Life Insurance Corporation of India vs RANGRAJ MEHTA

THIS appeal has been filed by the appellants LIC against order dated 26. 4. 2000 passed by the District Forum, Pali in Complaint No. 174/1997 by which the complaint of the complainant respondent was allowed in the manner that the appellants were directed to pay a sum of Rs. 1 lac in respect of policy No. 100051907 to the complainant along with interest at the rate of 12% p. a. from the date of filing of the complaint.

IT arises in the following circumstances-That the complainant respondent had filed a complaint before the District Forum on 17. 3. 1997 inter alia stating that his father Bhanwarlal, now deceased had taken an insurance policy bearing No. 100051907 for a sum of Rs. 1 lac from the appellants on 17. 3. 1993. It was further stated in the complaint that on 17. 3. 1993 a sum of Rs. 10,474 were paid as premium and thus policy should be treated to come in force w. e. f. 17. 3. 1993 and if additional premium to the tune of Rs. 1,890 was paid by the deceased on 15. 7. 1993, that would not make any difference. It was further stated that on 21. 9. 1994 the deceased had died because of the disease of cancer at Bombay and thereafter claim was preferred by the complainant respondent being the son and nominee of the deceased but that claim was repudiated by the appellants through letter dated 30. 3. 1995 inter alia stating that prior to 15. 7. 1993, the date on which additional premium was paid by the deceased, the deceased was suffering from the diseases just as swelling groin, fever, inguinal edonitis and since these facts were suppressed by the deceased, therefore, deceased was guilty of suppression of material facts regarding his health and he deliberately made misstatement and withheld material information. Thereafter, the present complaint was filed by the complainant respondent. A reply was filed by the appellants before the District Forum on 23. 5. 1997 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 30. 3. 1995. Apart from that it was stated that initially the premium was paid by the deceased on 17. 3. 1993 and he was got medically examined on 25. 3. 1993 and Rs. 1,890 was paid by him as additional premium on 15. 7. 1993 and thus the policy had come into force w. e. f. 28. 6. 1993. It was further replied that since before 15. 7. 1993 the deceased had taken treatment from Dr. Dhariwal and the decesed was aware of the fact that he was suffering from the disease of cancer. Therefore, since these facts were not disclosed by the deceased. Hence, he was guilty of suppression of material facts regarding his health and the claim was rightly repudiated by the appellants through letter dated 30. 3. 1995. After hearing the parties, the District Forum, Pali through impugned order dated 26. 4. 2000 had followed the complaint inter alia holding that the appellants had failed to prove the fact that even prior to 17. 3. 1993 or at the most 28. 6. 1993 or at the most 15. 7. 1993 the deceased was aware of the fact that he was suffering from the disease of cancer. Aggrieved from the said order of the District Forum, Pali, this appeal has been filed by the appellants LIC. In this appeal the main case of the appellants is that before issuance of the policy in question, the deceased was suffering from the disease of cancer for which he took medical treatment and since these facts were not disclosed by the deceased deliberately, therefore, he was guilty of suppression of material facts regarding health and thus on that ground the claim of the complainant respondent was rightly repudiated by the appellants through letter dated 30. 3. 1995 and the District Forum has committed serious error and illegality in decreeing the claim of the complainant respondent. Hence, the impugned order cannot be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.

On the other hand the learned Counsel for the respondent has supported the impugned order of the District Forum.

WE have heard the learned Counsel appearing for the parties and gone through the entire materials available on record. There is no dispute on the point that the deceased had taken a policy bearing No. 100051907 for a sum of Rs. 1 lac from the appellants Insurance Company and the deceased had died on 21. 9. 1994 from the disease of cancer.

