State Consumer Disputes Redressal Commission
Meera Devi vs Lic Of India on 16 February, 2009
APPEAL NO: 580/2008 Smt. Meera Devi Vs. Zonal Manager, Life Insurance Corporation of India, Jaipur & ors. 16.2.08 Before: Mr.Justice Sunil Kumar Garg-President Mrs.Vimla Sethia-Member
Mr.Jai Kishan Yogi counsel for the appellant Mr.Sanjeev Arora counsel for the respondents This appeal has been filed by the complainant appellant against order dated 11.2.08 passed by the District Forum, Alwar in complaint no. 417/2006 by which the complaint of the complainant appellant was dismissed.
2. It arises in the following circumstances-
The complainant appellant had filed a complaint before the District Forum,Alwar on 24.8.06 inter alia stating that her husband Ram Prasad, now deceased had taken LIC policy from the respondents for a sum of Rs.50,000/- bearing no. 192331114 ( not in dispute as payment of that policy had been made by the respondents LIC) and another policy bearing no.192484296 for a sum of Rs. 2 lacs on 28.7.05. It was further stated in the complaint that the deceased had died on 9.1.06 and after the death of the deceased claim was preferred by the complainant respondent being the wife and nominee of the 2 deceased before the office of the respondents but that claim was repudiated by the respondents through letter dated 15.4.06 on the ground that at the time of taking the policy the deceased had filled in up a declartion form regarding his health on 28.7.05 in which he had not mentioned that he was suffering from any kind of disease but they had the sufficient proof to prove the fact that prior to taking the policy i.e. on 28.7.05 , the deceased was suffering from TB for which he had consulted a medical man and had taken treatment from him and had remained on medical leave for 103 days for the period 28.7.02 to 28.7.05 and since these facts were not disclosed by the deceased in his declaration form on 28.7.05 at the time of taking the policy, therefore, the deceased was guilty of suppression of material facts regarding his health. Thereafter the present complaint was filed.
A reply was filed by the respondents on 7.2.07 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 15.4.06. It was further stated in the reply that apart from taking the leave from time to time the deceased was admitted in the Thareja Nursing Home on 1.12.05 and was discharged on 4.12.05 and diagnosis which was made by the doctors was Tubercular and Jaundice and the deceased was again admitted in that hospital on 14.12.05 and was discharged on 16.12.05 and the same diseases were diagnosed and it was prayed that complaint of the complainant be dismissed as claim of the complainant was rightly repudiated by the respondents.
3Note - During the pendency of the appeal the respondents LIC had produced a medical fitness certificate dated 26.2.05 issued by Dr. Rajendra Sharma indicating that the deceased had recovered from TB.
After hearing the parties, the District Forum, Alwar through impugned order dated 11.2.08 had dismissed the complaint inter alia holding-
(i) That in this case since the deceased had taken medical leave for the period 30.7.02 to 12.7.05 on different dates and since the deceased was admitted in the hospital twice prior to taking the policy i.e. on 28.7.05 , therefore, it was a case of suppression of material facts regarding health on the part of the deceased.
(ii) That the respondents were justified in repudiating the claim of the complainant appellant.
Aggrieved from the said order passed by the District Forum, Alwar, this appeal has been filed by the complainant appellant.
3. In this appeal, the main contention of the learned counsel for the appellant complainant is that repudiation of claim of the complainant appellant by the respondents on the ground of suppression of disease 'TB' and taking of medical leave was not justified and hence, repudiation of claim of the complainant appellant by the respondents was wholly illegal and arbitrary and in view of this the findings of the District Forum dismissing the 4 complaint of the complainant appellant could not be sustained as they suffer from basic infirmity, illegality and perversity and it was prayed that appeal be allowed.
4. On the other hand, the learned counsel appearing for the respondents has supported the impugned order of the District Forum.
5. We have heard the learned counsel for the appellant as well as for the respondents and gone through the entire materials available on record.
6. There is no dispute on the point that the deceased had taken LIC policy bearing no.192484296 for a sum of Rs. 2 lacs on 28.7.05. from the respondents .
7. There is also no dispute on the point that at the time of taking the policy a declaration was made by the deceased and in that declaration on 28.7.05 , he had not mentioned that he was suffering from any kind of disease .
8. There is also no dispute on the point that deceased had died on 9.1.06 meaning thereby within one year of issuance of the policy.
