Life Insurance Corporation of India vs USHA AGARWAL

THIS is an appeal against the judgment and order dated 4.12.1999 passed by District Consumer Forum-I, Agra in Complaint Case No. 930/1994.

THE facts of the case stated in brief are that the husband of the complainant No. 1, late Suresh Kumar Agarwal took an LIC policy for a sum of Rs. 50,000/- for a term of 20 years. THE date of commencement of the policy was 28.3.1991. Atthe time of taking policy the deceased was hale and hearty and was not suffering from any disease. He was running and managing a full-fledged business under the name and style of M/s. Sukesh Brothers. THE deceased deposited the last premium on 22.10.1992 and six months before his death he became ill. He was treated at Agra but his condition deteriorated in the first week of October, 1992. In the last week of same month, he was told that he was suffering from acute jaundice and was referred to Sir Ganga Ram Hospital where he died on 11.11.1992. The complainant No. 1 is the nominee and she filed a claim before the Insurance Company. She made personal contacts with the officials of Life Insurance Corporation and also reminded them to pay the amount of the policy. Ultimately on 29.7.1993 the Life Insurance Corporation informed her that the claim has been repudiated on the ground that her husband was suffering from jaundice five months earlier than the taking of policy. Correspondence was also made by the complainant with the Regional Office but to no effect. She, therefore, filed the complaint for recovery of Rs. 50,000/- alongwith 18% per annum interest from 12.12.1992 and Rs. 12,000/- as compensation.

The opposite party in their written version has alleged that the policy was taken in March, 1991. After investigation it was found that the deceased was suffering with swelling in the entire body for two years, i.e. 5 months before the date of proposal. On this ground the claim was repudiated.

THE parties filed evidence before the learned District Forum. After considering the case of the parties, the learned District Forum decreed the claim for a sum of Rs. 50,000/- alongwith interest at the rate of 15% per annum from 12.11.1992. It also allowed Rs. 2,000/- a, compensation. It was also directed that if the payment is not made within.45 days, the interest shall run at the rate of 18%. Aggrieved against the order of the learned District Forum, Life Insurance Corporation of India has come in appeal and has challenged the correctness of the order passed by the District Forum.

WE have heard the learned Counsel for the parties and have perused the evidence on record. Learned Counsel for the appellant has argued that five months prior to the taking of the policy, the deceased was suffering from jaundice and this material fact was suppressed by him at the time of filling up of the proposal form. He has placed this argument on the certificate of treatment given by the hospital, i.e. Ganga Ram Hospital. A perusal of this certificate, a photocopy of which is filed by the appellant, will go to show that there was generalised swelling of the body for the last two years and the patient was having jaundice within one month. It is further written that in 1990 he had jaundice with swelling of abdomen and lateral part of body. It was diagnosed as Cirrhosis of liver etc. which was the cause of death. There is one more certificate of the doctor. The name of the doctor cannot be made out as it has not been written, but he has only signed. It has been mentioned that the patient was under his treatment from the last 10 months but from the last 15 days from the date of death, he has not treated the patient. The cause of the death is mentioned as Jaundice with D.V.T., Cirrhosis of liver.

IT is an admitted fact that a person who has to be insured is medically examined by the doctor of the Insurance Corporation. The deceased was suffering from jaundice from last five months before the filling up of the proposal form and had also swelling on the body, then these facts could not have been suppressed by the deceased and could not have escaped attention from the eyes of the doctor. The doctor immediately on seeing a patient suffering from jaundice will notice the peculiar symptoms of the disease. The patient becomes weak and his eyes also develops yellow colour. These symptoms must be present on the date of medical examination as mentioned by the Insurance Company. If this was the fact then the doctor who had medically examined the patient would have noted down these facts in his medical report. Therefore, in view of the facts of the case it cannot be said that the deceased was suffering from jaundice and swelling of the body or cirrhosis of the liver for more than, two years before his death. The doctor who had given the certificate that he was treating the patient has not filed any evidence to prove his certificate. Moreover, in Clause No. 9, it has further been mentioned that no disease occurred before 1 year from death. In Clause No. 6 against the query as to when the deceased was first known, it is mentioned by the doctor as "one year". Thus it is clear from the certificate of the doctor who had treated the deceased that before one year of his death, he did not have the present disease. If this disease was existing before one year of the death of the patient, then this fact would have been mentioned by this doctor in his report. Thus from this very certificate, it is abundently clear that the deceased was not suffering from jaundice at the time of filling up of proposal form. Thus we find that this appeal has no force and the finding of the learned District Forum on this point is absolutely justified. However, in this case the interest awarded is 15% per annum and no appeal has been filed by the complainant against this order. Hence the interest cannot be enhanced and will remain at 15% per annum.

LEARNED Counsel has further argued that the interest has been awarded by the learned District Forum at 15% per annum from the next date of the death. This mistake has been committed by the learned District Forum because the trends of the decision are that the interest should be allowed after the expiry of three months of the date of submission of claim forms. The appeal is, therefore, liable to be allowed to this extent that the interest shall be payable to the claimant on the expiry of 3 months of the date of submission of the claim form. The learned District Forum shall enquire and decide this fact in the execution proceedings. ORDER The appeal is partly allowed to the extent that the interest at the rate of 15% per annum shall be payable after expiry of three months from the date of submission of the claim form. The rest portion of the judgment and order of the learned District Forum are confirmed with this above modification. Let compliance of the order be made within a period of two months from the date of this order. Let copy as per rules be made available to the parties. Appeal partly allowed.