Life Insurance Corporation of India vs GUNMALA GUPTA

THE Life Insurance Corporation appeals against the order of the District Forum, Hisar allowing the complaint and directing the payment of the insured amount with benefits alongwith interest and ancillary reliefs.

THE facts are not in serious dispute and merit notice with relative brevity. Shri N.K. Gupta took out an Life Insurance Policy for a sum of Rs. 50,000/- on 27th of August, 1990. He complied with the requisite formalities of filling in the printed proposal form which was duly endorsed and cleared by the appellant''s doctor vide Annexure ''A''. THE appellants issued the insurance certificate in which the respondent Smt. Gunmala Gupta was the nominee of the policy. Unfortunately, Shri N.K Gupta died on the 28th of September, 1991 in the All India Medical Institute, New Delhi patently after a year and one month of the commencement of the risk. THE widow-complainant then filed a claim for the aforesaid amount of Rs. 50,000/-, which however was repudiated by the appellants vide their letter dated 22nd of February, 1992. On notice being issued the appellants in their written statement pleaded that the complainant did not make mention about the reference of the deceased to the Civil Hospital, Hisar on the 30th of April, 1991. Reliance was sought to be placed on the report made by the All India Medical Institute dated the 3rd of September, 1990, based upon the alleged information supplied by the complainant to the effect that the deceased was suffering from weakness and a lump in the abdomen for the last one and half yea r. On that premise, it was alleged that the deceased had deliberately concealed material facts about his health at the time of the proposal form and consequently the contract of insurance was void-ab'' initio.

The complaint reiterated her sand firmly by way of replication and placed documentary evidence on the record in support of her case. Neither side made any challenge to the documents admitted into the evidence by the District Forum.

ON a detailed consideration of the evidence and the merits as also the submissions of the learned Counsel for the parties, the District Forum rejected the technical plea that the case involved complicated matters of law and fact which could not be adjudicated upon and categorically opined that in the case hardly any complication arose, on the simple issue whether the declaration of the deceased in the proposal form was correct or not. The District Fourm adverted in detail to the legal aspect as well and granted relief in the terms noticed at the very out-set. Mr. B.J. Singh, the learned Counsel for the appellant-Corporation apparently finding himself on a somewhat slippery ground on merits has projected the technical plea that the District Forum was in error in entertaining the matter because it involved deeply intricate questions of law and fact.

WE are unable to find much merit in the first submission of the learned Counsel. In a judgment of affirmance, it is unnecessary to tread the same ground again and it bears repetition that the District Forum adverted to this aspect and rejected the technical bar attempted to be raised. It came to the conclusion and in our view rightly that herein far from there being any complication the matter lay in a narrow field of determination whether the deceased assured had made any blatant suppression about the state of his health in the proposal form. In any case it appears to us that a plea of this nature is primarily at the trial stage and where the Forum in seized of the matter finds the issues not at all "complicated and decides the same on merits, the discretion exercised by it is not to be easily disturbed in the appellate jurisdiction. In any case learned Counsel for the appellant could make out no prejudice or any miscarriage or justice whatsoever in the adjudication on merits by the District Forum. The alternative submission of Mr. B.J. Singh was primarily based on the ground that the medical documents of the All India Medical Institute showed that the case history given by the respondent herself mentioned that her husband had complained of weak ness and a lump in the abdomen for about a year and a half prior there to. It was on this tenuous basis contended that the deceased was under a legal obligation to mention the feeling of weakness or some abdominal pain even at the very earlier stages in the proposal form and to the doctor of the appellant-Corporation who examined him. The submission was that the failure to mention these was tantamount to a grave suppression of material factors which would vitiate the whole contract of insurance from its very inception. Reliance was placed on Smt. Krishna Wanti Puri v. The Life Insurance Corporation of India, AIR 1975 Delhi 19. We are unable to find even a modicum of merit in the submission aforesaid. However, the legal aspect may first be cleared. There is no quarrel with the ratio of Smt. Krishna Wanti Puri v. The Life Insurance Corporation of India (supra) laying down that a deliberately fraudulent submission and suppression of material facts would entitle the appellant to avoid the policy. The question herein is one patently of fact whether there was any such deliberate fraudulent submission or a glaring supressio-veri.

HEREIN, we are unable to lay the least blame at the door of the deceased for the declaration made in the proposal form. It bears repetition that the deceased died after more than one year and one month after the 27th of August, 1990, which is the relevant date of the insurance cover. The mere fact that the widow of the deceased had mentioned in the relevant records of the AIMS that he was complaining of a feeling of weakness for a year or more, cannot be made a basis for the allegation that there was a deliberate fraudulent suppression of material facts at the stage of the proposal form. As is somewhat elementary a feeling of minor weakness can be occasioned by a wide variety of causes including protein deficiency, anaemia and glucose etc. A vague feeling of exhaustion is not a fatal or terminal disease, which has to be necessarily specified at the stage of the declaration in the proposal form. Even otherwise, the vague mention that the deceased was complaining thereof for more than a year, cannot be taken as a sacrosanct period and at its inception a year earlier the feeling of weakness may even be so marginal, as to be hardly noticeable and consequently the deceased cannot in the least be held guilty of any suppression because of not indicating this at the earlier stage.

WHAT has been said above is equally applicable with regard to some abdominal pain mentioned at the time of admission in the All India Medical Institute. It cannot be said that a year and half earlier, the abdominal pain was of such an intensity or indicated any fell disease which had to be necessarily mentioned in the proposal form. It has been forcefully argued on behalf of the respondents that abdominal pain may result from a small enlarged spleen which is indeed a disease of common occurrence in India. Nor it can be presumed that the small lum in the abdomen around the time of his death a year later was necessarily one either noticeable or detectable much earlier. On behalf of the appellants obviously there is no evidence that the deceased was suffering from any acute abdominal disease precisely at the date of the proposal form which he had deliberately and consciously suppressed. Lastly, what is of significance is the fact that the death of the deceased was occasioned and opined to be due to blood cancer. Neither weakness nor any abdominal disease had contributed to the fatality. Learned Counsel for the respondent has rightly and forcefully pointed out that blood cancer is a peculiarly fell disease which cannot be detected except by a specialized chemical medical test for its detection which was only done when the deceased was medically got examined at Hisar on the 30th of April, 1981 when the blood test indicated the incidence of the terminal disease. It was for that reason that he was referred to the All India Medical Institute where he remained as an out-door patient and was then admitted as an indoor one on the 3rd of September, 1991 and expired soon there after on the 28th of September, 1991. There is not even a suggestion on behalf of the appellant that the deceased was in any way aware of the incidence of blood cancer way back when the insurance policy was taken out.

Mrs. Shashi Ghuman, the learned Advocate forthe respondent has rightly placed reliance on I (1992) CPJ 101 (NC), Manjulaben V. Parmar & Anr. v. L.I.C. of India. Therein, the insured had died within eight month and 20 days of the taking out of the policy and in a detailed discussion of the matter by the National Commission goes in favour of the respondent because virtually penal damages to the tune of Rs. 20,000/- were allowed against the respondent-Life Insurance Corporation of India in the said case.

IN view of the detailed reasons above, this appeal fails and is hereby dismissed with costs which are assessed at a sum of Rs.500/- only. Appeal dismissed.