A. VENKATA RAVI KISHORE vs Life Insurance Corporation of India

AGGRIEVED by the order in C.D. No. 100 of 2001 on the file of District Forum, Kurnool the complainant preferred this appeal under Section 15 of the Consumer Protection Act.

THE brief facts as set out in the case are that the father of the complainant A. Venkataiah insured his life with opposite parties under Jeevan Mitra (Double Cover) policy bearing No. 651586815 for an amount of Rs. 1,00,000. THE father of the complainant died on 18.4.1999. THE complainant being the nominee under the policy submitted the claim along with necessary documents for settlement of the claim but the opposite parties repudiated the claim on 28.8.1999 on the ground of suppression of material facts relating to the health of deceased at the time of taking policy. Hence, this complaint seeking for directions to opposite parties to pay policy amount of Rs. 1,00,000 together with costs of this complaint. Opposite party No. 1 filed counter admitting the issuance and existence of policy in question but contended that the insured suppressed the material facts relating to his health at the time of taking the policy. Medical certificates produced before the employer for availing Medical Leave issued by Dr. T. Girinath reveals this fact. The diseased was suffering from enteric pyrexia (enteric fever), acid peptic disorder, viral fever and malarial fever even before the date of submission of proposal. The deceased obtained the non-medical policy with a fraudulent intention by answering "Good" for the queries about his health. The contract of insurance is based on principles of utmost good faith and if any statement made in the proposal later found to be false the contract shall be null and void. Since the deceased suppressed the material facts relating to his health at the time of taking of policy the Insurance Company rightly repudiated the claim on 28.8.1999. It is prayed to dismiss the complaint with costs.

Based on the evidence adduced i.e., Exs. B1 to B8 and the pleadings put forward the District Forum dismissed the complaint. Aggrieved by the said order the complainant preferred this appeal.

LEARNED Counsel for the appellant/complainant submitted that there is negligence on the part of opposite parties in repudiating the claim of the complainant since the policy was taken by the deceased A. Venkataiah two years ago. The Dist. Forum failed to consider the material filed along with complaint and the Dist. Forum did not take into account the sworn statement filed by the complainant at the time of arguments in support of the complaint. LEARNED Counsel for the appellant/complainant further submitted that the Dist. Forum failed to see that the insured did not suppress any material facts relating to his health while taking the policy as the policy was taken two years prior to the death of the life assured. Learned Counsel for the respondents submitted that the deceased availed leaves on medical grounds on several occasions prior to the date of proposal and that the Employer''s Certificate and Medical Certificate issued by Dr. T. Girinath reveal that the deceased was suffering from enteric pyrexia, acid peptic disorder, viral fever and malarial fever and, therefore, their repudiation is justified.

WE have perused the material on record. It is not in dispute that the deceased had another policy for Rs. 15,000 and that the claim was settled. The policy in question is Jeevan Mitra (Double Cover) policy No. 651586815 which was taken on 13.12.1995. It is not in dispute that the policy holder died on 18.4.1999 and the complainant being the nominee submitted all the necessary claim forms but the opposite parties repudiated the claim vide letter dated 28.8.1999 on the ground that the policy holder suppressed that he was suffering from acid peptic disorder and malarial fever prior to the date of proposal. Opposite parties relied on Exs. B4 to B7 which are medical certificates issued to the life assured for the period from 10.10.1993 to 31.10.1993, 20.1.1995 to 20.2.1995, 1.7.1995 to 10.7.1995, 1.12.1995 to 15.12.1995. It is pertinent to note that the Medical Certificates are issued for viral and malarial fever and peptic disorder and not for chronic major health ailments. These medical certificates were also produced over a period of two years from 10.10.1993 to 15.12.19995. The opposite parties did not choose to file the affidavit of the Doctor who has issued these certificates to establish that the life assured was suffering from chronic ailments which appeared periodically and perhaps led to his death. It is not the case of the opposite parties that the alleged suppression has led to death. The cause of death has not been stated either bythe complainant or by the opposite parties. The certificate of death that has been filed also does not disclose the cause of death. It is not the case of the opposite parties that the suppression of malarial fever or peptic disorder had led ultimately to the death of the life assured. It is only their case that he has taken medical leave for the periods mentioned in Exs. B4 to B7 for suffering from peptic disorder and malarial fever and this fact was suppressed prior to the issuance of the policy. We rely on the judgment of the Apex Court reported in Life Insurance Corporation Of India & Ors. v. Asha Goel & Anr., I (2001) SLT 89=AIR 2001 SC 549, wherein it is stated that it is for the opposite parties to prove that the suppression must be fraudulently made by the policy holder and that the policy holder must have known at the time of making the statement that it was false or that he suppressed the facts which was material to disclose. In the instant case the Insurance Company/opposite parties have failed to establish that the policy holder has fraudulently suppressed peptic disorder and malarial fever. We reiterate that both these ailments are minor in nature and also it is not the case of the opposite parties that these ailments have led to the death of the policy holder.

WE also rely on the judgment reported in 1992 (2) ALD Consumer 93 in which it is stated that mere production of Doctor''s Certificate enclosed with application for leave on medical grounds without examining the doctors does not prove that the insured was in fact suffering from diseases and that they have been suppressed by the insured. Therefore, we set aside the order of the District Forum and allow this appeal directing opposite parties to pay the policy amount of Rs. 50,000 and the policy is Jeevan Mitra (Double Cover) Endowment Policy, therefore, the complainant is entitled to Rs. 1,00,000 with interest @ 9% p.a., from the date of repudiation i.e., 28.8.1999 till the date of payment together with costs of Rs. 3,000.

IN the result this appeal is allowed and the order of the District Forum is set aside directing opposite parties to pay the policy amount of Rs. 1,00,000 to the complainant with interest @ 9% p.a., from the date of repudiation i.e., from 28.8.1999 till the date of payment together with costs of Rs. 3,000. Time for compliance six weeks. Appeal allowed.