National Consumer Disputes Redressal
Life Insurance Corporation Of India vs Jyotsana Rawal on 8 May, 2018
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 864 OF 2018 (Against the Order dated 15/12/2017 in Appeal No. 748/2014 of the State Commission Rajasthan) 1. LIFE INSURANCE CORPORATION OF INDIA DIVISIONAL OFFICE, JEEVAN PRAKASH, BHAWANI SINGH ROAD, POST BOX NO. 65, JAIPUR RAJASTHAN ...........Petitioner(s) Versus 1. JYOTSANA RAWAL W/O. LT. SHRI ANIL KUMAR RAWAL, R/O. PLOT NO. 69, INDRA COLONY, BANI PARK, JAIPUR-302016 RAJASTHAN. ...........Respondent(s)
BEFORE: HON'BLE MR. DR. S.M. KANTIKAR,PRESIDING MEMBER
For the Petitioner : Mr. Lakshay Sawhney, Advocate For the Respondent :
Dated : 08 May 2018 ORDER
ORDER
1. This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 against the order dated 15.12.2017 passed in Appeal No. 748 of 2014 by Rajasthan State Consumer Disputes Redressal Commission, Jaipur ( in short, "State Commission") whereby the State Commission dismissed the appeal of the insurance company and confirmed the order of the District Consumer Disputes Redressal Forum, Jaipur-III (in short, 'the District Forum").
2. The brief facts are that Anil Kumar Rawal, since deceased, husband of the complainant, took life insurance policy for sum of Rs. 1 lakh under Salary Saving Plan from the LIC of India/OP. He was working in various departments and the premium of Rs.408/- was being deducted from his salary every month. During the subsistence of the insurance policy, Anil Kumar Rawal, died due to heart attack on 19.09.2006. As a nominee in the said policy, the complainant, Jyotsana Ralal, wife of deceased, submitted a death claim before the OP but the claim was rejected by the OP after inordinate delay on 2.11.2007 with the reason that her husband had given wrong information regarding his health in the proposal form. It was stated that he was suffering with Tuberculosis (TB) for the last two years prior to take the policy. Therefore, the complainant had filed a complaint before the District Forum, Jaipur-III for the alleged deficiency in service from OP and prayed for insured amount of Rs. 1 lakh alongwith compensation.
3. The OP resisted the complaint by filing written version. It is submitted that the deceased life assured filled the proposal form with a wrong facts and he has not disclosed that he was suffering from TB two years prior to filling up of the proposal form. The deceased had taken departmental leaves for his illness. He took treatment in Savai Mansingh Hospital, Jaipur on 20.5.2003 and thereafter, he was referred to TB hospital alongwith investigations and the treatment sheets. Therefore, the repudiation of claim is justifiable.
4. On the basis of pleadings and evidence from both the parties, the District Forum allowed the complaint and directed the OP to pay R.s 1 lakh alongwith 18% interest per annum. It also awarded Rs.21,000/- for mental agony and cost.
5. Being aggrieved, the OP/LIC filed first appeal before the State Commission, Rajasthan. The State Commission dismissed the appeal by stating that the husband of complainant had expired due to heart attack, who had no concern with TB disease. Being aggrieved by the impugned order, LIC filed this revision petition.
6. I have heard the learned counsel for both the parties. Learned counsel for the petitioner submitted that the deceased insured had filled the proposal form on 11.3.2005. He had intentionally submitted wrong answers in columns No. 11 and 14 of the proposal form. The statements made by the insured were false, therefore, the insurance contract became null and void. The amount of premium paid was confiscated. The OP investigated the death claim and came to know that the deceased had taken several leaves during the period from 13.5.2003 to 24.12.2005 from his employment. In the medical certificate, it is clearly mentioned that the deceased had taken to Sawai Man Singh Hospital on 20.05.2003 where he visited the OPD and his treatment slip clearly mentioned that he was referred to TB hospital alonwith X-rays, which proves that the deceased was suffering from chronic asthma with general debility from two years before filling the insurance proposal form. At the time of death, deceased suffered asthematic attack and died at Satellite Hospital, Jaipur on 19.9.2006.
7. I have perused the entire evidence and the medical record on the file. The OPD slip of Sawai Mansingh Hospital revealed that the patient approached the hospital on 20.05.2003 and his blood investigations alongwith ECG and X-ray of chest were performed and thereafter he was referred to TB hospital for needful. The doctors treated the patient with higher antibiotics and Neurobion tablets. I have perused the leave certificate on record. The certificate of employer reveals that the deceased took leaves for several periods viz. 3.12.2000 to 08.01.2001, 10.12.2001 to 04.01.2002, 13.5.2003 to 31.5.2003, 20.04.2005 to 30.04.2005, 14.07.2005 to 23.07.2005, 15.10.2005 to 22.10.2005, 26.11.2005 to 24.12.2005, 8.3.2006 to 10.03.2006, 23.05.2006 to 19.06.2006, 14.08.2006 to 13.06.2006 and 13.09.2006 to 19.09.2006.
8. It is pertinent to note that none of the prescriptions on record show that the patient was treated for tuberculosis or any Anti cox medication were prescribed. On 19.9.2006 at 5.00 p.m., the deceased was admitted in Satellite Hospital with the complaints of Asthama (Asthmatic Chronic with general debility). He suffered severe Dyspnea and died due to heart attack. The cause of death given by the doctor was as heart attack. Thus, in my view, OP just relied upon the OPD slip, which has mentioned about refer to TB Hospital. Only mere referral slip is not a evidence to prove that the person was suffering from TB. The OP failed to prove that the deceased was suffering from tuberculosis.
8. In this context, I would like to rely upon the decision of Hon'ble Supreme Court in Civil Appeal No.8254 of 2015 in the case of Sulbha Prakash Motegaonkar & Ors. Vs. Life Insurance Corporation of India, decided on 05-10-2015. This was the case where the deceased died due to Ischemic Heart disease and myocardial infarction. There was a concealment of lumbar spondylitis with PID with sciatica and, therefore, the insurance company repudiated the claim. Hon'ble Supreme Court held that it was not the case of insurance company that the deceased was suffering from life threatening disease which could or did cause death of the insured. The Court observed as below:
"We are of the opinion that the National Commission was in error in denying to the appellants the insurance claim and accepting the repudiation of the claim by the respondent. The death of the insured due to ischemic heart disease and myocardial infarction had nothing to do with his lumbar spondylitis with PID with sciatica. In our considered opinion, since the alleged concealment was not of such a nature as would disentitle the deceased from getting his life insured, the repudiation of the claim was incorrect and not justified."
The facts in the instant revision petition are identical with the facts in the case supra.
9. On the basis of foregoing discussion, the OP/LIC failed to prove that the deceased was suffering from tuberculosis prior to taking the policy. Moreover, on medical ground, in my view, there is no direct co-relation between Tuberculosis and Heart Attack. I do not find any need to interfere in the well-reasoned order of both the fora. The revision petition is dismissed.
...................... DR. S.M. KANTIKAR PRESIDING MEMBER