State Consumer Disputes Redressal Commission
L I C vs Smt Sarda Devi on 1 July, 2015
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 First Appeal No. A/2004/563 (Arisen out of Order Dated in Case No. of District ) 1. L I C a ...........Appellant(s) Versus 1. Smt Sarda Devi a ...........Respondent(s) BEFORE: HON'BLE MR. Alok Kumar Bose PRESIDING MEMBER HON'BLE MRS. Smt Balkumari MEMBER For the Appellant: For the Respondent: ORDER RESERVED State Consumer Disputes Redressal Commission U.P., Lucknow. Appeal No.563 of 2004 Life Insurance Corporation of India, Branch Office-Ist, Shahjahanpur through Branch Manager, Life Insurance Corporation of India, Office-Ist, Mohalla: Jiyakhel Garra Road, Shahjehanpur. ...Appellant. Versus Smt. Sharda Devi w/o Late Sri Ravindra Prasad Awasthi, R/o Village & Post: Nigohi, Tehsil: Tilhar, Shahjehanpur. ....Respondent. Present:- 1- Hon'ble Sri A.K. Bose, Presiding Member. 2- Hon'ble Smt. Bal Kumari, Member. Sri Sanjai Jaiswal for the appellant. Sri J.P. Sexena for the respondent. Date 28.8.2015 JUDGMENT
Sri A.K. Bose, Member- Aggrieved by the judgment and order dated 31.1.2004, passed by the Ld. DCDRF, Shahjahanpur in complaint case No.45 of 2001, the appellant Life Insurance Corporation of India has preferred the instant appeal under Section 15 of the Consumer Protection Act, 1986 (Act 68 of 1986) on the ground that the impugned order is arbitrary, perverse and is bad in the eye of law. It was delivered without proper appreciation of law and/or application of mind on the basis of surmises and conjectures and therefore, it has been prayed that the same be set aside in the interest of justice otherwise the appellant will suffer irreparable loss.
(2)From perusal of the records, it transpires that husband of the respondent/complainant Sri Ravindra Prasad Awasthi s/o Sri Raja Ram Awasthi obtained a Life Insurance Policy bearing no.221244796 on 28.6.1997 for a sum assured of Rs.60,000.00 under Term and Table 14-15, the half yearly premium of which was Rs.2,663.00, payable in June and December every year. The insured deceased obtained another Life Insurance Policy bearing no.220787523 under Term and Table 14-10 for a sum assured of Rs.85,000.00 on 14.8.1996, the half yearly premium of which was Rs.5,062.00 payable in August and February every year. Smt. Sharda Devi was made nominee in both the policies. The first policy was to mature on 28.6.2012 whereas the second policy was to mature on 14.8.2006. However, the life assured Sri Ravindra Prasad Awasthi expired on 10.9.1999. Consequently, two separate claims were filed for payment of the amount under insurance. The claims were, however, repudiated vide a common order dated 17.11.2000 on ground of suppression of previous ailments. Feeling aggrieved by this repudiation, complaint case no.45 of 2001 was filed. The complaint was allowed on 31.1.2004 and the appellant LIC was directed to pay the entire amount under insurance i.e. Rs.60,000.00 for the first policy and Rs.85,000.00 for the second policy totalling to Rs.1,45,000.00 with 9% pendente lite and future interest. In addition to this, a sum of Rs.10,000 was also awarded as compensation and cost of litigation. Aggrieved by this judgment and order, the instant appeal has been preferred. We have heard both the (3) parties and have gone through the evidence on record.
