State Consumer Disputes Redressal Commission
Lic Of India vs Sheetla Devi on 29 November, 2010
H
H.P. STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, SHIMLA-9.
FIRST APPEAL No.204/2009.
DECIDED ON :
29.11. 2010.
In
the matter of:
Life Insurance Corporation of India, through its Sr. Divisional Manager,
Divisional Office, Kasumpti, Shimla.
Appellant.
Versus
Smt. Sheetla Devi wife of Shri Mohinder Singh,
Resident of Village Jole, Post Office Rewalsar, Tehsil Sadar, District Mandi, Himachal
Pradesh.
.. Respondent.
For the Appellant: Mr. G.D. Sharma, Advocate.
For the Respondent: Mr. B.R. Sharma, Advocate.
Honble Mrs. Saroj Sharma, Presiding
Member.
Honble Mr. Chander Shekhar Sharma, Member.
Whether approved for reporting? Yes.
O R D E R:
( Per Mr. Chander Shekhar Sharma, Member).
This appeal is directed against the order of District Forum, Mandi, Himachal Pradesh passed in Consumer Complaint No.65/2008, dated 30.03.2009 whereby the complaint of the respondent was allowed and the appellant was directed to pay to the respondent Rs.75,000/- being a sum of insurance policy of Shri Mohinder Singh deceased husband of the respondent alongwith all benefits and interest at the rate of 9% per annum from the date of institution of complaint till its realization. Rs.5,000/- was also awarded as compensation for harassment and litigation cost was quantified at Rs.1,500/-.
2. Factual matrix of the case in brief is that the husband of the respondent Shri Mohinder Singh who was working in HIMFED which is a Government undertaking had taken LIC policy through C.P.F. Department on 10.12.2004 bearing CPA A/C No.6062/160 in the sum of Rs.75,000/- vide policy No.162717956 and last premium of Rs.8,348/- was paid on 07.12.2005 from the account of the life assured to the appellant.
3. Further averments in the complaint are to the effect that the life assured (Shri Mohinder Singh) had died natural death during the currency of said policy.
Thereafter the respondent being the nominee of the life assured submitted all the relevant documents with claim file, but the said claim was rejected by the appellant on the ground that the life assured remained on medical leave for 178 days with effect from 01.04.2002 to 30.04.2004 and the respondent had withheld the material information regarding the state of his health at the time of taking policy since before taking policy the insured had been suffering from epilepsy, hypertension, Angina Neurosis, chronic Alcoholism and tuberculosis.
4. It was further pleaded by the respondents that the leave applied by the life assured was not in her knowledge and leave if any taken that might have been taken by the life assured for adjustment of his transfer and also for doing agricultural work at home being the sole member of his family and her deceased husband had never disclosed that he had taken any medical leave during the life time.
5. She also averred in the complaint that her husband never remained admitted in hospital, as such there was no occasion for him to make deliberate misstatement and to withheld the material information and the alleged answers given in the questionnaires to the respondents might have been put to the life assured and they might have been filled by the agent after procuring signatures of her husband on proposal form and at the time of filing of said form, her husband was on active duty and he was physically fit and healthy at that time and as such the respondents had insured him.
6. In this background the complaint under Section 12 of Consumer Protection Act, 1986 was filed for deficiency of service on the part of the appellant by illegally repudiating the claim of the respondent, wherein she had sought a direction to the appellant for payment of sum of Rs.75,000/- alongwith bonus and interest and also claimed Rs.20,000/- as a compensation and cost of litigation amounting to Rs.5,000/- was also claimed.
7. The respondent in the present case resisted and contested the complaint and taken preliminary objections that the respondent had not approached the Forum with clean hands as she had suppressed the material facts with regard to the pre-insurance medical history of her husband and as such there is a breach of policy and the complainant is estopped from filing the present complaint due to such act and conduct of the respondent. It was also pleaded that Shri Mohinder Singh deceased (life assured) in the proposal form dated 30.12.2004 to the Questionnaire No.11 had intentionally and deliberately answered in the negative the questions asked to him about the state of health despite the fact that he had pre-insurance medical history and has availed medical leave from his employer with effect from 01.04.2002 till his death and it was also denied that the death of the life assured was natural one as the life assured had died on 28.12.2005 due to heart attack within 114 days from taking of insurance policy. As such the claim of the respondent was rightly repudiated and there was no deficiency of service on the part of appellant.
8. The respondent had filed rejoinder reiterating the averments made in the complaint and controverting the averments made in the reply filed by the appellant.
