Life Insurance Corporation of India vs Madhu Bala

BOTH the Counsels agree that all these appeals, namely, Appeal Nos. 722 to 724 of 2000 can be decided by a single order as the repudiation of the claim by the appellant under three different policies have been dismissed on the same grounds and as such the same are being decided by a single order. In Appeal No. 722 of 2000, Insurance Policy No. 130757925 dated 23.11.1993; In Appeal No. 723 of 2000, Insurance Policy No. 130362681 dated 28.3.1988 and in Appeal No. 724 of 2000, Insurance Policy No. 131159203 dated 28.7.1997 are involved. Facts are being taken from Appeal No. 722 of 2000, LIC v. Madhu Bala.

BRIEF facts stated in the complaint are that the respondent-complainant-Madhu Bala (hereinafter called the complainant) is widow of Rajinder Prashad deceased who died on 28.1.1998 due to shock, diarrhoea and vomiting in Guru Gobind Singh Medical College and Hospital, Faridkot. Madhu Bala complainant was nominee of her deceased husband Rajinder Prashad and as such she was entitled to the amount of the policy in question. It was alleged in the complaint that the complainant''s husband was bona fide holder of policy bearing No. 130757925 dated 23.11.1993. The sum insured was Rs. 1,00,000/-. In addition thereto, Rajinder Prashad was entitled to Rs. 27,600/- by way of bonus. In this way the total amount to which the complainant was entitled came to Rs. 1,27,600/-. It was then alleged in the complaint that the complainant''s husband was enjoying good health and he never fell ill or complained of any serious disease prior to his death. Rajinder Prashad deceased had revived the policy on 4.9.1997 and the amount of premium along with interest was charged by the appellant-opposite parties (hereinafter called the opposite parties) and at the time of revival of the policy, the Life Insurance Corporation of India had issued a letter dated 3.9.1997 that the husband of the complainant should send only E.C.G., which was duly sent by him. No abnormality in the E.C.G. was found. It was then alleged in the complaint that all a sudden her husband died on 28.1.1998. After his death, she had approached the opposite parties for making payment of the insurance policy in question. The opposite parties illegally and unlawfully had arrived at a wrong conclusion and had repudiated the legitimate claim of the complainant on flimsy grounds. There was absolutely no legal evidence, according to the complainant, that her husband was suffering from any suffering disease or was operated upon. In fact, death of her husband took place all of a sudden and there was no evidence that her husband remained admitted in any hospital or took any treatment or was not having good health three-four years prior to his death. According to the complainant, her claim was wrongly repudiated on the basis of surmises that her husband had made deliberate mis-statement regarding his health. He was hale and hearty. There was absolutely no abnormality in his health. the opposite parties had verified from Guru Gobind Singh Medical College and hospital, Faridkot about the cause of death of her husband and the authorities of the said hospital verified that the death of her husand was due to vomiting. No other disease was pointed out by the doctors who were attending to her husband. Her husband was not having any past history of illness. She had written in reply to opposite party No. 1''s letter dated 7.11.1998 regarding good health of her husband. She had also filed an appeal/representation to the Zonal Manager, Life Insurance Corporation of India, New Delhi on 9.2.1999 but the same without any effect. It was then stated in the complaint that she was a widow and was in mental shock and agony. It was very difficult for her to cross the hurdles created unnecessarily by the opposite parties. In her complaint before the District Consumer Dispute Redressal Forum, Faridkot (hereinafter called the District Forum) she sought a direction to the opposite parties for payment of Rs. 1,27,600/- along with interest at the rate of 18% per annum w.e.f. 28.1.1998 in respect of insurance policy dated 23.11.1993 in favour of Rajinder Parshad deceased and Rs. 50,000/- along with costs for causing unnecessary harassment to her. Opposite parties filed the written statement and contested the complaint. Preliminary objections were taken that complaint as framed in the present form was not maintainable and the same was liable to be dismissed. The claim of the complainant had been repudiated after due inquiry, investigation and after completion of the formalities required and after application of mind and as such the same could not be reopened before the District Forum. It was then stated in the reply that the material facts regarding health of Rajinder Parshad, husband of complainant were concealed by the deceased himself at the time of revival of the policy on 3.9.1997 in the personal statement regarding health dated 30.8.1997 and the Medical Examiner''s Confidential Report of the same date. Therefore, claim with regard to the policy in question was not payable per terms and conditions of the policy. It was then stated that complex questions of law and facts were involved in the present complaint and, thus, the matter could not be decided before the District Forum. Opposite parties in their reply admitted that Rajinder Parshad deceased husband of the complainant was insured under the policy in question under T-T-110-20 and the sum insured was Rs. 1,00,000/-. The policy was revived on 3.9.1997 after the deceased gave his personal statement regarding the health and Medical Examiner''s report both dated 30.8.1997. It was also admitted by the opposite parties that ECG of the deceased husband of the complainant was called for. The plea of the opposite parties was that the deceased husband of the complainant was not actually keeping good health. The said facts, according to the opposite parties, were proved from the contents of DDR dated 28.1.1998 recorded on the basis of statement of Mr. Vikas, son of the deceased, according to which, deceased was not keeping good health for the last three-four years and was ill. The medical certificate issued by the Medical Officer on form No. 3816 and form No. 3784 made it clear that the death occurred due to suspected poisoning. It was then stated in the reply that the complainant in connivance with her relatives and friends received dead body of deceased Rajinder Parshad without getting Post-mortem Examination conducted thereon with a view to defraud the answering opposite parties and to conceal the material facts regarding his death. It was admitted that the complainant had preferred an appeal before the Zonal Manager, Life Insurance Corporation of India, New Delhi. It was further pleaded that the complaint was premature and without any cause of action. All other allegations were denied and ultimately a prayer was made that the complaint may be dismissed with costs.

