L.I.C. Of India vs SUNIL KUMAR

THIS is an appeal by the Life Insurance Corporation of India against the judgment and order dated 8.6.2001 passed by the District Forum, Almora whereby the complaint of the complainant, Shri Sunil Kumar for recovery of insured amount as nominee on the death of his father Sh. Ram Kishore was allowed.

THE brief facts of the case are that Sh. Ram Kishore was a resident of Ranikhet. He had taken a policy for Rs. 1,00,000/- (Rupees one lac) on 28.3.1997. He died on 20.5.1999 all of a sudden. THE complainant lodged the claim but he was not paid any amount on the pretext that the deceased was suffering from Amoebic Hepatitis from before taking the policy and he has suppressed this fact while taking the policy. When the claim was repudiated by the Insurance Company, the complainant filed the complaint. The Insurance company filed the written statement and alleged that Sh. Ram Kishore was suffering from the disease of Amoebic Hepatitis and he has suppressed this fact at the time of taking the policy and, therefore, the claim was rightly repud.

In the written statement, allegations of paras 1 to 4 of the complaint are admitted. Neither in the complaint, nor in the written statement, it is alleged how and from what disease, if any, the victim died? From the papers, it appears that the victim died due to chest pain. In para 10 of the written statement, it is alleged that the insured died on 20.5.1999 in Ranikhet and the death was within two years one month and nineteen days of the insurance, therefore, investigation was made and during investigation, it was revealed that the insured was suffering from Amoebic Hepatitis, of which disease he has taken treatment in Ranikhet. If the investigation was done and inquiry was made then the Insurance Company should have known by what disease the victim died? At any rate, there is no allegation at all from either side that the victim died out of this Amoebic Hepatitis. The report of the Surveyor has not been produced before us. The finding of the learned Forum that the victim has got treatment and was admitted in a hospital in Ranikhet for a month was also challenged by the complainant on the ground that there is absolutely no evidence that Sh. Ram Kishore was hospitalised in the hospital. It is said that it is true that he was on medical leave from 6.11.1996 to 5.12.1996 but he was never hospitalised and the finding to this effect is incorrect. The record shows that the insured was on medical leave from 6.11.1996 to 5.12.1996 of thirty days. The record also shows that he took leave. Ordinarily when a person is not granted earned leave or any other leave, he appears to take medical leave showing pretended illness because ordinarily medical leave cannot be refused. A judicial notice of the fact can be taken that in the days of election or in crisis in the office, leave is refused and then the employees prefer to take medical leave. Thus merely because the insured was on medical leave, there may be a presumption that the insured was suffering from this disease but it is always rebuttable presumption, the complainant has rebutted it that the insured was not ill at all. It is true that he should have justified this taking of leave. He has also tried to justify this taking of leave. He has produced papers that the insured was only on medical leave for this period and he was declared fit on 5.12.1996 to resume his duties. The fitness certificate is also here and there is no allegation at all that after this fitness certificate, the insured was suffering from any such disease and he was not able to discharge his duties. He was regularly discharging his duties, he was attending his office, he did not die out of this illness, therefore, he might have thought not to disclose this illness in the proposal form. This was not such a material fact which was suppressed fraudulently. It is the bounden duty of the Insurance Company to prove that there was not only suppression but the suppression was also of a material fact and that too fraudulently. No such fraud is at all apparent on record or has been tried to be proved. After the insurance on 28.3.1997 there is no evidence at all that the insured was ever ill or he took any leave on medical ground or he has been admitted in any hospital because of this disease. Except the medical certificate, there is nothing to show that if the insured was suffering from this disease, he has got any treatment, he has got any prescription or he has made any medical claim of any treatment in his department. Had the person been actually ill for thirty days, he must have taken some treatment and in that case some evidence should have come out. Atleast he should have also claimed some amount for his medical treatment from his department but he did not do so which may go to prove that medical leave was taken only for the purposes of leave and not necessarily on the ground of illness.

THE ruling reported in III (2002) CPJ 56 (NC), Sr. Divisional Manager, L.I.C. of India v. Smt. Gangama and Another, will not apply to the facts of the present case because in that case the deceased had actually malignancy, obtained treatment and that was proved by documents on record and that was suppressed. It has been held in the ruling reported in 2003 (2) CPR 425, Smt. Nirmala Soni v. Life Insurance Bima Nigam, Satna and Others, that, "Leave record itself is not sufficient to establish that the deceased has suppressed material fact fraudulently". THE claim form shows that the victim died all of a sudden at the age of 31 years and that was due to pain in chest, it was probably due to heart attack, it is not connected with any hepatitis. The learned Forum has given a finding that the insured was an illiterate man and the agent has filled in the form. The learned Counsel for the Insurance Company has referred the rulings to show that the agent who fills in the form is the agent of the consumer and not the agent of the Insurance Company. This fact is true. Merely on the ground that the form was filled in by the agent and the insured was an illiterate person, the claim cannot be allowed because the insured cannot disown the form but as the facts are, there is no proof of any illness, merely taking leave on medical ground is no ground to hold that the insured was actually ill and was admitted in the hospital or took some treatment.

THE learned Counsel for the Insurance Company also referred the ruling to show that the complaint could not have been filed against the Branch Office or Divisional Office because they are not juristic persons, it is the Life Insurance Corporation against whom the complaint should have been filed. We agree on this contention but this plea cannot be taken here, it should have been taken before the learned Forum itself who could have directed the complainant to array proper parties to the petition or should have directed the complainant to amend his complaint. At any rate it is the Insurance Company who has contested the complaint and has filed this appeal, on these technical grounds, the complaint cannot be rejected. We do not find any force in this appeal and the appeal is liable to be dismissed. ORDER The appeal is hereby dismissed. Cost of the appeal shall be easy. Appeal dismissed.