State Consumer Disputes Redressal Commission
Lic Of India vs Virender Bathla on 10 August, 2010
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA. First Appeal No. 2386 of 2006 Date of Institution: 13.10.2006 Date of Decision: 10.8. 2010 1 Life Insurance Corporation of India, through Sh.H.K. Chaudhary,Manager (Legal & HPF), Divisional Office, Sector 17-B, Chandigarh. 2 Manager, LIC of India, Karnal Division, Post Box No.6, Jeewan Parkash, Division Office 489 Model Town, Karnal. 3 Divisional Manager, LIC of India, Divisional Office, Kunjpura, Karnal. 4 Zonal Manager LIC of India, Jeewan Bharti, Cannaught Circus, New Delhi. 5 LIC of India, through its Manager, Near bus stand, Panipat. Appellants / OPs. VERSUS 1 Virender Bathla son of Sh. Ram Saran Dass Bathla, husband of the deceased Sudesh Bathla. 2 Varun Bathla son of Sh. Virender Bathla, 3 Neha Bathla daughter of Sh. Virender Bathla, all residents of H. No.20, Khadi Colony, Industrial Area, Panipat. Respondents / Complainants. BEFORE:- Honble Mr. Justice R.S. Madan, President. Dr. Rekha Sharma, Member. Sh. Diwan Singh Chauhan, Member. Present:- Mr. K.K. Doda, Advocate for the appellant. None for the respondent-complainant. O R D E R:
JUSTICE R.S.MADAN, PRESIDENT:
This appeal is preferred against the order dated 5.9.2006 passed by the District Consumer Disputes Redressal Forum, Panipat in complaint No. 505 of 2003 vide which the complaint of the respondents-complainants with respect to the payment of insured amount of the life insurance policy obtained by Sudesh Bathla (now deceased) wife of Virender Bathla, was accepted by granting following relief:-
For the reasons recorded above, we accept the present complaint and direct the respondents to pay the sum of Rs.2,00,000/- together admissible benefits and interest @ 9% p.a. from the date of repudiation i.e. 5.2.2002 till realization and a sum of Rs.1100/- as litigation expenses, within a period of 30 days from the date of receipt of copy of this order.
The brief facts of the present case not disputed between the parties are that Sudesh Bathla wife of Virender Singh Bathla respondent-complainant (hereinafter referred to as the life assured) had got insured her life with the appellants-opposite parties vide insurance policy No.172412836 dated 29.8.2000 for a sum of Rs.2,00,000/-. Unfortunately, the life assured died on 18.6.2001. The claim submitted by the complainants in respect of the above said policy was repudiated on the ground that during investigation it revealed by the investigator of the Corporation that the life assured had not disclosed the true and material facts with respect to her state of health in the Proposal Form/personal statement despite the fact that she was suffering from multiple fibroid uterus problem for which she had taken treatment from 1.10.2000 to 6.10.2000 in Sanjivani Hospital, Salarganj Gate, Panipat.
Challenging the action of the opposite parties, the complainant invoked the jurisdiction of the District Forum with the averments that at the time of obtaining insurance policy his wife was quite healthy and was medically examined by the doctors of the Corporation. Thus, alleging it a case of deficiency in service, the complainant sought direction to the appellants-opposite parties to pay insured amount along with interest and other benefits.
Upon notice, the opposite parties appeared and justified the repudiation of complainants claim on the ground mentioned in the preceding paras of this order and prayed for dismissal of the complaint.
Both the parties led evidence in support of their respective claims. On appraisal of the pleadings of the parties and evidence adduced on record, the District Forum accepted the complaint and granted relief as mentioned above. Hence this appeal.
We have waited for the learned counsel for the respondent-complainant to appear but none appeared on behalf of the complainants. Therefore, we proceed to decide the case after hearing the learned counsel for the appellants-opposite parties and perusing the record available on the file.
It is contended by the learned counsel for the appellants-opposite parties that it is a well proved case where the life assured had not disclosed the true and material facts with respect to her state of health despite the fact that she had taken treatment of multiple fibroid uterus problem from 1.10.2000 to 6.10.2000 in Sanjivani Hospital, Salarganj Gate, Panipat. In support of his arguments learned counsel for the appellants-opposite parties referred to Form Nos. 3816 and 3783 which reveal that certificate with respect to the treatment to the life assured was given by Dr.D.K.Singh (M.S), Sanjeevani Hospital, Salarganj Gate, Panipat.
We find force in the contention raised on behalf of the appellant-opposite parties. From the record it is established that in the proposal form the life assured had given wrong answers to the questions No.11
(a), (b), (e) and (i) which is reproduced as under:-
11. (a) During the last five years did you consult Medical Practitioner Answer for any ailment requiring treatment for more than a week? No
11. (b) Have you ever been admitted to any hospital or nursing home for general check up, observation, treatment or operation? No.
11. (e) Are you suffering from or have you ever suffered from Diabetes, Tuberculosis, High Blood Pressure, Low Blood Pressure, Cancer, epilepsy, Hernia, Hydrocele, Leprosy or any other disease? No
11. (i) What has been your usual state of health? GOOD.
From the perusal of the impugned order it is seen that the District Forum has allowed the complaint by recording a finding that the affidavit of the treating doctor has not been tendered by the opposite parties. But this finding of the District Forum is not sustainable in the eyes of law in view of the decision of the Honble National Commission in Revision Petition No.1935 of 1999 decided on 7.2.2006 LIC of India through its Divisional Manager, Sector 17, Chandigarh Vs. Krishan Chander Sharma, wherein the Honble National Commission has held that:-
In view of said pleadings and evidence, we are in agreement with Sh. Mittal, Advocate that non-filing of affidavit and/or non-examination of treating doctor is not ruinous. In our view, certificate of the medical officer of petitioner certifying the deceased as enjoying good health would not be of much consequence. Ultimate cause of death of the deceased has no relevance whatsoever to the disclosing of information regarding health as required by aforementioned clauses (a), (b),(d) and (i) of clause 11 of the proposal form. Obviously, the answers given by the deceased-who was suffering from asthma and allergic bronchitis etc. to these questions were false to her knowledge and petitioner-insurance company was, thus, justified in repudiating the claim by the said letter dated 30.3.1995. Order passed by for a below being legally erroneous, deserve to be set aside.
It is well settled principle of law that the contract of insurance is contract of uberrima fides and there must be complete good faith on the part of assured and thus the assured is under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not.
The declaration in the proposal form and the statement given by the life assured, were the basis of contract of Insurance between the life assured and the Insurance Corporation and any false statement with respect to state of health or disclosing the false information would make the contract vitiate as has been done in the present case. The medical record obtained from Sanjeevani Hospital, Salarganj Gate, Panipat has proved it a case of concealment of true and material facts with respect to state of health by the life assured.
Keeping in view the facts and circumstances of the present case, we feel that the District Consumer Forum has not taken into consideration the factual position on record and committed great error while accepting the complaint. As such, the impugned order is not sustainable in the eyes of law.
Accordingly, this appeal is accepted, impugned order is set aside and complaint is dismissed.
The statutory amount of Rs.25,000/-
deposited at the time of filing of the present appeal be refunded to the appellants against proper receipt and due verification as per rules on the subject, after the expiry of period of appeal and revision, if any, filed in this case.
10th August 2010. Justice R.S. Madan, President.
Dr. Rekha Sharma, Kr. Member.
Diwan Singh Chauhan, Member.