State Consumer Disputes Redressal Commission
Sharda Patel vs Lic on 21 December, 2015
M.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION
PLOT NO. 76, ARERA HILLS, BHOPAL (M.P.)
Appeal No.1264/2011
Smt. Sharda Patle ... Appellant
Vs.
Life Insurance Corporation of India . ... Respondents
BEFORE;
HON'BLE SHRI JUSTICE RAKESH SAKSENA, PRESIDENT
HON'BLE SMT. NEERJA SINGH, MEMBER
COUNSEL FOR THE PARTIES:
SHRI SUSHIL GOSWAMI, LEARNED COUNSEL FOR APPELLANT.
MS. CHITRA SHARMA, LEARNED COUNSEL FOR RESPONDENT.
ORDER
( PASSED ON 21.12.2015 ) The following order of the Bench was delivered by Smt. Neerja Singh, Member.
This appeal is by the complainant aggrieved by the order dated 26.07.11, passed by District Consumer Disputes Redressal Forum, Seoni in CC No. 18/11, dismissing her complaint against the opposite party Life Insurance Corporation Ltd. (hereinafter referred to as LIC).
2. The case of the appellant is that her deceased husband (hereinafter referred to as the insured), who was an Asstt. Lineman with the M.P. Electricity Company, took 8 insurance policies from LIC. The policies were as under - : 2 :
Policy No. Date of Issue
371497263 17.10.08
371497633 07.07.09
371496890 10.12.07
371497274 28.10.08
355364446 31.07.08
355364378 31.07.08
371495244 15.06.04
371495312 17.10.04
The insured, who paid the premiums regularly, died on 23.03.10. A claim was made with the respondent LIC, but they made payment of only 4 policies. The appellant was informed, vide letter dated 30.12.10, that the claim had been repudiated in 4 policies on account of suppression of material fact. The appellant avers that the insured was examined by a doctor of the respondent LIC and was not found to be suffering from any disease. She has prayed that the sum assured of the 4 policies amounting to Rs.5,75,000/- be paid to her with interest and compensation.
3. The respondent LIC submits that the insured was unwell and was a patient of pulmonary disease from 2006, a : 3 : fact which he suppressed when filling the proposal form .He had even taken medical leave for the same from his office. They aver that payment has been made for 4 policies. Policy Nos. 371495244 and 371495312 were taken prior to the insured having been diagnosed with the disease, hence the sum assured in these policies were paid. Policy numbers 355364446 and 355364378 were no-risk policies. Hence, the payment for these policies was also made. The remaining four policies were repudiated on the ground of suppression of material fact, as they were taken after the insured was diagnosed with lung disease.
4. We have heard the respective contentions of the learned counsel for the parties and perused the documents filed on record.
5. The certificate given by the hospital where he was last treated, states that the insured was brought in an unconscious state and died the same day of Bronchial Asthma. The certificate further mentions that as per the history given, he had asthma for the last 2 months.
6. The respondent LIC obtained the medical leave records of the insured from the employer. As per the medical : 4 : certificate of Dr. Prafull Jain, given by the insured to his employer, the doctor has certified that he was under his treatment from 14.10.06 to 31.10.06 for COPD with Pyrexia. The veracity of this certificate has not been challenged by the appellant. It evidences that the insured had been diagnosed with COPD in 2006.
7. Medical literature gives the information that COPD or Chronic obstructive pulmonary disease is a progressive disease that makes it hard to breathe and the disease gets worse over time. COPD has no cure yet and doctors don't know how to reverse the damage to the airways and lungs. It is one of the leading causes of death. Having being diagnosed with COPD in 2006, it was incumbent on the insured to inform the LIC about the disease at the time of taking the policy.
8. The insured again took long leave on medical grounds from 3.7.07 to 25.7.07. However, to the specific questions as to whether he had taken treatment for any disease for more than a week and whether he had to take any medical leave in the last 5 years, he has replied in the negative. It is a clear case of suppression of a serious : 5 : disease, a material fact that would have bearing on the risk involved. We do not find any deficiency in service on the part of the LIC in repudiating the claim.
9. As a last leg, learned counsel for the appellant argued that the appellant is at least entitled to the sum assured in policy number 371496890, issued on10.12.07 as the policy had been in existence for more than 2 years and Section 45 of the Insurance Act,1938, would be attracted.
10. Section 45 of the Insurance Act 1938, states that no policy of life insurance, after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance was inaccurate or false unless the insurer shows that such a statement "was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made" by the policy holder.
11. The onus lay on the LIC to show that the statement which was suppressed by the insured was material to disclose and was fraudulently made. The LIC have filed the certificate clearly showing that the insured was suffering from COPD. By suppressing the disease, which : 6 : ultimately caused his death in 2010, the insured suppressed material facts. It cannot be said to be a mere misstatement as it was very relevant to the proposal. Further, the insured suppressed the fact that he had taken treatment for more than 14 days for the disease. It cannot be said that he was not aware that he had been treated for a lung problem for which he had to take a long leave. In the overall picture, the suppression appears to be fraudulently made on a fact which was material to disclose. Hence, he cannot be given the benefit of Section 45 of the Insurance Act.
12. In view of the aforesaid, we find no infirmity in the order of the District Forum. The appeal fails and is dismissed. No order as to costs.
(JUSTICE RAKESH SAKSENA) (SMT. NEERJA SINGH)
PRESIDENT MEMBER