Life Insurance Corporation of India vs POORAN PRAKASH

THERE was difference of opinion in the instant case, President and Member being in favour of decreeing the claim of the complainant while the Lady Member Dr. Shakuntala Sharma disagreed with that opinion and by her order dismissed the same.

L.I.C. has a grievance that the order could not have been passed because of obvious concealment made by the insured when the proposal for Life Insurance Cover for Rs. 25,000/- was made to L.I.C. Before going on merit of the details to which reference shall be made a little later suffice to say that on the admitted fact Smt. Varsha wife of the complainant Pooran Prakash actually died on 9.6.1990 after delivering a female child on full terms of pregnancy in a nursing home. If this is so and nine months period is calculated on reverse, the last menstruation must have been some where in Oct./Nov., 1989. The majority view accepts the pleadings of the complainant that the declaration of good health in the proposal form No. 460 and also in the subsequent documents including medical examination report was not correctly filled inasmuch as DGH was a concocted and forged document. The Lady Member on the other hand was of the view that there was no reason for L.I.C. to concoct a false case just to deny Rs. 25,000/-. She further held that there was suppression of the fact of pregnancy when the proposal had been made whether the date of proposal was 26.10.1989 or it was 26.2.1990. She further concluded that Rs. 127/- was deposited in the suspense account on 26.10.1989. The remaining amount of premium of Rs. 200/- was deposited on 24.1.1990 by a cheque issued by policy holder Smt. Varsha. The majority judgment however concluded that the aforesaid sum of Rs. 200/- was not paid by the policy holder but it was paid out from rebate by Sri Yogesh Agarwal said to be an agent of L.I.C. This shall not be taken as a decision whether Sri Yogesh Agarwal was or is an agent of L.I.C. or not but reference has been made only on the pleadings existing on the record of the appeal. Since admittedly policy has been issued on 26.4.1990 for Rs. 25,000/- being policy No. 260310484. L.I.C. has repudiated the claim made by complainant Pooran Prakash on the aforesaid reasoning that there was obvious concealment in the proposal form as also in other documents of declaration of good health furnished by policy holder Smt. Varsha.

The controversy which arose before District Forum may be summarised. A proposal for Rs. 25,000/- was no doubt made in the name of Smt. Varsha through Yogendra Agarwal, the supposed agent of L.I.C. There is dispute about the date of making the proposal. According to the complainant''s case 26.10.1989 is the date of making of the proposal. L.I.C. contends that date is 26.2.1990. The second issue is that admittedly a sum of Rs. 127/- has been deposited in the suspense account of the branch of L.I.C. and another Rs. 200/- has been deposited in the same branch on 24.1.1990. The dates of these two deposits emerge from the record as already noted above. The complainant however in his complaint does not refer to the deposit of Rs. 200/- made in the suspense account on 24.1.1990. The claim of the complainant is only on the basis of deposit of a sum of Rs. 127/- made on 26.10.1989. The L.I.C. in the written statement came out with the specific averment that the amount of Rs. 200/- was in fact deposited on 24.1.1990 but since one month had already expired and the proposer was a lady, L.I.C. believing on the contents of the proposal form, medical report and declaration of good health numbered the proposal at 1049264 and issued policy on 26.4.1990 with back dating it w.e.f. 20.1.1990 as desired by the policy holder and the policy document was numbered as 260310484.

HAVING examined the rspective contentions it is clear that, as also Sri Arjun Bhargava has rightly pointed out, that in the proposal form and also in the declaration form, pregnancy was concealed. Once this is so and pregnancy alone became the casue of death on which issue there is no dispute, repudiation of the claim by L.I.C. was perfectly valid. When the appeal was admitted notices were issued but no one appeared on behalf of the complainant/respondent. Fresh notices were again issued through R.P. /AD, SPS and speed post but again no one has turned up to oppose the appeal.

HAVING examined the entire matter and in view of the discussions referred to above the view taken by the majority cannot be sustained and the opinion of Lady Member must prevail. Appeal thus succeeds and is allowed. Order of the District Consumer Forum, Agra, pased by majority dated 25.10.1995 is set aside. Complaint is dismissed. Parties will bear their own cost. Appeal allowed.