State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt. Pramila Deelip Patil on 10 June, 2009
1 F.A. No..: 1306-04
STATE CONSUMER DISPUTE REDRESSAL COMMISSION,
MAHARASHTRA, CIRCUIT BENCH AT AURANGABAD.
Date of filing : 22.07.2004
Date of Order : 10.06.2009
FIRST APPEAL NO. 1306 OF 2004
IN COMPLAINT CASE NO. 117 OF 2003
DISTRICT CONSUMER FORUM: LATUR.
1. Life Insurance Corporation of India
Branch Office 98-C
Near Bus Stand, Dhoot Complex,
Latur-Bidar Road, Dist Latur
Through
Life Insurance Corporation of India
Having their Western Zonal Office,
At Yogakshema, Jeevan Bima Marg,
Mumbai-400 021. ... Appellants
(Org. Opponent)
- VERSUS-
1. Smt. Pramila Deelip Patil
2. Sharada Deelip Patil
3. Sneha Deelip Patil
4. Sweta Deelip patil
All above residing at
Tajpur, Post. Nitur,
Tal. Nilanga, Dist. Latur. ... Respondents
(Org. Complainants)
Coram : Shri. S.G. Deshmukh, Hon`ble Judicial Member.
Mrs. Uma S.Bora, Hon`ble Member.
Present: Adv. N.V. Mande, for appellant.
None present for respondents.
2 F.A. No..: 1306-04:: ORAL ORDER ::
(Date: - 10-06-2009) Per Shri S. G. Deshmukh, Hon`ble Judicial Member
1. The present appeal is filed by the Life Insurance Corporation of India against the judgment and order dated 17.6.2004 in complaint case No.117/2003 passed by District Consumer Forum, Latur.
2. The deceased Deelip Patil the husband of respondent no.1 and father of respondent nos. 2 to 4 had taken the policy bearing No.981633128 under table and term 88-20 for sum assured Rs.35,000/-
commencing from 26.10.1996, policy no. 981736406 under table and term 111-29 for sum assured Rs.1,00,000/- commencing from 28.3.1998, policy no. 981736246 under table and term 14 -15 for sum assured Rs. 25,000/- commencing from 28.3.1998 and policy no. 981736980 under table and term 14 -15 for sum assured Rs.25,000/- commencing from 28.6.1998. It is contended that the above policies were lapsed from May-1999 for non payment of premium. It is contended that deceased Deelip Patil got revived the policies on 10 th July, 2000. It is contended that Deelip Patil died on 12 th Sept.2002. The respondent no.1 preferred the claim which was repudiated by the appellant on the ground that deceased Deelip Patil had suppressed material particulars about his health at the time of revival of above four policies and thus respondent nos. 1 to 4 approached the Forum.
3. The present appellant appeared before the Forum and resisted the claim on the ground that, policies mentioned above were in lapsed condition for non payment of premium which were got revived by Deelip Patil on 10th July, 2000. It is contended that at the time of revival deceased Deelip Patil suppressed material particulars about his health. It 3 F.A. No..: 1306-04 is contended that Deelip Patil was suffering from Amoebic Colitis with APD at the time of submission of the revival of policy. It is also contended that he had availed the leave on medical ground and he suppressed this fact at the time of revival and thus they have rightly repudiated the claim.
4. Forum below after going through the papers and hearing the parties allowed the complaint and directed the appellant to pay the amount of Rs. 1,85,000/- in respect of above policies with interest at the rate of 6% p.a. from 14.8.2003. The Forum also directed the appellant to pay the amount of Rs.2000/-towards mental agony and Rs.1000/- towards the cost.
5. Being aggrieved by the said judgment and order LIC came in appeal.
6. Notices were issued to the appellant as well as the respondents. Learned counsel Shri. N.V. Mande, appeared for appellant. None appeared on behalf of respondent. We heard learned counsel Shri. Mande for the appellant. Ld. Counsel Mande submitted that at the time of revival of the policies deceased Deelip Patil suppressed the material particulars about his health. He submitted that he was suffering from Amoebic Colitis with APD at the time of revival of the policy. He also submitted that deceased had availed leave on medical ground on six occasions, but he did not disclose this fact at the time of revival of the policies. According to him Forum did not consider this aspect and erred in allowing the complaint. He submitted that the contract of insurance was revived with fraudulent suppression of material particulars by the insured and thus policies are null and void.
