State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Mrs. Rajkali on 9 February, 2009
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND
DEHRA DUN
FIRST APPEAL NO. 170 / 2006
1. Manager, Life Insurance Corporation of India
Branch Office Ranipur Bend
Haridwar.
2. Life Insurance Corporation of India
Divisional Office, Dehradun
......Appellants / Opposite Parties
Versus
Mrs. Rajkali W/o late Sh. Vikram Singh
R/o Village Dhanpura, Thana Pathri
District Haridwar
.....Respondent / Complainant
Sh. Deepak Ahluwalia, Learned Counsel for the Appellants
Sh. Ajay Gupta, Learned Counsel for Respondent
Coram: Hon'ble Justice Irshad Hussain, President
C.C. Pant, Member
Smt. Kusum Lata Sharma, Member
Dated: 09.02.2009
ORDER
(Per: Justice Irshad Hussain, President):
This is insurer's appeal against the order dated 30.06.2006 passed by the District Forum, Haridwar, allowing the consumer complaint No. 258 / 2003 and directing the insurer to pay insured sum of Rs. 40,000/- together with interest @12% p.a. and Rs. 1,000/- as litigation expenses, for and in connection with the policy of insurance dated 28.03.2002 purchased for said sum of Rs. 40,000/- by late Sh. Vikram Singh. On the death of the insured, his widow Mrs. Rajkali had preferred the claim, which had been repudiated by the insurer on the ground that the insured had willfully suppressed the material fact regarding ailment, with which he had been suffering at the time of making the proposal and had given false declaration in the proposal 2 form regarding queries about his health and diseases, with which he was then suffering.
2. The District Forum, on an appreciation of the material on record, rejected the insurer's plea, by observing that the certificate dated 12.03.2003 (Paper No. 20) issued by the doctor of Ganga Valley Clinic and Diagnostic Centre, Kankhal, Haridwar, not being primary evidence, do not support the insurer's stand that the insured, at the time of making the proposal for policy of insurance, was suffering from heart ailment and for which, he was receiving treatment. It was observed that the xerox copy of the certificate was not admissible in evidence and further that the contents of the same have not been proved to be true by the doctor, who is alleged to have issued the certificate or any other authorised representative of the said hospital, from where the certificate was issued to the insurer. With this premise, the repudiation of the claim under the policy of insurance, was held to be unjustified and it was held that the insurer made deficiency in service, entitling the complainant to be paid insured sum with interest and litigation expenses. The impugned order was, thus, accordingly passed in favour of the complainant.
3. The only question, which arose for consideration in this appeal, is as to whether the insured willfully suppressed material fact as regards his ailment at the time of making the proposal for insurance policy purchased by him.
4. Learned counsel for the insurer persuasively argued that the District Forum fell in error in considering the import of the afore-mentioned certificate in proper perspective and also the affidavit of Sh. S.K. Chaturvedi, Assistant Administrative Officer of the insurance company (Paper Nos. 17 to19), which was filed on record 3 by way of proof of the allegations and the issuance of certificate from the hospital by the concerned doctor in the ordinary course of hospital business and the profession of the doctor of the hospital and that this resulted in drawing an incorrect inference against the insurance company. Learned counsel also urged that under the policy of insurance of the insured, risk commenced w.e.f. 28.03.2002 and the certificate dated 12.03.2003, indicated that the insured late Sh. Vikram Singh was suffering from Ant. Wall MI with Hypertension for the last one year, i.e., even prior to the submission of the proposal form for policy of insurance and that the certificate amply proved that the insured willfully suppressed material fact as regards his ailment, while giving replies to the queries about his health / ailments etc. in Clause 11 of the proposal form (Paper Nos. 28 to 31). Learned counsel also drew attention to the information, said to have been divulged by the said hospital in the claim form dated 07.04.2003 (Paper No. 21) and wherein, there was reiteration of the fact of the above-mentioned disease of the insured and that he remained admitted in the hospital from 19.12.2002 to 24.12.2002 and submitted that the documents on record, duly proved by the averment of the affidavit of Sh. S.K. Chaturvedi, fully established the insurance company's stand for repudiating the claim under the policy of insurance in question. On the other hand, learned counsel for the complainant supported the inference drawn by the District Forum and would submit that there being no reliable and admissible evidence on record to prove that the insured was suffering from any ailment of heart at the time of making the proposal for insurance policy, the question of willful suppression of the ailment did not arise and that the contract of insurance was, thus, not vitiated and the complainant was rightly held entitled to the insured sum with interest and litigation expenses.
