Rajasthan High Court - Jodhpur
Life Insurance Corporation Of India vs Samundar Singh (2024:Rj-Jd:1612) on 10 January, 2024
Author: Nupur Bhati
Bench: Nupur Bhati
[2024:RJ-JD:1612]
HIGH COURT OF JUDICATURE FOR RAJASTHAN AT
JODHPUR
S.B. Civil Writ Petition No. 18618/2023
Life Insurance Corporation Of India, Through Authorized Officer,
Life Insurance Corporation Of India, O-2, Ambaji Ind. Area, Near
Riico Guest House, Aburoad, District Sirohi (Rajasthan).
----Petitioner
Versus
Samundar Singh S/o Shri Mansingh, Resident Of Village-
Jamtha, Tehsil And District- Sirohi (Rajasthan).
----Respondent
For Petitioner(s) : Mr. Rajeev Purohit
For Respondent(s) : Mr. Tribhuvan Singh
HON'BLE DR. JUSTICE NUPUR BHATI
Order 10/01/2024 Reportable
1. The present writ petition has been filed under Article 226 of the Constitution of India with the following prayers :-
(i) by an appropriate writ, order or direction, the impugned award dated 03.10.2023 (Annexure-8) passed by the learned Permanent Lok Adalat, Sirohi may kindly be quashed and set aside.
(ii) any other appropriate order or direction, which this Hon'ble Court considers just and proper in the facts and circumstances of the case may kindly be passed in favour of the petitioner.
(iii) costs of the writ petition may kindly be awarded to the petitioner.
2. Brief facts of the case are that the respondent had taken two LIC policies in the name of his wife, Mrs. Leela Kanwar from the petitioner-corporation, wherein, one policy bearing No.155856827 (Downloaded on 28/01/2024 at 08:10:34 PM) [2024:RJ-JD:1612] (2 of 9) [CW-18618/2023] had a insurance cover of Rs.3 lacs under LIC Aadhaarshila Plan 944 whose yearly premium was Rs. 10,604/- and the second policy bearing No.155856828 had an insurance cover of Rs.10 lacs under LIC New Endowment Plan 914 whose half-yearly premium was Rs.19,518/-. The aforesaid policies were issued on 28.10.2021. The policies were issued on the aforementioned date but the policy holder with the intent to cheat the Life Insurance Corporation, chose the date of commencement of policy from 28.05.2021 (which is permissible in rules), however, concealed the fact of delivery by cesarean operation. If the facts of cesarean delivery had been mentioned in the column, the petitioner would not have issued the policy in favour of the policy holder before the six months of the surgery. On 23.12.2021, the wife of the respondent died at Mandar Health Centre during medical treatment. After the death of the wife of the respondent, the petitioner-corporation did not pay the insurance claim and being aggrieved of the same, the respondent preferred an application under Section 22 of the Legal Services Authorities Act, 1987, before the learned Permanent Lok Adalat, Sirohi. The petitioner filed a written statement and the learned Permanent Lok Adalat allowed the application vide order dated 03.10.2023 and the petitioner-corporation being aggrieved of the same, preferred the present writ petition.