4 F.A. No..: 1306-047. We perused the papers and gave our anxious thoughts to the argument advanced by the learned counsel. It is the contention of appellant that at the time of revival of the policy deceased was suffering from Amoebic Colitis with APD which he did not disclose in his declaration. It is also brought on record that deceased had availed the leave on medical ground on six occasions by producing the certificate of doctor concern. It is true that all the above policies were in lapsed condition those were got revived by deceased Deelip Patil on 10.7.2000. It has also come on record that deceased Deelip Patil had availed the leave by producing the certificates of the doctors. Only because the certificates of doctor had been produced for availing sick leave can not lead the conclusion that deceased had taken treatment from the concern medical practitioner.
8. In Smt. Deepshree Vs. LIC of India reported in AIR 1985 Bombay pg. 192. Hon'ble Bombay High Court held "that the mere failure to disclose in the proposal form the trivial ailments like influenza, decentery, bleeding piles and fever on some occasions cannot be construed as fraudulent suppression of material facts. Therefore, the second para of S.45 was not attracted to the facts of the present case. The action of the Corporation in concluding from certificate that the deceased was suffering from serious ailments and thereby repudiating the contract was wholly illegal."
The Hon'ble High Court also observed "that, the medical certificates are required to be produced before employer in accordance with service conditions and the mere fact that it was produced for obtaining sick-leave can not lead to the conclusion that deceased taken treatment from a Medical Practitioner.
5 F.A. No..: 1306-049. In Smt. Alia Begum Vs. LIC reported in 1997 (III) CPR- 60 (NC), The Hon'ble National Commission has held "that, in order to discharge its onus it was for insurance company to place material on the record to show that the deceased suppressed the facts which it was material to disclose, whether a fact is material depends upon the circumstances of a particular case. The test to determine materiality is whether the fact has any bearing on the risk under taken by the insurer. If the fact has any bearing on the risk it is a material fact, if not it is immaterial."
10. In LIC & others vs. Asha Goal and Anr. AIR 2001 S.C. 549. Hon'ble Apex Court held that, Insurance Act (4 of 1938) S.45--Life Insurance Corporation Act (31 of 1956) S. 303--Repudiation of claim by insured-- Merely on grounds that deceased had withheld correct information regarding his health at time of effecting insurance with corporation--Not proper--Matter of repudiation of policy should not be dealt with in a mechanical and routine manner but should be one of extreme care and caution.
11. In LIC vs. Nishar Khan decided on 08.03.2006 reported in 2006 NCJ 713 (NC). The Hon'ble National Commission held that, there should be nexus between the cause of death and the facts alleged to have been suppressed by the insured.
12. In LIC vs. Harish Joshi, reported in III 2003 CPJ 743 (N.C.). The Hon'ble National Commission relying on the Hon'ble Supreme Court case Life Insurance Corporation of India Vs. Smt. G.M. Chennabasamma, reported in (1991) I SSC 357, has held " that, Life Insurance Corporation of India was not justified in repudiating the complainant's case merely on the basis of certificate of hospital treatment without any corroborative 6 F.A. No..: 1306-04 evidence especially in view of the fact that the burden of proving that the insured had made false representation and suppressed material facts lay on the LIC of India and if the latter failed to discharge the said burden the repudiation of the claim of the policy holder was unjustified and amounted to deficiency in service on the part of the LIC of India."
13. We have mentioned that only because certificates of doctors had been produced for availing sick leave cannot lead the conclusion that the deceased had taken treatment. It also be mentioned that affidavits of doctors concerned who are said to have issued the certificates are also not on record. There is no dispute that the Deelip died due to heart attack. He is alleged to have suppressed the fact that he was suffering from Amoebic Colitis with APD which has no nexus with the cause of death of Deelip Patil. The Forum below has considered all these aspects in right perspective and rightly allowed the complaint.
14. Forum below while allowing the complaint granted the interest @ 6% p.a. from 14.4.2003. When the interest has been granted by the Forum on the sum assured the Forum ought not to have granted the amount of Rs.2000/- for mental agony. We are inclined to quash the order regarding mental agony. Accordingly we pass the following order.
-:: O R D E R ::-
1. Appeal is allowed in part.
2. The order granting Rs.2000/- regarding mental agony is hereby quashed and set aside.
3. Rest of order is maintained.
4. No order as to cost.7 F.A. No..: 1306-04
(Mrs.Uma S. Bora) (S. G. Deshmukh)
Member Presiding Judicial Member
Kalyankar