State Consumer Disputes Redressal Commission
Lic vs Smt. Saroj Devi on 27 February, 2006
H H.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION, SHIMLA. ------------------- APPEAL NO.18/2004. Before: Honble Mr. Justice Arun Kumar Goel(Retd.) President. Honble Mrs. Saroj Sharma, Member. In the matter of: Life Insurance Corporation of India through its Branch Office, Nahan, H.P. Appellant. Versus Smt. Saroj Devi Wd/0 late Sh. Mohan Lal Chauhan, R/O Village Dhak Walli, P.O. Nahan, District Sirmour, H.P. Respondent. 27.2.2006. Present: Mr. Narender Sharma, Advocate, for the appellant. Mr. Anil Tomar, Advocate, for the respondent. ---- O R D E R:
Justice Arun Kumar Goel (Retd.), President (Oral)
1. Admitted facts of this case are that the deceased Shri Mohan Lal Chauhan husband of the respondent, was insured with the appellant in the sum of Rs.50,000/- as per policy, particulars whereof are not in dispute. It was a Double Accident Benefit policy, obtained on 10.6.2000. Rs.5770/- was deposited by the deceased towards premium. He was working as a Drawing Master in a Government School.
2. As per averments made in the complaint, on account of acute dysentery he was admitted at District Hospital, Nahan. His condition being serious, he was referred to P.G.I., Chandigarh on 3.7.2000, where he died on 4.7.2000. Cause of death was stated by the doctor to be Septic Shock.
3. Claim was lodged by the respondent with the appellant. It was repudiated because of incorrect information provided by the deceased regarding his state of health when he got himself insured. According to the appellant, deceased was suffering from Alcoholic Liver Disease, at the time of his insurance. This fact came to its notice from the history of the patient after admission of the deceased at P.G.I., that he was having history of alcoholism for 15 years. However, this fact was not disclosed by the deceased in the proposal form and answers given in this behalf in the proposal form, particularly in its Col.11 were incorrect. This resulted in obtaining insurance fraudulently.
District Forum below while allowing the complaint has ordered payment of Rs.1,00,000/- by the appellant to the respondent together with interest @ 12% per annum with effect from the date of filing of the complaint, i.e. 18.4.2002 till actual payment was made. In addition to this, appellant has been burdened with Rs.2,000/- as litigation cost. Payment has been ordered to be made within 45 days of the receipt of the copy of the order.
4. Mr. Sharma, learned Counsel for the appellant submitted that the contract of insurance is based on bonafide and utmost good faith i.e. uberrima fides. Accepting whatever information regarding his personal medical history as provided by the deceased, his client entered into the contract. Policy was later on found to have been obtained by mis-statement as well as by suppression of, true and correct facts. Therefore, on this ground alone, this appeal deserves to be allowed and he prayed for accordingly. In the alternative, he further submitted that without conceding this plea, that there is neither any averment in the complaint nor any evidence worth the name produced by the respondent to uphold the impugned order so far payment of Rs.1,00,000/- ordered by the Forum below is concerned.
5. Policy in question was admittedly a Double Accident Benefit policy in the sum of Rs.50,000/-. As such, unless it was satisfactorily proved that the death was caused by accident, in no case any amount beyond Rs.50,000/- could have been ordered to be paid. Both these please have been controverted by Mr. Tomar on behalf of the respondent. According to him, impugned order suffers from no infirmity, whatsoever.
Further he prayed for dismissal of the appeal while upholding the order of the Forum below.
6. So far policy having been obtained by suppression of true information as well as on account of withholding of correct facts is concerned, for the reasons to be recorded hereinafter, it is without substance. Reliance in this behalf was placed by Mr. Sharma on Claim Form No.3816 purported to have been issued under the signatures of Senior Resident (S/R), Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh. It is of no consequence. Reason being that it has not been filled-in by the doctor who had attended upon the patient ie. the deceased Mohan Lal Chauhan. Column Nos.5 (b), (d), (e) and 7 (d) & (e) of this form being relevant are extracted hereinbelow:-
5. (b) Was the history reported by the (b) Patient attendant.
patient himself, or by some, one else.
Relationship of the person who reported.
Was the patient present at that time and was he conscious?
xxxxx xxx xxxxx
(d) To whom was the history, reported and (d) Doctor on duty in by whom was it recorded? emergency.
(e) Is the Doctor, to whom the history was (e) Still in the hospital.
reported who has recorded the history, still with the Hospital and if not, what is the present address?
xxxxx xxx xxxx
7.
(d) By whom history was ported? (If not
(d) by relative.
by the patient himself, please indicate if it was in his presence and to his knowledge)
(e) By whom the history was noted and
(e) by relative recorded? (If the doctor is not with the Doctor on duty.
hospital at present please give his present address)
7. Least that could have been and infact should have been done by the appellant was, to have produced some evidence in the shape of affidavit or otherwise from the doctor who had actually attended upon the deceased when he was admitted till he died on 4.7.2001. A perusal of Columns extracted above out of Claim Form No.3816 clearly indicates that doctor to whom history was reported and who had recorded the same, was still in the hospital. There is no evidence worth the name why this form was not got filled up from him or why his affidavit could not be filed. This was the minimum that was required of the appellant in case it wanted to succeed on this plea. It is also not the case of the appellant that either doctor concerned was not available or he refused to furnish the requisite affidavit. As such, this plea is without any substance and is thus rejected.
8. So far plea of the appellant that claim having been wrongly allowed in the sum of Rs.1,00,000/- by the Forum below is concerned, there is substance in this. In order to have double accident benefit, again it was imperative upon the respondent to have proved that the death was either the direct result of and/or was attributable to an accident. Case set up by the respondent in the complaint was, that the deceased was admitted to the District Hospital at Nahan when he was suffering from acute dysentery and as his condition was considered serious by the doctors there, he was referred to P.G.I., Chandigarh. In the face of this claim of the respondent, there is hardly any doubt that the death was not attributable to accident and was caused due to acute dysentery. This aspect of the case has been completely ignored by the Forum below. Thus it fell into error by allowing sum of Rs.1,00,000/- in favour of the respondent. Mr. Tomar on behalf of the respondent was not in a position to satisfy us as to how his client is entitled for a sum of Rs.1,00,000/-. In this view of the matter, submission made on behalf of the appellant to this limited extent deserves to be upheld. Ordered accordingly.
9. No other point is urged.
In view of the aforesaid discussion, as well as keeping in view the record of the Forum below, this appeal is partly allowed and as a result of it, it is ordered that the respondent is only entitled to Rs.50,000/-, with 12% interest from the date of insitution of complaint i.e. 18.4.2002 till the date of its deposit/payment, whichever is earlier. Respondent is also held entitled to the litigation cost of Rs.2,000/- as ordered by the Forum below. Impugned order stands modified to this extent. Parties are left to bear own costs. All interim orders passed from time to time during the pendency of this appeal shall stand vacated forthwith.
Shimla.
February 27, 2006 (Justice Arun Kumar Goel) (Retd.) President /BS/ (Saroj Sharma ) Member.