State Consumer Disputes Redressal Commission
Shivkanti Devi vs L I C on 20 January, 2016
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/2009/170 (Arisen out of Order Dated in Case No. of District ) 1. Shivkanti Devi a ...........Appellant(s) Versus 1. L I C A ...........Respondent(s) BEFORE: HON'BLE MR. Alok Kumar Bose PRESIDING MEMBER HON'BLE MR. Sanjay Kumar MEMBER For the Appellant: For the Respondent: ORDER RESERVED State Consumer Disputes Redressal Commission U.P., Lucknow. Appeal No. 170 of 2009 Smt. Shiv Kanti aged about 52 years, W/o Sri Govind Narain Tiwari, R/o 1852 Rajendra Nagar, Urai, Pargana Urain Distraic: Jalaun. ....Appellant. Versus Bhartiya Jeevan Bima Nigam through Shakha Prabandhak, Gandhi Market, Urai District: Jalaun. ....Respondent. Present:- 1- Hon'ble Sri A.K. Bose, Presiding Member. 2- Hon'ble Sri Sanjai Kumar, Member. None for the appellant. Sri Sanjay Jaiswal for the respondent. Date 24.2.2016 JUDGMENT
Sri A.K. Bose, Member- Aggrieved by the judgment and order dated 4.12.2008, passed by the Ld. DCDRF, Urai, District: Jalaun in complaint case No.139 of 2007, the appellant Smt. Shiv Kanti 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 she will suffer irreparable financial loss.
From perusal of the records, it transpires that the husband of the appellant/complainant Sri Govind Narain (2) Tiwari had a life insurance policy bearing no.233311563 under Table & Term 169-10 for a sum assured Rs.1 lac, the yearly premium of which was Rs.11,672.00 + 100 = 11,672.00. The date of commencement of the policy was 28.1.2005 and the appellant/complainant Smt. Shiv Kanti, being wife, was nominee in the said policy.
From perusal of the records, it further transpires that the life assured Sri Govind Narain Tiwari expired on 28.7.2005 due to Cardiac Arrest. A claim was, therefore, filed for payment of the amount under insurance. Since the claim related to an early death, therefore, an enquiry was conducted into the matter where upon, it was revealed that the life assured had concealed material facts relating to the status of his health and previous ailments in the Proposal Form. Documentary evidences were collected from the Hospital and after due consideration of all material facts, the claim was repudiated on 10.3.2006 on the ground that the answers given by the insured in the proposal form were false. The insured was suffering from Tuberculosis for about 8 years before making the proposal. He had consulted Doctors and had undergone treatment in Hospital.
Aggrieved by this repudiation, an appeal was preferred before the Claim Review Committee. The Claim Review Committee examined the matter and upheld the repudiation on 12.5.2006. The appellant/complainant was informed accordingly.
Aggrieved by the repudiation and dismissal of the appeal by the Complaint Review Committee, complaint (3) case no.139 of 2007 was preferred. The Forum below, after hearing the parties and on the basis of documentary evidence available on record held that the life assured was suffering from Tuberculosis with Diabetes Mellitus for about 8 years prior to the proposal but he had concealed these material informations in the proposal and thereby, obtained the policy by deceit. Consequently, the complaint was dismissed. Aggrieved by this judgment and order, the instant appeal was preferred.
From perusal of the records, it transpires that on 20.1.2016, it was observed that the appellant/complainant was not taking interest in the appeal. Since the appeal was pending for more than 6 years for disposal, therefore, in view of the provisions contained under Rule 8(6) of the U.P. Consumer Protection Rules, 1987 read with Section 30(2) of the Act 68 of 1986, we preferred to proceed with the matter. Consequently, the Ld. Counsel for the respondent was heard.
