State Consumer Disputes Redressal Commission
Lic Of India vs Mathura Devi on 14 June, 2007
H H.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, SHIMLA CAMP AT MANDI. Appeal No. 254/2005. Date of Decision 14.06.2007. 1. Life Insurance Corporation of India, through its Divisional Manager, Divisional Office, Kasumpti Shimla 171 009, 2. Life Insurance Corporation of India through Branch Manager, Mandi, DisPtt. Mandi. . Appellants. Versus Mathura Devi W/o late Sh. Chandermani R/o VPO Galma Tehsil Sadar, Distt. Mandi, HP. . Respondent. Honble Mr. Justice Arun Kumar Goel, President. Honble Mr. Narinder Singh Thakur, Member. Honble Mrs. Saroj Sharma, Member. Whether Approved for reporting? Yes. For the Appellants. Mr. Bimal Kumar Sharma, Advocate. For the Respondent. Mr. A.S. Thakur, Advocate. O R D E R:
Justice Arun Kumar Goel (Retd.) President (Oral) Admitted facts of this case are that the deceased husband of respondent, late Shri Chandermani had obtained a policy in the sum of Rs 1 lac from the respondent in the month of August, 2000. He died of all of a sudden due to cardiac pain on 5.1.2003 at Civil Hospital Mandi. Claim of the respondent was repudiated on 31.3.2004 on the ground that the deceased had not disclosed his ailment from which he was suffering prior to his obtaining the policy and he had not given the proper answers in the proposal form. He having remained on medical leave in the year 1997 and had also not disclosed his disease to the medical officer who had examined him, before insuring.
2. Deceased was not suffering from any disease nor remained under treatment was the plea set out by respondent and further according to her he had died all of a sudden due to heart attack. Therefore, repudiation of the claim was not justified and it amounts to deficiency in service on the part of the appellants. Fraud was set out as a ground by the appellants against deceased when he obtained the policy. With a view to substantiate its plea, reliance was placed by the appellant on the proposal form Annexure R-I, and R-II the medical examiners confidential report, besides Annexure R-VII certificate of the employer and Annexure R-X form No. 3816 issued by the Medical Officer (Specialist), Zonal Hospital Mandi. On the basis of these documents repudiation of claim was justified by the appellants. In this background on the complaint of the respondent District Forum below has allowed the same while directing the appellant to pay Rs. 1 lac with vested bonus due and payable with interest @ 6% per annum from 31.3.2004 when the claim was repudiated besides Rs 2000/-, as compensation and cost of litigation. Hence this appeal.
3. In case on the basis of material on record it is established that the deceased had obtained the policy by exercise of fraud, there is no escape from allowing this appeal. As it hardly needs to be emphasized that fraud vitiates everything, otherwise consequence is obvious.
4. We shall first take up Annexure R-X i.e. Form No. 3816. According to this, the deceased was admitted on 5.1.2003 and chest pain plus (illegible) history was given by the patient to Dr. N.K. Handa who as per its columns 5 (d) and (e) was working as Medical Officer, Z.H Mandi. He is not a signatory of this document. Best person to have said something in this behalf was Dr. Handa, who was posted in the hospital. There is nothing on record that any attempt was made either to get his affidavit and or on his refusal to file the same, any attempt to get him summoned was made. Therefore, no benefit can be derived by the appellant from this document.
5. Now coming to Annexure R-VIII certificate of employer. Its perusal shows that he was on leave from 29.8.1997 to 27.10.1997 he was on commuted leave on medical ground. For rest of the period there is nothing to hold that he was on medical leave.
6. Merely being on one occasion medical leave, does not mean that the deceased was suffering from heart trouble so as to hold that he had intentionally suppressed the material facts with a fraudulent purpose to obtain insurance policy. No doubt deceased ought to have declared his state of health and disease, if any, he had suffered from. However in order to succeed that such suppression was fraudulent it was for the Insurance Company to have proved the fraud which is a question of fact. No material is placed on record by the appellant to substantiate such a plea. Learned counsel for the appellant submitted that by not disclosing about his state of health while obtaining the insurance policy, is enough to allow this appeal. This plea we cannot accept. For the simple reason that the onus to prove fraud was on the Insurance Company. Mere suppression by itself in our opinion does not constitute fraud, therefore, we find no fault with the impugned order passed by the District Forum below and thus it deserves to be upheld. Ordered accordingly .
7. No other point is urged.
In view of the aforesaid discussion there is no merit in this appeal which is accordingly dismissed, leaving the parties to bear their own costs.
All interim orders passed from time to time in this appeal shall stand vacated forthwith.
Office will also make available a copy of this order to the parties free of costs as per rules.
Mandi 14th June, 2007. (Justice Arun Kumar Goel) Retd.
President.
(Narinder Singh Thakur), Member.
(Saroj Sharma), Karan* Member.