Life Insurance Corporation of India vs Vimlesh Kumari

THIS is an appeal against the order dated 22.3.1997 passed by District Forum, Bulandshahr in complaint Case No. 116/1995. The facts of the case stated in brief are :

THAT Smt. Vimlesh filed the present complaint for recovery of Rs. one lac on account of death of her husband Sri Bhupendra Kumar. Sri Bhupendra Kumar got himself insured with Life Insurance Company on 7.3.1991 for Rs. one lac. The complainant Sri Bhupendra Kumar died on 25.7.1992. The claim had been repudiated by opposite party vide letter dated 24.12.1993. It is further alleged that Insurance Company has wrongly mentioned in the letter of repudiation that the deceased was suffering from many diseases. As a matter of fact he was not suffering from any disease at the time of taking life policy. The opposite party in the written statement has alleged that the deceased had suppressed material facts at the time of taking insurance policy. He died within two years from taking the policy. After considering the entire material on record, the learned District Forum decreed the. claim of Rs. one lac alongwith interest @ 15% per annum w.e.f. 1.11.1992. A sum of Rs. 6000/- was also awarded as compensation. The compliance was to be done within one month and if the same is not done then rate of interest was to be @ 18%. Aggrieved from this order, Insurance Corporation has come up with this appeal and has challenged the order passed by District Forum, Bulandshahr.

Learned Counsel Mr. V.S. Bisaria and learned Counsel Mr. G.S. Chauhan have been heard.

IT is apparent from the file that the policy was taken on 7.3.1991 and Sri Bhupendra Kumar died on 25.7.1992, i.e. within two years of taking of policy. Repudiation was done by Insurance Company on 24.12.1993. Thereafter, this present claim petition was filed. According to the Counsel for appellant, deceased has suppressed the material facts and did not disclose the same in the proposal form. Therefore, the policy is vitiated and the complainant is not entitled to any claim from Insurance Corporation. According to learned Counsel, the death of deceased took place on account of heart attack at Delhi and the deceased himself disclosed it before the doctor concerned that he is suffering from this disease for the last four years. In support of this case he has placed reliance on certain papers which maybe referred. Annexure III is certificate of hospital treatment when the deceased was taken at All India Institute of Medical Sciences, New Delhi. A perusal will go to show that the patient was admitted on 25.7.1992 the date on which he died. It has been written in column 3 that the patient was under the treatment in CTVS ward where he was admitted on 24.7.1992 on a routine basis. In the next column i.e. No. 4, it is mentioned that the patient was brought to COPD in unconsciousness condition by some passerby. The patient was in respiratory arrest. No details were available with the patient.

IN column No. 7, it has been mentioned that when the deceased was observed by the doctor, it is written against this column that he was suffering from this disease for the last four years. Thus, the patient was suffering from this disease before issuance of the policy and this fact was disclosed by the patient himself to the doctor as written in this document. In columns 8 and 9, it is written that Sri Bhupendra Kumar expired on 25.7.1992 at 12.45 p.m. In column 10(A) of the same document, it is mentioned that patient was admitted in CTVS Ward on 24.7.1992. The next paper is history- sheet of the patient, a perusal of which goes to show that the patient was admitted on 24.7.1992. It has been mentioned therein that four years back he developed easy fati-quability, other details of his condition also mentioned. At one place of this document it has been written on 25.7.1992 that Duty Officer was informed by the Sister Incharge of the ward that the patient has been absconding since 11.30 a.m. All these facts clearly go to show that the deceased was suffering from heart disease since about 1988 i.e. before he took the policy. As mentioned in the earlier part of the judgment the policy was taken on 7.1.1991 after he developed the disease. Thus, the deceased also died with the same disease which had developed about 4 years back. This leads to be material suppression of the facts by the deceased when he took the policy because at that time he was suffering from a heart ailment. But he did not disclose this while filling the proposal form. In fact, in reply to questions 19,20 and 21, the patient mentioned that he has not been suffering from any disease. He has also stated that he is not suffering with blood pressure or pain in the chest etc. relating to heart. Thus, we find that the deceased has deliberately suppressed this fact. Learned Counsel has argued that there might be manipulation done by the hospital staff. But there is no allegation or evidence on record to prove about any manipulation. When the deceased was admitted a day before death and the deceased disclosed facts of his illness to doctor then we cannot doubt the facts written by the doctor.

IT has been argued by the learned Counsel for complainant that medical report prepared by doctor has not been proved because the statement of J.K. Jain, Record Incharge of All India Institute of Medical Sciences, New Delhi does not prove it. However, Annexure ''6'' on page 46 does not show that document in question was not written by doctor R.N. Kundu who prepared this report. The witness has proved the fact that this report was prepared by Dr. Kundu. In cross- examination, it is stated that he does not recognise the signature and initials of all the doctors and cannot say as to who had initialled of these documents. This statement does not have any effect on the merit of the case.

THUS, in view of all what has been said above, the complainant is not entitled to claim any insurance amount on the ground that the deceased has materially suppressed the facts when he took the policy. The appeal is liable to be allowed. ORDER The appeal is allowed and order of learned District Forum is set aside and claim petition is dismissed. Let the copy of this order be made available to the parties as per rule. Appeal allowed.