State Consumer Disputes Redressal Commission
Life Insurance Corporation Of India vs Smt Lata W/O Prakash Rawat on 4 December, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION STATE CONSUMER DISPUTES REDRESSAL COMMISSION MAHARASHTRA STATE, CIRCUIT BENCH, NAGPUR 5th floor, Administrative Building, Civil Lines, Nagpur-01 Appeal No. A/06/1875 (Arising out of Order dtd. 07.08.2006 in Complaint No. CC/05/25 of District Forum, Gondia) 1. Life Insurance Corporation of India Through its Branch Manager Tumsar, Dist. Bhandara 2. Life Insurance Corporation of India Through its Zonal Office Yogakshema, Jeevan Bima Marg Mumbai- 400 021 .Appellant(s) Versus Smt Lata W/o Prakash Rawat R/o Tirora,Dist. Gondia BEFORE: Honble Mr S. M. Shembole, Presiding Member Hon'ble Smt.Jayshree Yengal, Member Hon'ble Mr N. Arumugam, Member PRESENT: Adv. Mr P P Kothari ..for the Appellant Proxy Adv. Mr C Thamke of Adv. Mr I Choudhari .....for the Respondent JUDGEMENT
(Passed on 04.12.2013) Per Mr S M Shembole, Honble Presiding Member This appeal is directed against the judgement & order dtd.07.08.2006 passed by District Consumer Forum, Gondia in Consumer Complaint No.CC/05/25 allowing the complaint directing the o.p. / appellant - Insurance Co.
to pay amount of insurance Rs.65,000/- to the complainant / respondent with interest @ 12% p.a. and also amount of Rs.1,000/- more towards cost of proceedings.
(For the sake of brevity the appellant hereinafter is referred as the Insurance Co. and the respondent as the complainant) Brief facts giving rise to this appeal are that:-
1. Deceased Prakash who was the husband of the complainant died on 25.04.2003 due to Heart Attack. During his lifetime he obtained three insurance policies of total amount Rs.65,000/-. Firstly on 28.12.2001 he obtained the policy of Rs.25,000/-, secondly on 01.03.2002 he obtained the policy of Rs.20,000/- and thereafter on 28.03.2003 he obtained third policy of Rs.20,000/-. At the time of his death all these policies were in force.
Therefore, after his death with widow complainant made insurance claim. However, her claim came to be repudiated by the Insurance Co. on the ground that the deceased has suppressed the material fact about his illness while submitting the Proposal Forms, etc. Therefore, complainant filed Consumer Complaint before the Forum.
2. Insurance Co. resisted the claim vide its Written Version contending inter alia that the claim is rightly repudiated as the deceased suppressed the material fact while submitting the Proposal Form. It is contended that he was fully aware that he was suffering from different ailments such as blood sugar, heart, lever, kidney, piles, etc. with a mala fide intention to get the insurance claim. It is submitted to dismiss the complaint.
3. On hearing both the sides and considering the documents on record the Forum allowed the complaint, holding that though deceased Prakash was suffering from the ailments as averred by the Insurance Co., he was not aware about those ailments while obtaining the policies and therefore, there could be no mala fide intention on his part to suppress any material fact.
4. Feeling aggrieved by the same judgement & order the Insurance Co. has preferred this appeal.
5. We heard Ld. Counsel for both the sides at length, perused the Written Notes of Argument, copies of impugned judgement & order, complaint, Written Version, insurance policies and medical certificates.
6. The undisputed facts are that deceased Prakash died on 25.04.2003 due to heart attack, i.e. just 27 days after obtaining the last insurance policy and while submitting the Proposal Form for obtaining the policies, deceased has not disclosed anything about his ailment. It is also obvious from the copies of insurance policies. Further the Insurance Co. collected insurance certificates, which are obtained by the deceased Prakash and produced the same. The Insurance Co. also collected the copies of leave applications of the deceased from the school, where he was working and produced the same. All those copies of leave applications and medical certificates of deceased Prakash reveal that he was suffering from Hepatitis, Broncho Pneumonia and therefore, he was required to proceed on medical leave from 05.11.2001 to 27.12.2001 and 05.01.2002 to 28.02.2002 and also for other period. All these documents are not disputed by the Proxy Adv. Mr C Thamke appearing on behalf of Adv. Mr Choudhari. However, he has submitted that deceased was terminated from his service on 28.04.1986 and therefore, he was required to challenge his termination order by filing the proceedings before the School Tribunal and therefore, he was required to avail medical leave by obtaining medical certificates, though he was not ailing from any ailment, etc. It is further submitted that deceased Prakash died all of a sudden by heart attack and not from any other disease.
