State Consumer Disputes Redressal Commission
Smt.Manna Devi vs Lic Of India on 15 December, 2009
APPEAL NO: 1506/2008 Smt.Manna Devi w/o Badrilal Mali r/o Mehendwas ki Johpariya, Teh. & Distt. Tonk. Complainant-appellant Vs. Br.Manager Life Insurance Corporation of India, Near old Bus Stand, Tonk. Opposite party-respondent 15.12.09 Before: Mr.Justice Sunil Kumar Garg-President Mrs.Vimla Sethia-Member
Ms. Rekha Arora counsel for the appellant Mr.J.P.Sharma counsel for the respondent BY THE STATE COMMISSION This appeal has been filed by the complainant appellant against order dated 1.8.08 passed by the District Forum, Tonk in complaint no. 213/2005 by which the complaint of 2 the complainant appellant was dismissed.
2. It arises in the following circumstances-
That the complainant appellant had filed a complaint before the District Forum,Tonk on 20.5.08 inter alia stating that her husband Badrilal now deceased had taken LIC policy from the respondents for a sum of Rs.1 lac bearing policy no.195229446 on 29.3.06 . It was further stated in the complaint that prior to taking the said policy the deceased had taken a policy no. 198620448 and after the death of the deceased payment had been made by the LIC in respect of the earlier policy. It was further stated in the complaint that the deceased had died on 27.4.07 and after the death of the deceased claim was preferred by the complainant respondent being the wife and nominee of the deceased before the office of the respondents but that claim was repudiated by the respondents through letter dated 28.2.08 on the ground that no doubt the policy in question was taken by the deceased on 29.3.06 and at the time of taking the policy the deceased had filled in up a declartion form regarding his health on 29.3.06 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to one month before taking the policy the deceased was suffering from Hypertension and CRF for which he had consulted a medical man and had taken treatment from the hospital 3 and since these facts were not disclosed by the deceased in his declaration form on 29.3.06 at the time of taking the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the respondents on 14.7.08 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 28.2.08 . Apart from that it was stated in the reply that prior to taking the policy on 29.3.06 the deceased had taken the treatment from Dr. Rajeshwari Wadhwani, MD (physician ) on 21.2.06 and the doctor concerned had diagnosed that the deceased was suffering from HT, CRF and thus the fact that before taking the policy in question the deceased was a patient of HT, CRF is well established . It was further stated in the reply that later on the deceased had further consulted Dr.L.C.Sharma on 6.5.06 and Dr.Sharma had found that the deceased was a patient of HT & CRF and further the deceased was admitted in the SMS Hospital, Jaipur on 23.5.06 and the same diseases were also diagnosed and thus it was a case of suppression of material facts regarding health on the part of the deceased and it was prayed that claim of the complainant was rightly repudiated by the respondents and complaint of the complainant be dismissed.
4After hearing the parties, the District Forum, Tonk through impugned order dated 1.8.08 had dismissed the complaint inter alia holding-
(i) That in this case the respondents had proved the fact that before filing in up the declaration form on 29.3.06 the deceased was a patient of HT, CRF and since that fact was not stated by the deceased in his declartion form dated 29.3.06 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased .
(ii) That the respondents were justified in repudiating the claim of the complainant appellant.
Aggrieved from the said order dated 1.8.08 passed by the District Forum, Tonk this appeal has been filed by the complainant appellant.
3. In this appeal, the main contention of the learned counsel for the appellant complainant is that since the deceased was not aware of the fact at the time of taking the policy that he was a patient of HT, CRF and hence, repudiation of claim of the complainant appellant by the respondents was wholly illegal and arbitrary and in view of this the findings of the District Forum dismissing the complaint of the complainant appellant could not be sustained as they suffer from basic infirmity, illegality and perversity 5 and it was prayed that appeal be allowed.
4. On the other hand, the learned counsel appearing for the respondents has supported the impugned order of the District Forum.
5. We have heard the learned counsel for the appellant as well as for the respondents and have gone through the entire materials available on record.
6. There is no dispute on the point that the deceased had taken LIC policy from the respondents for a sum of Rs.1 lac bearing policy no.195229446 on 29.3.06 .
7. There is also no dispute on the point that at the time of taking the policy a declaration was made by the deceased and in that declaration on 29.3.06 , he had not mentioned that he was suffering from any kind of disease .
8. There is also no dispute on the point that deceased had died on 27.4.07 meaning thereby within one year of the issuance of the policy.
9. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the respondents through letter dated 28.2.08 on the grounds mentioned therein.
10. On file there is a prescription slip dated 21.2.06 of 6 Dr.Rajeshwari Wadhwani which clearly reveals that the deceased was a patient of HT,CRF.
11. On file there is also a prescription slip dated 6.5.06 of Dr.L.C.Sharma in which the disease of HT,CRF is also mentioned and further there is a bed head ticket of the SMS Hospital, Jaipur which clearly reveals that the deceased was admitted in the hospital on 23.5.06 and the diseases of HT, CRF was mentioned.
12. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint of the complainant appellant was dismissed could be sustained or not and whether the repudiation of the claim of the complainant appellant by the respondents was justified or not.
13. It may be stated here that from the record it is well established that the deceased had first consulted Dr.Rajeshwari Wadhwani on 21.2.06 and the disease of HT,CRF was diagnosed and further from the prescription slip of Dr.L.C.Sharma, the fact that the deceased was a patient of HT,CRF was further confirmed and it was further confirmed by the record of the SMS Hospital, Jaipur where the deceased was admitted on 23.5.06 and thus there is cogent and reliable evidence on the part of the respondents to show that prior to filling in up the declaration form on 29.3.06 the deceased was aware of the fact that he was a patient of HT,CRF and since being aware he had not mentioned this fact in his 7 declartion form regarding health dated 29.3.06 which clearly goes to prove the fact that the deceased had knowingly, fraudulently and intentionally suppressed the disease of HT,CRF and had taken the policy in question by suppressing material facts and therefore, it would amount to suppression of material facts regarding health on the part of the deceased in real sense.
14. For the reasons stated above, it is held that repudiation of claim of complainant appellant by the respondents through letter dated 28.2.08 on ground of suppression of material facts regarding health by the deceased was justified and no illegality or irregularity has been committed by the respondents in repudiating the claim of complainant appellant and in view of this the findings of the District Forum dismissing the complaint of the complainant appellant are liable to be confirmed as they are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity,illegality or perversity and this appeal deserves to be dismissed.
15. During the course of arguments the learned counsel for the complainant appellant has stated that in case the appeal of the appellants is going to be dismissed, in such circumstances some amount of compensation as ex-gratia be allowed to the complainant respondent who is a widow and poor lady having two children.
8On ex-gratia payment
16. Ex-gratia payments are made as an act of grace, if the damage caused is outside the scope of the policy terms, or the liability under the policy is doubtful. In such cases the payment is made as an act of grace on humanitarian grounds. As a matter of fact, the loss or damage is outside the terms of the policy but the insurer takes a lenient view on humanitarian grounds. In such cases, full amount to indemnify the damages is not made. Such payments do not place the insurer under an obligation to make such payments in similar circumstances in future.
17. Further ex-gratia payment of claim would arise where there was no legal liability on the Life Insurance Corporation to make payment as in the case of repudiated claim or unconcluded contract. Such claims are paid to mitigate hardship to the claimants by way of equitable relief. The analysis, particularly of a repudiated claim for consideration of an ex-gratia payment, would be a skilful exercise on the part of the concerned officers of the opponent Life Insurance Corporation of India. Ex-gratia payment cannot be claimed as a matter of right. For that the law laid down by the Hon'ble National Commission in the case of LIC Vs. Shashi Gupta ( 1994) 2 CPR 622 (NC) ) may be referred to.
18. Further the word 'ex-gratia' payment itself means a payment which is voluntarily and charitable in nature and 9 since the C.P.Act,1986 is based on the principle of equity, therefore, hypertechnicalities could be ignored and equitable consideration should be kept in mind while deciding the matter.
19. However, looking to the entire facts and circumstances of the case and looking to the fact the LIC policy was for a sum of Rs.1 lac and on humanitarian consideration, this Commission thinks it just and proper to award ex-gratia amount of Rs.10,000/- in lumpsum to the complainant appellant.
20. It is further made clear that ex-gratia payment to the tune of Rs.10,000/- in lumpsum is being given to the complainant appellant who is a widow having two children, not as a matter of right but taken into consideration the facts and circumstances that the condition of a widow in India is not good and in the present case the complainant appellant is a widow lady.
21. In view of the discussions made above, this appeal filed by the appellant is dismissed . However, the respondents LIC would pay a sum of Rs.10,000/- in lumpsum as ex-gratia payment to the complainant appellant within a period of two months from today.
Member President