Life Insurance Corporation of India vs MURTI DEVI

-THIS appeal is directed against the order dated 12. 3. 2003 passed by the District Consumer Disputes Redressal Forum, Sonepat whereby while accepting the complaint of the respondent-complainant against the appellant-opposite parties following conclusions have been drawn : "in the opinion of this Forum, Smt. Murti Devi is entitled to the claim as alleged in the complaint, i. e. , Rs. 50,000 plus accidental benefits plus other losses suffered by the complainant. If the same matter has been decided in the year 1998, or the complainant has got the claim in the MACT case allegedly pending at Panipat, then, she is not entitled to get this insurance claim, but otherwise, she is entitled to get the claim of Rs. 50,000 plus Rs. 10,000 as litigation charges for harassment and mental agony which the Insurance Company is liable to pay with interest @ 12% per annum from the date of issuance of the policy till realisation. Accordingly, the present complaint is accepted. We order accordingly. The respondents are directed to ensure the compliance of this order within 30 days from the pronouncement of this order. "

PUT shortly, the facts as can be gathered from the record briefly stated are that Om Parkash husband of the complainant had taken a Life Insurance Policy for a sum of Rs. 50,000 under the term plan 75-20 with accidents benefit on 1. 9. 1994 commencing from 28. 12. 1993 from the opposite parties. He had paid the premium of Rs. 1,646. The policy No. 170851254 was issued to him by the opposite party No. 1. It is the case of the complainant that prior to his taking the aforesaid policy on 7. 3. 1994 her husband had met with an accident as he was on duty as the driver of the Haryana Roadways, Panipat Depot bus and had suffered grievous injuries. He remained under treatment from different hospitals including P. G. I. , Rohtak and could not recover from the said injuries and died on 21. 12. 1994. The report of the accident bearing FIR No. 53 of 1994 was also registered with the Police Station Ishrana, District Panipat. It is further alleged by the complainant that her husband had not been suffering from any disease including TB, etc. After the death of her husband, she had put up the claim with the opposite parties in respect of the aforesaid insurance policy. The opposite parties repudiated the claim on the ground that husband of the complainant was suffering from Koch''s chest disease which he had not disclosed at the time of taking the policy and made a wrong declaration in the proposal form regarding his health. In addition he had also remained on leave on account of the aforesaid disease during different intervals from 27. 10. 1991 to 28. 10. 1993 and this factual position was also concealed by him. Aggrieved by the action of the opposite parties the complainant invoked the jurisdiction of the District Forum by filing the present complaint. The opposite parties contested the complaint. In the written statement filed it was pleaded that the complainant had suppressed the factum of his being a patient of tuberculosis, Phenomonia, CLVF and patient of Koch''s chest and had made a wrong declaration about his good health at the time he submitted his proposal form. It was further stated that on account of the aforesaid ailments he remained on earned leave and half pay leave without mentioning the nature of leave availed by him while serving as a driver under the General Manager, Haryana Roadways, Panipat and on account of mis-statement and suppression of the true facts with regard to the health of the complainant the contract entered into between the parties had become void ab initio. Accordingly, it was prayed that the complaint merited dismissal.

The District Forum taking into consideration the respective stands of the parties and the evidence adduced on record came to the conclusion that simply because the deceased was suffering from tuberculosis and had concealed the material facts, cannot be taken as the sole ground for repudiation of the claim and for that reason rejected the stand of the opposite parties while accepting the complaint as per order dated 12. 3. 2003 noticed above. It is against this order the present appeal has been filed.

LEARNED Counsel representing the parties have been heard at length. Challenge to the order of the District Forum dated 12. 3. 2003 has been made from the side of the appellants on three counts. Firstly, that the contradictory version with regard to the manner injuries were suffered by the husband of the complainant in accident has been rendered by the complainant. Secondly, that despite there being sufficient evidence with regard to the suppression of material facts and mis-statement made by the deceased at the time of submitting of proposal form with regard to condition of his good health and his suffering from tuberculosis, Phenomonia, CLVF disease, the complaint has been accepted ignoring the settled position of law. Thirdly, that there was no deficiency of service whatsoever on the part of the opposite parties. Learned Counsel representing the respondent-complainant has justified the order of the District Forum for the reasons stated therein.

