Life Insurance Corporation of India vs Balchand Jain

THE appellants are Branch Manager and Divisional Manager of Life Insurance Corporation of India respectively at Jhalawar and Ajmer. THE respondent in the appeal is Bal Chand Jain husband of late Smt. Lad Kanwar Jain.

THE Life Insurance Policy bearing No. 180521454 of the sum insured of Rs. 1,00,000/- commencing from 15.3.90 had been obtained by Smt. Lad Kanwar Jain. THE said insured died on 10.4.90 owing to heart attack and the complaint before the District forum, Jhalawar for the sum assured with interest and compensation was filed by her husband Balchand on 16.8.93. THE version of the opposite parties was that when Smt. Lad Kanwar Jain had submitted the proposal for her life insurance on 15.3.90, she was suffering from Pericardial Effusion and this material fact was suppressed by her in the proposal form. THE Life Insurance Corporation vide its letter dated 17.3.93 repudiated the claim of the complainant on the ground that the deceased had withhold the material information regarding her health at the time of effecting the insurance. It was stated in the repudiation letter that the Corporation holds indisputable proof to show that Smt. Lad Kanwar Jain had submitted her proposal of assurance on 10th November, 1989 and she suffered from Pericardial Effusion and had taken medical treatment for the same. This fact was not disclosed by her in the proposal form and therefore, the Corporation was not liable for any payment. The complainant Bal Chand Jain filed an affidavit wherein he requested that his wife Smt. Lad Kanwar had died on 10.4.90 as a result of heart attack. He denied that she had been ill for any disease or had taken treatment of any disease at Ahmedabad, Jhalawar or Indore. She had only shown herself once or twice at Mahaveer Nursing Home, Jhalawar on account of some pain in intestines which can occur to anyone. There was sudden pain in the chest of Smt. Lad Kanwar and she began to prespire and, therefore, she was taken on 10.4.90 in a jeep to Dr. Dilip Kumar Jain at Jhalarapatan and she died as a result of heart failure.

A certificate of Dr. D.K. Jain had been produced and he had given the certificate that Smt. Lad Kanwar Jain died of Meyocardial Infraction on 10.4.90 at 4.30 p.m. and the said doctor had last attended him. It appears that on 28.7.90, 25.8.90 and 7.9.90, the Branch Manager of Life Insurance Corporation at Jhalawar had written to the complainant that Smt. Lad Kanwar Jain had been admitted in Mahaveer Nursing Home on 14.12.89 for Perricardial Effusion and thereafter she got herself treated at Indore and Ahmedabad. The complainant was asked to submit the prescription and particulars of the treatment which Smt. Lad Kanwar Jain had got done of these places. Reply was sent by the complainant to these letters and he denied that Smt. Lad Kanwar had undertaken any treatment at Indore or Ahmedabad. The opposite parties produced the admission record of Smt. Lad Kanwar Jain in Mahaveer Nursing Home and Research Hospital, Jhalawar dated 14.12.89. This record goes to show that Smt. Lad Kanwar Jain had been admitted in Mahaveer Nursing Home and Research Hospital, Jhalawar on 14.12.89 and she was discharged on 18.12.89. The diagnosis mentioned was Pericardial Effusion. It appears that at Mahaveer Nursing Home and Research Hospital, Jhalawar, Smt. Lad Kanwar Jain was seen by Dr. S. Mehta of Bombay Hospital, Smt. Lad Kanwar Jain was prescribed injection Lasix and Inj. Derriplylline apart from some other medicines. ECG and screening of chest was also done. She was discharged from the hospital on 18.12.89. It is clear and there is not any dispute that the proposal of assurance of Smt. Lad Kanwar Jain had been made on 15th November, 1989. The complainant in his application filed before the District Forum, Jhalawar had admitted that Smt. Lad Kanwar Jain had been examined on 16.11.89 by Smt. Madhu Jain, authorised doctor of the Life Insurance Corporation and she had submitted her report on 21.11.89. It might be that Smt. Lad Kanwar Jain would have been examined by Dr. Madhu Jain when she submitted the proposal, but the fact lies that Smt. Lad Kanwar Jain was admitted in Mahaveer Nursing Home and Research Hospital, Jhalawar for investigation and treatment. As already stated, she was admitted in Mahaveer Nursing Home and Research Hospital, Jhalawar on 14.12.89 and was discharged from there on 18.12.89. These dates were subsequent to the date of proposal for assurance which was dated 15.11.89. It cannot, therefore, be said that Smt. Lad Kanwar Jain knew on 15.11.89 that she was suffering from Perricardial Effusion. The case of the opposite parties was, as appears from the various letters sent by the Life Insurance Corporation to the complainant, that Smt. Lad Kanwar Jain had prior to that taken admission at Indore Hospital and at Ahmedabad Hospital. In this regard, the Branch Manager of the Life Insurance Corporation of India, Jhalawar had written three letters to the complainant. The complainant denied by sending a reply that his wife ever got treatment at Indore and Ahmedabad. In such circumstances, it was necessary for the opposite parties to produce the relevant record of Ahmedabad and Indore hospitals to show that the insured Smt. Lad Kanwar Jain had undertaken treatment at Ahmedabad and Indore Hospital about her ailments. That was, however, not done by the opposite parties. The burden of proof was upon the opposite parties to establish that Smt. Lad Kanwar Jain was suffering from Perricardial Effusion at the time she had submitted the proposal form. The record of Mahaveer Nursing Home and Research Hospital, Jhalawar produced in the case does not mention any past history of ailments of Smt. Lad Kanwar Jain. All that this record goes to show that she was admitted in the said hospital on 14.12.89 and then diagnosis was Perricardial Effusion. But this was about one month after the submission of the proposal form. The opposite parties, therefore, failed to discharge their burden that the deceased was suffering from Perricardial Effusion when she submitted the proposal form on 15.11.89.

THE learned Counsel for the appellant referred to the decision of the National Commission in Life Insurance Corporation of India v. Kantaben reported in I (1996) CPJ 115 (NC). In that case, the proposal was submitted on 9.9.89 and they had produced histology report dated 12.8.89 which revealed state of health of the insured and the treatment for cancer and ultimately referred on 26.8.89 by Dr. Patel to Ahmedabad for Chemotherapy. Thus, in the above case of the National Commission, there was reliable medical evidence in the form of histology report dated 12.8.89 (which was prior to the date of proposal) which showed that the inspired was suffering from cancer. In the present case before us, the opposite parties, although they asserted in their various letters that Smt. Lad Kanwar Jain had earlier taken treatment at Indore and Ahmedabad, but they did not produce any document or record to prove this fact. It cannot, be, therefore, said that insured has suppressed any illness or that she was suffering from Perricardial Effusion when she had submitted the proposal for assurance on 15.11.89. THEre was no denial on the part of opposite parties to the assertion made by the complainant in his application that Smt. Lad Kanwar Jain had been examined by Dr. Smt. Madhu Jain of the Life Insurance Corporation on 16.11.89 and thereafter her proposal was accepted. In the above circumstances, the repudiation of the claim by the opposite parties-appellants cannot be said to be justified. THE District Forum, Jhalawar was, therefore, correct in allowing the claim filed by the complainant. This appeal has, therefore, no merit in it and it is hereby dismissed. Appeal dismissed.