9. There is no dispute on the point that the claim of the above mentioned policy was repudiated by the appellants through letter dated 15.4.06 on the grounds mentioned therein.
10. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the 5 District Forum could be sustained or not and whether the repudiation of the claim of the complainant appellant by the respondents was justified or not.
11. It may be stated here that as per record produced by the respondents it is very much clear that the deceased had taken medical leave from time to time in the following manner-
S.no.
period Days Leave Reason 1 11.6.04 to 18.6.04 8 SL sickness 2 2.9.04 to 20.10.04 49 SL "
38.11.04 to 16.11.04 9 SL "4
8.2.05 to 26.2.05 19 SL "
52.3.05 to 19.3.05 18 SL "
12. Further there is no dispute on the point that the medical certificates were issued by Dr. Rajendra Sharma and there could not be dispute on the point that Dr.Rajendra Sharma had given a certificate dated 26.2.05 showing that the deceased had recovered from the disease of TB, meaning thereby prior to that the deceased was a patient of TB and thus leaves which were taken by the deceased could be connected with the disease of TB.
13. On file there is discharge ticket of Thareja Nursing Home which shows that the deceased was admitted in the hospital on 1.12.05 and was discharged on 4.12.05 and he was again admitted on 14.12.05 and was discharged on 16.12.05 and Tubercular and Jaundice was diagnosed by the doctors.
14. Thus, from the above record it is very much clear that the deceased was a patient of TB since June 2004 and had taken medical leave from time to time as mentioned above on ground of 6 TB and ultimately he was admitted in the Thareja Nursing Home for taking the treatment of TB on 1.12.05 and again on 14.12.05 and later on he had died on 9.1.06 and in our considered opinion, non-mentioning of these facts in the declaration form dated 28.7.05 regarding health on the part of the deceased would certainly amount to suppression of material facts in real sense.
15. For the reasons stated above, the respondents were justified in repudiating the claim of the complainant appellant on the ground of suppression of material facts regarding health on the part of the deceased and the findings of the District Forum rejecting the claim of the complainant appellant are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity or illegality or perversity and hence, no interference is called for with the same and this appeal deserves to be dismissed.
16. During the course of arguments the learned counsel for the appellant has stated that in case the appeal of the appellant is going to be dismissed, in such circumstances some amount of compensation as ex-gratia be allowed to the complainant appellant who is a widow and poor lady.
On ex-gratia payment
17. Ex-gratia payments are made as an act of grace, if the damage caused is outside the scope of the policy terms, or the liability under the policy is doubtful. In such cases the payment is made as an act of grace on humanitarian grounds. As a matter of fact, the loss or damage is outside the terms of the policy but the insurer takes a lenient view on humanitarian grounds. In such 7 cases, full amount to indemnify the damages is not made. Such payments do not place the insurer under an obligation to make such payments in similar circumstances in future.
18. Further ex-gratia payment of claim would arise where there was no legal liability on the Life Insurance Corporation to make payment as in the case of repudiated claim or unconcluded contract. Such claims are paid to mitigate hardship to the claimants by way of equitable relief. The analysis, particularly of a repudiated claim for consideration of an ex-gratia payment, would be a skilful exercise on the part of the concerned officers of the opponent Life Insurance Corporation of India. Ex-gratia payment cannot be claimed as a matter of right. For that the law laid down by the Hon'ble National Commission in the case of LIC Vs. Shashi Gupta ( 1994) 2 CPR 622 (NC) ) may be referred to.
19. Further the word 'ex-gratia' payment itself means a payment which is voluntarily and charitable in nature and since the C.P.Act,1986 is based on the principle of equity, therefore, hypertechnicalities could be ignored and equitable consideration should be kept in mind while deciding the matter.
20. However, looking to the entire facts and circumstances of the case and looking to the fact the LIC policy was for a sum of Rs.2 lacs and on humanitarian consideration, this Commission thinks it just and proper to award ex-gratia amount of Rs.25,000/- in lumpsum to the complainant appellant.
21. It is further made clear that ex-gratia payment of Rs.25,000/- is being given to the complainant appellant who is a widow, not as a matter of right but taken into consideration the 8 facts and circumstances that the condition of a widow in India is not good and in the present case the complainant appellant is a widow lady.
Accordingly, this appeal filed by the appellant is dismissed. However, the respondents are directed to pay to the complainant appellant a sum of Rs.25,000/- in lumpsum as ex-gratia amount within a period of two months from today.
Member President