed by the appellants LIC against 2 order dated 1.9.06 passed by the District Forum, Chittorgarh in complaint no. 522/2005 by which the complaint of the complainant respondents was allowed in the manner that the appellants were directed to pay the amount of the LIC policy alongwith other benefits within one month and further to pay a sum of Rs. 2500/- as costs of litiation.
2. It arises in the following circumstances-
That the complainant respondents had filed a complaint before the District Forum, Chittorgarh on 1.12.05 inter alia stating that husband of complainant respondent no.1 and father of complainant respondent no. 2 Srinarayan, now deceased had taken a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97. It was further stated in the complaint that the deceased had died on 10.2.02 and after the death of the deceased claim was preferred by the complainant respondent no.1 being the wife and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 29.11.04 on the ground that after taking the policy, the policy was lapsed due to non payment of the premium and the same was revived on 18.3.01 and at the time of revival of the policy in question the deceased had filled in up a fresh declartion form regarding his health on 18.3.01 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to revival of the policy i.e. on 18.3.01 , the deceased was suffering from TB for which he was admitted in the hospital and since these facts were not 3 disclosed by the deceased in his fresh declaration form on 18.3.01 at the time of revival of the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the appellants before the District Forum, Chittorgarh on 6.5.06 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 29.11.04. It was further stated in the reply that the deceased was admitted in the Govt. Hospital, Udaipur in the Deptt. of Chest and TB on 9.1.02 and he was declared dead on 10.1.02 and the cause of death of the deceased was TB and since the disease of TB might be old one, therefore, on the date of revival of the policy i.e. on 18.3.01, it should be presumed that the deceased was a patient of TB and since these facts were not disclosed by the deceased in his fresh declaration form dated 18.3.01 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased and it was prayed that claim was rightly repudiated by the appellants and complaint be dismissed.
After hearing the parties the District Forum, Chittorgarh through impugned order dated 1.9.06 had allowed the complaint inter alia holding that -
(i) That since there is nothing on record to prove the fact that prior to revival of the policy the deceased had taken the treatment from any doctor and had admitted in any hospital for the disease of TB and if the 4 deceased was admitted in the hospital on 9.1.02, that too after revival of the policy i.e. on 18.3.01 , therefore, it was not a case of suppression of material facts regarding health on the part of the deceased.
(ii) That the appellants were not justified in repudiating the claim of the complainant respondent and it had amounted to deficiency in service on the part of the appellants.
Aggrieved from the said order dated 1.9.06 passed by the District Forum, Chittorgarh , this appeal has been filed by the appellants.
3. In this appeal the main contention of the learned counsel for the appellants is that before revival of policy in question, the deceased was suffering from the disease of TB and since these facts were not disclosed by the deceased deliberately in his fresh declaration form on 18.3.01 , therefore, he was guilty of suppression of material facts regarding health and thus on that ground the claim of the complainant respondent was rightly repudiated by the appellants through letter dated 29.11.04 and the District Forum had committed serious error and illegality in decreeing the claim of the complainant respondent. Hence the impugned order could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.
4. We have heard the learned counsel for the appellants and have gone through the entire materials available on record.
5. There is no dispute on the point that the deceased had taken 5 a life insurance policy for a sum of Rs. 25,000/- from the appellants bearing policy no. 18170995 on 24.9.97 and the same was revived on 18.3.01.
6. There is also no dispute on the point that at the time of revival of the policy , a fresh declaration was made by the deceased and in that declaration on 18.3.01 , he had not mentioned that he was suffering from any kind of disease or had taken any treatment from any hospital.
7. There is also no dispute on the point that deceased had died on 10.2.02 meaning thereby within two years of the revival of the policy.
8. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the appellants through letter dated 29.11.04 on the grounds mentioned therein.
9. On file there is a bed head ticket of the Govt. Hospital, Udaipur which shows that the deceased was admitted in the hospital for the first time on 9.1.02 and he was declared dead on 10.1.02 and the the deceased was a patient of TB.
10. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint was allowed could be sustained or not and whether the repudiation of the claim of the complainant respondent by the appellants was justified or not.
11. It may be stated here that there is nothing on record to prove the fact that prior to revival of the policy i.e. on 18.3.01, the 6 deceased was admitted in any hospital or had taken the treatment of TB from any doctor , therefore, in absence of that it could not be said that the deceased was aware of the fact that he was a patient of TB and the appellants had failed to prove the fact that the deceased was a patient of TB prior to revival of the policy.
12. Since in the present case there is no documentary proof or evidence available on record to show that the deceased was admitted in any hospital for taking the treatment of TB prior to filling in up the fresh declaration form on 18.3.01 and the policy was revived, it could not be said that the deceased was guilty of suppression of material facts about his health. No doubt in bed head ticket it was mentioned that the deceased was suffering from the disease of TB but to corroborate to prove that entry, no documentary proof or evidence or material has been produced by the appellant showing that the deceased had earlier taken the treatment of TB in any hospital.
13. Thus the appellants had misrably failed to produce any document or paper to show that the deceased had taken the treatment for the disease of TB prior to filling in up the fresh declaration form regarding his health , therefore, it could not be said that it was a case of suppression of material facts regarding health on the part of the deceased.
14. For the reasons stated above, the appellants were not justified in repudiating the claim of the complainants respondents on the ground of suppression of material facts and the appellants have repudiated the claim of the complainants respondents without any basis and on wrong assumption and in an arbitrary manner and in view of this, the findings of the District Forum 7 decreeing the claim of the complainants respondents are liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity, illegality or perversity and this appeal deserves to be dismissed on merits.
On point of compensation
15. In this case it may be stated here that while preferring this appeal the appellants had deposited a sum of Rs. 15,400/- before the District Forum, Chittorgarh on 28.9.06 and in compliance of the order dated 9.1.07 passed by this Commission, the rest amount was also deposited by the appellants and thus a sum of Rs. 25,000/- for which the policy was taken by the deceased had been deposited by the appellants and the appellants had made full compliance of the impugned order dated 1.9.06 passed by the District Forum as the District Forum had not awarded any interest on Rs. 25,000/-.
16. It may be stated here that in para 3 of the impugned order dated 1.9.06 the District Forum, Chittorgarh had observed that the deceased had taken a loan from the appellants and there was a due of Rs.2500/- against the deceased and that amount should be ordered to be recovered from the deceased.
17. In our considered opinion, since no interest has been awarded by the District Forum, therefore, this Commission does not want to deduct the amount of Rs.2500/- from the amount which was ordered to be paid by the appellants to the complainant respondents.
818. Accordingly, the appeal filed by the appellants is dismissed. However, it is made clear that the complainant respondents are free to withdraw the amount deposited by the appellants before the District Forum, Chittorgarh alongwith interest that had accrued on that amount.
Member President