Admittedly, the date of commencement of the policy no.221244796 was 28.6.1997 and the date of commencement of policy no.22078753 was 14.8.1996. Both the policies got lapsed on failure to payment of half yearly premium in time. Consequently, the deceased applied for revival of the policies and accordingly, submitted declaration of good health on 8.12.1997 and 5.6.1999. The proposals for revival of the policies were accepted vide Revival Form 460 with effect from 8.12.1997 and Revival Form 680 with effect from 5.6.1999. However, the life insured expired on 10.9.1999 and thereafter, claims were filed. Upon investigation, it was revealed that the insured was suffering from COPD (Chronic Obstructive Pulmonary Disease) for the last 5-6 years. He had other diseases also as per the Bed Head Ticket of the District Hospital, Shahjahanpur. The medical reports further indicate that the deceased insured was also suffering from Muscular Dystrophy with Ventilatory Failure with LRTE with Dec-cor-pulmonale. However, he suppressed these ailments at the time of revival of the policies. He answered all questions in negative pertaining to status of his health while making proposals for revival. Consequently, the claims were repudiated on ground of concealment of previous ailments in the proposal for revival.
From perusal of the Bed Head Ticket of the deceased issued by the District Hospital, Shahjahanpur, it transpires (4) that the deceased was suffering from "Muscular Dystrophy with Ventilatory Failure with LRTE with Dec-cor-pulmonale." Muscular Dystrophy is a group of muscle diseases that weaken the musculoskeletal system and hamper locomotion. Muscular dystrophies are characterized by progressive skeletal muscleweakness, defects in muscle proteins, and the death of muscle cells and tissue. Ventilatory Failure is a rise in Pa Co2 (hypercapnia) that occurs when the respiratory load can no longer be supported by the strength or activity of the system. The most common causes are acute exacerbations of asthama and COPD, overdoses of drugs that suppress ventilatory drive and conditions that cause respiratory muscle weakness (eg, Guillain-Barre syndrome, myasthenia gravis, botulism). Findings include dyspnea, tachypnea, and confusion. Death can result. Lower Respiratory Tract Infection (LRTI) while often used as a synonym for pneumonia, can also be applied to other types of infection including lung abscess andacute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue. There are number of infections that can affect the lower respiratory tract. The two most common are bronchitis and pneumonia. Influenza affects both the upper and lower respiratory tracts, whereas Dec-cor-pulmonale or Pulmonary heart disease (New Latin pulmonale, of the lungs), also known as Cor pulmonale (Latin cor, heart + of the lungs) is the enlargement and failure of the right ventricle of the heart (5) as a response to increased vascular resistance or high blood pressure in the lungs (pulmonary hypertension). Chronic pulmonary heart disease usually results inright ventricular hypertrophy (RVH), whereas acutepulmonary heart disease usually results in dilatation. Hypertrophy is an adaptive response to a long-term increase in pressure. Individual muscle cells grow larger (in thickness) and change to drive the increased contractile force required to move the blood against greater resistance. Dilatation is a stretching (in length) of the ventricle in response to acute increased pressure, such as when caused by a pulomonary embolism or ARDS (acute respiratory distress syndrome). To be classified as pulmonary heart disease, the cause must originate in the pulmonary circulations system. Two major causes are vascular changes as a result of tissue damage (e.g. disease, hypoxic injury, chemical agents, etc.) and chronic hypoxic pulmonary vasoconstriction. If left untreated, then death may result, RVH due to a systemic defect is not classified as pulmonary hear disease. The heart and lung are intricately related. Whenever the heart is affected by disease, the lungs will follow and vice versa. Pulmonary heart disease is by definition a condition when the lungs cause the heart to fail. The hospital records further shows that the deceased was suffering from COPD (Chronic Obstructive Pulmonary Disease) for the last 5-6 years. Chronic Obstructive Pulmonary Disease (COPD), also known as chronic obstructive lung disease (COLD) and chronic (6) obstructive airway disease (COAD), among others, is a type of obstructive lung disease characterized by chronically poor airflow. It typically worsens over time. The main symptoms include shortness of breath, cough and sputum production. Most people with chronic bronchitis have COPD.
