National Consumer Disputes Redressal
Sulochana Devi vs Lic Of India on 15 December, 2011
NATIONAL CONSUMER DISPUTES
REDRESSAL COMMISSION
NEW DELHI
REVISION PETITION NO. 3534 OF 2007
(Against order dtd.
09.02.2007 in appeal no. 276/05
of the
State Commission, M.P.)
Sulochana Devi
........ Petitioner (s)
Vs.
Life Insurance Co. of
India
........ Respondent (s)
BEFORE:
HON'BLE MR. JUSTICE
ASHOK BHAN, PRESIDENT
HONBLE MRS. VINEETA RAI,
MEMBER
For Petitioner :
Mr.M.K.Sharma, Advocate
For Respondent : Mr. Rajat Bhalla,
Advocate
Pronounced on 15th December, 2011
ORDER
PER VINEETA RAI, MEMBER This revision petition has been filed by Sulochana Devi (hereinafter referred to as the Petitioner) being aggrieved by the order of the State Consumer Disputes Redressal Commission, M.P. (hereinafter referred to as State Commission) in Appeal No.276/2005 wherein Life Insurance Corporation of India was the Respondent.
The facts of the case according to the Petitioner who was the original complainant before the District Forum are that her late husband, Ravindra Prasad (hereinafter referred to as the deceased/insuree) who was an employee of the Food Corporation of India, had purchased two insurance policies of Rs.50,000/- each from the Respondent/Insurance Corporation for which he regularly paid the premium. He was also enjoying good health and performing his duties.
However, he passed away following an illness on 19.03.2003. Petitioner being his nominee and widow submitted claim before the Respondent/Insurance Company which was repudiated on the grounds that the Petitioner had suppressed the fact that he was suffering from serious ailments at the time of his taking the policies and that his previous ill-health was also confirmed by the fact that he had taken 76 days medical leave because from 10.03.1998 to 12.03.2001. According to the Petitioner, this was factually not correct and she, therefore, filed a complaint before the District Forum on grounds of deficiency in service and requested that the Petitioner pay her the amounts claimed along with interest @ 18% and Rs.50,000/- as compensation.
The contention that the insurance claim was wrongly repudiated was denied by the Respondent/Insurance Company who stated that the statement of the insuree at the time of filling up the policy form that he was enjoying good health was accepted in utmost good faith but after his death when Respondent/Insurance Company investigated the matter, it was revealed that insurance was suffering from Tuberculosis and related breathing ailments and also that he had been continuously taking leave on grounds of ill health. Respondent/Insurance Company also made inquiries from the J.A. Group of Hospitals, Gwalior where the deceased/insuree was treated which also confirmed that he had been suffering from T.B. and related respiratory problems for the last 5 years and for which he was taking medical treatment. This fact, coupled with the medical leave taken by the deceased/insuree on a number of occasions, therefore, confirmed that he had been suffering from and taking treatment for T.B. prior to his having taken the insurance policy. Since, suppression of material facts, as per the terms and conditions of the policy, were valid grounds for repudiation of the claim, Respondent/Insurance Company was justified in rejecting the claim.
The District Forum after hearing both parties and on the basis of the evidence produced on record dismissed the complaint by observing as follows:
Non-applicant has submitted the photo copies of Medical Report of treatment from 14.02.2003 to 19.03.2003 from J.A.H. Gwalior and regarding death and absence from service of applicant, from which it is proved that Policy holder Ravinder Prasad was patient of T.B. disease about 5 years prior 14.02.2003 and he was getting treatment of his illness since last three years or from the year 2000. By giving false information about this fact, the policy holder has denied in his application dated 12.12.2001 and 30.04.2001, in his reply to the contents of para 11 regarding his health. Policy holder has intentionally concealed the fact about his illness of T.B. disease and stating having good health in his application. He has done fraud for getting Insurance Policy. On the basis of these contentions, the Non-applicant has rejected the claim of applicant. Therefore, this matter does not come in deficiency in service.