THERE is also no dispute on the point that the first premium for a sum of Rs. 10,474 was deposited by the deceased on 17. 3. 1993 and he was got medically examined on 25. 3. 1993 and rest premium was deposited by the deceased on 15. 7. 1993 and the policy had come into force w. e. f. 28. 6. 1993. There could also no dispute on the point that on 8. 7. 1993 the deceased was examined by Dr. M. R. Dhariwal who had advised some tests. It is made clear that from perusal of the prescription slip dated 8. 7. 1993 nobody could gather that the deceased was a patient of cancer.

THERE is also no dispute on the point that the deceased was got admitted in the MB Hospital, Jodhpur on 27. 7. 1993 and was discharged on 30. 7. 1993 and various tests were got conducted and prima facie a case of cancer was detected.

THERE is no dispute on the point that thereafter the deceased was admitted in Jaslok Hospital, Bombay on 29. 8. 1994 where he had died on 21. 9. 1994 and the diagnosis which was found in that hospital was Pyogenic Meningitis with Non Hodgkins Lymphoma. Thus, there is no dispute that the deceased had died because of the disease of cancer. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the present case was a case of suppression of material facts or not or whether the claim was rightly repudiated by the appellants or not or whether the findings of the District Forum could be sustained or not.

In our considered opinion the findings recorded by the District Forum should be sustained for the simple reason that before 28. 6. 1993, the date on which the policy had come into force, there is nothing on record to show that the deceased had ever taken any treatment for the disease of cancer. Even the prescription slip dated 8. 7. 1993 does not reveal that the deceased was a patient of cancer and Dr. Dhariwal had only advised for some tests and the disease of cancer was diagnosed for the first time when the deceased was admitted in the MB Hospital, Jodhpur on 27. 7. 1993.

FOR the reasons it could easily be said that even prior to 28. 6. 1993 or 15. 7. 1993 the deceased was not aware that he was a patient of cancer and, therefore, the case of the appellant that he had suppressed the disease of cancer could not be found acceptable. Apart that the diagnosis of cancer is made by various means, the most important being biopsy, q. v. ; use to devices for visualization of hollow organs; reontogenography including computerized axial tomography (CAT); mammography; ultrasound, cytology such as the Papanicolaus test, q. v. ; and palpation for lumps. Some of these techniques and devices will demonstrate as increase in the size or change in the shape of an organ, but such alteration may be due to either a benign or malignant growth. There are various cancer stating systems to help delineate the extent and prognosis of tumours. An example of one of these is the tumour, node, metastasis system (TNM ). Numbers are added to each category to indicate degree of dissemination.

SINCE in the present case the above tests were conducted for the first time after 27. 7. 1993, therefore, from the point of view also to say that the deceased was aware of the fact that he was suffering from the disease of cancer could not be found established. Thus, it is held that non-mentioning of the disease ''cancer'' in the declaration form by the deceased does not amount to suppression or concealment of material fact or misstatement in real sense and, therefore, the appellants were not justified in repudiating the claim of the respondent on the ground of suppression of material facts and in view of this the findings of the District Forum by which the claim of the complainant was allowed are based on correct appreciation of entire materials on record and no infirmity or illegality is found in them. For the reasons stated above, no illegality or irregularity has been committed by the District Forum in decreeing the claim of the complainant respondent. The findings of the District Forum decreeing the claim are based on correct appreciation of entire materials available on record and they do not suffer from any basic infirmity, illegality and perversity and hence, no interference is called for with the same and this appeal deserved to be dismissed. On point of interest

SINCE in this case the District Forum had awarded interest @ 12% p. a. but looking to the facts and circumstances of the case it appears to be on higher side and it is just and proper to award interest @ 9% p. a. instead of 12% and to that extent the impugned order of the District Forum on point of rate of interest deserves to be modified. Accordingly, the appeal filed by the appellants is dismissed. However, the complainant respondent would get interest from the appellants @ 9% p. a. instead of 12% p. a. and to that extent the impugned order of the District Forum, Pali dated 26. 4. 2000 on point of rate of interest stands modified. Appeal dismissed.