National Consumer Disputes Redressal
Life Insurance Corporation Of India vs Shahida Khatoon & Anr. on 10 September, 2013
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 2406 OF 2012 (From order dated 10.02.2012 in First Appeal No. 1878 of 2008 of the State Consumer Disputes Redressal Commission, U.P., Lucknow) Life Insurance Corporation of India H-39 1st Floor, New Asiatic Building Connaught Place, New Delhi-01, Through its Assistant Secretary (Legal Cell) Sh. Balihar Singh Petitioner Versus 1. Smt. Shahida Khatoon R/o Bhagirathi Colony Nayee Abadi Sultanpur Road, Shahganj, Jaunpur (UP) 2. Km. Fatima Shamim Under the guardianship Of her mother Smt. Shahida Khatoon R/o Bhagirathi Colony Nayee Abadi Sultanpur Road, Shahganj, Jaunpur (UP) Respondents BEFORE: HONBLE MR.JUSTICE J. M. MALIK, PRESIDING MEMBER HONBLE DR. S. M. KANTIKAR, MEMBER For the Petitioner s : Mr. U.C. Mittal, Advocate For the Respondent : Mr. S.D. Singh, Advocate Pronounced On September 10 , 2013 ORDER
PER DR. S.M. KANTIKAR
1. This Revision Petition is filed against the impugned order of U.P. State Disputes Redressal Commission, Lucknow (in short, State Commission, U.P.) in First Appeal No. 1878/2008 against the Consumer Case No. 68/2007 of Consumer Disputes Redressal Forum, Jaunpur (in short District Consumer Forum).
2. Facts in Brief: The Complainant is a nominee of her husband late Mohammad Shamim Khan, who took two LIC policies for Rs.1,00,000/- each on 28.09.2002. At the time of his death on 15.02.2005 both the policies were in operation. The Insurance claim made by the Complainant was rejected by the OP on illegal grounds. Hence, alleged deficiency in service, the Complainant filed a complaint before District Forum.
3. The OPs in their counter affidavit stated that the terms and conditions of insurance policy were violated. The husband of the Complainant obtained insurance policies by way of fraud and by concealing the diseases which he was suffering from. Hence, the claim was rejected.
4. The District Forum allowed the complaint partially and passed an order as :
The dispute no. 68 of 2007 is allowed partially against the opposite parties and opposite parties are directed to pay the complainant the insured money of rupees one lakh against policy no. 282982311 and similarly rupees one lakh against policy no. 2829830001 taken by her husband along with benefit of accident and interest @ 6% PA within two months from the date of this order.
5. Against the order of District Forum the OP preferred an appeal before the State Commission.
6. The State Commission heard counsel of both the parties and on basis of evidence & documents on record, dismissed the appeal by making observations as follows:
We reach the conclusion that in absence of legally based evidences, it cannot be established that before taking both the insurance policies in question, the policy holder was ailing and he had knowledge of the alleged defect in kidney and disease of diabetes. Only on the basis of imagination, rejecting the insurance claim by the Insurance Corporation is illegal.
7. Aggrieved by the order of the State Commission, the OP filed this revision before this Commission.
8. We have heard arguments of learned counsel of both sides. The counsel for Complainant brought our attention towards the discrepancies in the Medical Certificate issued by Dr. PK Rai, Opal Hospital Rathyatra Varanasi.
9. The medical attendants certificate of LIC which was filled by Dr. Pardeep Kumar Rai. In para 4 of the certificate, which is in Hindi version and after its translation, the heading 4.c is, For how long the deceased was suffering from this disease, which was answered as, one year. But in the next column the same doctor wrote in the heading 4 d that :- DM x10yrs.
HT+ 1 yr. ; this clearly indicates the deceased was suffering from Diabetes Mellitus for past 10 years and by Hypertension for 1 year.
Hence both the statements appear to be contradictory.
10. We have carefully perused another document - the medical prescription on letter head of Dr. Pradeep Kumar Rai , Opal Hospital ,Varanasi . The one of the entry on 06/02/2004 shows DM x 10yrs, HT(+) and diagnosed as DM,DN,CKD,CRD with CAD The same prescription shows multiple entries on date 21/2/2004, 5/3/2004,12/7/2004.
11. But, in fact the above said deceased insured filled proposal forms for both policies in October 2002 ; and concealed the material facts that he was suffering and under treatment for Diabetes Mellitus for past 10 years as per Annexure P-7 the prescription of Dr. PK Rai Opal Hospital Rathyatra Varansi
12. We have relied upon several judgments of Honble Supreme Court in cases Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. (2009) 8 SCC 316 P.C. Chacko and anr. Vs. Chairman, LIC of India (2008) 1 SCC 321 LIC of India Vs. Smt. Asha Goel (2001) 2 SCC 160 have discussed the term Material Fact as fact which goes to the root of the contract of insurance and has a bearing on the risk involved would be material. The term material fact is not defined in the Act and therefore, it has been understood and explained in general terms to mean as any fact which influence the judgment of a prudent insurer in fixing the premium or determine whether he would like to accept the risk.
13. Therefore, we do not find any force in the arguments of counsel for complainant/respondent. Both the fora below have erred in not considering the non-disclosure of material facts by the deceased and filled the proposal form. Accordingly, we set aside the orders passed by fora below and allow this revision petition by dismissing the complaint. No order as to cost.
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(J.M. MALIK J.) PRESIDING MEMBER .
(Dr. S.M. KANTIKAR) MEMBER Mss/5