L.I.C. Of India vs RANI KAUR

THIS appeal under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 31.3.2004 in Complaint No. 104/03 by the District Consumer Disputes Redressal Forum, Rajnandgaon (hereinafter called the ''Distt. Forum'' for short), directing the appellant/insurer to pay her a sum of Rs. 1,00,000/- in pursuance of the policy obtained by the deceased husband, with interest, etc.

UNDISPUTABLY, deceased insurer Hardayal Singh Bhatia was the husband of the complainant/respondent and had obtained Policy No. 382261297, covering the risk on his life from 10.2.2001 to 10.2.2014. The complainant/respondent is the nominee under the said policy. The deceased/insured died on 9.12.2002. The complainant/respondent laid claim with the appellant/insurer. Her claim was however repudiated by the appellants/insurers by their letter dated 11.8.2003, on the ground that the insured suppressed the material facts regarding state of his health and that though he suffered from chest pain, Angina I.H.D. prior to submission of his proposal form, he did not disclose the said diseases in his proposal form. Aggrieved by the repudiation of her claim as above, the complainant approached the Distt. Forum and filed complaint. According to the averments in the complaint there was no suppression of any material fact by her husband/insured. She prayed that the assured amount under the policy, be directed to be paid to her.

The complaint was resisted by the appellant/insurer mainly on the ground that the complainant''s husband/insured committed breach of agreement of insurance, by not disclosing his diseases and thus suppressing material facts regarding the state of his health.

THE Distt. Forum repelled the defence as above raised by the appellant/insurer and directed that the assured sum of Rs. 1,00,000/- (one lac) be paid to the complainant, with interest. Learned Counsel for the parties were heard and the record was perused.

THE question that arises for consideration is: as to whether there was any material suppression of fact in the proposal form submitted by the deceased/insured? In the proposal form dated 31.3.2001, the deceased/insured stated to the effect that his health was good and that he did not receive any treatment. The appellants to show that the information as above is not correct, have filed a special querry report dated 15.7.2003 allegedly given by Dr. Pukhraj Bafna of Rajnandgaon. In the said report, it has been stated in Column 2 that the deceased suffered from chest pain, Angina I.H.D. It was also stated therein that the doctor was consulted by the deceased insured for the first time in October, 2000 as would appear from Column No. 1 of the said report. It may be noticed that there is a overwriting in the said column and instead of October, 2001 it has been changed to October, 2000. In the above context, it may be noted that the complainant has submited an affidavit that her husband was not suffering from any disease prior to 31.3.2000 before submitting his proposal. It may also be noticed that Dr. Bafna in his affidavit dated 27.2.2004 specifically admitted that in certificate dated 15.7.2003, captioned as special query form he had initially written October, 2001 which was subsequently corrected as October, 2000, on the asking of the complainant''s son. It would, therefore, be clear that the date on which the deceased consulted Dr. Bafna was initially shown as October, 2001 which was later corrected as is the admission of Dr. Bafna himself. In his affidavit Dr. Bafna has also categorically stated that the deceased Hardayal Singh Bhatia was completely all right prior to October, 2001. In view of the above, it is clear that the certificate dated 15.7.2003 of Dr. Bafna is rendered worthless and would not go to show that the deceased suffered from any disease, from October, 2000 or that he consulted the Doctor, at that time.

THERE is no other material to show that the deceased suffered from any ailment prior to submitting his proposal form, on 31.3.2001. Consequently, the appellants have failed to prove and discharge its burden that the deceased suffered from any disease while he obtained policy or that there was any material suppression of fact by him. THEREfore, repudiation of the claim of the complainant/respondent by the appellant/insurer was not justified, as has been rightly held by the Distt. Forum.

WE find no substance in this appeal. Consequently, it is dismissed. The appellants shall bear their own costs of this appeal and shall pay that of the complainant/respondent which is quantified at Rs. 1,000/-. Appeal dismissed.