Life Insurance Corporation of India vs VIRENDER

SMT. Manjeet wife of Virender obtained an endowment assurance policy No. 330689575 dated 28.3.2001 for Rs. 25,000 and had paid one instalment of premium of Rs. 439 towards the said policy. She died on 18.9.2001. Necessary documents for payment of the sum assured was submitted by the complainant to the appellant. However, the appellant repudiated the claim as per letter dated 4.3.2003 on the ground that at the time when SMT. Manjeet had taken the policy of insurance, she has concealed the factum of her pregnancy and she had died after delivering a baby girl due to meningitis. It is thereafter the complainant invoked the jurisdiction of the District Forum and the District Forum found no substance in the stand of the appellant and directed the appellant to pay the assured sum to the complainant within a period of 45 days, failing which he would be entitled to interest @ 10% per annum from the date of filing of the complaint till realisation. Aggrieved by the said order, the present appeal has been filed.

THE Counsel representing the parties have been heard at length. The learned Counsel representing the appellant at the threshold of arguments assailed the findings of the District Forum primarily on the ground that evidence adduced on record had been overlooked by the District Forum which fully established that Smt. Manjeet insured had concealed the factum of her pregnancy and thus committed the breach of terms of the policy which fully justified the action of the appellant to repudiate the claim put up by the complainant. Opposing the submission made, the learned Counsel representing the respondent has justified the order of the District Forum for the reasons stated therein.

It is not disputed that Smt. Manjeet had obtained the endowment policy of her life on 28.3.2001 and thereafter she died on 18.9.2001. It is clearly spelt out from the record that she had delivered a baby girl on 2.9.2001 and had remained ill on account of Typhoid. In addition, she had a high temperature and ultimately died on 18.9.2001 due to meningitis. In support of the stand taken, inquiry report prepared by Shri Lalit Sharma, ABM, Rewari has also been placed on record, in addition to the affidavit of Sh. Sanjay Khurana, Branch Manager of the appellant at Rewari. It is also brought out on record that in the proposal form submitted by the deceased, she has stated that she was having a good health and had not disclosed the factum of her pregnancy at that time. The Counsel representing the complainant has contended that it was not possible for the insured to have known that she was carrying pregnancy as age of pregnancy was only of 12 weeks. This stand of the appellant is not substantiated on record. As already stated that policy was taken by the deceased on 28.3.2001 while she delivered a baby girl on 2.9.2001. It means that on the date when policy was taken by the deceased, she was carrying a pregnancy of about 15 weeks. Therefore, it cannot be said that the deceased had no knowledge about the pregnancy. This very fact of pregnancy she had not disclosed in the proposal form and as such it has to be construed that she has concealed the material fact at the time of taking the insurance policy. Needless to say that contract of insurance is depended upon utmost ub errima fides and trust between the insured and the insurer and where it is proved that the insured had violated these norms and had not disclosed vital fact to the Insurance Company while taking the policy, then the Insurance Company would be justified in repudiating the claim. This question has directly arisen in case Darshan Singh v. Branch Manager, Life Insurance Corporation of India and Another, 1998 (2) CPC 482, wherein a stand was taken from the side of the claimant that pregnancy was only of 12 weeks duration at the time of death which developed much after the date of policy. On the basis of evidence adduced on record, stand of the complainant was rejected and it was held that the Insurance Company was fully justified in repudiating the claim. In this case also, it is totally inconceivable that a pregnancy of more than 15 weeks was not known to the deceased as sought to be propounded from the side of the complainant. The District Forum has not given due consideration to the factual position on record and for that reason the impugned order cannot be sustained.

FOR the aforesaid reasons, while accepting the appeal, we set aside the impugned order and dismiss the complaint. The amount of Rs. 12874 deposited by the appellant at the time of filing the appeal be refunded to the appellant as required under the law and rules after proper verification. Appeal allowed.