IT is not disputed on record that in the death certificate Ex. C-4 issued by P. G. I. , Rohtak, on 21. 12. 1994 no cause of death has been indicated. The fact remains that the husband of the complainant had taken the Life Insurance Policy No. 170851254 for Rs. 50,000 on 15. 1. 1994 with commencement from retrospective date of 28. 12. 1993. He died on 21. 12. 1994. In this manner he died within one year of his getting himself insured on 15. 1. 1994. At the time of taking policy he had submitted the proposal form Ex. R1. In para Nos. 11 (a), 11 (c) , 11 (e) and 11 (i) of the proposal form he had declared that he was keeping good health and was not suffering from tuberculosis and other diseases mentioned therein. The stand of the opposite parties is that he had made a wrong declaration in this regard. In order to support this stand principally reliance has been placed on the medical certificate issued by P. G. I. Rohtak Ex. R4 which indicates that he remained in the hospital from 7. 3. 1994 to 12. 4. 1994. In this certificate it is clearly stated that his was a known case of patient being of Koch''s chest disease. It is also recorded that he had taken treatment for two years back. The District Forum did not accept the certificate Ex. C-4 merely on the ground that the Doctor who had issued the certificate had not been examined. In addition it has also been recorded that no medical record relating to the past disease, has been produced from the side of the opposite parties. The above findings of the District Forum, as such, cannot be accepted for the reasons noticed hereinafter. In Revision Petition No. 1935 of 1999, Life Insurance Corporation of India v. Krishan Chander, the Hon''ble National Commission on the facts of the case concluded "non-filing of affidavit and/or non-examination of treating Doctor is not ruinous. " Further, reference be also made to the case, Draupadi Devi S. Chaudhari v. United India Insurance Co. Ltd. , I (1993) CPJ 94 (NC), wherein the repudiation of the insurance claim was done primarily on the history of the patient recorded in the Hospital Discharge Card wherein it was stated that he had ". . . chest discomfort since ten years. . . " was accepted despite the fact that no affidavit of the treating doctor was produced in this regard. Further, reference may also be made to another case titled as Life Insurance Corporation of India v. Mansa Devi, II (2003) CPJ 135 (NC), Revision Petition No. 148 of 1998 decided on 3. 9. 2002, wherein it was observed as under : ". . . . The learned State Commission disbelieved all the documents produced by the petitioner that they were copies of the originals and that they were not properly attested and that the Insurance Company did not file an affidavit in support of the said documents. It further observed that the opinion of the Doctor cannot be authentic unless he is subjected to the examination and cross-examination. They have not considered the fact of suppression in the proposal for the policy and disbelieved the documents placed before them. We find the State Commission has erred in its view that the petitioner has failed to substantiate that the respondent''s husband had suppressed material facts at the time of proposing for insurance. It is very clear from the statement of the employer of the respondent Executive Engineer, Township Division. B. B. M. B. , Sunder Nagar wherein he certified that the life assured was a diabetes patient and that he was under treatment of Doctors in P. G. I. . . . . . . . "

"the State Commission has failed to appreciate that the contracts of insurance are of utmost good faith i. e. Ubremma Fidae and the life assured is bound to disclose honestly, truthfully and correctly all the answers in the proposal form concerning the state of his health and any suppression renders the contract of insurance illegal, invalid, void ab initio and unenforceable. The State Commission has failed to appreciate that in the proposal form the deceased had given an undertaking that all information and answers therein are true and correct and the same constitute the basis of the contract. "

The above stated observations clearly indicate that it is not the law that as and when certificate of the Doctor is not supported by affidavit of the treating Doctor, the same should be excluded from consideration. In this case medical certificate Ex. R-4 has been admitted on record without objection and on this account as well cannot be excluded from consideration as has been done by the District Forum on the ground that data recorded with regard to the ailment of the deceased in the history of the Doctor cannot be accepted without production of the original record and affidavit of the Doctor concerned. Therefore, from the evidence adduced on record it is fully established that at the time the deceased had submitted the proposal form, he had not disclosed that he had suffered from tuberculosis, Phenomonia, CLVF and Koch''s chest. In fact, the complainant has admitted that he had been suffered from tuberculosis, Phenomonia, CLVF and was patient of Koch''s chest disease about two years back and had remained admitted in the hospital. Therefore, as there was a deliberate concealment on the part of the deceased about the true state of his health, the contract of insurance entered into him and the opposite parties stood vitiated on account of fraud committed by him. In fairness to the Counsel for the opposite parties it was pointedly urged by him that the deceased had been performing his duties as a driver of Haryana Roadways, Panipat Depot and if he had not fully recovered from the above stated ailment, he would not have been permitted to ply the bus. He has referred to the injuries suffered by the deceased in the accident for which F. I. R. Ex. P-7 was recorded with the Police Station concerned. No doubt, in this case claim had also been preferred before the Motor Accidents Claims Tribunal, Panipat and injuries caused to the deceased in the accident had also been admitted. It is not the case of the opposite parties that the deceased had not on account of the injuries suffered in the accident. Therefore, the incident of accident, as such, has no bearing whatsoever with regard to the suppression of material facts in respect of the ailment suffered by the deceased at the time he had submitted the proposal form.

FOR the aforesaid reasons, while accepting the appeal the order of the District Forum is set aside and the complaint is accordingly dismissed.

THE amount of Rs. 25,000 deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification in accordance with rules. Appeal allowed.