Aggrieved by this, Petitioner filed an appeal before the State Commission which also dismissed the appeal by making the following observations:
Late insured died on 18.03.2003 while he was admitted in JA Group of Hospital Gwalior for treatment of pulmonary tuberculosis. From his treatment papers, it is clear that he was suffering with the said ailment for last 5 years immediately preceding the date of his admission i.e. 18.02.2003.
There is further evidence available on record that he during his employment had been on leave on medical ground for several days during the period from 10.03.1998 to 12.03.2001 i.e. prior to his taking the said two policies. However, in his proposal form he suppressed all these material facts.
Needless to say that the suppression was on material points and thus vitiated the contract of insurance. The respondent-LIC was justified in repudiating the appellants claim and her complaint has also been rightly dismissed by the Forum below.
Hence, the present revision petition.
Counsel for both parties made oral submissions.
Counsel for Petitioner stated that as per the medical record filed by the Respondent/Insurance Company, the deceased/insuree was admitted for treatment only in 2002 whereas he had taken the insurance policy in 2001 and at that time he was not aware that he had any illness/ailment. While it is a fact that he had been taking leave but these were on grounds of minor illnesses and there are several rulings of the Consumer Fora that leave on medical grounds by itself is no ground to presume that the insured was suffering from any disease [LIC of India Vs. Dayawati III(2005) CPJ 544)]. Since there was no suppression of material facts on the part of the deceased/insuree, the claim was, therefore, wrongly rejected.
Counsel for Respondent/Insurance Company challenged the above contentions and stated that from the medical records of both the Parul Pathology Clinic and B.H.U. Institute of Medical Sciences & S.S. Hospital, it was clearly indicated that in 2002, the insuree was suffering from Tuberculosis which was either in an advanced or terminal stage. In the medical history sheet of the insuree dated 26.02.2002, it was again stated that he was a patient of chronic bronchitis etc. and that his lungs had been destroyed because of these ailments. These were not diseases that had developed overnight and obviously by 2002, these were at a very advanced stage which is further established by the fact that the insuree died within a year thereafter. This medical evidence as well as medical leave taken by the insuree between the period from 1998 to 2001 thus supports and confirms the fact that he was suffering from Tuberculosis and related diseases prior to his having taken the insurance policy and he had suppressed these facts.
The Fora below which are court of facts after considering the evidence, had given concurrent findings that the Respondent/Insurance Company was justified in repudiating the claim because of the above reasons.
We have heard learned Counsel for both parties and have gone through the evidence on record. We note that the two documents filed in evidence by the Respondent/Insurance Company as proof that the insuree had been suffering from serious ailments for about 5 years prior to his death, clearly indicate that the insuree was suffering from Tuberculosis which was in an advanced/terminal stage in 2002 and that further he had been suffering from chronic bronchitis which had destroyed his lungs. Petitioner has not been able to produce any evidence to challenge these medical documents issued from two institutes of repute. While it is a fact that there are rulings of the Consumer Fora that leave taken on medical grounds by itself is not proof of an insuree suffering from serious illness, in the instant case, this is not the only evidence relied on but is only a supplementary evidence. We, therefore, find force in the contention of the Respondent that the credible documentary evidence on file referred to above confirms that the insuree was suffering from a serious disease (TB) at the time of his having taken the insurance policy, which he suppressed and the undisputed fact that he took medical leave several times during the period from 10.03.1998 to 12.03.2001 further confirms that he had been in ill health well before he had taken the insurance policy and that he knowingly suppressed these material facts.
It is a settled principle of law that an insurance policy is a contract made between the parties in utmost good faith and its breach would negate the contract. In the instant case, as observed by the Fora below, this principle was breached by the insuree who suppressed material facts regarding his health, thus, justifying repudiation of the insurance claim by the Respondent. We, therefore, uphold the order of the Fora below and dismiss the revision petition. No costs.
Sd/-
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(ASHOK BHAN J.) PRESIDENT Sd/-
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(VINEETA RAI) MEMBER /sks/