3. Learned counsel for the petitioner submits that the respondent was duty-bound to disclose all the material facts which also include the treatment undergone by the wife of the respondent i.e. the cesarean operation on 23.06.2021 (Annexure- (Downloaded on 28/01/2024 at 08:10:34 PM)
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4). Learned counsel for the petitioner submits that in the proposal form, under the Head of "personal and family details for health", the respondent's wife concealed the material fact and answered in 'NO', whereas, the column of 'Ailment' requiring treatment and any operation undergone. Learned counsel for the petitioner further submits that the sole reason for repudiating the claim of the respondent was suppression of the material facts and the learned Permanent Lok Adalat has completely ignored the same. Learned counsel for the petitioner further submits that the respondent has cheated upon the petitioner-corporation as the LIC policy was taken and issued on 28.10.2021 and the date of commencement of the policy was chosen from 28.05.2021, while concealing the fact that the respondent had undergone a cesarean section on 23.06.2021 and if the fact of the cesarean delivery would have been mentioned in the requisite column, the petitioner-corporation would not have issued the policy before the six months of the surgery which also reflected from the guidelines. Learned counsel for the petitioner also submits that as per the guidelines issued on 11.05.2018 (Annexure-3), there are certain conditions/underwriting medical condition/diseases/complication, where the life insurance policy cannot be issued for the period since operation is of more than six months in which, the Lower Segment cesarean Section (LSCS) is also included. Learned counsel for the petitioner also draws the attention of the Court towards the proposal form filled up by the respondent's wife (Annexure-9) while submitting that the petitioner in the Column 'c' which pertains to the information in respect to "admission to any hospital or nursing home for general checkup, observation, (Downloaded on 28/01/2024 at 08:10:34 PM) [2024:RJ-JD:1612] (4 of 9) [CW-18618/2023] treatment or operation?, if yes, give details", the respondent had said 'NO' and also submits that against Column No.14 "any operation, accident or injury/any bodily defect or deformity", the respondent had mentioned 'NO', whereas, the respondent had undergone the cesarean operation on 23.06.2021 and the said proposal form was filled up by the respondent's wife on 26.10.2021. Learned counsel for the petitioner submits that on account of the cesarean section undergone by the respondent's wife on 23.06.2021, she gave birth to a child and on 23.12.2021 passed away because of heart attack, which is evident from Annexure-5 i.e. the outdoor slip issued by the Government Hospital. Learned counsel for the petitioner places reliance upon the judgment passed by the Hon'ble Apex Court in the case of Branch Manger, Bajaj Allianz Life Insurance Company Ltd & Other Vs. Dalbir Kaur reported in 2020 AIR SC 5210 and submits that as per the law laid down in the judgment, the Hon'ble Apex Court has held which is read as under:-
"a proposer who seeks to obtain a policy of life insurance is duty-bound to disclose all material facts bearing upon the issue as to whether the insurer would consider it appropriate to assume the risk which is proposed."
4. Learned counsel for the petitioner submits that the present case relates to life insurance policy which is entirely different from a mediclaim policy. The Hon'ble Apex Court in the case of Satwant Kaur Sandhu vs New India Assurance Company Ltd reported in (2009) 8 SCC 316 has categorically held as under :-
"a mediclaim policy is a non-life insurance policy meant to assure the policy holder in respect of certain (Downloaded on 28/01/2024 at 08:10:34 PM) [2024:RJ-JD:1612] (5 of 9) [CW-18618/2023] expenses pertaining to injury, accidents or hospitalizations. Nonetheless, it is a contract of insurance falling in the category of contract uberrimae fidei, meaning a contract of utmost good faith on the part of the assured. Thus, it needs little emphasis that when an information on a specific aspect is asked for in the proposal form, an assured is under a solemn obligation to make a true and full disclosure of the information on the subject which is within his knowledge. It is not for the proposer to determine whether the information sought for is material for the purpose of the policy or not. Of course, the obligation to disclose extends only to facts which are known to the applicant and not to what he ought to have known. The obligation to disclose necessarily depends upon the knowledge one possesses. His opinion of the materiality of that knowledge is of no moment."
5. Per contra, learned counsel for the respondent submits that the wife of the respondent was duly admitted on 23.06.2021 on account of the pregnancy and she delivered the child on 23.06.2021 by way of cesarean section and she was discharged from the hospital on 25.06.2021 which is evident from the discharge summary (Annexure-4). Learned counsel for the respondent submits that upon the discharge from the concerned hospital, a certificate was issued in favor of the petitioner (Annexure-4) certifying that the petitioner was discharged from the hospital on 25.06.2021 in normal and healthy condition which reflects that there was no complication after the respondent's wife undergone the cesarean section on 26.03.2021.
6. Learned counsel for the respondent further submits that the respondent's wife has not concealed any material fact while filling up the proposal form as against column No.14, the requisite (Downloaded on 28/01/2024 at 08:10:34 PM) [2024:RJ-JD:1612] (6 of 9) [CW-18618/2023] information was in respect to any operation, accident or any injury/any bodily defect/deformity being suffered but in the present case, the respondent's wife had not suffered any illness or any accident or injury or any bodily defect or deformity and the cesarean section undergone by the respondent's wife therefore was not required to be disclosed under Column No.14 of Section III of the proposed plan. Learned counsel for the respondent further submits that as far as the information that was required to be given against Column 'C' of Section III of the proposed plan, the information was required to be given in respect to admission to any hospital or any nursing home or treatment or operation and as the respondent's wife was never admitted for the purpose of any treatment or operation in respect to any illness, therefore, she had accordingly marked 'NO' in the said column.
