Life Insurance Corporation of India vs Malkiat Kaur

THIS appeal is by Life Insurance Corporation against order of District Forum, Sangrur dated February 27,1997 whereby the appellant was directed to pay the insured amount of Rs.50,000/- with 12% p.a. interest thereon w.e.f. August 3, 1991 till payment alongwith a sum of Rs. 500/- towards litigation expenses to Malkiat Kaur and other legal heirs of Dalbar Singh.

DALBAR Singh, aged about 32 years had taken a life insurance policy for a sum of Rs. 50,000/-. The period of the policy was from May 20,1991 to May 19, 2011. On June 13,1991, he is alleged to have died of heart attack at Village Choppa. Thus, the legal heirs claimed the insured amount. The Corporation having failed to pay the amount, the complainants, Malkiat Kaur, wife, Pawandeep Kaur and Sandeep Kaur, minor daughters and Santokh Singh, minor son of the insured approached the District Forum for the relief. As usual, the Corporation took up the plea that the insured had concealed material facts with respect to his health at the time of taking the insurance policy and thus the claim was rightly repudiated. Both the parties led their evidence on affidavits and documents on the basis of which the impugned order was passed. Learned Counsel for the Corporation vehemently argued that the Corporation collected material to come to the conclusion that the insured had concealed material facts about his health at the time of taking the insurance policy. Since in the present case, the death occurred within few months of taking of the policy, it was necessary for the Corporation to hold enquiry and collect material and the repudiation of the claim being justified, no case for grant of compensation was made out. This contention in the facts of the present case cannot be accepted. At the outset, it may be stated that the Corporation did not collect any material about the nature of the treatment ever taken by the insured prior to taking the insurance policy. Reference was made to Ex. C6, a proposal form wherein as usual answers to the questions relating to the previous health of the insured were answered in the negative. Answer to Question No. 17(a) was answered in the affirmative, which was his usual state of health. Answers to Question No. 18 particularly with respect to (b) and (e) and Question No. 20 were answered in the negative. The same related to as to whether the insured ever suffered or was suffering from High or Low Blood Pressure---------nervous break-down or any other disease of the brain or the nervous system and during the last five years suffered any ailment requiring treatment for more than a week. In the repudiation letter, it was further stated that such answers were incorrect that as per material collected, the insured was suffering from High Blood Pressure and Mental Depression for which he had consulted medical man and had taken treatment from him. The Corporation relied upon Annexure R1 which is not relevant for the purpose of the present case. These are the particulars collected from the School Records. Ex. R2 was a certificate from Dr. Jarnail Singh wherein general observations were made regarding suffering by the insured from Blood Pressure since, 1980. Ex R3 is the copy of the repudiation letter reference to which has already been made. Prom the material aforesaid, it could not be held that the insured had concealed material particulars about his health. It has been held by the National Commission as well as this Commission that intention of the insured has to be gathered from the facts as to whether he intended to defraud the Corporation by concealing material facts and Blood Pressure as such is not considered material fact unless the death has occurred on that account. Similar observations were made with respect to diabetes. The insured may not come to know about these diseases unless some checks/tests are done and control of these diseases would hardly be treated as a disease to be disclosed moreso when the death is not on that account. In such cases, the nexus has to be established between the cause of death and the material concealed. The same logic will apply to the cases of mental depression. In the absence of any specific material collected about the intensity of the depression and its duration, occasional depression can hardly be treated as a disease. Furthermore, in the present case, the Corporation did not collect any material regarding the medicines prescribed or the treatment taken by the insured. The Corporation also did not get any material that for a continuous period of seven days, the insured had taken any treatment much less from the doctor whose certificate was produced or in any hospital. The repudiation of the claim in the present case was arbitrary and the District Forum was fully justified in granting the claim. Finding no merit in the appeal, the same is dismissed with costs of Rs. 1,000/-. The directions would be complied within one month from the receipt of copy of the order. Appeal dismissed with costs. _________________