9. Brief resume of evidence led by the parties in nutshell is that the appellant in support of its case has filed affidavit of Shri M.R. Joshi its Manager and placed reliance upon various documents Annexure RW-1/A detail of earned leave, as well as medical leave taken by Shri Mohinder Singh deceased, Annexure RW-1/B leave account of Shri Mohinder Singh, Annexure-CA extract of service book pertaining to leave and various medical fitness certificates, prescription slips, discharge slips etc. marked as A to J.
10. Respondent in support of her case filed her own affidavit and placed reliance on various documents Annexure C-1 to C-3 which are letter dated 24.03.2006 addressed to the Regional Provident Fund Commissioner by the Accounts Officer HIMFED copy thereof was endorsed to the respondent and letter of repudiation dated 28.06.2007 issued by Zonal Manager LIC to the respondent, death certificate issued by Secretary, Nagar Panchayat Rewalsar dated 15.01.2006. Respondent in support of its case had examined RW-1 Shri Surinder Kumar Sr. Assistant, RW-2 Dr. Hemant Kumar, RW-3 Dr. R.N. Jarial and RW-4 Dr. Dev Kumar Verma.
11. We have heard learned counsel appearing for the parties and have also gone through the record of the case minutely.
12. Mr. G.D. Sharma, learned counsel appearing for the appellant argued that since there was material suppression of facts relating to various diseases suffered by the life assured Shri Mohinder Singh such as epilepsy, bleedings piles, hypertension, chronic Alcoholism and tuberculosis, which fact is clearly evident from the deposition of the doctors examined by the respondent and the fact that the life assured remained on medical leave/earned leave on account of illness for a period of 178 days with effect from 01.04.2002 to 30.04.2004 and deceased Shri Mohinder Singh had answered all the questions relating to his state of health in the negative while answering Question No.11 (ka) to (ja) except Question No.11 (jha) wherein it was stated that his state of health is good. As such due to material suppression of aforesaid facts, the appellant had rightly repudiated the claim of the respondent and as such there was no deficiency of service on its part.
13. It was also argued that the death of Shri Mohinder Singh life assured was not of natural one, but he had died due to heart attack. His main stress of the argument was to the effect that the claim was rightly repudiated in view of Section 45 of Insurance Act, 1938 since the life assured husband of the respondent had suppressed the material facts relating to his suffering from various diseases and as such it was obtained by him by fraudulent means.
14. Mr. B.R. Sharma, learned counsel for the respondent had supported the order of the District Forum below and his main thrust of argument was that there was no nexus between the cause of death which was due to heart attack with the disease which the life assured was alleged to have suffered.
15. After hearing arguments of both the parties, as well as going through the record of case minutely, we are convinced that there is no merit in the present appeal and it deserves dismissal. Reason being that after going through the record of case minutely, we are of the view that there is no legal infirmity in the order of District Forum below, since it had rightly directed for payment of Rs.75,000/- which was a sum assured alongwith all benefits and interest at the rate of 9% per annum from the date of institution of complaint and moreover Consumer Protection Act is a beneficial legislation and as such just claim cannot be repudiated.
16. In the present case after minute examination of record of the case, it cannot be said that there was any material suppression of facts relating to diseases etc. on the part of insured even denial of questions asked to the insured viz. question No.11 (ka) to (ja) wherein he had replied in the negative relating to certain questions about availing of leave and about suffering from disease and the fact that he had stated that he was keeping good health is not of any material significance as they did not in any way pointed material suppression of facts on the part of insured.
17. As per detail of leave which was availed by the husband of the respondent Shri Mohinder Singh deceased as described in Annexure RW-4/A it mostly pertains to some medical leave, earned leave etc. which was only for a short spell and even the prescription slip and medical certificate placed on record do not depict that the life assured was suffering from any serious disease and he ever remained admitted in the hospital for the long period.
18. Even this fact had come on record in the averments made in the complaint which is duly supported by affidavit of respondent Sheetla Devi that her husband might have taken leave for adjustment of his transfer and for doing agricultural work etc. and it is not to her knowledge that her husband had ever taken any medical leave as it was never disclosed to her during his life time by her husband and as per her, her husband was physically fit and healthy at the time when he had insured himself.
19. Even from perusal of statement of Dr.Hemant Kumar RW-2, this fact had come in the cross-examination that this fact is correct that no record was produced to him relating to test conducted on deceased Shri Mohinder Singh regarding tuberculosis and even he had stated in cross-examination that tuberculosis and piles are curable diseases.
20. In the present case, this fact had come on record as per evidence led by the appellant that Shri Mohinder Singh deceased had died due to heart ailment, but there is no iota of evidence on record to prove that Shri Mohinder Singh had ever remained admitted in any hospital for taking treatment of heart ailment. Moreover, the disease like piles etc. has no nexus with the cause of death of deceased which was a heart attack.