7. Learned counsel for the respondent also submits that upon perusal of the discharge summary as issued by the Government hospital on 23.12.2021, it reflects that the cause of death of respondent's wife was acute chest pain and breathlessness on account of which his wife was put on oxygen concentrator and thereafter she was died, therefore, the death of the respondent's wife is not related to the cesarean section undergone by her on 23.06.2021.
8. Heard learned counsel for the parties and perused the material available on record.
9. Admittedly, the respondent's wife underwent cesarean section on 23.06.2021 and the child was delivered on 23.06.2021 and the respondent's wife was discharged on 25.06.2021 and was in normal healthy condition as reflected from the Annexure-4 (Downloaded on 28/01/2024 at 08:10:34 PM) [2024:RJ-JD:1612] (7 of 9) [CW-18618/2023] which is placed on record. The respondent's wife had taken two life insurance policies on 28.10.2021 w.e.f. from 28.05.2021. Learned counsel further submits that the respondent's wife was not suffering from any prior illness as there is no medical report submitted by either of the parties and she was discharged from the hospital in a healthy condition after she had undergone the cesarean section and it was therefore on account of some medical illness that the wife of the respondent was admitted in the Government Hospital on 23.12.2021 and on the same date of admission after one hour, she collapsed and died. The purpose of seeking the medical condition/medical details of the policy holder is that if any person taking the policy is suffering from any pre- illness, then the corporation would not be liable to bear the brunt of such illness, if any, prior to issuing of policy and in the present case, if there had been any pre-medical condition existing with the respondent's wife and the same had been concealed while filling up the proposal form and on account of such pre-medical condition, the respondent's wife had expired then in such condition, the decision of the petitioner to repudiate the insurance claim of the policy holder would have been justified, however, in the present case, there was no pre-medical condition existing and the respondent's wife had not concealed any pre-existing medical condition and on account of sudden illness being suffered by her on 23.12.2021, the wife of the respondent died on the same day.
10. The late wife of the respondent was a very young woman of the age of 35 years and by no stretch of imagination anybody could have imagined that she would not survive and die an untimely death and, therefore, the respondent or his wife would (Downloaded on 28/01/2024 at 08:10:34 PM) [2024:RJ-JD:1612] (8 of 9) [CW-18618/2023] not have taken the policy with an intention to cheat the petitioner- corporation. Since, there was a gap of about six months from the date of C-section to the date of death, therefore, the C-section cannot be said to be the cause of the death of the respondent's wife. Further, it is important to note that if the cause of the death had been the C-section, then the non-furnishing the information of the C-section would have been fatal for the claimant. The petitioner-corporation being a State Organization having given a welfare policy to the claimant ought to have taken a wholesome view and once on the face of it, there is no intention of cheating or fraud on the part of the claimant, the benefit needs to be passed to the claimant. Merely, not giving the information of the C-section at the best can be said to be an incomplete information given by the claimant which would not cause any illegality to the petitioner and the petitioner at best can treat it as an incomplete information without having any bearing upon the claim put up by the claimant. The insured had an impression that the young lady would survive or have long life as she was not suffering from any ailment and in order to secure the future of the family, the policy was taken by her. If the insured had succumbed to the C-section, then, it could be said that she had concealed the fact of undergoing the C- section and the petitioner-corporation would have been justified in repudiating the claim, whereas, in the present case, it is not so. Thus, the legitimate expectation which is a doctrine settled in law ought to operate in this case and claim is required to be given to the claimant and thus, the order dated 03.10.2023 passed by the Permanent Lok Adalat, Sirohi is upheld.
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11. The petition being bereft of merits is hereby dismissed. Stay application as well as all other pending applications, if any, also stand dismissed.
(DR. NUPUR BHATI),J 240-ajayS/-
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