From perusal of the records, it transpires that the life assured Sri Govind Narain Tiwari made the proposal for insurance on 10.2.2005. He replied all questions in negative relating to the status of his health in the proposal form and also stated that general condition of his health had been good all along. He further informed that he had not taken any medical leave prior to the proposal. From perusal of the records, it transpires that the life assured was a Government employee and was working in U.P. Sahkari Gram Vikas Kendra, Urai, District, Jalaun. On the basis of these declaration, the proposal was accepted and (4) policy bond bearing no.233311563 was issued which commenced from 28.1.2005. Excerpts of his Service Book is on record. It reveals that he had taken Medical Leave from 4.5.2002 to 18.6.2002 for Gal-Bladder Operation and thereafter, he had again taken Medical Leave from 7.6.2005 till his death for fever and other ailments. The proposal was filed on 10.2.2005. Thus, it is clear that he concealed the fact that he had taken medical leave from 4.5.2002 to 18.6.2002 in the proposal form. Furthermore, from perusal of the records, it transpires that the life assured was admitted in Maharani Laxmi Bai Chikitsalaya (Medical College), Jhansi on 30.6.2005 for Pulmonary Tuberculosis with Diabetes Mellitus with Diabetic Ketoacidosis (DKA) with Renal Stone. The case history maintained by the Medical College/Hospital indicates that the patient was suffering from Diabetes Mellitus (Stage-II) since 8 years. An effort was made to interpolate the period of ailment in the records. The period of 8 years was changed to 2 months which can be noticed by nacked eyes. The repudiation letter shows that it was initially 8 years which was later on changed to 2 months. From perusal of the records, maintained by the Medical College, Jhansi, it is clear that the patient was a known case of Tuberculosis with Diabetes Mellitus and Diabetes Ketoacidosis and Renal Stone. He was referred to SGPGI, Lucknow/Higher Centre on 19.7.2005 for further treatment. The genuineness of these documents has not been denied. Thus, it is clear that the life insured was suffering from Pul. Tuberculosis with Diabetes Mellitus (5) with Diabetes Kitoacidosis with Renal Stone for about 8 years prior to filing the proposal. He was admitted in the Medical College on 30.6.2005 and was referred to SGPGI/Higher Centre on 19.7.2005. He had also taken medical leave from 4.5.2002 to 18.6.2002 but he had concealed all these material informations in the proposal form. The respondent LIC repudiated the claim on ground of concealment of material facts in the proposal form and the appeal before the Claim Review Committee had been dismissed.
In the backdrop of the above, we are required to see whether the repudiation was justified or not ? In Maya Devi vs. LIC of India, III (2011)CPJ 43 (NC), it has been held that the case history given in the certificate of Doctor can not be disbelieved. It is immaterial whether the insured was declared medically fit by the Penal Doctor of the LIC or not. In Smt. Shashikala Vijaykumar Bohra vs. LIC of India, Legal Digest 2010 pg. 134, it has been held that examination by Penal Doctors of the LIC does not absolve life insured his duty to disclose the factum of previous ailment. Thus, the contention that the hospital documents/prescriptions cannot be read in evidence in the absence of the affidavit of the Doctor holds no force in view of ruling laid down in Pushpa Chauhan vs. LIC of India, II (2011) CPJ 44 (NC), in which it has been held that the affidavit of the Doctor is not required. It may be observed here that the Hon'ble Apex Court in P.C. Chacko & Anr. vs LIC of India, (2001) SCC 321, was pleased to hold that:
(6)"the purpose for taking a policy of insurance is not, in our opinion, very material. It may serve the purpose of social security but then the same should not be obtained with a fraudulent act by the insured. Proposal can be repudiated if a fraudulent act is discovered. The proposer must show that his intention was bone fide. It must appear from the face of the record. In a case of this nature it was not necessary for the insurer to establish that the suppression was fraudulently made by the policy holder or that he must have been aware at the time of making the statement that the same was false or that the fact was suppressed which was material to disclose. A deliberate wrong answer which has a great bearing on the contract of insurance, if discovered may lead to the policy being vitiate in law."
A similar view was taken by the Hon'ble National Commission in LIC of India vs. Shahida Khatoon & Anr. Legal Digest (2013) 294 (NC).
Thus, in view of the discussions made and the rulings cited hereinabove, we are of the considered opinion that in the instant matter, the insured Sri Govind Narain Tiwari concealed the material informations regarding the status of his health in the proposal form. As such, repudiation of the claim was justified. The insured obtained the policy in breach of principles of Uberrimae fide. The Forum below has rightly dismissed the complaint. There is no irregularity or illegality in the order and, therefore, we are not inclined to interfere in it. Consequently, the appeal, being meritless, is liable to be dismissed.
(7)ORDER The appeal is dimissed. No order as to costs. Certified copy of the judgment be provided to the parties in accordance with rules.
(A.K. Bose) (Sanjai Kumar) Presiding Member Member Jafri PA II Court No.3 [HON'BLE MR. Alok Kumar Bose] PRESIDING MEMBER [HON'BLE MR. Sanjay Kumar] MEMBER