Since in the present case deceased Mohinder Singh died due to heart failure as such in this case the heart failure has no nexus with the decease as already stated above. Our view is supported by a decision of this Commission in case titled as Life Insurance Corporation of India and another versus Mathura Devi 2008(1) CPC 313.
21. This Commission had also taken a view in the case of LIC, Bilaspur & Anr. versus Sarojan Devi 1 (2009) CPJ 293 that repudiation of policy is unjustified when cause of death has no connection with the disease. Also see Shantaben Ratilal Patel versus LIC of India 1996 (2) CPJ 92 Gujarat, Life Insurance Corporation of India versus Chatri Devi, HLJ 2009 (HP) 511 and Life Insurance Corporation of India versus Smt. Karuna Verma, HLJ 2009 (HP) 1297.
22. Moreover high blood pressure is not a serious disease and it is a part of ordinary stress and strain. Also see III (2008) CPJ 120 titled as Life Insurance Corporation of India and others versus Sarbjit Kaur SCDRC, Chandigarh.
23. Legal Position in the matters covered u/s 45 of the Insurance Act, 1938 had been dealt in detail by the Apex Court in case titled as P.C.Chacko And Another versus Chairman Life Insurance Corporation of India and Others, (2008) 1 Supreme Court Cases 321, wherein it was held that policy should not be obtained with fraudulent acts by the insured and proposal can be repudiated if fraudulent act is discovered and suppression material facts were made fraudulently. Three conditions were held essential for application of section 45 of the Insurance Act, 1938 in this case. See para-14, page-326.
(a) the statement must be on a material matter or must Suppress facts which it was material to disclose ;
(b) the suppression must be fraudulently made by the policy-holder ; and (c ) the policy-holder must have known at the time of making the statement that it was false or that it suppressed facts which it was material to disclose.
24. Hence, as per law laid down by the Apex Court, Section 45 is applicable only in cases of deliberate concealment of facts/fraud made by the policy holder, but in view of the oral and documentary evidence which had come on record, this case does not come within the ambit of suppression of material facts/fraud made by the policy holder where upon the policy can be repudiated by the appellants and as such repudiation of policy is not legally warranted in the present case.
25. Other cases decided by various State Commissions in the matter of Life Insurance Corporation of India & Anr. versus Shanti Rajbhar 1 (2009) CPJ 479 SCDRC, West Bengal, wherein it was held that suppression of material facts-Non disclosure of material information not proved-Leave taken by the employee on medical ground, not proof of actual illness-Repudiation unjustified.
26. In the present case, the respondent had specifically averred in the complaint that the answers to the alleged questionnaires No.11 might not have been put to the deceased and the proposal form might have been filled up by the agent after procuring signatures of deceased on the proposal form. In such a situation, it was incumbent upon the appellant either to file the affidavit of agent or to examine him who has submitted the proposal form stating therein that the life assured had himself filled up the proposal form. But since no affidavit of the agent had been filed by the appellant in this regard, nor he has been examined and as such adverse inference is to be drawn against the appellant for the same.
27. Learned counsel for the appellant in this case had also laid much stress on the point that the deceased/insured denied in Question No.11 (ja) of the proposal form regarding his using of alcohol drinks. However such concealment regarding drinking habits of the deceased is not material for the repudiation of the claim of the insured in view of decision given in case of Life Insurance Corporation of India versus Krishna Devi, 1992 CPC 423 Punjab, wherein it was observed that repudiation of claim on the ground that the insured deceased concealed the fact relating to his drinking habit is not justified.
28. Legal position relating to repudiation of claim on the ground of concealment of material facts relating to suffering from disease etc. had been laid down in the latest judgment of Honble Apex Court in case Satwant Kaur Sandhu Vs. New India Assurance Company Ltd., 2009 CTJ 956 (SC) (CP), wherein it had been held that the insurer is under solemn obligation to make true and correct disclosure of the information within his knowledge about the questions asked in the proposal form and any incorrect information entitles the insurer to repudiate his claim in case of material suppression relating to his state of health.
This legal position is not disputed. Moreover in the present case before the Honble Supreme Court, ailments were of serious nature spanning over a period of 16 years. It was thus on facts of this case that the aforesaid observations were made by the Honble Apex Court.
29. No other point was urged.
30. In view of the aforesaid discussion and legal position explained above and keeping in view the facts and circumstances of the case there is no cogent, convincing and reliable evidence on record to prove that there was material concealment of facts/fraud on the part of the policy holder and as such there are no reasons to interfere with the order of District Forum below and same is upheld by dismissing the present appeal. There is no order as to the costs.
31. Learned counsel for the parties have undertaken to collect copy of this order from the Court Secretary free of cost as per rules.
SHIMLA 29.11.2010 ( Saroj Sharma ) Presiding Member.
(Chander Shekhar Sharma) Member.
/dinesh/