From perusal of the Bed Head Ticket of the District Hospital, Shahjahanpur further indicates that the deceased was under treatment for the aforesaid diseases for more than 4-5 years and was also admitted in the Hospital on 8.9.1999. All the diseases mentioned hereinabove were serious in nature and the deceased/insured had undergone treatment to get rid of them. Therefore, it would be most inappropriate to hold that he had no idea or knowledge about them. The concealment was deliberate and intentional. It is a clear case of concealment of previous diseases at the time of revival of the policies. The Forum below failed to take into consideration the factum before delivering the impugned judgment. The contract of insurance is based on Uberrimae fidei and the insured was under obligation to make true and full disclosure within his knowledge regarding the status of his health as held by the Hon'ble Apex Court in Satwant Kaur Sandhu vs. New India Assurance Company Ltd., IV (2009) CPJ 8 (SC), Life Insurance Corporation of India vs. Shahida Khatoon & Anr., IV (2013) CPJ 370 (NC), Life Insurance Corporation of India & Anr. vs. Kempamma & Anr., I(2013) CPJ 653 (NC) and Maya Devi vs. Life Insurance Corporation of India, III(2011) CPJ 43 (NC).
(7)It was argued on behalf of the Ld. Counsel for the respondent that the Bed Head Ticket of the District Hospital and the Medical Certificate given by the Physician of the District Hospital, Shahjahanpur are not admissible documents as the attending Doctor did not file any affidavit. In support of this, a ruing laid down in Life Insurance Corporation of India & Ors. vs. Harbans Kaur, IV (2009) CPJ 123 (NC) was cited. It was also argued on behalf of the Ld. Counsel for the respondent that if the insurer LIC had any doubt regarding the status of the health of the insured at the time of revival of the policy then it could have asked the insured to undergo for medical examination but no such examination or enquiry in any other form was conducted and, therefore, it would be inappropriate to take defense that the deceased had deliberately concealed his previous ailments at the time of the revival of the policies. In support of the above contention, rulings laid down in Life Insurance Corporation of India & Anr. vs. Anil Kumar Rastogi, IV (2009) CPJ 300 (NC) and Life Insurance Corporation of India & Anr. vs. Mithilesh & Ors., IV (2009) CPJ 244 were cited before us. We have gone through the evidence in the light of the rulings. As far as, the Affidavit of the Doctor is concerned, it may be noted that in the instant matter the insured was admitted in the District Government Hospital and the Bed Head Ticket was maintained by the Doctors of the Hospital. The physician of the Hospital gave certificate in the light of the (8) BHT. Therefore, in view of the ruling laid down in Pushpa Chauhan vs. Life Insurance Corporation of India, II (2011)CPJ 44 (NC), we are of the considered opinion that no affidavit was required to be filed by the attending Doctor. The insurance policies are based on the principle of Uberrimae fidei and the insured was under solemn obligation to make a true and full disclosure of the information regarding the status of his health. It is not for the insured to determine whether the information sought for is material for the purposes of the policy or not, as held in Satwant Kaur Sandhu's case (Supra). In the instant matter, the insured deceased was suffering from diseases like Muscular Dystrophy with Ventilatory Failure with LRTE with Dec-cor-pulmonale with COPD (Chronic Obstructive Pulmonary Disease) for 5-6 years prior to revival of the policies and, therefore, it will not be appropriate or logical to disgest the contention that he had no knowledge of the same.
Considering the totality of the circumstances, we are of the considered opinion that this is a case of suppression of previous ailments at the time of revival of the policies. The Forum below failed to deal with the matter as per law and documentary evidence on record. The judgment and order, being erroneous and out of record, can not be allowed to sustain. Consequently, the appeal deserves to be allowed.
ORDER The appeal is allowed and the judgment and order (9) dated 31.1.2004, passed by the Ld. DCDRF, Shah-Jehanpur in complaint case No.45 of 2001 is set aside. No order as to costs. Certified copy of the judgment be provided to the parties in accordance with rules.
(A.K. Bose) (Bal Kumari) Presiding Member Member Jafri PA-II Court No.4 [HON'BLE MR. Alok Kumar Bose] PRESIDING MEMBER [HON'BLE MRS. Smt Balkumari] MEMBER