Complainant had filed a rejoinder reiterataing the allegations in the complaint and controverting those stated in the written statement.

AFTER hearing the Counsels for the parties and after having gone through the record of the case, District Forum allowed the complaint. Hence this appeal.

WE have heard the learned Counsels for the parties and have gone through the record of the case with their help. Admittedly, Rajinder Parshad deceased husand of the complainant was a bona fide holder of insurance policy dated 23.11.1993 and he got the same revived on 4.9.1997. The sum insured was Rs. 1,00,000/-, besides the same the deceased was entitled to Rs. 27,600/- as bonus. Rajinder Parshad died on 28.1.1998 in Guru Gobind Singh Medical College and Hospital, Faridkot. There is no reliable evidence on the record that Rajinder Parshad died of any poisoning. No post-mortem on the dead body of Rajinder Prashad was conducted. The post-mortem examination would have been the best piece of evidence for proving cause of death of Rajinder Parshad deceased. Medical attendance certificate Annexure-8 only indicates that information was sent to the Police Station, Kotkapura regarding the death by suspected poisoning and the dead body was handed over to the police. The report of the doctor shows that the patient reported for vomiting and diarrhoea of three hours'' duration and that he was in shock and it was a case of suspected poisoning or GIT. There is no reliable medical evidence suggestive of the fact that Rajinder Parshad had died due to poisoning. The doctor had only stated that the patient was referred as a case of vomiting and diarrhoea of three hours'' duration and it was a case of suspected poisoning/GIT. There is no definite opinion of the doctor that Rajinder Parshad had died actually on account of taking poison. The repudiation of the claim of the complainant by the opposite parties, thus, on the ground that Rajinder Parshad had died due to suspected poisoning was not in order. There is no evidence on the record to show that Rajinder Parshad was suffering from any ailment at the time of revival of the insurance policy in question. The revival letter Annexure-7 shows that the opposite parties had actually called for E.C.G. of Rajinder Parshad deceased at the time of revival of the policy, which was duly furnished. Therefore, the allegation of the opposite parties that Rajinder Parshad had concealed the material facts of his ailment at the time of revival of the policy was an afterthought and is not proved on the record at all. Had the opposite parties suspected any ailment of Rajinder Parshad at the time of revival of his insurance policy, opposite parties must have got him medically examined and then revived the policy in question. In these circumstances, we do not find any infirmity in the order of the District Forum. This appeal is, therefore, dismissed. Consequently, all these appeals, namely, Appeal Nos. 722 to 724 of 2000 are dismissed. Appeal dismissed.