But the Insurance Co. relying upon the medical certificates falsely repudiated the insurance claim, etc. Further it is submitted that the diseases, which are shown in the medical certificate have no relevancy with the actual cause of death of deceased Prakash. Thus, he has tried to support the impugned judgement & order.
7. However, Mr P P Kothari, Ld. Counsel for the Insurance Co. submitted that deceased Prakash was well aware about his ailment and therefore, he obtained insurance policies continuously for three years before his death with a mala fide intention to get the insurance amount to his wife by suppressing material facts about his ailment. Therefore, since, undisputedly, insured Prakash died after 27 days of obtaining the last policy, we find much force in the submission of Adv. Mr Kothari. Moreover, on perusal of copies of medical certificates, it manifests that deceased Prakash was ailing since prior to the year 2001 only and not since the year 1986, when he was terminated. Moreover, though, he was required to file any proceedings before the School Tribunal in the year 1986 or thereafter, there could be no reason for him to obtain such medical certificates for availing medical leaves after 14 years of his termination.
8. Moreover, it is pertinent to note here that when undisputedly Prakash was in service from 1976 onwards, he has not obtained any insurance policy till the year 2001. But since 2001 successively he obtained insurance policy. If really he was not aware about his ailment, in our opinion, he would not have obtained such insurance policies successively in the year 2001, 2001 and 2003. Therefore, the reasonable inference can be drawn that deceased Prakash obtained the policies with mala fide intention to get the insurance claim after when he was suffering from various ailments. Therefore, it cannot be accepted that deceased Prakash was not aware about his ailments from which he was suffering, has no relevance with the cause of death. i.e. heart attack.
9. Considering all these facts, we find much force in the submission of Adv. Mr Kothari for the Insurance Co. Adv. Mr Kothari has also supported his submission by relying on the decision on National Commission in the case of Kokilaben Narendrabhai Patel Vs. LIC of India, reported in Legal Digest January 2011. In this case deceased husband of Kokilaben died due to heart attack on 21.06.1996 and just before two years of his death he had obtained insurance policy for Rs.1.00 Lac. However, he had suppressed the fact that he was suffering from the Enteric Fever and he was under treatment from 28.12.1992 to 13.01.1993. He had also applied for sick leave for the said period and therefore, the claim of his wife was repudiated on the ground that deceased suppressed the material fact while submitting Proposal Form, etc. While deciding the matter, Honble National Commission relied on following three decisions of Honble Supreme Court:-
i. Life Insurance Co. & Ors. Vs. Asha Goel (Smt) & Anr. reported in (2001)2 SCC 160 ii. P C Chacko & Anr. Vs. Chairman, LIC of India & Ors. Reported in (2003) 1 SCC 321 iii.
Satwant Kaur Sandhu Vs. New India Assurance Co Ltd reported in (2009) 8 SCC 316.
and held that the statement which was given by the deceased insured in the Proposal Form as to his state of health was palpably incorrect to his knowledge.
It is further observed that There was clear suppression of material facts with regard to his health and the insured was fully justified in repudiating the contract of insurance.
10. The decision of Honble National Commission in the case of Kokilaben (supra) is perfectly applicable to the present case. Therefore, without considering other facts and arguments advanced by the Ld. Counsel for both the sides, we are of the view that the Insurance Co. has rightly repudiated the insurance claim of the complainant. But the Forum without considering the evidence on record properly, committed error in holding that the insured deceased Prakash had not suppressed the material facts about his health while submitting the Proposal Form, etc. and thereby committed error in allowing the complaint. Therefore, the impugned judgement & order of the Forum is being erroneous, cannot be sustained.
11. In the result, the appellant Insurance Co. succeeds and appeal deserves to be allowed:-
Hence, the following order:-
ORDER i. Appeal is allowed.
ii. Impugned judgement & order passed by District Consumer Forum, Gondia in Consumer Complaint No. CC/05/25 is set aside. Consequently, the complaint is dismissed.
iii. Having regards to the peculiar facts of the case, we direct the parties to bear their own cost.
iv. Copy of this order be supplied to the parties.
[ S. M. SHEMBOLE ] PRESIDING MEMBER [ SMT.JAYSHREE YENGAL] MEMBER [ N. ARUMUGAM] MEMBER sj