45. Having considered the submissions of the learned counsel for the parties in the light of the facts, circumstances and legal aspects of the case, we may state at the outset that there is no merit in this appeal. The reasons are that the District Forum was fully justified in not placing reliance on the copy of certificate dated 12.03.2003 of the doctor, as it was neither proved by the evidence of the doctor, nor any of the authorised representative of the hospital, from which it was obtained by the insurance company. Information said to have been given by the hospital in the form dated 07.04.2003, can not also be taken to serve the purpose, for the simple reason that as per endorsement in it, past record regarding the ailment and treatment of the insured, was not available in the hospital. Mere fact that insured was admitted in the hospital from 19.12.2002 to 24.12.2002 as a follow-up case of Ant. Wall MI and Hypertension, it could not be inferred that the insured was himself well aware of any of his ailment at the time of making the proposal for policy of insurance. The inference is lent credence to by the fact that the insurance company could not place on record any material, which may have indicated that prior to 19.12.2002, insured received treatment from any doctor or hospital for any heart ailment. Therefore, even if the insured got himself admitted and received treatment from 19.12.2002 to 24.12.2002, the same would have no bearing on the commencement of the risk much prior to the said date and particularly from 28.03.2002 and during which period, the insured had not been shown to have received any treatment for any ailment. Under these circumstances, the above referred certificate and form, which refer to alleged fact that the insured was suffering from heart ailment for last one year, would not carry any conviction and these could not be taken to place reliance on the stand taken by the insurance company.
56. In the face of the above facts of the case, the reported decisions in the case of Brahm Dutt Sharma Vs. Life Insurance Corporation of India; AIR 1966 Allahabad 474, Life Insurance Corporation of India Vs. Mansa Devi; II (2003) CPJ 135 (NC), Life Insurance Corporation of India Vs. Krishan Chander Sharma; 2007 (1) CPC 590 (NC), Life Insurance Corporation of India and another Vs. M. Gowri and others; 1994 (3) CPR 398 (NC), Angoori Devi Vs. LIC of India and others; 2008 (4) CPR 304 (NC), P.C. Chacko and another Vs. Chairman, Life Insurance Corporation of India and others; III (2008) CPJ 78 (SC) and Panni Devi Vs. LIC and others; III (2003) CPJ 15 (NC), pressed into service by the learned counsel for the insurance company, would not help the cause of the insurance company, so as to assail the inference drawn by the District Forum in the impugned order. In other words, there being no willful suppression of material fact as regards any ailment by the insured, the insurance company was not justified in repudiating the claim. It was a case, in which the insurance company made deficiency in service and was, thus, rightly held liable to pay the insured sum to the complainant. However, as submitted, the interest awarded @12% p.a. appear to be on the higher side and in our view, interest @9% p.a. would have been just and proper in the peculiar circumstances of the case. To that extent, the impugned order is liable to be modified.
7. For the reasons aforesaid, the appeal succeed partly and is to be allowed accordingly.
8. Appeal is partly allowed. The rate of interest is reduced from 12% p.a. to 9% p.a. Rest of the order of the District Forum, is hereby affirmed. Cost of the appeal made easy.
(SMT. KUSUM LATA SHARMA) (C.C. PANT) (JUSTICE IRSHAD HUSSAIN) Kawal