State Consumer Disputes Redressal Commission
Lic vs Smt.Pushpa Kumawat on 9 November, 2022
Daily Order M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PLOT NO.76, ARERA HILLS, BHOPAL FIRST APPEAL NO. 280 OF 2017 (Arising out of order dated 12.01.2017 passed in C. C. No.132/2014 by District Commission, Ratlam) LIFE INSURANCE CORPORATION OF INDIA, THROUGH DIVISIONAL MANAGER, LEGAL CENTRAL REGIONAL OFFICE, JEEWAN SHIKHA, 60-B, HOSHANGABAD ROAD, BHOPAL (M.P.) .... APPELLANT. Versus SMT. PUSHPA KUMAWAT, W/O LATE SHRI VIJENDRA KUMAR KUSHWAHA, R/O KUMAWAT SADAN, POLYTECHNIC CHOURAHA, JAORA, DISTRICT-RATLAM (M.P.) .... RESPONDENT. BEFORE : HON'BLE SHRI JUSTICE SHANTANU S. KEMKAR : PRESIDENT HON'BLE SHRI S. S. BANSAL : MEMBER
HON'BLE DR. (MRS) MONIKA MALIK : MEMBER COUNSEL FOR PARTIES : Ms. Preetima Shrivastava, learned counsel for the appellant. Shri Yash Vidyarthi, learned counsel for the respondent. O R D E R (Passed On 09.11.2022)
The following order of the Commission was delivered by Dr. (Mrs) Monika Malik, Member:
This appeal by the opposite party /appellant Life Insurance Corporation of India (hereinafter referred to as 'LIC') is filed against the order dated 12.01.2017 passed by the District Consumer Disputes Redressal Commission, Ratlam (for short the 'District Commission') in C. C. No. 132/2014 whereby the complaint filed by the complainant/respondent (hereinafter referred to as 'respondent') has been partly allowed.
-2-2. Briefly put, facts of the case are that respondent's late husband Shri Brijendra Kumar Kumawat (hereinafter referred to as 'deceased-insured') during his lifetime had obtained life insurance policy no. 345697330 from the LIC on 20.07.2010. The sum assured under the policy was Rs.2,00,000/-. The deceased-insured died on 10.02.2012 due to heart attack. The claim filed by the respondent, with the LIC was repudiated vide letter dated 04.12.2012 on the ground that the deceased-insured was suffering from Diabetes Mellitus since last 11 years and this fact was concealed by him while filling up the proposal form for obtaining the insurance policy.
3. The LIC resisted the complaint stating that the fact that the deceased-insured was suffering from Diabetes Mellitus since last 11 years was concealed by him in the proposal form, in order to obtain the insurance cover. Therefore, the contract of insurance became null and void. It was prayed that the complaint be dismissed.
4. The District Commission partly allowed the complaint and directed the the opposite parties jointly and severally, to pay sum assured of Rs.2,00,000/- to the respondent with interest @ 7% p.a. from the date of repudiation of claim i.e. 04.12.2012, till its realization. In addition compensation of Rs.10,000/- with another sum of Rs.2,000/- as costs is also awarded. Hence this appeal.
-3-5. Heard. Perused the record.
6. Learned counsel for the LIC argued that the treatment sheets of the hospital, where the deceased-insured was treated clearly show that the deceased-insured was suffering from Diabetes-Mellitus since last 11 years. The aforesaid information in the history sheet, was given by the attendant i.e. son of the deceased-insured. The deceased-insured knowingly suppressed the aforesaid information, while filling up the proposal form in order to obtain the policy cover. The deceased-insured thus violated the principle of uberrimae fidei i.e. utmost good faith and therefore the contract of insurance became null and void. The District Commission did not consider the aforesaid while passing the impugned order and therefore the same deserves to be set-aside.
7. Learned counsel for the respondent supported the impugned order and argued that in the medical certificate issued by the treating doctor of Department of Medicine, SAIMS Medical College & Hospital, Indore it is mentioned that deceased-insured had Diabetes Mellitus since 1 year. This is against the LIC's submission that the deceased-insured was suffering from Diabetes-Mellitus since last 11 years. Also the treating doctor in the said certificate could not specify that when the deceased-insured had approached him for treatment in past 3 years. This shows that the deceased-insured was not having any serious ailment, for which he could -4- require medical consultation. Therefore, owing to the aforesaid, this appeal by the LIC deserves to be dismissed.
8. We find that repudiation letter dated 04.12.2012 is available in the record of the District Commission. The repudiation of the claim of the deceased-insured is based on incorrect replies to the queries asked in Column no. 11 of the proposal form. It is specified in the repudiation letter that the deceased-insured, who has Diabetes Mellitus since last 11 years had suppressed the same while filling up the proposal form.
9. It is submitted by the LIC that the deceased-insured was suffering from Diabetes Mellitus since 11 years, but had concealed this material information in the proposal form filled by him. The LIC has placed medical documents/treatment sheets of Shri Aurobindo Institute of Medical Sciences, (SAIMS Hospital) Indore, in the record of the District Commission. On Page no. 8 which is 'Indoor case history sheet,' it is specified that the "patient was K/C/O-Diabetes Mellitus-2 since last 11 years". On the next page of this document yet again it is mentioned that he has a past history of Diabetes Mellitus since 11 years. The history is noted to be is given by attendant i.e. his son.
10. The respondent cannot be benefitted merely on the basis of unsubstantiated obscure inscription in column 6(2) of the medical certificate. Also the column no.9 specifically refers to the consultation given by the -5- issuing authority of the said certificate, wherein it is quoted that the patient only had emergency treatment. Since this question was asked from the treating doctor, regarding when the patient had approached the doctor in past 3 years, the aforesaid was mentioned. But this specifically does not indicate that the patient who had not approached the said doctor, did not take any treatment elsewhere also. The treatment sheets issued by Shri Aurobindo Institute of Medical Sciences (SAIMS Hospital) Indore bearing seal and signatures of the hospital, cannot be disbelieved and therefore, the District Commission has committed error in allowing the complaint filed by the respondent.
11. In view of the foregoing discussion, we are of a considered opinion that the impugned order deserves to be and is hereby set-aside. This appeal filed by the appellant-LIC is allowed. However, there is no order as to costs.
(JUSTICE SHANTANU S. KEMKAR) (S.S.BANSAL) (DR. MONIKA MALIK) PRESIDENT MEMBER MEMBER